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PubMed1997

Seropositivity against HPV 16 capsids: a better marker of past sexual behaviour than presence of HPV DNA.

OBJECTIVES: To assess if seropositivity to human papillomavirus type 16 capsids is a better marker of sexual history than the presence of HPV DNA. STUDY DESIGN: A population based age stratified random sample of 234 Norwegian women (mean age 32.8 years, range 20-44) was examined for HPV serum antibodies, cervical HPV DNA, cytology and age in relation to sexual behaviour. RESULTS: Neither age nor age at first sexual intercourse was associated with HPV 16 antibodies. Adjusted ORs for 4-5; 6-10 and > 10 versus 0-1 lifetime sexual partners, were 13.1 (95% CI 1.5-110.8), 8.2 (1.0-69.6) and 10.5 (1.2-94.0) for HPV 16 seropositivity, respectively; and 2.6 (0.2-27.8), 3.4 (0.4-31.7) and 4.1 (0.4-42.8) for HPV 16 DNA positivity, respectively. CONCLUSION: Seropositivity to HPV 16 capsids is positively associated with the number of sexual partners, suggesting that HPV 16 is predominantly sexually transmitted. The fact that serology had a stronger association with number of sexual partners than viral DNA suggests that seroreactivity is a better measure of lifetime history of HPV infection.

Adult↗
PubMed2005

[Sexual transmission of hepatitis C virus].

Hepatitis C virus (HCV) is usually transmitted parenterally, but sexual transmission is considered likely in the 20% of cases with no other risk factors. Retrospective cohort studies conducted among persons who have never injected drugs show that factors predictive of HCV seropositivity include the number of lifetime sexual partners, high-risk sexual practices, other sexually transmitted infections, and HIV seropositivity. Persons in long-term monogamous heterosexual relationships with a partner seropositive for HCV are at lower risk of HCV acquisition (0 to 0.6% peryear) than persons with multiple partners or those at risk for sexually transmitted diseases (0.4 to 1.8% per year). HCV RNA is detectable in genital fluids, but there is not yet any proof that the HCV RNA in genital secretions represents infectious virus. HCV can be transmitted by sexual intercourse but much less efficiently than other sexually transmitted viruses, such as HBV and HIV. Sexual transmission of HCV may be enhanced by other concomitant sexually transmitted infections with genital erosive lesions or via traumatic sexual intercourse with abrasion of the genital mucosa.

Adolescent↗
PubMed2006

Oral contraception and unprotected sex with occasional partners of women HIV-infected through injection drug use.

Among HIV-infected women, unprotected sex with the main sexual partner is common practice. Conversely, studies about condom use with sexual partners of unknown HIV sero-status are sparsely reported. We aimed to assess the impact of oral contraception on unsafe sexual behaviours with occasional partners in women HIV-infected through injection drug use. The analysis focused on 90 women, enrolled in the French cohort MANIF 2000 and reported having engaged in sexual relationships with occasional partners during a 48-month period. Visits where women reported unprotected sex with occasional partners in the prior 6 months were compared to visits where they reported protected sex using a logistic model based on Generalised Estimating Equations. Unprotected sex with occasional partners was independently associated with oral contraception (OR[95%CI] = 3.2[1.4-7.2]), reporting only one occasional partner (OR[95%CI] = 3.1[1.6-6.2]) and antiretroviral treatment receipt. No significant association was found between unprotected sex and CD4 level or plasma viral load. With the growing population of people living with HIV as a chronic infection, the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Risk reduction counselling and interventions are needed to promote either the use of dual contraception or, alternatively, that of female condom.

Adult↗
PubMed2005

Risk factors for ectopic pregnancy in Lagos, Nigeria.

