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Cornelis A Rietmeijer

Publications and source records attributed to Cornelis A Rietmeijer.

At least 19 recordsLinked to original sources
PubMed2007

Acceptability of urine-based screening for Chlamydia trachomatis to asymptomatic young men and their providers.

OBJECTIVE: The objective of this study was to describe acceptability of urine chlamydia testing among asymptomatic men and providers' attitudes toward testing. STUDY DESIGN: Asymptomatic men (no urethral discharge/dysuria) were offered free testing and characteristics of men who accepted were compared with those who declined. Acceptability logs tallied the proportion who accepted, and a standardized survey was administered to providers at study's end. RESULTS: Median acceptance was 64% (range, 8-100%). Men accepting were younger and more likely to be in adolescent primary care or detention, to report higher numbers of recent partners, no prior sexually transmitted disease, time to last healthcare visit >1 year, and to have received an incentive. Provider-reported barriers to testing included difficulty in conveying importance of testing to asymptomatic men (65%) and time constraints (24%). CONCLUSIONS: Asymptomatic men are likely to accept testing depending on venue and approach. However, barriers exist for men and providers, even when testing is free.

Adolescent↗
PubMed2007

Discussing HIV serostatus with prospective sex partners: a potential HIV prevention strategy among high-risk men who have sex with men.

OBJECTIVE: To study factors associated with HIV serostatus discussions among men who have sex with men (MSM). DESIGN: The authors conducted a cross-sectional survey among MSM visiting an urban sexually transmitted infection (STI) clinic. METHODS: MSM were asked about sex partner recruitment, serostatus of partners, condom use, drugs use, and HIV serostatus discussions with sex partners. RESULTS: Among 1,400 MSM reporting occasional sex partners, serostatus discussion with 100% of partners was reported by 509 (36.3%), with 50% to 99% of partners by 263 (18.8%), and with <50% of partners by 628 (44.9%). Factors associated with serostatus discussion included lower number of sex partners, anal sex with an occasional partner, and sex partner recruitment through the Internet. Partner recruitment in bathhouses and having sex with both men and women were negatively associated. CONCLUSIONS: Discussion of HIV serostatus was common among MSM studied. Although this strategy has limitations, interventions should address HIV status discussions. Because the Internet may facilitate these discussions, web-based interventions should be evaluated.

Adult↗
PubMed2006

Age-bridging among young, urban, heterosexual males with asymptomatic Chlamydia trachomatis.

OBJECTIVES: To determine the prevalence of age-bridgers among urban males aged 14-24 years, asymptomatically infected with chlamydia and to determine factors that distinguish age-bridgers from non age-bridgers. An index was defined as an age-bridger if within 2 months, he had had at least two sexual partners who differed from him in age by > or =2 years. METHODS: Infected males provided data about themselves and up to four sexual partners in the past 2 months. Bivariate and multivariable logistic regression was used in the analysis. RESULTS: The prevalence of age bridging was 21% in Baltimore and 26% in Denver. In both cities, in bivariate analysis, age-bridgers and their partners engaged in significantly more risky sexual behaviours. In adjusted multivariable analysis after controlling for number of sexual partners, age bridging was associated with having a sexual partner in the past 2 months, who, at time of last sexual intercourse, was drinking. CONCLUSION: Age-bridgers represented major proportions of the study populations and, along with their sexual partners, were more likely to engage in risky sexual behaviours. Male age-bridgers may be key players in the transmission of sexually transmitted infections among youth linking age-disparate sexual networks.

Adolescent↗
PubMed2006

High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening.

