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Biomedical subjects

K K Holmes

Publications and source records attributed to K K Holmes.

At least 37 records · Page 2Linked to original sources
PubMed2000

Human leukocyte antigen class II DQ alleles associated with Chlamydia trachomatis tubal infertility.

OBJECTIVE: To investigate epidemiologic tubal infertility risk factors and the relationship between HLA class II alleles and Chlamydia trachomatis tubal infertility. METHODS: Forty-seven women with tubal infertility and 46 fertile controls were studied in Nairobi, Kenya. A questionnaire was administered and serum collected for measurement of C trachomatis antibodies. HLA class II molecular typing was done with DNA extracted from peripheral blood lymphocytes. The prevalence of C trachomatis microimmunofluorescence antibody, chlamydia heat shock protein 60 antibody, and HLA class II alleles was compared among cases of tubal infertility and fertile controls. RESULTS: Women with tubal infertility more often had histories of pelvic inflammatory disease (15% versus 0%; odds ratio [OR] 16; 95% confidence interval [CI] 5.5, 47) histories of spontaneous abortion (34% versus 7%; OR 6.7; 95% CI 2.8, 16), and antibodies to C trachomatis (53% versus 26%; OR 3.2; 95% CI 1.3, 7.7) than controls. Among infertile women, DQA*0101 and DQB*0501 alleles were positively associated with C trachomatis tubal infertility (OR 4.9; 95% CI 1.3, 18.6, and OR 6.8; 95% CI 1.6, 29.2, respectively). DQA*0102 was negatively associated with C trachomatis tubal infertility (OR 0.2; 95% CI 0.005, 0.6). CONCLUSION: Chlamydia trachomatis infection is an important cause of tubal infertility in Nairobi. The association of specific HLA class II alleles with C trachomatis microimmunofluorescence seropositivity among women with tubal infertility suggests that the DQ locus might modify susceptibility to and pathogenicity of C trachomatis infection.

Adult↗
PubMed2000

Preventing genital infections with human papillomavirus: lessons learned from the HIV epidemic.

Despite the major differences in the clinical epidemiology of HIV and HPV infections, several lessons learned from the HIV epidemic may be relevant to future prevention of HPV infection. There has been a paradigm shift in conceptualizing the epidemiology of STDs; targets of prevention now include: (1) determinants of exposures of susceptibles to infectious persons; (2) the efficiency of transmission; and (3) the duration of infectiousness. Lessons learned that may be potentially relevant to HPV prevention include: (1) advances in treatment of HIV have been rapidly adopted, whereas advances in prevention have not; (2) therapeutic and preventive trials have been too brief in duration, sometimes failing to adequately address major problems with relapse that become evident later; and (3) involvement of affected individuals and populations in research and prevention efforts has been essential and useful. Specific suggestions for HPV prevention efforts are discussed.

Disease Outbreaks↗
PubMed2000

Introduction to the 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus.

Opportunistic infections (OIs) are well recognized to produce substantial morbidity and mortality among patients with HIV infection. Since measures are available for reducing the incidence and the impact of these processes for patients, the United States Public Health Service and the Infectious Diseases Society of America, with endorsing professional societies, have developed guidelines for implementing a comprehensive strategy to prevent these OIs. These guidelines have been developed by a diverse working group of expert health care providers and patient representatives in order to synthesize available data and to provide practical advice for health care practitioners and patients.

AIDS-Related Opportunistic Infections↗
PubMed2000

Unique gonococcal phenotype associated with asymptomatic infection in men and with erroneous diagnosis of nongonococcal urethritis.

The percentage of gonococcal isolates in King County, Washington, requiring citrulline and uracil (CU auxotype) increased from 1.6% in 1986 to 16.5% in 1997. Among men, urethral infection with the CU auxotype (n=93), in comparison with infection by other auxotypes (n=1211), was associated with coexisting chlamydial infection, younger age, heterosexual contact, and fewer new recent partners (P<. 05). Among heterosexual men, urethral infection with the CU auxotype, compared with infection with other auxotypes, less often produced symptoms of urethral discharge (75% vs. 92%) or dysuria (47% vs. 74%) or signs of moderate or profuse urethral discharge (57% vs. 89%, P<.05 for each comparison), produced symptoms of longer duration (7. 0 vs. 4.5 days, P<.01), less often resulted in urethral smears showing gram-negative intracellular diplococci (67% vs. 95%, P<.01), and thus more often was erroneously diagnosed as nongonococcal urethritis. Several mechanisms could explain reduced inflammatory response to the CU auxotype and its recent spread.

