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At least 433 records · Page 24Linked to original sources
PubMed1998

Can women at risk of cervical abnormality be identified?

OBJECTIVE: To determine if use of a detailed risk factor profile accurately predicts the presence of cytological abnormality of the cervix or improves the appropriateness of referral for colposcopic assessment when women are found to have these abnormalities. DESIGN: Cross-sectional survey. SETTING: Family planning clinic. POPULATION: 1219 consecutive women, aged between 15 and 19 years, attending for contraceptive advice. Variables included age, social class, educational status, hormonal and obstetric history, smoking and alcohol habits, history of sexually transmitted diseases, the age of first intercourse, number of sexual partners, duration of each relationship, frequency of intercourse, contraception used and the age of each partner. MAIN OUTCOME MEASURES: Presence or absence of cytological abnormality and the presence or absence of histological abnormality in those with cytological abnormality referred for colposcopic assessment. RESULTS: Univariate analysis confirmed many of the known associations of cervical abnormality. Discriminant analysis identified five independent significant predictors of cytological abnormality and four independent predictors of dyskaryotic cytology. At best models, derived from identified variables correctly predicted 10.1% of individuals with cytological abnormality and 13.5% of those with dyskaryotic cytology. Of those referred for colposcopic assessment because of abnormal cytology, models were able to predict 23.5% of those with histological evidence of cervical intraepithelial neoplasia. CONCLUSIONS: Despite the availability of detailed information regarding the known correlates of cervical neoplasia in this age group, it was not possible to identify the majority of women with cervical abnormality. It is concluded that the strength of these associations is not sufficient to allow useful prediction of membership of a high risk group.

Adolescent↗
PubMed2006

Caesarean section and subsequent fertility in sub-Saharan Africa.

OBJECTIVE: To determine the impact of caesarean section on fertility among women in sub-Saharan Africa. DESIGN: Analysis of standardised cross-sectional surveys (Demographic and Health Surveys). SETTING: Twenty-two countries in sub-Saharan Africa, 1993-2003. SAMPLE: A total of 35 398 women of childbearing age (15-49 years). METHODS: Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models. MAIN OUTCOME MEASURES: Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery. RESULTS: The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P < 0.01; controlling for age, parity, level of education, urban/rural residence and young age at first intercourse). Caesarean section was also associated with prior fertility and desire for further children: among multiparous women, an interval > or =3 versus <3 years between the index birth and the previous birth was associated with higher odds of caesarean section at the index birth (OR = 1.4, 95% CI 1.1-1.7, P= 0.005); among all women, the odds of desiring further children were lower among women who had previously delivered by caesarean section (OR = 0.67, 95% CI 0.54-0.84, P < 0.001). Caesarean section did not appear to increase the risk of a subsequent pregnancy ending in miscarriage, abortion or stillbirth. CONCLUSIONS: Among women in sub-Saharan Africa, caesarean section is associated with lower subsequent natural fertility. Although this reflects findings from developed countries, the roles of pathological and psychological factors may be quite different because a much higher proportion of caesarean sections in sub-Saharan Africa are emergency procedures for maternal indication.

Adolescent↗
PubMed1997

Progression and regression of low-grade epithelial abnormalities of the cervix.

The records of 738 women with low-grade cervical epithelial abnormalities were examined for changes in degree of cervical disease and lesion size, as well as sociodemographic and behavioural factors which influence the development of invasive cancer of the cervix. Survival analysis was used to determine the predictors and rates of progression and regression. The results suggest that about 80% of the low-grade epithelial abnormalities of the cervix will not progress within 2 years. The only predictors of progression were a biopsy diagnosis of CIN 1 and the size of the lesion. Predictors of regression were older age, older age at first intercourse, greater parity, fewer sexual partners, and absence of a past history of genital herpes. Although progression rates of low-grade abnormalities of the cervix were very low, CIN 1 lesions were 2.4 times (95% CI: 1.6 to 3.7) more likely to progress than lower-grade lesions and large lesions (> 1/2 ectocervix) were 2.0 times (95% CI: 1.2 to 3.3) more likely to progress than small ones (< 1/4 ectocervix).