BACKGROUND: Studies show 11% to 15% of women treated for Chlamydia trachomatis are reinfected 3 to 4 months after treatment, suggesting the need for rescreening. There is little information on infections among men, infections with Neisseria gonorrhoeae or Trichomonas vaginalis, or long-term follow-up. OBJECTIVE: To determine the incidence of new sexually transmitted infections during the year after a visit to a sexually transmitted disease (STD) clinic and associated risk factors. DESIGN: Secondary analysis of data from a randomized, controlled trial (RESPECT-2). SETTING: 3 urban STD clinics. PATIENTS: Sexually active patients enrolled in an HIV prevention counseling trial. MEASUREMENTS: Patient characteristics at the initial visit; behaviors during follow-up; and new infections with C. trachomatis, N. gonorrhoeae, or T. vaginalis (women only) detected during 4 scheduled return visits and any other interim visits. RESULTS: 2419 persons had 8129 three-month follow-up intervals. Among 1236 women, 25.8% had 1 or more new infections (11.9% acquired C. trachomatis, 6.3% acquired N. gonorrhoeae, and 12.8% acquired T. vaginalis); among 1183 men, 14.7% had 1 or more new infections (9.4% acquired C. trachomatis, and 7.1% acquired N. gonorrhoeae). Black persons and those with sexually transmitted infections at baseline were at highest risk for recurrent infection (adjusted odds ratio, 2.5 and 2.4, respectively). For persons infected at baseline, the risk for infection was high at 3 and 6 months (16.3 per 100 three-month intervals) and remained high at 9 and 12 months (12.0 per 100 three-month intervals). Most (67.2%) infections were diagnosed during study-related visits, and 66.2% of these patients reported no symptoms. LIMITATIONS: Because patients were recruited from STD clinics, results may not be generalizable. CONCLUSIONS: Men and women who receive diagnoses of C. trachomatis, N. gonorrhoeae, or T. vaginalis infections should return in 3 months for rescreening because they are at high risk for new asymptomatic sexually transmitted infections. Although single-dose therapy may adequately treat the infection, it often does not adequately treat the patient.

Adolescent↗
PubMed2006

Sex partner selection, social networks, and repeat sexually transmitted infections in young men: a preliminary report.

GOAL: The goal of this study was to examine the risk for repeat sexually transmitted infections (STIs) associated with reducing the number of sex partners who come from within the social networks of males 13 to 25 years old in Baltimore, Maryland, and Denver, Colorado. STUDY: Asymptomatic males diagnosed with chlamydia and/or gonorrhea as part of an asymptomatic chlamydia and gonorrhea male screening project were recruited and interviewed about their sexual behaviors and their perceptions of social characteristics and sexual behaviors of their sex partners. We characterized the sex partners of each participant as belonging to or not belonging to his social network. We examined whether a decrease in percentage of sex partners who were in the participant's social network was associated with repeat infection. RESULTS: There were 47 participants in Baltimore and 92 in Denver. In both cities, there was a trend toward a finding that decreasing the percentage of sex partners belonging to a participant's social network was protective for repeat STI. CONCLUSION: These data suggest that interventions may need to be designed to reduce the prevalence of infection in the social networks of infected men.

Adolescent↗
PubMed2006

Assessing community needs and agency capacity--an integral part of implementing effective evidence-based interventions.

Community-based organizations and public health departments have historically applied for and received funding to implement a variety of HIV prevention interventions, but it is unclear how they make decisions regarding which interventions to implement or whether their agency has sufficient capacity and/or resources to effectively carry them out. Assessment activities can play a valuable role in helping agencies make these decisions by providing information to better target services. Recent funding efforts supporting the Diffusion of Effective Behavioral Interventions Project and other evidence-based approaches for HIV prevention require that agencies possess basic skills to effectively conduct individual-, group-, or community-level interventions, as well as the specific activities associated with an evidence-based intervention (EBI). We examine the link among community assessment, agency capacity, and intervention effectiveness, and provide resources to better guide programs in assessing their communities and organizations in order to implement the most effective EBI.

Efficiency, Organizational↗
PubMed2005

Concurrent sexually transmitted infections (STIs) in sex partners of patients with selected STIs: implications for patient-delivered partner therapy.