Adult↗
PubMed2000

To notify or not to notify: STD patients' perspectives of partner notification in Seattle.

BACKGROUND AND OBJECTIVES: To obtain patients' perspectives on why only some partners are notified in partner-notification programs, the cornerstone of sexually transmitted disease (STD) control, although low proportions of partners are located and evaluated. GOALS: To describe patterns of partner notification reported by persons with STD infection. STUDY DESIGN: In-depth interviews conducted in Seattle with 60 heterosexual men and women with gonorrhea, chlamydial infection, or nongonoccocal urethritis, and 19 men with gonorrhea reporting sex with men (MSM) were tape recorded, transcribed verbatim, and content analyzed. RESULTS: The typical notification pattern was to notify a main partner but not others. Least likely to be notified were partners perceived as transmitters, contacts preceding the onset of symptoms, the oral sex and anonymous contacts of MSM, one-time partners of men, and incarcerated and former partners of women. Fears among young heterosexual participants included gossip and violence (women). Fears among MSM included rejection. CONCLUSIONS: Partner-notification programs should develop innovative approaches for partners perceived as transmitters, oral-sex only contacts of MSM, and contacts preceding symptom onset.

Adolescent↗
PubMed2000

Comparative epidemiology of heterosexual gonococcal and chlamydial networks: implications for transmission patterns.

OBJECTIVE: Networks of sex-partner interaction affect differential risk of acquiring sexually transmitted infections. The authors evaluated sociodemographic and behavioral factors that correlated with membership in networks of gonococcal and chlamydial transmission. METHODS: Face-to-face interviews were conducted with 127 patients with gonorrhea and 184 patients with chlamydia (index cases) and their named sex partners, as well as the partners of infected partners. Detailed information was obtained regarding demographic, behavioral, and sexual-history characteristics of all respondents. RESULTS: Gonococcal-network members differed significantly from chlamydial-network members in a number of demographic variables, including race or ethnicity, education, and unemployment status. Gonococcal-network members were more likely to report past history of crack-cocaine use, sexual assault, and having been in jail. Gonococcal-network members also reported having more sex partners during the past 1 year and 3 months than did chlamydial-network members. Gonococcal and chlamydial mixing matrices demonstrated assortativeness for sex partner selection by race or ethnicity but not by sexual activity level, and no systematic differences between networks were noted. Gonococcal networks were larger than chlamydial networks. CONCLUSIONS: Network analyses of gonococcal and chlamydial infections demonstrated significant differences in sociodemographic and behavioral variables. Further research is required to delineate specific predictors of network membership among persons at risk for sexually transmitted infections.

Adolescent↗
PubMed2000

Sexual bridging by Cambodian men: potential importance for general population spread of STD and HIV epidemics.

BACKGROUND: Linkages between sexual networks influence STD and HIV epidemics. GOAL: This study quantifies male sexual "bridging" and associated factors in Cambodia's 1997 behavioral surveillance survey. STUDY DESIGN: Among persons randomly selected from clusters of military, police, and motorcycle taxidrivers in five cities, associations between individual characteristics, behaviors, social context, and "active bridging" were tested using logistic regression analyses. RESULTS: The authors defined 20.5%, 15.7%, and 14.7% of military, police, and motorcycle taxidrivers as active bridgers (men who have unprotected sex with high and low risk partners). Among the military and police, logistic regression revealed that age (odds ratio [OR], 1.05), age of first sexual intercourse (OR, 0.89), having friends who frequent sex workers (OR, 3.31), and residence in the port city (OR, 3.34) were associated with active bridging. Among motorcycle taxidrivers, residence in the border city (OR, 2.23) or the port city (OR, 2.84) was associated with active bridging. Sexually transmitted disease symptoms during the past year were significantly associated with active bridging. CONCLUSIONS: Social characteristics influence sexual bridging more than individual ones. The pervasiveness of bridging and the association with sexually transmitted disease symptoms underscore the potential of men who are active bridgers to spread sexually transmitted disease and HIV in Cambodia beyond high-risk groups.

