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Biomedical subjects

S O Aral

Publications and source records attributed to S O Aral.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1998

Interrelationships among douching practices, risky sexual practices, and history of self-reported sexually transmitted diseases in an urban population.

GOALS: To describe the interrelationships of douching, sex during menses, dry sex, and anal intercourse and their associations with self-reported history of sexually transmitted diseases (STD). STUDY DESIGN: The authors interviewed by telephone 422 white Americans (WA) and 44 African Americans (AA) selected using random-digit dialing, and 135 AA selected from a listed sample of census tracks having a population of at least 40% AA. RESULTS: After adjusting for lifetime numbers of vaginal sex partners, sex during menses was associated with self-reported history of chlamydial infection among women (WA: odds ratio [OR] = 3.9; confidence interval [CI]: 1.1, 14.0; AA: OR = 1.6; CI: 0.6, 4.2). Anal sex was associated with self-reported history of genital warts, genital herpes, hepatitis, and gonorrhea; douching with a twofold increase in self-reported pelvic inflammatory disease. Anal sex was most common in women with a history of same- and opposite-sex partners. CONCLUSIONS: These data confirm the association of douching and anal sex with various STD and suggest that sex during menses is associated with chlamydial infection.

Adult↗
PubMed1998

Do differences in sexual behaviors account for the racial/ethnic differences in adolescents' self-reported history of a sexually transmitted disease?

BACKGROUND AND OBJECTIVES: African-American adolescents have the highest rates of sexually transmitted diseases (STDs) of any racial/ethnic group of adolescents. The objective of this study was to determine the degree to which racial/ethnic differences in sexual behaviors account for African-American adolescents' higher rates of STDs. STUDY DESIGN: A secondary analysis of data collected as part of the Youth Risk Behavior Survey supplement to the 1992 National Health Interview Survey was conducted. The sample included 5,189 nationally representative civilian noninstitutionalized sexually experienced United States adolescents 14 to 21 years of age. RESULTS: The age- and sex-adjusted odds ratio (OR) for a reported history of an STD for African-American adolescents was 3.86 (95% confidence interval [CI] = 1.57, 9.50). The STD risk for African-American youth increased with the adjustment for other sociodemographic factors (OR = 4.13; CI = 1.71, 9.99) and decreased with the adjustment for sexual behaviors (OR = 3.67; CI = 1.55,8.66). CONCLUSIONS: Differences in sexual behaviors do not fully account for African-American adolescents' increased risk for STDs. Interventions designed to reduce sexual risk taking among African-American adolescents may not ameliorate racial/ethnic differences in rates of STDs.

Adolescent↗
PubMed1998

Heterosexual repertoire is associated with same-sex experience.

OBJECTIVE: The association of sexual repertoire with sexual preference, partnership and sociodemographic characteristics, and sexual history among white American (WA) and African-Americans (AA) is described. DESIGN: Cross-sectional computer-assisted telephone survey. METHODS: Seattle residents 18 to 39 years of age selected via random digit dialing; an additional sample of AA sampled from listed telephone numbers from census tracks with over 40% Aa. RESULTS: The study included 356 WA and 140 AA ever engaging in vaginal intercourse who answered questions regarding their usual sexual repertoire with their most recent opposite-sex partner. The 5% of WA engaging in vaginal, oral, and anal intercourse with their most recent opposite-sex partner were 2.7 times (95% CI: 0.9, 7.9) as likely to report nonmonogamy and 8.4 times (95% CI: 2.6, 27.2) as likely to report a history of same-sex partners. Persons reporting a history of both same- and opposite-sex partnerships were more likely than those with only opposite-sex partners to report engaging in anal and oral sex with their most recent opposite-sex partner regardless of gender (anal: women 24% vs. 4%, p < 0.001; men: 33% vs. 6%, p < 0.001; oral: women 95% vs. 74%, p = 0.03; men 89% vs. 78%, p = 0.4). Persons with a history of a same-sex partner were also more likely than those with only opposite-sex partners to have a nonmonogamous current relationship (WA: odds ratio [OR] = 2.3; 95% CI: 0.9, 5.7; AA: OR = 6.8; 95% CI: 0.6, 338) to engage in sex during menses (WA: OR = 1.9; 0.7, 5.4; AA: 9.6; 1.0, 4.6) and to have more sex partners in their life (WA: p = 0.002; AA: p = 0.07). CONCLUSIONS: Diverse sexual repertoires are associated with other risk behaviors putting the individual at high risk of acquiring or transmitting a sexually transmitted diseases (STD).

Adolescent↗
PubMed1998

Social and behavioral correlates of pelvic inflammatory disease.