BACKGROUND: Ectopic pregnancy is an important cause of maternal deaths in Nigeria and in other developing countries. In Lagos, Nigeria, it is responsible for 8.6% of maternal deaths, and has a case fatality rate of 3.7%. The purpose of this study was to determine the risk factors for ectopic pregnancy in Lagos. METHODS: A case-control study of 100 patients and 280 controls was performed in the three hospitals--Lagos University Teaching Hospital, Ayinke House Maternity Hospital, and Lagos Island Maternity Hospital--in Lagos from June 1999 to December 1999. Data were analyzed by using logistic regression. RESULTS: The incidence was 23.1/1000 (1 : 43) deliveries and was responsible for 48.5% of gynecologic emergencies. Age, marital status, socioeconomic status, and parity were not the significant risk factors for ectopic pregnancy. An early age of sexual debut increased the risk of ectopic pregnancy almost two-fold (adjusted OR = 1.93; 95% CI = 1.71-2.93), whereas a late age of sexual debut was protective (adjusted OR = 0.37; 95% CI = 0.19-0.59). History of multiple lifetime sexual partners, induced abortions, pelvic inflammatory disease, sexually transmitted disease (STD), miscarriage, and pelvic surgery independently and significantly increased the risk of ectopic pregnancy. Induced abortion and STD increased the risk 14-fold and nine-fold, respectively. Previous use of intrauterine contraceptive device increased the risk almost four-fold (adjusted OR = 3.76; 95% CI = 2.12-6.69), whereas the use of condoms was protective (adjusted OR = 0.35; 95% CI = 0.17-0.71). CONCLUSIONS: Proper sex education, prevention of unwanted pregnancy, and prevention and proper treatment of sexually transmitted infections will reduce the incidence of ectopic pregnancy.

Adolescent↗
PubMed2001

Efficacy of a preventive intervention for youths living with HIV.

OBJECTIVES: HIV transmission behaviors and health practices of HIV-infected youths were examined over a period of 15 months after they received a preventive intervention. METHODS: HIV-infected youths aged 13 to 24 years (n = 310; 27% African American, 37% Latino) were assigned by small cohort to (1) a 2-module ("Stay Healthy" and "Act Safe") intervention totaling 23 sessions or (2) a control condition. Among those in the intervention condition, 73% attended at least 1 session. RESULTS: Subsequent to the "Stay Healthy" module, number of positive lifestyle changes and active coping styles increased more often among females who attended the intervention condition than among those in the control condition. Social support coping also increased significantly among males and females attending the intervention condition compared with those attending the control condition. Following the "Act Safe" module, youths who attended the intervention condition reported 82% fewer unprotected sexual acts, 45% fewer sexual partners, 50% fewer HIV-negative sexual partners, and 31% less substance use, on a weighted index, than those in the control condition. CONCLUSIONS: Prevention programs can effectively reduce risk acts among HIV-infected youths. Alternative formats need to be identified for delivering interventions (e.g., telephone groups, individual sessions).

Adaptation, Psychological↗
PubMed1991

Androscopy for anogenital HPV.

BACKGROUND: Strong evidence now links anogenital intraepithelial neoplasia to the transmission of the human papillomavirus (HPV) through sexual intercourse. While there is increasing research on women with this disease, less is known about their male sexual partners. METHODS: Male patients whose female sexual partners had been diagnosed as having anogenital intraepithelial neoplasia were recruited for the study. The genital regions of the male patients were examined and biopsied with the aid of a colposcope after application of a 5% acetic acid solution. Treatment was based on the specific findings in each patient. RESULTS: Genital lesions were found on 65% of the male patients examined, even though no disease had been detected by the individual. Seventy-nine percent of patients who were compliant with the prescribed treatment protocol had no detectable HPV-related lesions at the time of their last androscopic examination. CONCLUSIONS: Magnified examination of the male genitalia using an androscope following the application of 5% acetic acid solution is an effective method by which the primary care physician can detect and treat male HPV-related anogenital lesions.

Acetates↗
PubMed2003

Results of an explorative empirical study on human mating in Germany: handsome men, not high-status men, succeed in courtship.

Recent research on human mating depicts men as searching for physical attractiveness (PA) and women as searching for status. To identify the mechanisms which lead to universal, biologically interpretable structures in social processes, we focused on the proximate causes for inter- and intrasexual differences in human mating preferences, attraction, and tactics. We collected data on 180 young singles (mean age 26.9 years) without a steady relationship. A questionnaire and a video sequence (20-30 seconds) of each subject was taken. Next, each video sequence was rated by approximately 20 individuals of the opposite sex, who also participated in this study. Surprisingly, the answers given by male and female subjects regarding sociosexual behaviour and mating preferences are predominantly congruent. Sex differences among preferences for good looking and high-status partners were small or even insignificant. Lower educated subjects had considerably higher status preferences than higher educated individuals. In both sexes, PA was much more preferred in a potential partner than status. For both sexes, physical appearance was decisive for the subject's dating attractiveness. Male, but not female dating attractiveness also correlates with a kind and charismatic appearance. Furthermore, there was a positive linear relationship between men's PA and their number of sexual partners within the last year. Men with more than four sexual partners were all above-average in PA, while the most attractive women had a medium number of sexual partners. However, in this respect, status had no influence. The results show that sex differences in mating are more complex than hitherto assumed.