BACKGROUND: Patient-delivered partner therapy (PDPT) is the practice of providing disease-specific antimicrobial agents to patients for delivery to their sex partners. Some partners who receive PDPT may forgo clinical evaluation, resulting in missed opportunities for the diagnosis and treatment of comorbid conditions. METHODS: We conducted a review of electronic charts for 8623 individuals attending 4 sexually transmitted disease clinics who were sex partners of patients with selected sexually transmitted infections (STIs). We evaluated the concordance between STIs diagnosed in partners and their reported exposures for which they might have received PDPT. RESULTS: Among 3503 female and 4647 heterosexual male partners, 19 (0.4%) of 4716 individuals tested were newly diagnosed with human immunodeficiency virus (HIV) infection, and 61 individuals (0.7%) had syphilis. Pelvic inflammatory disease was diagnosed in 133 women (3.8%). Seventy-two (3.2%) of 2226 female and heterosexual male partners reporting exposure to patients with chlamydial infection had gonorrhea diagnosed. Chlamydial infection or gonorrhea was diagnosed in 81 heterosexual male partners (10.3%) who reported contact with women with trichomoniasis. Among 473 men who have sex with men (MSM; including bisexual men), 13 (6.3%) of 207 tested were newly diagnosed with HIV infection, and 8 (1.7%) had syphilis. Six (6.1%) of 98 MSM reporting exposure to patients with chlamydial infection had gonorrhea diagnosed. CONCLUSIONS: Infrequent coinfections in female and heterosexual male partners exposed to patients with chlamydial infection or gonorrhea would not preclude use of PDPT. However, PDPT for male partners of women with trichomoniasis and for MSM requires further study.

Adolescent↗
PubMed2005

Trends in clinic visits and diagnosed Chlamydia trachomatis and Neisseria gonorrhoeae infections after the introduction of a copayment in a sexually transmitted infection clinic.

BACKGROUND: To meet their sexually transmitted infection (STI) control mission, STI clinics most often offer services at no or minimal cost to clients. However, there is little knowledge about the effects of charging service fees on clinic attendance and STI identification. As a result of budget shortfalls, a clinic fee of 15 US dollars for Denver residents (up to 65 US dollars for nonresidents) was introduced in the Denver Metro Health (STI) Clinic (DMHC) in December 2002. We evaluated the effects of the fee on clinic utilization and diagnosed Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections. METHODS: Using the DMHC computerized medical record system, we compared clinic visits and CT/GC diagnoses between the first 3 quarters of 2002 and 2003. We also compared CT/GC cases reported by DMHC with those reported by other Denver providers during 2002 and 2003. RESULTS: Compared with 2002, there were 3250 fewer visits (-28.5%) to DMHC in 2003 with no variance across quarters. CT diagnoses declined by 427 cases (-28.1%), disproportionately affecting women (-40%) and those under 20 (-42%). In addition, there were 332 fewer GC diagnoses (-38.1%) with no clear demographic preponderance. Although there were some decreases in non-DMHC CT/GC reports, the ratio of DMHC to non-DMHC reports declined from 0.42 to 0.33 (-21.4%) for CT and from 0.94 to 0.61 (-35.1%) for GC. CONCLUSIONS: Even a modest fee for service appears to have a major impact on the use of STI clinic services and may result in a significant effect on the ability to diagnose CT/GC infections, especially among those at highest risk.

Adult↗
PubMed2003

Risks and benefits of the internet for populations at risk for sexually transmitted infections (STIs): results of an STI clinic survey.

BACKGROUND: The Internet is increasingly used for the recruitment of sex partners, potentially leading to increased risks for sexually transmitted infections (STIs). Less is known about the use of the Internet as a resource for STI education and prevention. GOAL: To evaluate the use of the Internet for sex-seeking and STI information purposes by clients of a large STI clinic. STUDY DESIGN: A 10-item survey was conducted among clients of the Denver Metro Health (STI) Clinic who visited the clinic for a new problem between September 2000 and May 2001. RESULTS: Among 4,741 clients surveyed, 2,159 (45.5%) had Internet access. Of these, 138 (6.4%) reported to have gone on-line with the specific purpose of finding a sex partner and 146 (6.8%) reported having sex with a partner they found over the Internet. Internet sex-seeking was more common among men who have sex with men (MSM; 77/269, or 28.6%) than among men who have sex with women (MSW; 52/1,176, or 4.4%; P < 0.0001) and higher among MSW than among women (9/714, or 1.3%; P < 0.001). The Internet was accessed by 604 persons (28.0%) to find information on STIs. Of these, 65.1% did so for general STI information, 36.3% for information on HIV, 25.7% for information on genital herpes, 22.4% for information on chlamydia, 21.7% for information on HPV, 19.9% for information on gonorrhea, 16.1% for information on syphilis, and 9.3% for other information. Of persons seeking sex, 54.4% accessed the Internet for STI information, compared to 26.2% of persons not seeking sex (P < 0.0001). CONCLUSIONS: Among STI clinic clients in Denver, nearly half have access to the Internet. Sex-seeking appears to be most prevalent among MSM. Internet use for STI information is common among those with Internet access and even more widespread among those who access the Internet to seek sex. Research is needed to develop and evaluate Internet-based STI-prevention interventions.