OBJECTIVES: To review the social and behavioral correlates of pelvic inflammatory disease (PID) in the light of the renewed interest in the transmission dynamics of communicable diseases, the new emphasis on health care seeking and health service provision, and increased attention to contextual and population level factors affecting morbidity. METHODS: Social and behavioral correlates of PID are reviewed using a conceptual scheme that matrixes the differences among risk factors for exposure, acquisition, and development of sequelae with the differences between individual-level risk factors and population-level determinants. RESULTS: Two major factors contribute to the development of PID: recurrent (or persistent) chlamydial infection of the cervix, which are geographically concentrated and associated with contextual variables, and critical delays in detection and treatment of cervical infection, which are amenable to interventions. CONCLUSIONS: Widespread screening for cervical infection followed by timely and appropriate treatment is key for prevention of PID. Health care seeking, provider training, and availability of detection technologies and drugs need to be improved.

Chlamydia Infections↗
PubMed1997

Herpes simplex virus type 2 in the United States, 1976 to 1994.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) infection is usually transmitted sexually and can cause recurrent, painful genital ulcers. In neonates the infection is potentially lethal. We investigated the seroprevalence and correlates of HSV-2 infection in the United States and identified changes in HSV-2 seroprevalence since the late 1970s. METHODS: Serum samples and questionnaire data were collected during the National Health and Nutrition Examination Surveys (NHANES) II (1976 to 1980) and III (1988 to 1994). HSV-2 antibody was assessed with an immunodot assay specific for glycoprotein gG-2 of HSV-2. RESULTS: From 1988 to 1994, the seroprevalence of HSV-2 in persons 12 years of age or older in the United States was 21.9 percent (95 percent confidence interval, 20.2 to 23.6 percent), corresponding to 45 million infected people in the noninstitutionalized civilian population. The seroprevalence was higher among women (25.6 percent) than men (17.8 percent) and higher among blacks (45.9 percent) than whites (17.6 percent). Less than 10 percent of all those who were seropositive reported a history of genital herpes infection. In a multivariate model, the independent predictors of HSV-2 seropositivity were female sex, black race or Mexican-American ethnic background, older age, less education, poverty, cocaine use, and a greater lifetime number of sexual partners. As compared with the period from 1976 to 1980, the age-adjusted seroprevalence of HSV-2 rose 30 percent (95 percent confidence interval, 15.8 to 45.8 percent). The seroprevalence quintupled among white teenagers and doubled among whites in their twenties. Among blacks and older whites, the increases were smaller. CONCLUSIONS: Since the late 1970s, the prevalence of HSV-2 infection has increased by 30 percent, and HSV-2 is now detectable in roughly one of five persons 12 years of age or older nationwide. Improvements in the prevention of HSV-2 infection are needed, particularly since genital ulcers may facilitate the transmission of the human immunodeficiency virus.

Adolescent↗
PubMed1997

The natural history of syphilis. Implications for the transmission dynamics and control of infection.

BACKGROUND: Syphilis remains a significant cause of morbidity in many developing countries and in some areas within North America and Europe. Mathematical models of the transmission dynamics of sexually transmitted infections have provided insights of relevance both to the interpretation of observed epidemiological patterns and to the design of control programs. Their use for the study of syphilis has been limited to date. GOALS AND STUDY DESIGN: The authors investigated the transmission dynamics of syphilis against a template based on the natural history of infection in individual patients with the aim of (1) identifying gaps in our understanding of the biology of infection, and (2) providing insights of relevance to the design of control policies. RESULTS: Analyses reveal that Treponema pallidum has a moderate to high probability of transmission during contact between susceptible and infectious sexual partners. This, combined with questions over the existence of any immunity to reinfection, helps to ensure the long-term persistence of syphilis within "core" activity groups. Patterns of treatment in North America are shown to have significantly altered the relative frequency of individuals in the different stages of disease. CONCLUSIONS: The analyses emphasize the benefits to be gained from treating infected people early in the primary stage of infection to reduce the effective period during which infected people can transmit to others. This form of treatment is beneficial for both the individual and the community. Treatment has greatly altered the incidence of different disease stages, but the full implications of treatment depend on whether immunity is present.

Contact Tracing↗
PubMed1997

The promise of integrated representative surveys about sexually transmitted diseases and behavior.