Adult↗
PubMed1999

Quantitative assessment of subclinical spasticity in human T-cell lymphotropic virus type I infection.

OBJECTIVE: To compare human T-cell lymphotrophic virus type I (HTLV-I) seropositive and seronegative women for symptoms and signs of spasticity. BACKGROUND: Infection with HTLV-I causes tropical spastic paraparesis/ HTLV-I-associated myelopathy (TSP/HAM). Certain populations, including female commercial sex workers (FSW), are at increased risk of developing this infection. Fewer than 5% of HTLV-I-seropositive persons develop TSP/HAM, which is typically associated with spasticity. METHODS: Cross-sectional study of 255 registered FSW in Callao, Perú, involving a questionnaire detailing demographics and neurologic symptoms, standard neurologic examination, quantitative assessment of spasticity (QSA) of muscle tone, and serologic testing for HTLV-I. Participants and examiners were blinded to serology results. RESULTS: On the questionnaire and neurologic examination, none of the 32 HTLV-I-seropositive or 223 seronegative women had signs or symptoms of spasticity. However, mean values on QSA were significantly higher among seropositive women (27.1 Newton-meters/radian [N-m/r]) than among seronegative women (21.6 N-m/r, p = 0.01), indicating a subclinical increase in lower extremity tone. With values of QSA divided into tertiles, and the first tertile serving as the comparison group, the odds ratio for seropositivity was 1.4 (95% confidence interval [CI] 1.0 to 2.0) in the second and 3.1 (95% CI 2.2 to 4.3) in the third tertile, after adjusting for age and place of birth. CONCLUSIONS: Although a standard neurologic evaluation could not distinguish between women with and without HTLV-I infection, QSA indicated significantly increased lower extremity tone in those with infection. Long-term follow-up will determine whether these subclinical findings in asymptomatic women progress to overt TSP/HAM.

Adult↗
PubMed1999

Field measurement of dermal soil loadings in occupational and recreational activities.

Risks associated with dermal exposure to contaminated soil are not well-characterized, but nevertheless must be estimated to define endpoints for remedial strategies. Among the parameters contributing to the uncertainty of these estimates is soil adherence to skin. Pre- and postactivity soil loadings have been obtained from hands, forearms, lower legs, faces, and/or feet of volunteers engaged in various occupational and recreational activities. These data are distinguished from other sources of estimates of soil adherence by the manner of their collection. Soil loads were obtained directly from multiple body parts before and after uncontrived exposure scenarios. Data presented for the first time here supplement prior results and roughly double the available data base. This expanded data base provides a useful perspective on types of behavior likely to lead to soil contact falling within general classes of activity (e.g., background, low, moderate, or high contact). Prior conclusions supported by the additional data include the following: (1) post-activity loadings are typically higher than preactivity levels, demonstrating that exposure is episodic; (2) hand loadings are dependent upon class of activity; (3) hand loadings generally provide conservative estimates of loadings on nonhand body parts within activity classes; and (4) hand loadings do not provide conservative estimates of nonhand loadings across activity classes. Finally quantitative estimates of relative loads on unclothed nonhand body parts are presented.

Activities of Daily Living↗
PubMed1999

Effects of human immunodeficiency virus 1 infection on microbial origins of pelvic inflammatory disease and on efficacy of ambulatory oral therapy.

