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PubMedDate not supplied

Reproductive health practices in women attending an inner-city STD clinic.

Inner-city sexually transmitted disease (STD) clinics may provide an important access point to educate patients at high risk for reproductive health problems and their peers in order to effect behavior change. In a pilot study to evaluate the knowledge, health practices, and behavior of patients attending an inner-city STD clinic, 116 women were surveyed concerning their reproductive and general health practices, their knowledge of both, and screened for STDs. The women who had a history of first intercourse before age 18 years had a statistically significant higher rate of infection. Thirty-three percent of the patients did not know the purpose of a Pap smear; of the 67% who stated that they did know, only 30% actually stated that a Pap smear is used to detect cancer. STD clinics offer a unique opportunity for the integration of health care services and education to a group of high-risk patients.

Adolescent↗
PubMedDate not supplied

A population-based serosurveillance of syphilis in Costa Rica.

As part of a case-control study to investigate the high incidence of cervical cancer in Costa Rican women, the seroprevalence of the treponematoses, in particular, syphilis was determined. In each age group, women with a history of two or more sex partners were two to four times more likely to be seroreactive in tests for syphilis than women with zero or one sex partner. The highest percentage of reactive results in the microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) was seen in samples from women aged 50-59 who had had two or more lifetime partners (23.8%). Three observations from our study support reactivity due to syphilis rather than yaws or pinta: (1) a similar percent of reactive rapid plasma reagin (RPR) card test results among MHA-TP reactors in the two age groups of women who were surveyed (42 vs. 49%) was observed; (2) women who were seroreactive in the MHA-TP had multiple risk factors for STD [low socioeconomic status (9.4%), urban residence (22.8%), first intercourse under 16 years of age (14.1%), and multiple sex partners (26.3%)], and (3) only sexually experienced women had reactive results in the MHA-TP test.

Adult↗
PubMedDate not supplied

Determinants of genital human papillomavirus infection in low-risk women in Portland, Oregon.

OBJECTIVES: To confirm the risk factors for genital human papillomavirus (HPV) infection. GOAL OF THIS STUDY: To investigate risk factors for HPV detection independent of the correlated risk factors for cervical neoplasia in a low-risk population. STUDY DESIGN: HPV DNA was assessed among 483 cytologically normal women with no known history of cervical neoplasia. A cervicovaginal lavage was collected for HPV detection and typing using a PCR-based DNA amplification system. Information on risk factors of subjects was obtained through a questionnaire. RESULTS: HPV DNA was found in 17.7% of study women. On univariate analysis, factors associated with increasing HPV prevalence included younger age, fewer years of education, lower income, higher lifetime number of sex partners, lower age at first intercourse, nulliparity, oral contraceptive use, and current smoking. After statistical adjustment, we found younger age and higher number of sex partners were strongly and independently associated with higher HPV prevalence. We also observed increased HPV prevalence among women with lower levels of education and lower incomes. CONCLUSION: These findings and corroborative data from the companion reports in this issue of the journal support the sexual route of transmission of the virus.

Adolescent↗
PubMedDate not supplied

Determinants of genital human papillomavirus infection among cytologically normal women attending the University of New Mexico student health center.

OBJECTIVES: To confirm the risk factors for genital human papillomavirus (HPV) infection. GOAL OF THIS STUDY: To investigate risk factors for HPV detection apart from the correlated risk factors for cervical neoplasia. STUDY DESIGN: Cervical human papillomavirus (HPV) DNA was assessed in 357 cytologically normal women attending the University of New Mexico student health center. Cervical swab samples were obtained for HPV DNA detection and typing using a PCR-based DNA amplification system. Possible determinants of cervical HPV were examined including age, ethnicity, history of sexually transmitted disease, oral contraceptive use, smoking, age at first intercourse, lifetime number of sex partners, marital status, and history of pregnancy. RESULTS: A 44.3% overall prevalence of cervical HPV was observed. On univariate analysis, factors associated with increasing HPV prevalence included higher lifetime number of sex partners and single marital status. After adjustment for potential confounding variables, we found that HPV prevalence increased with higher lifetime number of sexual partners. CONCLUSION: These findings, along with those from the companion reports in this issue of the journal, support the sexual route of transmission of the virus.