Adult↗
PubMed2003

HIV transmission risk behavior and its relation to antiretroviral treatment adherence.

BACKGROUND: Rising rates of antiretroviral drug resistance among recently infected persons are evidence of high-risk behavior among persons in HIV care. GOAL: The goal was to determine HIV transmission risk behavior among persons in HIV care and evaluate its association with treatment adherence. STUDY DESIGN: The study involved a structured interview of a random sample of patients in HIV care in an urban public clinic. Participants were categorized by transmission risk: high risk = unprotected anal/vaginal sex and/or needle sharing; low risk = protected anal/vaginal sex, unprotected and/or protected oral sex, no needle sharing; no risk = no sex or needle sharing. RESULTS: Of the 95 participants, 21 (22%) reported high-risk behavior, 36 (38%) reported low-risk behavior, and 38 (40%) reported no transmission risk in the past 3 months. Younger, more educated persons and those with an active substance abuse diagnosis were more likely to have high transmission risk (P < or = 0.05). Patients who engaged in high-risk behavior had equivalent use of antiretroviral therapy (P = 0.80) but lower adherence (P < or = 0.01) and higher median plasma viral loads (P = 0.05). CONCLUSIONS: There was a wide spectrum of transmission risk behavior among persons in HIV care. Persons reporting high-risk behavior were less adherent to antiretroviral therapy, providing a behavioral basis for transmission of drug-resistant HIV.

Adult↗
PubMed2003

Increases in gonorrhea and sexual risk behaviors among men who have sex with men: a 12-year trend analysis at the Denver Metro Health Clinic.

BACKGROUND: Recent increases in rates of sexually transmitted diseases (STDs) and decreases in safe sex behaviors among men who have sex with men (MSM) in several American and European cities have been noted by researchers. It has been suggested that these trends are the result of perceptions that HIV/AIDS is less serious because of the availability of highly active antiretroviral therapy (HAART). GOAL: The goal of the study was to examine trends in STD rates and risk behaviors among MSM and men who have sex with women (MSW) visiting a public STD clinic in Denver and to determine whether there is an ecological association with the availability of HAART. STUDY DESIGN: This is a two-part retrospective analysis of male visits to the Denver Metro Health Clinic (DMHC). The first part describes gonorrhea and early (primary and secondary) syphilis trends among MSM between 1982 and 2001. For the second part, data were grouped into two 6-year time periods to represent pre-HAART and post-HAART time frames, 1990 to 1995 and 1996 to 2001. RESULTS: Gonorrhea and early syphilis cases among MSM declined precipitously between 1982 and 1988 and then stabilized at low rates. The proportion of male visits to the clinic made by MSM decreased from 14.1% in 1990 to 7.2% in 1995 and then increased to 13.0% in 2001. Gonorrhea positivity rates among MSM increased after 1995 and were significantly higher in the period 1996 to 2001 (12.9%) than in the period 1990 to 1995 (8.1%; P<0.0001). Conversely, gonorrhea rates among MSW dropped from 11.2% in the first period to 6.9% in the second (P<0.0001). Among MSM known to be HIV-infected, gonorrhea rates increased from 11.6% in the first time period to 24.0% in the second period (P<0.0001). Reports of anal sex among MSM increased from 64.4% to 70.9% (P<0.0001). Reporting more than one sex partner increased for MSM from 65.2% to 70.3% (P<0.0001), but it significantly decreased from 52.6% to 46.2% for MSW (P<0.0001). No or inconsistent condom use increased from 60.9% to 63.0% for MSM (P=NS) and decreased from 85.1% to 82.4% among MSW (P<0.0001). CONCLUSIONS: These trends appear to reflect a change toward higher risk-taking behaviors among MSM but not MSW since the time HAART became available and raise concerns about the potential for increased HIV transmission in this group.

