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J M Zenilman

Publications and source records attributed to J M Zenilman.

77 records · Page 5Linked to original sources
PubMedDate not supplied

Gonococcal susceptibility to antimicrobials in Baltimore, 1988-1994. What was the impact of ciprofloxacin as first-line therapy for gonorrhea?

BACKGROUND: Single-dose, oral quinolones have been a recommended treatment option for gonorrhea since 1989 and have since been used as first-line therapy for gonorrhea in Baltimore. METHODS: The impact of this strategy on antimicobial susceptibility patterns in Neisseria gonorrhoeae was assessed utilizing data collected as part of the National Gonococcal Isolate Surveillance system. This system evaluates a systematically collected sample. Minimum inhibitory concentrations to penicillin, tetracycline, ceftriaxone, and ciprofloxacin were determined by agar dilution. RESULTS: Between January 1988 and September 1994, 1,846 gonococcal isolates were evaluated. The proportion of isolates with plasmid-mediated resistance (penicillinase-producing Neisseria gonorrhoeae or tetracycline-resistant Neisseria gonorrhoeae) increased from 22% in 1988 to 46% in 1992 and then dropped to 20% in 1994. In contrast, the prevalence of chromosomally mediated resistant isolates ranged between 3% and 10%. Between 1988 and 1994, the geometric mean penicillin and tetracycline minimum inhibitory concentrations decreased slightly (penicillin: from 0.509 microgram/ml to 0.369 microgram/ml; tetracycline: from 1.01 micrograms/ml to 0.767 microgram/ml). The mean ceftriaxone MIC increased from 0.005 microgram/ml in 1988 to 0.021 microgram/ml in 1992, and then abruptly decreased. Ciprofloxacin minimum inhibitory concentrations did not change substantially during the study period. Concurrent studies performed in this community suggest that quinolones were infrequently used for infections other than sexually transmitted ones during this time period. CONCLUSIONS: Single-dose quinolone therapy does not appear to foster development of resistant gonococcal isolates. However, resistance may develop as a result of complex ecological interactions with the community, underscoring the need for continued surveillance.

Ambulatory Care Facilities↗
PubMedDate not supplied

Early intervention for human immunodeficiency virus in Baltimore Sexually Transmitted Diseases Clinics. Impact on gonorrhea incidence in patients infected with HIV.

BACKGROUND: High incidences of sexually transmitted diseases (STD) after posttest counseling have been documented in patients diagnosed with human immunodeficiency virus (HIV) in Baltimore STD clinics. In July 1991, the authors instituted an HIV early intervention program providing long-term medical care and social work services. This study compares the incidence of gonorrhea after post-HIV+ test counseling in patients diagnosed with HIV before and after the institution of the early intervention program. METHODS: Medical records of a cohort composed of all patients newly diagnosed with HIV and those who underwent posttest counseling for HIV in 1991 to 1993 in two Baltimore STD clinics were reviewed. Patients were offered early intervention medical and social work services. Gonorrhea incidence in this cohort was compared to a historical cohort diagnosed and counseled for post-HIV+ testing in 1988 to 1989 who were not offered early intervention services. RESULTS: The mean follow-up time was 418 days (range, 26 to 703 days). After post-HIV+ test counseling, gonorrhea developed in 39 of 468 (8.3%) men in the 1989 cohort and 13 of 400 (3.3%) men in the 1991 to 1993 cohort. Controlling for variable length of follow-up, the 1991 to 1993 cohort had a relative risk of 0.442 for the development of gonorrhea during the study period (95% confidence interval, 0.225 to 0.790; P = 0.006). Incident gonorrhea after post-HIV+ test counseling also was associated with a prevalent gonorrhea condition at the time of HIV diagnosis (RR = 3.02; 95% CI, 1.75 to 5.23; P = 0.0001) and failure to return for post-HIV+ test counseling as scheduled (RR = 2.27; 95% CI, 1.17-4.43; P = 0.013). After adjustment for gonorrhea at the time of HIV diagnosis and failure to return for scheduled posttest counseling, the difference in gonorrhea incidence between men in the two cohorts remained statistically significant (RR = 0.494; 95% CI, 0.260 to 0.941; P = 0.032). In comparison, overall gonorrhea rates in Baltimore changed little between 1988 and 1993. No significant difference was found in gonorrhea incidence in women, which may have been the result of active gonorrhea screening during the 1991 to 1993 period, which was not performed in 1988 to 1989. CONCLUSIONS: Providing clinical care to persons with HIV may facilitate the reduction of high-risk behaviors that lead to incident STDs and further HIV transmission.

Adult↗
PubMedDate not supplied

Reliability of partner reports of sexual history in a heterosexual population at a sexually transmitted diseases clinic.

BACKGROUND: In epidemiologic research, information about sexual frequency and condom use is by necessity based on self-reports. This study investigated the reliability of self-reported sexual behavior in 162 heterosexual partnerships. METHODS: Subjects were part of a larger study of condom use and sexually transmitted diseases (STD) conducted in two Baltimore STD clinics from 1990 to 1992. Partners were enrolled on the same day and were interviewed separately. Information about sexual activity and condom use was collected using a retrospective calendar for the 30 days before enrollment. RESULTS: Participants were predominantly young, unmarried African-Americans. Based on Spearman's correlation coefficients and kappa statistics, the authors found only fair agreement (K = 0.43; r = 0.51) between partner reports of overall condom use for the 30-day period before the interview. Correlation coefficients ranged from 0.43 for frequency of any sexual activity to 0.56 for number of days on which vaginal intercourse occurred. CONCLUSIONS: Partner agreement for condom use and frequency of sexual activity decreased as the recall period increased. Higher partner agreement was observed for questions with definite answers compared to the more open-ended sexual behavior questions. These findings indicate potential reporting bias in self-reports of sexual behavior in a population at high risk for STDs.

Adolescent↗
PubMedDate not supplied

Asymptomatic neurosyphilis after doxycycline therapy for early latent syphilis.

A 50-year-old woman allergic to penicillin with early latent syphilis was treated with two courses of doxycycline. Ten months after diagnosis, she had no evidence of serologic response. A lumbar puncture demonstrated asymptomatic neurosyphilis. Penicillin desensitization was performed and she was successfully treated. This case re-emphasizes the need for close serologic follow-up in patients with latent syphilis.

Desensitization, Immunologic↗