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J Zenilman

Publications and source records attributed to J Zenilman.

34 records · Page 2Linked to original sources
PubMed1998

Susceptibility to vaccine-preventable diseases in a sexually transmitted disease clinic population.

BACKGROUND AND OBJECTIVE: Sexually transmitted disease (STD) clinics often serve a population that has low medical care utilization. The objective of this study was to determine the susceptibility of an STD clinic population to vaccine-preventable diseases. STUDY DESIGN: A cross-sectional study of immunization practices and susceptibility to vaccine-preventable diseases was undertaken by enrolling consecutive patients attending an STD clinic. Demographic information and a history of disease or immunization was assessed by interview. Immunity to measles and rubella was determined by measuring IgG antibodies by ELISA assays. RESULTS: Of the 288 patients evaluated, the mean age was 28 years and 70.5% were male. Serologically, 16.3% were susceptible to rubella and 8% to measles. Only 8% reported hepatitis B immunization. Although measles protection was high, nearly one in six was susceptible to rubella. Hepatitis B immunization was severely underused. CONCLUSION: Baltimore STD clinic patients may benefit from an enhanced rubella and hepatitis B prevention strategy.

Adult↗
PubMed1998

Evaluation of vaginal infections in adolescent women: can it be done without a speculum?

OBJECTIVE: Given that highly sensitive urine-based nucleic acid amplification tests may eliminate the need for speculum exam to diagnose gonorrhea and chlamydia cervicitis, we sought to determine if vaginal infections could be diagnosed without using a speculum. METHODS: Matched pairs of vaginal specimens were collected from participants before and during speculum exam for diagnosis of trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Females age 12 to 22 years presenting to the Johns Hopkins adolescent primary care clinics who required a pelvic examination were eligible to participate. A convenience sample of 686 patients was recruited between July 1995 and August 1996. Paired vaginal specimens were evaluated with blinded microscopic evaluation. Analysis consisted of: 1) comparison of collection method sensitivities; and 2) assessment of proportions of infections detected by one method that were also detected by the other method. RESULTS: Sensitivities of speculum and nonspeculum collection methods were 75% and 77% (difference = -2%; 95% confidence interval, -11%, 7%) for trichomoniasis, 64% and 68% (difference = -4% [-10%, 3%]) for bacterial vaginosis, and 85% and 80% (difference = 5% [-12%, 22%]) for vulvovaginal candidiasis. The speculum method identified 88% (trichomoniasis), 90% (bacterial vaginosis), and 81% (vulvovaginal candidiasis) of infections detected by the nonspeculum method. The nonspeculum method identified 91% (trichomoniasis), 95% (bacterial vaginosis), and 76% (vulvovaginal candidiasis) of infections detected by the speculum method. CONCLUSIONS: Vaginal infections can be adequately diagnosed without a speculum. Once urine-based diagnosis of gonorrhea and chlamydia becomes well established, it may be possible to perform evaluations for uncomplicated genitourinary complaints without using a speculum.

Adolescent↗
PubMed1997

Sex, drugs, and infections among youth. Parenterally and sexually transmitted diseases in a high-risk neighborhood.

BACKGROUND AND OBJECTIVES: To determine the extent to which youth who reside in households in a neighborhood with large numbers of drug injectors 1) are infected with parenterally or sexually transmitted agents, and 2) engage in high-risk behaviors. STUDY DESIGN: A multistage probability household sample survey was conducted in Bushwick, Brooklyn from 1994 to 1995. All households in 12 randomly selected primary sampling units were screened for age-eligible youth. One hundred eleven English-speaking 18- to 21-year-olds were interviewed. One hundred three sera were tested for human immunodeficiency virus type 1 (HIV-1), Hepatitis B virus, hepatitis C virus (HCV), human T-cell lymphotrophic virus types I and II (HTLV-I/II), herpes simplex virus type 2 (HSV-2), or syphilis. Urines were tested for chlamydial infection, and for opiate and cocaine metabolites. RESULTS: Eighty-nine percent had sex in the past year, 45% with two or more partners. Only 19% of the sexually active always used condoms. Two (of 95) had had sex with a crack smoker. Thirty percent of women reported being coerced the first time they had sex, and 23% of women and 3% of men reported having been sexually abused. Only 3% reported ever using heroin, and 9% cocaine. Only one reported ever having injected drugs or smoked crack. Some underreporting of stigmatized behaviors occurred: two "nonreporters" had opiate-positive urines and two had cocaine-positive urines. Marijuana use was common, with 48% using it in the past year. No subjects tested positive for HIV-1, HIV-II, or syphilis; 2% tested positive for HTLV-I and 3% for hepatitis C; 3% had hepatitis B markers, 12% had chlamydial infection, and 50% serologic HSV-2 markers. CONCLUSIONS: Population-representative samples of high-risk communities can provide important knowledge. Although heroin and cocaine use, during drug injection, and rates of infection with parenterally transmitted infectious agents appear to be lower among these youth, sexual risk behaviors and chlamydial and HSV-2 infection are widespread. Sexually transmitted disease screening and outreach strategies are needed both to prevent sexually transmitted disease sequelae (including potential increased susceptibility to HIV infection) and to prevent transmission to partners.