Adult↗
PubMed2002

Young adults on the Internet: risk behaviors for sexually transmitted diseases and HIV(1).

PURPOSE: To examine the sexual behaviors and related risk factors for sexually transmitted diseases and HIV among young adults who seek sex partners on the Internet. METHODS: Study staff recruited participants in online chat rooms, bulletin boards, and other online venues. A total of 4507 participants responded to a 68-item, self-administered, online survey of Internet sex-seeking practices. The survey solicited information on sexual behavior with partners found on the Internet; in addition, a parallel set of questions addressed sexual behaviors with partners found off the Internet. Of the respondents, 1234 (27.4%) were 18-24 years old. Of the young adults, 61% were male and 75% were white. Responses from young adults were compared to those received from older adults. In addition, responses from young adults who seek sex partners online were compared to responses from young adults who do not seek sex partners online. Analyses, including logistic regression, Chi-square tests, Student's t-tests, and analyses of variance, focused on the difference between young and older adults, as well as the differences in sexual behavior with partners located online and offline. RESULTS: Young adults who seek sex on the Internet report substantially different sexual behavior patterns than young adults who do not seek sex on the Internet. Young adults with online partners reported sexual behaviors similar to older respondents who used the Internet to find sex partners; however, older respondents were more likely than young adults to have been tested for sexually transmitted diseases and HIV. CONCLUSIONS: Young adults who seek sex partners online may be at significantly greater risk for sexually transmitted diseases than their peers who do not seek sex partners online. These data point to an urgent need for online sexual health promotion.

Adolescent↗
PubMed2002

Incidence and repeat infection rates of Chlamydia trachomatis among male and female patients in an STD clinic: implications for screening and rescreening.

BACKGROUND: Nucleic acid amplification tests permit widespread screening for Chlamydia trachomatis. However, the public health benefit of screening may be reduced by high chlamydia incidence and repeat infection rates. GOAL: To study chlamydia incidence and repeat infection among clients of a sexually transmitted disease (STD) clinic. STUDY DESIGN: A retrospective cohort study of all clients tested for chlamydia on two or more occasions during a 30-month period. RESULTS: Between January 1, 1997 and June 30, 1999, 3568 clients were tested on multiple occasions. Of these, 491 (13.8%) had positive test results at their first visit (baseline infections), and 385 (10.8%) had positive results at a subsequent visit (incident infections). The overall incidence was 11.7 per 100 person-years of follow-up evaluation (95% CI, 10.6-12.9). The incidence was significantly higher among those 25 years of age or younger (19.7/100 person-years; 95% CI, 17.3-22.2) than among older subjects (6.8/100 person-years, 95% CI, 5.7-7.9; relative hazard, 3.0; 95% CI, 2.5-3.7). The incidence of new infections among persons without a baseline infection was 10.0 per 100 person-years (95% CI, 8.8-11.2), whereas the incidence of repeat infections was 23.6 per 100 person-years (95% CI, 18.9-28.2; relative hazard, 2.4; 95% CI, 1.9-3.0), with repeat infections accounting for 26% of all incident infections. In the multivariate analysis, the factors associated with new infections included young age, black race, male gender, history of sexually transmitted disease, a new sex partner in the previous 30 days, and inconsistent condom use. The factors associated with repeat infection were younger age, nonuse of condoms, and no treatment after contact with a partner who had a diagnosis of chlamydia or a chlamydia-related condition, as measured at the initial visit. CONCLUSIONS: Among clients making multiple visits to the clinic, repeat infection rates were significantly higher than new infection rates, likely because of reexposure to untreated partners. These findings point to the need for more effective strategies to prevent chlamydia infection, including enhanced partner management services and rescreening.

Adolescent↗