Adolescent↗
PubMedDate not supplied

Human papillomavirus type 18 and other risk factors for cervical cancer in Jakarta, Indonesia.

Infection with human papillomavirus (HPV) has now been established as a necessary cause of cervical cancer. Indonesia is a country with a high cervical cancer incidence and with the world's highest prevalence of HPV 18 in cervical cancer. No information exists about the prevalence of HPV 18 or other HPV types in the Indonesian population. We conducted a hospital-based case-control study in Jakarta, Indonesia. A total of 74 cervical carcinoma cases and 209 control women, recruited from the gynecological outpatient clinic of the same hospital, were included. All women were HPV typed by the line probe assay, and interviews were obtained regarding possible risk factors for cervical cancer. HPV was detected in 95.9% of the cases and in 25.4% of the controls. In the control group, 13.4% was infected with a high-risk HPV type. HPV 16 was detected in 35% of the case group and in 1.9% of the control group and HPV 18 was identified in 28% of the case group and in 2.4% of the control group, suggesting that the oncogenic potentials of HPV 16 and HPV 18 in Indonesia are similar. In addition to HPV infection, young age at first intercourse, having a history of more than one sexual partner, and high parity were significant risk factors for cervical cancer. Within the control group, we did not identify determinants of HPV infection. We hypothesize that the high prevalence of HPV 18 in cervical cancer in Indonesia is caused by the high prevalence of HPV 18 in the Indonesian population.

Adult↗
PubMed1993

Cigarette smoking and human papillomavirus in patients with reported cervical cytological abnormality.

OBJECTIVE: To assess the relation between two risk factors for cervical neoplasia: smoking and infection with oncogenic human papillomavirus. It has been suggested that smoking causes a local immunological defect, which could facilitate the infection and persistence of human papillomavirus. DESIGN: Cross sectional epidemiological study. Completion of a structured questionnaire by the patients, analysis of cervical scrapes for human papillomavirus, and morphological examination of biopsy specimens. SETTING: Outpatient gynaecological clinic. SUBJECTS: 181 women with a report of cervical cytological abnormality. MAIN OUTCOME MEASURES: Prevalence of infection with oncogenic human papillomavirus and smoking habits. RESULTS: Oncogenic human papillomavirus was found in the cervix of 26 (41%) of the 63 women who did not smoke, 22 (58%) of the 38 who smoked 1-10 cigarettes a day, 28 (61%) of the 46 who smoked 11-20 cigarettes a day, and 26 (76%) of the 34 who smoked > or = 21 cigarettes a day. The prevalence of the virus thus increased in accordance with the number of cigarettes smoked (p = 0.001). This relation remained after adjustment for age at first intercourse and lifetime number of sexual partners. Of the 63 non-smokers, 23 had previously smoked at least 10 cigarettes a day at some time. Of these 23 women, 14 (61%) had oncogenic human papillomavirus in their cervix. Of the 40 women who had never smoked at least 10 cigarettes a day, 12 (30%) had the virus. The prevalence of oncogenic human papillomavirus in non-smokers therefore depended on previous smoking habits (p = 0.03). CONCLUSION: The dose dependent effect of cigarette smoking on the occurrence of oncogenic human papillomavirus favours a causal relation between these risk factors for cervical neoplasia.

Adult↗
PubMed1994

Primary infertility: characteristics of women in North America according to pathological findings.

STUDY OBJECTIVE: To determine, in women with primary infertility, whether specific characteristics or behavioural factors are associated with the various pathological conditions identified as contributing to the infertility. DESIGN: Case-control study. SETTING: Seven institutions in the USA or Canada. PARTICIPANTS: Study subjects were 1750 women who presented with primary infertility, among whom the main pathological cause of infertility was male factor (417), tubal obstruction (231), endometriosis (194), luteal phase defects (153), other ovulatory problems (193), cervical abnormalities (92), and polycystic ovarian disease (84) and 1765 control women who delivered their first child at the same institution. MAIN RESULTS: Except for tubal obstruction and polycystic ovarian disease, the characteristics and behaviours of the women with infertility did not differ appreciably according to the pathological conditions recorded. Women with tubal obstruction had had more sexual partners, an earlier age at first intercourse, were more likely to have used an intrauterine device but less likely to have used a condom, and were more likely to have smoked cigarettes and to have used various recreational drugs than the other women. Women with polycystic ovarian disease were more obese, had had fewer sexual partners, and were less likely to have used cigarettes, contraceptives, and recreational drugs than the other women. CONCLUSIONS: Sexually transmitted infections seem to increase the risk of tubal obstruction but not other causes of infertility. Obesity is associated with polycystic ovarian disease. These data offer few clues to the aetiology of infertility attributed to endometriosis, cervical abnormalities, luteal phase defects, other ovulatory defects, or to male factors.