Adolescent↗
PubMed1997

Reasons for not using condoms of clients at urban sexually transmitted diseases clinics.

BACKGROUND AND GOAL: Greater understanding of the factors related to inconsistent condom use is essential in the development of strategies to promote condom use among clients who access public, inner-city sexually transmitted diseases (STD) clinics. Therefore, this study aimed to explore reasons for not using condoms among 260 predominantly African American heterosexual male and female clients presenting for care at two inner-city STD clinics. STUDY DESIGN: Clients selected for this descriptive analysis reported having had at least one unprotected episode of sexual intercourse in the last 10 episodes. In face-to-face interviews, clients provided information about sexual activity, sexual partners, and condom use in the previous 30 days. In addition, they were asked to indicate the main reason for not using condoms when having unprotected sex. RESULTS: Content analysis showed six major categories of reasons for not using condoms: reasons related to partner relationships, reasons related to sexual sensation, reasons related to situational constraint, reasons related to condoms themselves, reasons related to pregnancy, and reasons related to types of sexual activity. Most frequent explanations given for not using condoms included partner trust (19.6%), the feel of condoms (11.9%), and lack of condom availability (11.5%). Clients also reported barriers to condom use that included beliefs about condom sensation and partner relationships. CONCLUSIONS: These results show the continued barriers that exist with respect to condom use in at-risk populations and emphasize the need to tailor meaningful interventions in order to promote condom use among persons who, for differing reasons, choose not to use them.

Adult↗
PubMed1997

Definitions of genital ulcer disease and variation in risk for prevalent human immunodeficiency virus infection.

OBJECTIVES: Although genital ulcer disease (GUD) has been associated with human immunodeficiency virus (HIV) infection in a number of studies, definitions of genital ulceration have varied. The authors hypothesized that the association of GUD with prevalent HIV infection may vary according to the definition of GUD that is used. METHODS: As part of a prospective cohort study, 863 patients were interviewed and examined who presented to a sexually transmitted disease (STD) clinic for new symptom evaluation and who agreed to HIV testing to determine demographic and behavioral risk associated with prevalent HIV infection. To determine the association between GUD and prevalent HIV, the following definitions of GUD were used: observed ulcers, history of syphilis, serologic evidence of syphilis, observed culture-proven genital herpes, and serologic evidence of herpes simplex virus type II (HSV-2) infection. RESULTS: Of 481 men and 382 women enrolled, prevalent HIV infection was detected in 12.5% and 5.2%, respectively. In multivariate analyses controlling for known HIV risk behaviors, prevalent HIV infection was associated with observed GUD (odds ratio [OR] = 2.0, 95% confidence intervals (CI) = 1.0-3.9), a history of syphilis (OR = 6.0, CI = 2.8-12.7), and serologic evidence of syphilis (OR = 3.7, CI = 1.9-7.0), but not with serologic evidence of HSV-2 (OR = 1.2, CI = 0.7-2.1), nor with observed HSV-2 culture-positive genital ulcerations (OR = 1.0, CI = 0.4-4.2). Factors contributing to different strengths of association between HIV infection and a history of syphilis or serologic evidence of syphilis included the presence of underdiagnosed syphilis infection in people with reactive serologic tests and the absence of serologic reactivity in people with a positive history. CONCLUSIONS: Although GUD is strongly associated with prevalent HIV, the strength of the association depends on the definition of GUD used. For accurate evaluation of people at risk for HIV, clinicians and researchers should use multiple definitions of GUD.