Adolescent↗
PubMedDate not supplied

Screening for Chlamydia trachomatis infection in pregnant women in Martinique.

GOAL OF THIS STUDY: To determine the prevalence of Chlamydia trachomatis urogenital infection and to identify behavioral, demographic, and clinical factors associated with the infection in pregnant women in Martinique. STUDY DESIGN: One-thousand-four-hundred-eleven patients 15-39 years old, at 10-16 weeks of gestation and attending the prenatal clinic at Lamentin Hospital, were tested for Chlamydia trachomatis infection of the cervix and urethra using tissue culture. RESULTS: Chlamydia trachomatis was isolated from 375 (26.7%) women; 34% of them were positive in the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Factors found by multivariate analysis to be significantly associated with chlamydial infection were age less than 25 years, first intercourse at less than 18 years old, previous induced abortions, mucopurulent cervicitis, and repeated candidiasis. CONCLUSIONS: None of the factors associated with chlamydial infection was sensitive enough to permit efficient selective screening. It is cost effective to recommend a routine screening for chlamydial infection together with an educational program.

Abortion, Induced↗
PubMed1999

Reliability of self-reported sexual histories: test-retest and interpartner comparison in a sexually transmitted diseases clinic.

BACKGROUND AND OBJECTIVES: The objective was to assess reliability of self-reported sexual histories among sexually transmitted disease clinic attendees who enrolled in a study in 1994. GOAL OF THIS STUDY: Knowledge about the reliability of sexual data is important to decide whether these measures of sexual behavior can be used in epidemiologic studies of sexually transmitted diseases. STUDY DESIGN: In 288 attendees, degree of agreement was assessed in responses to an identical set of sexual questions asked independently by a medical doctor and a public health nurse and in responses made by members of the same couple (n = 50) to a public health nurse. RESULTS: In the test-retest comparison, high agreement was found for most questions: kappa-values and exact agreement ranged from 0.73 to 0.96 and 54% to 99%, respectively. Participants interviewed by the medical doctor reported significantly lower numbers of partners and a higher age at first intercourse. Stratified analyses showed variability in agreement across subgroups. Most consistent, women provided more reliable reports than men. In the comparison of couples, substantial agreement was found for the municipality where they met (88% agreement; kappa = 0.72) and contraceptive method (87% agreement; kappa = 0.60), but only moderate agreement was found for frequency of sexual intercourse (26% agreement; kappa = 0.50). CONCLUSION: The authors conclude that data on sexual behavior can be collected reliably among sexually transmitted disease clinic attendees, although reporting bias does occur. The frequency of sexual intercourse was not sufficiently reliable and should be interpreted as an estimate only.

Adult↗
PubMed1999

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and human immunodeficiency virus (HIV) infection among injection and noninjection drug users in Quebec City and to identify associated risk factors. STUDY DESIGN: Cross-sectional study of 738 drug users attending a sexually transmitted disease/HIV prevention and needle-exchange program in Quebec City, Canada. RESULTS: The prevalences of N. gonorrhoeae and C. trachomatis were, respectively, 0.4% (95% CI: 0.08%-1.2%) and 3.4% (95% Cl: 2.2%-5.0%). Through multivariate analysis, risk factors associated with sexually transmitted diseases were: among women, being aged between 20 and 24 years and having unprotected sex with commercial partners; in noninjection drug users; cocaine use and first intercourse before 13 years of age; in male noninjection drug users, having regular sexual partners in the previous 6 months. No case of HIV was found in participants who have never injected drugs, but the prevalence was 5.5% (6/110) among the exinjectors and 10.1% (35/347) in current injectors. CONCLUSION: Moderate sexually transmitted disease and HIV prevalences were found, although a high proportion of drug users reported risky behaviors. Needle-exchange program sites may offer a good opportunity to provide sexually transmitted disease/HIV prevention and medical services to drug users.