Age Factors↗
PubMed2006

Mycoplasma genitalium: prevalence and behavioural risk factors in the general population.

BACKGROUND: Mycoplasma genitalium has been shown to cause urethritis in men and cervicitis in women and may also be a causative agent in female infertility. OBJECTIVE: To estimate the prevalence of urogenital M genitalium infection and identify sexual behavioural risk factors in the general population. METHODS: Participating individuals were 731 men and 921 women aged 21-23 years and not seeking the healthcare system because of symptoms. They answered questionnaires on sexual behaviour and provided samples for M genitalium testing. RESULTS: In women aged 21-23 years, the prevalence of infection was 2.3% (21/921) and in men of the same age it was 1.1% (8/731). For both sexes, an increasing number of partners was associated with a greater chance of being infected. Among women a shorter duration of a steady relationship and having a partner with symptoms was associated with being infected, and for men younger age at first intercourse was associated with M genitalium infection. CONCLUSIONS: We conclude that the prevalence of infection in the general population is too low for population-based screening. However, the development of test algorithms based on behavioural risk factors is a promising alternative.

Adult↗
PubMed1994

Clinical and microbiological characteristics of symptomatic vulvovaginal candidiasis in HIV-seropositive women.

OBJECTIVES: To evaluate the clinical and microbiological characteristics of symptomatic vaginal candidiasis in Human Immunodeficiency Virus (HIV)-seropositive women attending a gynaecologic outpatient clinic for sexually transmitted diseases (STDs). DESIGN: Vaginal, rectal and oral specimens from cases and controls were cultured for Candida spp. SUBJECTS: Eighty-four consecutive HIV-seropositive and 384 HIV-seronegative women with clinical signs of vulvovaginitis. SETTING: A gynaecological out-patient clinic in Pavia, Italy. RESULTS: The overall prevalence of vaginal candidiasis was 61.9% (52/84) in the cases and 32.3% (124/384; p < .001) in the controls. After adjustment by logistic regression analysis for confounding factors (age at first intercourse, lifetime sex partners, new partner/s in the last 6 months, type of contraceptive used), HIV-seropositive patients were at higher risk for both Candida albicans (odds ratio = 2.5; 95% confidence interval 1.31-4.69; p = 0.006) and Torulopsis glabrata vaginitis (OR = 3.5; 95% CI = 1.05-11.60; p = 0.04) than controls. HIV-seropositive subjects had also increased rates of oral and rectal colonisation with Candida spp. Finally, the time to recurrence of vaginal infection was significantly shorter in HIV-seropositive patients than controls and was correlated with the severity of HIV-induced immunodepression. CONCLUSIONS: Vulvovaginal candidiasis is very common in HIV-seropositive women and its prevalence is correlated with the immunological status of the host. These patients have higher frequencies of Torulopsis glabrata vaginal infection and are more prone to recurrence than HIV-seronegative controls.

AIDS-Related Opportunistic Infections↗
PubMed2001

Rising incidence and prevalence of herpes simplex type 2 infection in a cohort of 26 year old New Zealanders.