Adolescent↗
PubMed1997

Sexually transmitted disease control in the era of managed care: "magic bullet" or "shadow on the land"?

Sexually transmitted diseases (STDs) are a major public health problem. In the United States, nearly 12 million STD infections occur annually, generating estimated direct annual health care costs exceeding $12 billion. Lifetime costs may total $88 billion. Meanwhile, inflation-adjusted public funding for STD clinical care and control decreased over the past two decades. Previous STD control officials warned that declining support for STD control programs would result in program elimination and increased rates of STDs ("Brown's Law"). Effective public health and primary prevention efforts have been difficult to implement because of societal sensitivities about sexuality, and the curative rather than preventive focus of our health care system. Proven cost-effective medical interventions, such as chlamydia screening, have not been universally implemented because of health care system inefficiencies, whereby public STD clinical services generate private sector savings not reinvested into these public prevention programs. However, the dramatic growth in managed care presents opportunities, as well as risks, for better STD management.

Adolescent↗
PubMed1996

Diagnosis by AMPLICOR PCR of Chlamydia trachomatis infection in urine samples from women and men attending sexually transmitted disease clinics.

Screening of urine specimens from men for Chlamydia trachomatis infection by a commercial PCR assay (AMPLICOR C. trachomatis Test; Roche Diagnostic Systems, Inc., Branchburg, N.J.) is a sensitive and specific noninvasive diagnostic assay. Since screening of women for C. trachomatis infection with the AMPLICOR C. trachomatis Test has been limited to use with endocervical swab specimens, we conducted an evaluation of the AMPLICOR C. trachomatis Test for the detection of C. trachomatis using female urine samples and compared the results of those obtained by in vitro culture and PCR of endocervical swab specimens. For 713 men we compared the performance of AMPLICOR C. trachomatis Test with urine specimens with that of culture of urethral specimens. For specimens that were PCR positive and culture negative, two additional tests were used to resolve the discrepancies: direct fluorescent-antibody assay (DFA) of sediment from a spun endocervical specimen culture vial and major outer membrane protein-based PCR of the sediment from the endocervical specimen culture vial. Of 525 urine specimens from females, 67 (12.8%) were PCR positive, and 41 (7.8%) endocervical specimens from the 525 women were culture positive. After resolution of the discrepancies, the resolved sensitivity of the urine PCR was 93.3%, whereas the sensitivity of endocervical swab specimen culture was 67.3%. Of 468 female endocervical swab specimens, 47 (10.0%) had a positive PCR result and 33 (7.0%) were culture positive. The resolved sensitivity of the endocervical swab specimen PCR was 86%. Of 415 matched female urine and endocervical swab specimens, there were 49 confirmed infections; 30 (61.2%) specimens were positive by culture of the endocervical swab specimen, 40 (81.6%) were positive by confirmed endocervical swab specimen PCR, 43 (87.8%) were positive by confirmed urine PCR, and all 49 (100%) were positive by either endocervical swab specimen PCR or urine PCR. For men, the resolved sensitivity of the urine PCR was 88%, and the sensitivity of culture was only 50.7%. These results indicate that urine PCR is highly sensitive for the detection of C. trachomatis in both women and men and provides a noninvasive technique for routine screening for chlamydial infection.

Ambulatory Care Facilities↗
PubMed1995

Increased genital shedding of herpes simplex virus type 2 in HIV-seropositive women.

OBJECTIVE: To compare the prevalence of genital herpes simplex virus type 2 (HSV-2) shedding in human immunodeficiency virus (HIV)-seropositive women and HIV-seronegative women. DESIGN: Cross-sectional study. SETTING: A major inner-city medical center. PATIENTS: 106 women who were HIV-seropositive and HSV-2-seropositive and 70 women who were HIV-seronegative and HSV-2-seropositive were enrolled from various primary care settings. MEASUREMENTS: Herpes simplex virus type 2 antibody determinations were done for all patients. Regardless of symptoms, vulvar and cervical HSV cultures were obtained from all HIV-seropositive women and from a randomly selected subgroup of HIV-seronegative women. RESULTS: The prevalence of HSV-2 shedding was nearly four times greater in HIV-seropositive than in HIV-seronegative women (13.2% compared with 3.6%; P = 0.04; odds ratio, 4.1 [95% CI, 1.0 to 27.4]) when the serum antibody for HSV-2 was present. Seventy-nine percent of viral shedding among HIV-seropositive women was asymptomatic. Overall viral shedding increased significantly as the CD4 cell count decreased. CONCLUSIONS: Women with HIV infection, particularly those with low CD4 cell counts, shed HSV-2 from the vulva and cervix more commonly than women not infected with HIV. Most of this shedding is asymptomatic.