Adult↗
PubMed2001

Prevalence and risk factors for herpes simplex virus type 2 infection among middle-age women in Brazil and the Philippines.

BACKGROUND: Data comparing type-specific herpes simplex virus type 2 (HSV-2) seroprevalence and risk factors between comparable populations are largely unavailable, particularly from less-developed countries. GOAL: To examine the seroprevalence of HSV-2 infection and the risk factors for this infection among women in São Paulo, Brazil, and Manila, the Philippines. STUDY DESIGN: Altogether, 552 middle-aged women participating as control subjects in two cervical cancer studies were screened for type-specific HSV-2 antibodies. RESULTS: Herpes simplex virus type 2 seroprevalence was higher in Brazil (42%) than in the Philippines (9.2%). The mean ages of Brazilian (n = 181) and Filipino (n = 371) women were 52.4 and 46.6 years, respectively. Brazilian participants had more lifetime sexual partners, less education, and more often a husband with other sexual partners than Filipino women. Herpes simplex virus type 2 was independently associated with younger age at first intercourse in both countries. More than one lifetime sexual partner, a husband with other sexual partners, urban/semi-urban residence, and no history of condom use were HSV-2 risk factors in Brazil, but not in the Philippines, where long-term hormonal contraceptive use was associated with increased risk. CONCLUSIONS: The higher HSV-2 seroprevalence in Brazil than in the Philippines may be explained largely by differences in the sexual behavior of women and their husbands. Herpes simplex virus type 2 seroprevalence data may be used as a marker of past sexual behavior for the direct comparison of different population groups.

Antibodies, Viral↗
PubMed2002

Factors associated with risk behaviors for sexually transmitted disease/AIDS among urban Brazilian women: a population-based study.

BACKGROUND: The proportion of women among persons with sexually transmitted disease (STD)/AIDS in Brazil is increasing rapidly, and studies are needed to understand risk behaviors. GOAL: The goal of this study was to identify factors associated with risk behaviors for acquiring STD/AIDS among women aged 15 to 49 years in Pelotas, Brazil. STUDY DESIGN: A representative sample of women was surveyed by means of interviewer-administered and self-administered confidential questionnaires. Of the women we sought to include, 3.5% refused and 1543 participated. RESULTS: Risk behaviors included nonuse of condoms (72%); first intercourse before the age of 18 years (47%); use of drugs or alcohol by the partner (14%) or by the woman (7%); multiple partners (7%); and anal sex (3%). The risk score was significantly associated with being younger than age 30 years, having <5 years of schooling, being divorced or separated, and being a smoker. CONCLUSION: Preventive strategies should prioritize efforts toward young women, those with little schooling, smokers, and those who are divorced or separated.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Predictors and risk-taking consequences of drug use among HIV-infected women.

OBJECTIVE: To determine rates of drug use among women with HIV, and to examine associations between drug use, health, risk behavior, and sexually transmitted diseases (STD). DESIGN: A longitudinal cohort study of 260 women with confirmed HIV-positive serostatus. METHODS: Each participant contributed a self-report interview, a clinical examination, laboratory testing of cultures for Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and urinalysis for the presence of metabolites of cocaine and opiates. Data were examined on 140 women at 1-year follow-up. Women were defined as drug users if they reported crack, cocaine, or heroin use in the 6 months before the interview or if they had a positive toxicologic test result for cocaine or opiates. RESULTS: 34% of those in the sample were classified as positive for drug use. Drug use was associated with the number of sexual partners, age at first intercourse, prevalence of STDs, and lower quality of life. STDs were present at baseline in 33.7% and 15.5% of drug users and nonusers, respectively. Drug use among this population was also associated at both baseline and follow-up with the likelihood of having a Karnofsky score below 80, and with overall perceived general health. CONCLUSIONS: Drug users in this cohort were more likely to engage in behaviors that place them at risk for STDs, to have elevated STD prevalence, and to have lower perceived health across several indices. Identification of drug use and treatment for it need to be a central component of HIV care for women.