OBJECTIVES: To examine changes in the incidence and prevalence of herpes simplex type 2 (HSV-2) infection in a birth cohort of 26 year old New Zealanders in whom seroprevalence had been measured at 3.4% at age 21. METHODS: Sera from 869 cohort members were tested using an indirect IgG enzyme linked immunoassay specific to the HSV-2 glycoprotein G. Serological results were compared with detailed sexual histories. RESULTS: In all, 96 participants (11%) were seropositive for HSV-2, including at least 56 who seroconverted after their 21st birthday. Among those known to be seronegative at age 21, the annual seroconversion rate was 13.5 cases per 1000 per year, compared with 8.1 cases per 1000 per sexually active year before age 21. New infections were associated with female sex and an early age of first intercourse. The average rate of partner change was lower in the cohort after age 21, and was only modestly increased among those who acquired new HSV-2 infections between ages 21 and 26. CONCLUSIONS: HSV-2 seroprevalence has risen sharply in this sexually active cohort, despite a reduction in the overall level of partner change. Increased rates of HSV-2 acquisition after age 21 may be due to a higher prevalence of infection in the pool of potential partners encountered during the third decade of life. Factors related to partner choice may have more influence on the risk of HSV-2 infection than the number of sexual partners alone.

Adult↗
PubMed2003

Prospective study on cervical neoplasia: presence of HPV DNA in cytological smears precedes the development of cervical neoplastic lesions.

OBJECTIVES: The principal aim of the study was to verify whether HPV infection in healthy women, as determined by HPV DNA detection, was associated with an increased risk of development of cervical lesions. METHODS: Cervical smears collected at enrolment into the prospective study conducted in Prague during 1975-83 were tested for the presence of HPV DNA by means of a polymerase chain reaction (PCR) using the general GP5/6 primers and a mixture of primers specific for the E6 gene. 120 smears from patients in whom cervical neoplasia had been detected in the course of the prospective study and 208 smears from control women who had remained healthy throughout the observation period were analysed. Patients and controls were matched by age, number of sexual partners, age at first intercourse, and smoking habit. Patients were divided into three groups, A, B, and C, according to their cytological, colposcopic, and histological findings at enrolment. Group A consisted of 67 women found ill at enrolment, group B of 26 women with slightly suspicious findings, while group C comprised 27 women with normal findings at enrolment. In addition, sera taken at enrolment from these patients and controls were tested for the presence of antibodies reactive with virus-like particles (VLPs) of HPV 16, 18, and 33. RESULTS: For the whole cohort, there was a statistically highly significant difference in the presence of HPV DNA between patients and controls. Furthermore, the difference in the presence of HPV DNA between patients and controls was highly significant not only in those who had been found ill at enrolment (group A) but, most importantly, also in women who had developed the disease in the course of the follow up (groups B and C). Women positive for HPV DNA possessed HPV antibodies to VLP16, 18 and 33 significantly more often than those who were free of HPV DNA. CONCLUSION: This indicated that healthy women who were positive for HPV DNA at enrolment were at an increased risk of developing cervical neoplasia (OR = 18.5; CI 5.9 to 57.6).

Adult↗
PubMedDate not supplied

Cervical cytology screening in Vietnamese asylum seekers in a Hong Kong detention center. Population demographics and historical perspectives.

OBJECTIVE: To provide a brief review of the history and demographics of the Vietnamese asylum-seeking population in Hong Kong and their possible effects on the initiation of a cervical cytology screening program at a Hong Kong detention center. STUDY DESIGN: Analysis of case histories, questionnaires and interviews with women in a detention center identified demographic features related to Pap smear history, knowledge of the Pap test, age at first intercourse and cigarette smoking status among women aged 17 years and over. Analysis of Pap smear uptake following initiation of a screening program was undertaken. RESULTS: Of the 1,171 women in the detention center who were eligible for a Pap smear, 536 (45.8%) actually obtained one, although enrollment, which was strong at the initial offering, slowed considerably as the program progressed. None of the women had had a Pap smear prior to leaving Vietnam. Knowledge of the utility and risk status criteria for Pap testing was very limited. The majority (77.9%) of the subjects started sexual activity after age 20 years, and three (0.6%) smoked. There were four (0.2%) abnormal smears identified among those tested. CONCLUSION: Convincing evidence was obtained that the Pap test was not widely used in Vietnam among the asylum-seeking population, and its role in preventing cervical cancer was not well known to the women studied. The initial strong uptake of the Pap smear was not maintained. That may be attributable to psychosocial factors associated with detention under harsh conditions and trauma associated with fleeing Vietnam.

Adolescent↗
PubMedDate not supplied

AIDS and the adolescent.