BACKGROUND: It has been difficult to conduct representative surveys measuring both sexually transmitted disease prevalence and behavioral data. This article reviews the literature, describes a recent pretest of the feasibility of integrated surveys, and discusses the potential implications. METHODS: Several national surveys are reviewed, including the National Health and Nutrition Examination Surveys, National Health and Social Life Survey, and National Survey of Adolescent Males. The 1994 pretest of the National Survey of Adolescent Males collected urine specimens of male respondents, which were tested for Chlamydia trachomatis using ligase and polymerase chain reaction tests. RESULTS: There have not been any prior national surveys that collect clinical measures of STD infection and detailed behavioral data. In the pretest, 85% of the eligible interview respondents provided a urine specimen. Of those tested, 6% were positive for C. trachomatis. CONCLUSIONS: Combining behavioral surveys with collection of urine specimens for STD testing in representative samples is feasible. However, STD testing adds new operational and ethical challenges to the conduct of household surveys.

Adolescent↗
PubMed1996

The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies.

Each sexually transmitted disease (STD) epidemic evolves through predictable phases, shaped by a dynamic interplay among the pathogen, the behaviors of the subpopulations in which it emerges, and the prevention efforts that are developed to limit its impact. As STD epidemics move through these phases, the sexual and social networks that fuel them become located in subpopulations characterized by progressively higher rates of sex partner change and less contact with the health care system. As a result, phase-appropriate prevention strategies and research issues are essential to reducing STDs and their consequences.

Disease Outbreaks↗
PubMed1995

STD/HIV prevention in Turkey: planning a sequence of interventions.

This study was initiated to assess which mix of early STD/HIV prevention interventions would potentially be effective, cost-effective and sustainable in Turkey; and to program an intervention sequence to maximize synergy among the interventions. During rapid assessment we: 1) reviewed past issues of 3 leading newspapers; 2) collected information on TV coverage; 3) interviewed key informants including taxicab drivers, hotel employees, grocery store owners, academicians in public health and law, investigators of STD/HIV and reproductive tract infections, and officials in the ministry of health; 4) reviewed available evidence on STD/HIV morbidity, sexual behavior patterns, migration patterns and same/opposite gender sex trade. We found: 1) discrepancies between decision makers' perceptions and social realities with respect to the epidemiology of sexual behavior and STDs, and the state of public health programs; 2) discrepancies between sexual practices and public expression regarding sexual practices; 3) economic, demographic, and political pressures in Turkey and in surrounding countries for the expansion of prostitution; 4) a sexual double standard and gender specific migration patterns which sustain a high demand for commercial sex; 5) patterns of health care seeking behaviors and provision of STD clinical services which indicate other STDs may play a very important role in spread of HIV infection; 6) an important mass media role in opinion formation; 7) consensual denial of risk for the majority based on beliefs embedded in machismo, nationalism and religion, and a resulting marginalization and externalization of STD/HIV risk; 8) high prevalence of syphilis among both Turkish and immigrant female prostitutes in Istanbul (early latent 8 and 13%; late latent 0 and 4%; previous history 9 and 22%) 9) and high rates of syphilis among male prostitutes (early latent 11%, late latent 21% and previous history 58%). We concluded that interventions should initially include, in the following order; 1) awareness raising for decision makers and opinion leaders including members of parliament and mass media; 2) awareness raising for members of the general population; 3) needs assessment and intervention development for sex workers; 4) training in HIV and other STDs for medical personnel; and 5) quality assurance and control for laboratory procedures for STDs/HIV.

Female↗
PubMed1994

Predictors of high-risk behavior in unmarried American women: adolescent environment as risk factor.

BACKGROUND: Heterosexual intercourse with two or more partners in a short time period represents a high-risk behavior for acquisition and transmission of sexually transmitted pathogens (STDs). Identification of factors that may predict high-risk sexual behavior can help to focus primary prevention strategies on women at risk for future acquisition of infection. METHODS: We analyzed survey data obtained in 1988 from a nationally representative sample of 8,450 American women of reproductive age in order to identify such factors. RESULTS: Of all sexually experienced unmarried women, 6.6% reported having had two or more sexual partners in the preceding three months. Earlier age at first sexual intercourse was associated with multiple recent partners, and with lower reports of abstinence. Birth region in the West, lack of attendance at religious services as an adolescent, and having a mother who had her first child before she was 25 years of age were factors associated with multiple recent partners. Among unmarried white women having a mother who worked full time and not living with both parents during adolescence were associated with multiple recent partners; among unmarried black women, the inverse was true (p for racial difference < .05). Multivariate analysis showed western birth region and earlier age at first sexual intercourse to be significant predictors of having multiple recent sex partners. CONCLUSIONS: Early environment and race influence later sexual behavior. These factors should be considered in targeting and planning education for STD prevention.

Adolescent↗