Adult↗
PubMed2002

Loop electrosurgical excision procedure in vulvar intraepithelial neoplasia treatment.

OBJECTIVE.: Our objective was to compare by response rate the therapeutic options of loop electrosurgical excision procedure (LEEP), laser therapy, and wide local excision in managing high-grade vulvar intraepithelial neoplasia in a pilot study for a randomized clinical trial. MATERIALS AND METHODS.: Between 1995 and 1999, 109 patients presenting with vulvar lesions were registered at a comprehensive cancer center and 2 associated colposcopy clinics. From these 109, we identified 74 patients with lesions histologically proven to be vulvar intraepithelial neoplasia who underwent treatment with CO2 laser, wide local excision, or LEEP. Clinical and pathological features were reviewed retrospectively. Wilcoxon rank sum test and life table analyses were used to compare groups. Response rates for this retrospective study will be used to calculate the sample size for a prospective clinical trial. RESULTS.: Our population was similar to others reported in the literature in age, range of diagnoses, and follow-up. Only 1 of 74 patients (1%) had invasive cancer. In a subset of 62 patients treated for the first time, LEEP and wide local excision were equal in their ability to achieve complete response. Laser ablation was the least successful of all methods (10/20 with laser, 3/20 with LEEP, and 2/22 with wide local excision experienced recurrences [p = .04]). No statistically significant differences among the 3 were noted in time to recurrence (p = .24). Age, age at first intercourse, and number of sexual partners were not correlated with recurrence and did not confound the results. Using a chi approximation, an alpha error of 0.05, and a power of 0.80, researchers should enroll 25 patients per arm if improvement over standard therapy is expected to be 40%, 45 if expected to be 30%, and 95 if expected to be 20%. CONCLUSIONS.: Because of differences in recurrence rate and length of hospital stay and indications of potential differences in cost found in this pilot, LEEP merits comparison in a prospective randomized clinical trial with wide local excision and laser therapy in which recurrence rate, patient treatment preference, and cost-effectiveness are evaluated. Patients entered in such a trial should be stratified according to their risk of invasion. If the risk of invasion is high, then the laser should be used to excise a sample rather than ablate.

Journal Article↗
PubMed2005

Outcomes of a randomized, controlled community-level HIV prevention intervention for adolescents in low-income housing developments.

OBJECTIVES: Youth are increasingly at risk for contracting HIV infection, and community-level interventions are needed to reduce behavioral risk. DESIGN: A randomized, controlled, multi-site community-level intervention trial was undertaken with adolescents living in 15 low-income housing developments in five US cities. METHODS: Baseline (n = 1172), short-term follow-up (n = 865), and long-term follow-up (n = 763) risk assessments were conducted among adolescents, ages 12-17, in all 15 housing developments. The developments were randomly assigned in equal numbers to each of three conditions: experimental community-level intervention (five developments); "state-of-the-science" skills training workshops (five developments); and, education-only delayed control intervention (five developments). RESULTS: At long-term follow-up, adolescents living in the housing developments receiving the community-level intervention were more likely to delay onset of first intercourse (85%) than those in the control developments (76%), while those in the workshop developments (78%) did not differ from control condition adolescents. Adolescents in both the community-level intervention (77%) and workshop (76%) developments were more likely to use a condom at last intercourse than those in control (62%) developments. CONCLUSIONS: Community-level interventions that include skills training and engage adolescents in neighborhood-based HIV prevention activities can produce and maintain reductions in sexual risk behavior, including delaying sexual debut and increasing condom use.

Adolescent↗
PubMed2006

Fear of inability to conceive in pregnant adolescents.