Recent findings on young people's response to HIV/AIDS and its perceived relevance to their sexual lives are reviewed. Research into adolescent sexual behaviour suggests a trend, over the last 2 decades, for an earlier age of first intercourse and a greater number of recent and lifetime sexual partners. Older cohorts of adolescents and those with either multiple partners or more 'steady' partners have been found to have lower rates of condom use. Data on the prevalence of specific sexual activities such as anal intercourse, while sparse, suggests a considerable number of young people engaging in behaviours carrying some risk of HIV infection. It is clear that sex education programmes which simply advocate 'safer sex' practices without addressing the interpersonal skills and emotional implications of negotiating such practices, and which do not provide a positive view of sexual health, are failing to influence adolescent behaviour. Recent research has highlighted a number of issues that need addressing if sex education and HIV/AIDS prevention campaigns are to be effective.

Adolescent↗
PubMed1996

Characteristics of subgroups of attenders and non-attenders in an organised screening programme for cervical cancer.

OBJECTIVE: Several studies have compared attenders and non-attenders in organised cervical screening programmes but few have analysed subgroups of attenders and non-attenders. This study presents social and other characteristics of such subgroups. SETTING: Aarhus County, Denmark. METHODS: A case-control study in a cohort of 133,500 women, aged 23-60, included in the programme from 1 October 1990 to 1 April 1994. The participation rate was 75%, and those taking part comprised women with opportunistic screening or who had had a smear owing to symptoms in the previous three years ("active" attenders), and women who were invited for screening because they had not been otherwise tested ("passive" attenders). "Passive" (n = 708) and "active" attenders (n = 692) were compared. Women who had never had a smear test ("never" attenders, n = 287) were then compared with "ever" attenders (n = 1215)-that is, women who had not had a smear test during the previous 42 months, but had had at least one previous test. Data were collected by mailed questionnaires. RESULTS: The response rate was 81% and 53% for attenders and non-attenders, respectively. After correction for age, there was no difference between the "active" and "passive" attenders for cancer risk factors (smoking, age of first intercourse, number of sexual partners, and social group), or in the degree of responsibility for close relatives, but "active" attenders seemed to have more frequent contact with their general practitioner. "Never" attenders had less frequent contact with their general practitioner than "ever" attenders. They were more often living alone and nullipara, but had no overrepresentation of cancer risk factors. CONCLUSIONS: Increased effect cannot be obtained by focusing on the described groups, but by increasing the participation rate. "Never" attenders do not belong to a special risk group.

Adult↗
PubMed2002

Do clinic-based STD data reflect community patterns?

Sexually transmitted disease (STD) interventions in communities are often based on studies conducted in STD clinics. Clinic-based studies are relatively easy to conduct, but they do not include all people at risk for STDs in the community. Although it is widely believed that clinic-based data present a biased picture of the community, the differences between clinical and community perspectives seldom have been quantified. The Sexually Transmitted Epidemic Prevention (STEP) Project included in-depth standardized interviews administered in an STD clinic and the neighbourhoods of the same town. The populations could be quantitatively compared on some questions. The two samples yielded similar estimates of the proportions using condoms, the average age at first intercourse, and the proportion sexually abused as a child. Risky sexual behaviours were more common in the clinic population, however, and the community sample was more socio-economically stable. Clinic-based data may be useful for targeting high risk people in the community but less useful for reaching those at lower risk. The utility of clinic-based studies for community-based interventions may be enhanced by collecting extra information from clinic patients with lower risk profiles.

Adolescent↗
PubMed2004

Sexual behaviour among young men in Sweden and the impact of pornography.

The purpose was to investigate the sexual behaviour among young men (n = 300), visiting a genitourinary clinic in Sweden, focusing on the impact of pornography. Almost all, 98% (n = 292) claimed to be heterosexual. The mean age at first intercourse was 16 years and on that occasion 64% (n = 187) used some kind of contraceptive, mainly condom. All, 99% (n = 296) had consumed pornography and 53% (n = 157) felt that pornography impacted their sexual behaviour; they got inspired. About half (n = 161) had had anal intercourse. Of these, 70% (n = 113) had had it more than once and 84% (n = 133) could imagine doing it again. Only 17% (n = 28) always used a condom in this situation. One out of four (n = 70) had had at least one sexually transmitted disease. The low use of condoms when heterosexual men have anal sex might have serious consequences for a spread of sexually transmitted diseases.