CD4 Lymphocyte Count↗
PubMed1995

Clinical manifestations and risk factors of Pseudomonas aeruginosa infection in patients with AIDS.

Fifty-eight patients with human immunodeficiency virus infection were analyzed for clinical manifestations and potential risk factors for Pseudomonas aeruginosa infection by use of case-control methodology. Most had AIDS. Of 73 episodes of P. aeruginosa infection, 45 (62%) were bacteremias primarily associated with central venous catheters (16), pneumonia (12), soft tissue (4), or urinary tract infections (4). Twenty-eight episodes (38%) were nonbacteremic, with pneumonia (13), soft tissue infections (6), and sinusitis (4) accounting for the majority of infections. Fifty episodes (68%) were community-acquired. The recurrence rate was 23%. The overall mortality attributable to P. aeruginosa infection was 22%. Central venous and urinary catheter use and steroid therapy were significantly more frequent in cases than controls (P < .05). Thus, P. aeruginosa infection in patients with advanced human immunodeficiency virus disease is often community-acquired and associated with substantial mortality and, in some cases, specific risk factors.

AIDS-Related Opportunistic Infections↗
PubMed1995

Ligase chain reaction for detection of Neisseria gonorrhoeae in urogenital swabs.

The ligase chain reaction (LCR) is an in vitro nucleic acid amplification technique that exponentially amplifies targeted DNA sequences. In a multicenter study, we evaluated the use of a 4-h LCR-based assay for the diagnosis of Neisseria gonorrhoeae infection of the cervix and male urethra. The LCR results were compared with those of culture for N. gonorrhoeae by using selective media. This assay amplifies target sequences within the N. gonorrhoeae opacity gene. Discordant LCR-positive and culture-negative specimens were further evaluated by testing by another LCR assay which used N. gonorrhoeae-specific pilin probe sets. A total of 1,539 female endocervical specimens and 808 male urethral swab specimens were evaluated in the study. An expanded "gold standard" was defined to include all culture-positive as well as culture-negative, confirmed LCR-positive specimens. After resolution of discrepant samples, the sensitivities of the N. gonorrhoeae LCR assays for the female and male specimens were 97.3 and 98.5%, respectively, with specificities of 99.6 and 99.8%, respectively. Resolved culture sensitivities were 83.9 and 96.5% for the female and male specimens, respectively. The LCR assay for gonorrhea is a rapid, highly sensitive nonculture method for detecting gonococcal infection of the cervix and male urethra.

Bacteriological Techniques↗
PubMed1994

Association of hepatitis C virus infection with false-positive tests for syphilis.

The prevalence of false-positive reactions for syphilis (reactive rapid plasma reagin [RPR] test and nonreactive fluorescent treponemal antibody absorption [FTA-ABS] test) among patients at sexually transmitted disease (STD) clinics was assessed to evaluate the association between false-positive RPR reactions and hepatitis C virus (HCV) infections. Among 2672 patients, 400 (15.0%) had antibodies to HCV (anti-HCV) and 254 (9.5%) had a reactive RPR test. Of the 254 reactive RPR tests, 231 (90.1%) were also positive by FTA-ABS, leaving 23 false-positive RPR reactions. After excluding the 231 patients with positive FTA-ABS tests, false-positive RPR tests were found in 9 (2.7%) of 330 anti-HCV-positive patients compared with 14 (0.6%) of 2154 anti-HCV-negative participants (relative risk, 4.5; 95% confidence interval, 1.9-10.9; P = .0017). These data demonstrate that HCV infection is associated with false-positive RPR test results. However, because of the high prevalence of syphilis among STD patients, the RPR test remains a strong indicator of syphilis in this setting.