OBJECTIVE: To estimate the demographic and health history differences between pregnant adolescents who had fears that they would not be able to conceive and those without these fears. METHODS: Three hundred pregnant adolescents presenting for their first prenatal visit participated in a cohort study that addressed attitudes about pregnancy. All participants were aged younger than 20 years and gave informed consent. The outcome of interest was a positive response to the question "Did you have any fears that you wouldn't be able to get pregnant?" Independent measures included health history and demographic variables. RESULTS: Among participants, 42% stated they had fears about not being able to conceive. The total sample included 20% 12-15 year olds, 39% 16-17 year olds and 41% 18-19 year-olds. There was no statistically significant difference in fear of not being able to conceive by maternal age, reported sexually transmitted disease rates, or age at first intercourse. More adolescents who expressed fear of infertility had a previous spontaneous abortion, previous pelvic examination, and were sexually active for a longer period of time compared with those without this fear. CONCLUSION: A large proportion of pregnant adolescents in this study expressed fear that they would not be able to conceive. Understanding the basis of the fear is critical to appreciating its association with current and future adolescent pregnancy and contraceptive use. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2007

Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data.

OBJECTIVE: To estimate the prevalence and correlates of bacterial vaginosis among women between the ages of 14 and 49 years in the United States. METHODS: Data from the 2001-2001 and 2003-2004 National Health and Nutrition Examination Surveys were combined. Correlates of bacterial vaginosis evaluated included sociodemographic characteristics (age, race or ethnicity, education, poverty income ratio) and sexual history (age of first intercourse, number of sexual partners). Crude and adjusted odds ratios and 95% confidence intervals were estimated from logistic regression analyses. RESULTS: Almost one third of women (29%) were positive for bacterial vaginosis. Bacterial vaginosis prevalence varied with age, race or ethnicity, education, and poverty. Black, non-Hispanic (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.58-3.80) and Mexican-American (OR 1.29, 95% CI 0.99-1.69) women had higher odds of bacterial vaginosis than white, non-Hispanic women after adjustment for other sociodemographic characteristics. Douching in the past 6 months was also an important predictor of bacterial vaginosis prevalence (OR 1.93, 95% CI 1.54-2.40). CONCLUSION: Bacterial vaginosis is a common condition among U.S. women, and the prevalence is similar to that in many treatment-seeking populations. Further studies are needed to disentangle the interactions between race or ethnicity and other sociodemographic characteristics. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2006

The development of cervical cancer and its precursors: what is the role of human papillomavirus infection?

Human papillomavirus (HPV) is a significant health care burden in the United States. The majority of sexually active men and women will be infected with HPV at some point in their lives and are subject to developing human papillomavirus-associated disease. Current estimates suggest that 20 million Americans are currently infected, and more than 5 million new infections occur each year. The prevalence of human papillomavirus is highest in populations in their late teens and early twenties, with nearly half of all new human papillomavirus infections occurring within 3 years of first intercourse. HPV is the necessary cause of genital warts, cervical intraepithelial neoplasia, and invasive cervical cancer. As such, human papillomavirus is responsible for significant medical morbidity and health care costs. Screening with cervical cytology has significantly reduced mortality rates; however, approximately 3900 women will die in 2005 from cervical cancer in the United States. Human papillomavirus DNA testing has shown promise in identifying high-grade abnormalities as an adjunct to traditional cytology, and should be used according to guidelines established by the American Cancer Society and the American College of Obstetricians and Gynecologists. The epidemiology of HPV infection and a brief introduction to the natural history of HPV infection will be presented here.

Adolescent↗
PubMed2004

High prevalence of sexually transmitted diseases in young women seeking HIV testing in Rio de Janeiro, Brazil.

BACKGROUND AND OBJECTIVES: Few data are available on the prevalence of and risk factors for sexually transmitted diseases (STDs) other than HIV in Brazil. GOAL: The goal of this study was to determine the prevalence of HIV infection and other STDs in Brazilian women who seek HIV testing, investigate risk factors for these infections, and assess feasibility of screening in HIV test clinic settings. STUDY DESIGN: We conducted a cross-sectional study of 200 women, aged 14 to 29 years, who attended an HIV testing site in central Rio de Janeiro. Participants completed a questionnaire and received testing for HIV, syphilis, chlamydia, and gonorrhea. RESULTS: HIV and other STDs were common (HIV 8%, syphilis 6.5%, chlamydial infection 8%, and gonorrhea 9.5%). HIV was significantly associated with lower education and with having an HIV-infected partner. Other STDs were significantly associated with younger age at first intercourse, heavy alcohol consumption, and marijuana use. CONCLUSION: STDs appear to be substantial health problems among young Brazilian women seeking HIV testing. HIV testing sites in Brazil should consider offering screening and treatment for STDs and substance abuse as part of their HIV prevention services.