OBJECTIVE: This study was undertaken to determine the effects of human immunodeficiency virus 1 infection on the clinical presentation, severity, causal organisms, and response to ambulatory therapy of pelvic inflammatory disease. STUDY DESIGN: Women 18 to 40 years old with lower abdominal pain for <1 month were recruited. Participants underwent a standardized questionnaire, physical examination, screening for human immunodeficiency virus 1 and other sexually transmitted infections, and endometrial biopsy to detect plasma cell endometritis. Reevaluations were performed at 1 and 4 weeks to assess response to therapy. RESULTS: Among 162 women with adequate endometrial biopsy specimens 63 (39%) had histologically confirmed endometritis. Endometritis was more frequent among women who were seropositive for human immunodeficiency virus 1 than among women who were seronegative (odds ratio, 3.0; 95% confidence interval, 1.5-5.9). Infections with either Neisseria gonorrhoeae or Chlamydia trachomatis, or both, were least common and bacterial vaginosis was most common among human immunodeficiency virus 1-infected women with CD4 T-lymphocyte counts <400 cells/microL (P <. 04, P <.03, respectively). After oral antibiotic therapy, similar proportions of both women who were seropositive and women who were seronegative for human immuno-deficiency virus 1 had a >/=75% reduction in clinical severity score (81% vs 86%). CONCLUSION: Outpatient treatment of pelvic inflammatory disease was successful regardless of human immunodeficiency virus 1 serostatus.

Administration, Oral↗
PubMed1999

Correlates of gonococcal infection and of antimicrobial-resistant Neisseria gonorrhoeae among female sex workers, Republic of the Philippines, 1996-1997.

From 1994 to 1997, the proportion of Neisseria gonorrhoeae highly resistant to ciprofloxacin (MIC >/=4 microg/mL) increased substantially among female sex workers (FSWs) in the Philippines. Among 1499 Filipina FSWs, we evaluated factors associated with gonococcal infection and with gonococcal antimicrobial resistance. By multivariate analysis, gonococcal infection was associated with sex with a new client, self-prescribed prophylactic antimicrobial use, work in a brothel, and inconsistent condom use and was negatively associated with registration status and vaginal hygiene practices. Factors associated with ciprofloxacin-resistant gonococci included: marital status, living alone, duration of sex work, and clinic site. Further, gonococci highly resistant to ciprofloxacin were isolated from 10 (11.5%) of 87 FSWs reporting self-prescribed antimicrobial use versus 44 (3.4%) of 1295 reporting no antimicrobial use (P<.001). Self-prescribed prophylactic antimicrobial use and inconsistent condom use could be important factors in the continued emergence of gonococcal antimicrobial resistance in the Philippines.

Adult↗
PubMed1999

Partner notification for chlamydial infections among private sector clinicians in Seattle-King County: a clinician and patient survey.

BACKGROUND & OBJECTIVES: To describe partner notification practices for chlamydial infections among private sector clinicians. STUDY DESIGN: Telephone interviews of clinicians and patients identified through public health case reports in Seattle-King County, August-October 1998. RESULTS: Clinicians reported advising 135 of 150 (90%) patients to notify their sex partners, but knew that all partners of only 26 (17%) patients received treatment. While 71 (57%) clinicians acknowledged ever providing medicine-to a patient to give to a partner, only 6 (4%) so treated a patient about whom they were interviewed. Most (87%) clinicians believed the health department should routinely contact all patients about partner notification. Almost all patients (72/76-95%) reported that their provider had advised them to notify their partners and 59 (78%) stated they did so. Most patients (11/17-65%) who did not notify all of their partners would have been willing to allow their clinician or the heath department to do it for them. CONCLUSION: Private sector clinicians and their patients are generally unaware of chlamydial partner notification outcomes but are receptive to expanded partner notification services.

Adult↗
PubMed1999

Erythromycin-resistant Neisseria gonorrhoeae and oral commensal Neisseria spp. carry known rRNA methylase genes.

Two Neisseria gonorrhoeae isolates from Seattle and two isolates from Uruguay were resistant to erythromycin (MIC, 4 to 16 microg/ml) and had reduced susceptibility to azithromycin (MIC, 1 to 4 microg/ml) due to the presence of the self-mobile rRNA methylase gene(s) ermF or ermB and ermF. The two Seattle isolates and one isolate from Uruguay were multiresistant, carrying either the 25.2-MDa tetM-containing plasmid (Seattle) or a beta-lactamase plasmid (Uruguay). Sixteen commensal Neisseria isolates (10 Neisseria perflava-N. sicca, 2 N. flava, and 4 N. mucosa) for which erythromycin MICs were 4 to 16 microg/ml were shown to carry one or more known rRNA methylase genes, including ermB, ermC, and/or ermF. Many of these isolates also were multiresistant and carried the tetM gene. This is the first time that a complete transposon or a complete conjugative transposon carrying an antibiotic resistance gene has been described for the genus Neisseria.