Adolescent↗
PubMed1988

Sexually transmitted diseases in homosexual adolescents.

In 1986, an estimated 13 million cases of sexually transmitted diseases (STDs) were diagnosed in the United States, with the highest incidence rates occurring within the adolescent age group. Homosexual adolescent men are at particularly high risk for STDs. Because of the myriad clinical presentations of STD in gay men, these diseases are often not recognized as being sexually transmitted. In this paper, the epidemiology and clinical features of STDs in gay adolescents are discussed. The sexual history is emphasized as an integral tool in developing a differential diagnosis. A priori, the sexual history also can give a risk-assessment profile for STD. Clinical aspects of STD are reviewed using a syndrome approach, and the diagnostic workup is outlined for the etiologic agents most likely implicated in each syndrome. Clinical signs and symptoms of urethritis, genital ulcers and papular lesions, pharyngitis, and hepatitis are reviewed. Sexually acquired gastrointestinal disorders are described. As the AIDS epidemic continues, disease prevention, risk reduction, and patient education are becoming more important. Current recommendations for "safer sex" practices are reviewed.

Adolescent↗
PubMedDate not supplied

Epidemiologic risk factors for incident sexually transmitted diseases in young Thai men.

BACKGROUND AND OBJECTIVES: Prospective studies of incidental sexually transmitted diseases in developing countries rarely have been reported. As the human immunodeficiency virus epidemic widens, knowledge of the epidemiology of sexually transmitted diseases as co-factors for human immunodeficiency virus infection is viewed as vitally important. GOAL: To determine epidemiologic risk factors for incidental sexually transmitted diseases in young men in northern Thailand. STUDY DESIGN: A cohort of 2,417 men selected by lottery for military conscription was followed an average of 22 months, with epidemiologic risk factors and sexually transmitted disease histories assessed semiannually. Sexually transmitted diseases were determined by physician or symptom histories obtained by interview. RESULTS: Sexually transmitted disease incidence was 17.04 per 100 person-years. Gonorrhea and chancroid were commonly reported, whereas incident syphilis was rare. Sexually transmitted disease incidence declined significantly in the 2-year period. Most sexually transmitted diseases were acquired through commercial sex patronage. However, among men who did not report visiting a brothel, there was a significant increase in sexually transmitted diseases among men reporting sex with a girlfriend. Other risk factors included inconsistent condom use, drug use, and low educational level. Frequent alcohol use was associated with incident sexually transmitted diseases in bivariate analysis, but drinking at the time of last brothel visit was not associated with increased sexually transmitted diseases. CONCLUSIONS: Sexually transmitted disease control in Thailand is based on an integrated sexually transmitted disease clinic system. Many commercial sex workers are examined and treated routinely, but too infrequently to reduce sexually transmitted disease transmission between them and their male clients. Condom-use levels in commercial sex settings still may be too low to reduce sexually transmitted disease transmission. More consistent and effective sexually transmitted disease treatment of commercial sex workers and their clients and education of men on the effective and consistent use of condoms is required to reduce the risks of sexually transmitted disease transmission in this population.

Adult↗
PubMedDate not supplied

The cost of a preventable disease: estimated U.S. national medical expenditures for congenital syphilis, 1990.

Reported cases of congenital syphilis have increased rapidly in recent years. The purpose of this study was to estimate first-year medical care expenditures among 1990 incident cases of infants diagnosed with congenital syphilis. The authors used a synthetic estimation model to calculate expenditures for congenital syphilis as the number of treated cases multiplied by cost per case. The number of cases was derived from surveillance data adjusted for underreporting and presumptive (false-positive) treatment. Cost per case was based on expected hospital and physician charges applied to case treatment protocols appropriate to case severity. Base-case estimated first-year medical expenditure for 1990 treated cases (N = 4,400) in 1990 was +12.5 million. In sensitivity analysis, estimates ranged from +6.2 million to +47 million. Substantial reduction in congenital syphilis treatment costs could be achieved through targeted public health interventions consisting of prenatal maternal screening and contact tracing of males testing positive for syphilis. Physicians should be aggressive in presumptive treatment of newborns, since this usually prevents future disability but represents a small portion of total national expenditure for congenital syphilis. More precise data on severe cases resulting in long-term disability are needed to make reliable cost estimates.

Female↗