Adolescent↗
PubMed1988

Gynecology and sexuality in middle-aged women.

In Sweden and other Western societies, the number of women above the age of 40 is increasing and health and well-being of middle-aged women is an increasing matter of concern. This study examines menstrual histories, gynecological operations, urinary incontinence, and reproductive functions in a representative sample of middle-aged women, as well as the frequency of climacteric symptoms and how to predict the women at risk for acquiring these symptoms. The sexuality of the mature woman as also explored. Women aged 37 to 66 years were randomly selected from the Census Register in Goteborg, Sweden. The bulk of information was obtained by means of questionnaires. Among the findings are that the median age for natural menopause was 50.9 years. Forty percent of the postmenopausal women reported frequent vasomotor symptoms. The occurrence of climacteric complaints is strongly connected to psychosocial variables. Every tenth woman reported frequent urinary leakage. Fifty-three percent of the women had undergone a D&C and 9% were hysterectomized. The woman around 40 reported few sexual partners (median 3) and her first intercourse occurred at age 18. Extramarital sex was uncommon. The masturbation rate was low and the frequency of homosexuality was extremely low. The majority of women had experienced orgasm.

Climacteric↗
PubMed2002

Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence.

OBJECTIVE: To evaluate the empirical associations between alcohol use and risky sex at two levels of analysis. Global associations test whether individuals who engage in one behavior are more likely to engage in the other, whereas event-specific associations test whether the likelihood of engaging in one behavior on a given occasion varies as a function of engaging in the other on that same occasion. METHOD: Studies examining the association between drinking and risky sex in samples of college students and youth were reviewed. Those published in the past 10 years and using event-level methodology or random sampling were emphasized. RESULTS: Findings were generally consistent across levels of analysis, but differed across types of risky behaviors. Drinking was strongly related to the decision to have sex and to indiscriminate forms of risky sex (e.g., having multiple or casual sex partners), but was inconsistently related to protective behaviors (e.g., condom use). Moreover, the links among alcohol use, the decision to have sex and indiscriminate behaviors were found in both between-persons and within-persons analyses, suggesting that these relationships cannot be adequately explained by stable individual differences between people who do and do not drink. Analysis of event characteristics showed that drinking was more strongly associated with decreased protective behaviors among younger individuals, on first intercourse experiences and for events that occurred on average longer ago. CONCLUSIONS: Future efforts aimed at reducing alcohol use in potentially sexual situations may decrease some forms of risky sex, but are less likely to affect protective behaviors directly.

Adolescent↗
PubMedDate not supplied

Herpes simplex virus type 2 infection in pregnancy: asymptomatic viral excretion at delivery and seroepidemiologic survey of two socioeconomically distinct populations in São Paulo, Brazil.

The objective of the present study was to estimate the prevalence of herpes simplex virus type 2 (HSV 2) antibodies in child bearing women of 2 Brazilian populations with different socioeconomic status and to determine the risk of neonatal HSV exposure by means of maternal cultures at the onset of labor. The study was conducted at 2 hospitals: A, serving very low income patients and B, serving middle socioeconomic class. 173 participants from group A and 127 from B answered a questionnaire which showed that the patients had similar ages (27.7 and 26.8 years, respectively) but differed with regard to socioeconomic status, age at first intercourse (18.6 vs 20.6 years), number of sex partners (1.5 vs 1.2) and previous sexually transmitted diseases (15% vs. 1.5%). History of genital herpes was given by 11% of group A participants and by a similar number, 7%, of patients from group B. In addition, 200 serum samples from population A and 455 from B were tested by ELISA for anti HSV antibodies and 92% and 86%, respectively, were found to be positive. Sixty seropositive samples from group A and 90 from B were further analyzed by Western blot, which showed the presence of type 2 specific antibodies in 46% and 36%, respectively, suggesting an overall HSV 2 prevalence of 42% in group A and 31% in B. Cervical specimens were obtained for culture from 299 asymptomatic patients of population A and 313 of B. HSV was isolated from one specimen in each group, indicating a 0.3% incidence of asymptomatic viral excretion in both populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