Adolescent↗
PubMed2004

Adolescents' views on decision-making regarding risky sexual behaviour.

PURPOSE: To explore adolescents' views regarding risky sexual behaviour who were aged between 13 and 19 years. METHODS: A purposive sample was drawn from adolescents who were participating in workshops, organized by the Ministry of Health and Social Welfare. The sample consisted of a mix of in-school and out-of-school adolescents aged between 13 and 19 years. The overall aim of the workshops was to explore adolescents' views on decision-making regarding risky sexual behaviour. The educational status of participants lay between grades 0 and 12. A total of 24 focus group discussions were conducted, six in each of the four regions of Swaziland (Manzini, Hhohho, Lubombo and Shiselweni). Each group consisted of 6-12 participants. All focus group discussions were audiotaped and later transcribed. FINDINGS: The following four major themes emerged from content analysis: sexual behaviour, age at first intercourse, peer pressure and trust in the relationship. These were all found to be important factors in decision-making for risky sexual behaviours. CONCLUSIONS: Obtaining a sexual history, motivation to use condoms, guidance and counselling on ways to reduce adolescents' risk of sexual exploitation, and peer education programmes, are all of importance when aiming to reduce risky sexual behaviour. RECOMMENDATION: Adolescents should receive positive reinforcement for responsible sexual behaviour including abstinence and, where appropriate, use of active birth control.

Adolescent↗
PubMed1993

Is HIV infection associated with an increase in the prevalence of cervical neoplasia?

OBJECTIVE: To test the hypotheses: (1) that HIV infection predisposes to cervical intraepithelial neoplasia (CIN); (2) that this CIN is a result of HIV related immunosuppression; and (3) that this CIN is a result of immunosuppression causing increased expression of the potentially oncogenic viruses, human papilloma virus (HPV), Epstein Barr virus (EBV) and herpes simplex virus (HSV). DESIGN: A matched cross sectional study. SETTING: The Department of Gynaecological Oncology, The Samaritan Hospital, London; the Department of Genitourinary Medicine, St Mary's Hospital, London; and the Family Planning Clinic, Claremont Terrace, Glasgow. SUBJECTS: Fifty HIV seropositive women enrolled from the Genitourinary Medicine Department and the Drug Dependency Unit at St Mary's Hospital, London, and the Unit of Infectious Diseases at Ruchill Hospital, Glasgow. Forty-three HIV seronegative controls enrolled from the Department of Genitourinary Medicine at St Mary's Hospital, matched against 43 of the seropositive women for age, age at first intercourse, lifetime number of sexual partners, and smoking habit. MAIN OUTCOME MEASURES: Associations between CIN, as detected by cytology and histology, and HIV infection. Association was also sought between CIN and immunosuppression, as measured clinically by T4 cell number, beta-2-microglobulin and p24 antigen. Associations of these with: (1) HPV, as detected by Southern blot testing and the polymerase chain reaction; (2) EBV, as detected by Southern blot testing; and (3) HSV, as detected by tissue culture of endocervical swabs, was also studied. RESULTS: There was no significant difference in the prevalence of CIN or oncogenic viruses between HIV seropositive and seronegative women in the absence of immunosuppression. If the HIV infected women showed signs of immunosuppression, the prevalence of CIN was increased. No association was shown between detection of HPV, EBV and HSV and immunosuppression or CIN. CONCLUSION: HIV infection may only be associated with an increased risk of CIN when immunosuppression is present.

Adult↗