Amino Acid Sequence↗
PubMed1999

Sexual mixing patterns in the spread of gonococcal and chlamydial infections.

OBJECTIVES: This study sought to define, among sexually transmitted disease (STD) clinic attendees, (1) patterns of sex partner selection, (2) relative risks for gonococcal or chlamydial infection associated with each mixing pattern, and (3) selected links and potential and actual bridge populations. METHODS: Mixing matrices were computed based on characteristics of the study participants and their partners. Risk of infection was determined in study participants with various types of partners, and odds ratios were used to estimate relative risk of infection for discordant vs concordant partnerships. RESULTS: Partnerships discordant in terms of race/ethnicity, age, education, and number of partners were associated with significant risk for gonorrhea and chlamydial infection. In low-prevalence subpopulations, within-subpopulation mixing was associated with chlamydial infection, and direct links with high-prevalence subpopulations were associated with gonorrhea. CONCLUSIONS: Mixing patterns influence the risk of specific infections, and they should be included in risk assessments for individuals and in the design of screening, health education, and partner notification strategies for populations.

Adolescent↗
PubMed1999

Elimination and reintroduction of primary and secondary syphilis.

OBJECTIVES: This study was conducted to define factors associated with the epidemic spread, elimination, and reintroduction of primary and secondary syphilis in King County, Washington, from 1987 through 1998. METHODS: Reports of primary and secondary syphilis in King County from 1987 through 1998 were reviewed retrospectively. RESULTS: During the epidemic spread of syphilis, only 15.8% of cases were imported. A total of 24.0% of patients reported cocaine use, and 18.3% of female patients reported having commercial sex. During the elimination of syphilis, significantly higher percentages of cases were imported and lower percentages of patients reported cocaine use or female commercial sex. During the reintroduction of syphilis in 1997-1998, 68% of patients were men who reported sex with men; of this 68%, 66% were sero-positive for HIV. Most men reporting sex with men were 30 years or older and recruited many anonymous partners. CONCLUSIONS: As syphilis wanes, local control must focus on outbreaks following its reintroduction. Resurgence of syphilis among men reporting sex with men recapitulates the epidemiology of syphilis before the historical advent of AIDS, warranting immediate attention to this problem.

Adult↗
PubMed1998

Migration, ethnicity and environment: HIV risk factors for women on the sugar cane plantations of the Dominican Republic.

OBJECTIVE: To determine risk factors for HIV infection among women living in the sugar cane plantation communities (bateyes) of a large private sugar cane company in the Dominican Republic. DESIGN: Cross-sectional study of sexually active female volunteers living in the bateyes. METHODS: Of 98 bateyes, 23 were randomly selected and visited by a mobile medical unit, to interview, examine and test volunteers for seroreactivity to HIV and syphilis. RESULTS: The 490 subjects ranged in age from 16 to 72 years (median, 37 years); 53% were born in Haiti, 36% in Dominican Republic bateyes, and 12% elsewhere in the Dominican Republic; 58% had no formal education; and 87% had no income. HIV seropositivity was found in 28 women (5.7%), including 8.8% of those aged < 35 years. By logistic regression analysis, HIV infection was independently associated with age < 35 years [odds ratio (OR), 4.5; P < 0.01), being single with children (OR, 4.3; P < 0.01), more than one lifetime sex partners (OR, 3.4; P = 0.06), engaging in sex during menses (OR, 3.2; P = 0.02), and self-description as a prostitute (OR, 4.4; P = 0.05)1. For Haitian women, those coming to the Dominican Republic alone were more likely to have HIV infection than those coming with a male partner. Less than 4% of women reported condom use at last intercourse. CONCLUSIONS: Women in the bateyes have a much higher rate of HIV infection than that estimated for women in the general population of Dominican Republic and a rate comparable to that of female sex workers in the Dominican Republic. AIDS prevention in the bateyes should address condom education and distribution as well as employment opportunities and education for women.

Adolescent↗