Adult↗
PubMed2006

The influence of pregnancy on the development of autoimmunity in chronic lymphocytic leukemia.

To examine whether pregnancy influences the development of autoimmunity in chronic lymphocytic leukemia (CLL), we studied 591 consecutive CLL patients (202 post-menopausal women and 389 men). The mean observation time for all patients was 3.8 years, corresponding to approximately 2200 person-years of follow-up. Autoimmune manifestations were analyzed in 194 women with known obstetric history and known number of long-term sexual partners, and in the 389 male CLL patients for comparison. One hundred and fifty-nine of the CLL patients exhibited autoimmune manifestations, 38% in females and 21% in men. In female CLL patients, the frequency of autoimmunity and the number of pregnancies and the number of partners were strongly correlated. Each of the major autoimmune types approximately doubled in frequency for each additional pregnancy. The impact of pregnancy on expressed autoimmunity increased with each additional sexual partner (the odds of autoimmunity increased 11 times with each long-term sexual partner). The average numbers of pregnancies in female CLL patients with and without autoimmunity were 4.92 and 2.24, respectively (P < 0.001). Coombs' positive autoimmune anemia, a gastric ulcer with parietal cell autoantibodies and idiopathic thrombocytopenic purpura were equally common in women and men, whereas autoimmune thyroiditis, Sjögren's syndrome, rheumatoid arthritis and systemic lupus erythematosus were seen in higher rates in women than in men. The spectrum of autoimmunity suggests that pregnancy-related alloimmunization may be involved in the development of autoimmunity in CLL.

Autoantibodies↗
PubMed1993

Predictors of changes in sexual behavior among women on methadone.

This study identified predictors of reported sexual risk reduction among 109 female injection drug users enrolled in methadone clinics. Univariate analyses were used to examine the individual effects of each variable on the outcome of sexual behavior change over the past 6 months. Multiple logistic regression was then used to identify which of these variables were independently associated with such a change. Women with more than one sexual partner were more likely than women with one or no sexual partner to report changing their sexual behavior. African-American women were less likely than White Anglo or Latina women to report changing their sexual behavior. Women who held stronger beliefs that luck plays the largest role in getting AIDS were less likely to report changing their sexual behavior. Change in sexual behavior was associated with feeling comfortable asking partners to use condoms, higher depression scores, and loss of friends or family to AIDS. The observed relationship between personal susceptibility and depression suggests that risk reduction interventions should also address the depressive symptomatology associated with feelings of vulnerability.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Validation of a Parent-Adolescent Communication Scale for use in STD/HIV prevention interventions.

This study reports on the validation of a scale to assess adolescent girls' frequency of sexual communication with their parents. The Parent-Adolescent Communication Scale (PACS) was administered to 522 African American female adolescents ranging in age from 14 to 18. The PACS demonstrated satisfactory internal consistency (across multiple administrations) and acceptable test-retest reliability over a 12-month follow-up period. Concurrently, scores on the PACS were correlated with frequency of sexual communication with partner, sexual communication self-efficacy (boyfriend), perceived parental knowledge, family support, depression, and condom use with steady male sex partners. Prospectively, baseline PACS scores were correlated with frequency of sexual communication with partner and condom use. The present investigation indicates that the PACS is a reliable and valid measure of frequency of sexual communication between female adolescents and their parents. Utility of the PACS for researchers and practitioners is discussed.

Adolescent↗
PubMed1996

The differences between male and female drug users: community samples of heroin and cocaine users compared.

Although gender-related issues are often cited as playing an important part in determining patterns of illicit drug use, little is known about the differences between male and female drug users outside treatment settings. In the present study, 558 heroin and cocaine users recruited from a range of community settings were interviewed by Privileged Access Interviewers. The women were found to be younger than the men. Differences existed in their drug use; women used smaller amounts, for a shorter duration, and were less likely to inject than their male counterparts. No differences existed between treatment contact for the heroin users, but differences were found among the cocaine-using sample, with men being more likely to have contacted a treatment agency. Men were financing themselves through more criminal activities than women. Drug-using sexual partners were found to be an important influence over women's drug use, with most female injectors having been given their first injection by a male sexual partner. Structural differences in patterns of drug use found among female drug users and the influence of male sexual partners are likely to play an important role in determining appropriate treatment options for women drug users.

Adolescent↗
PubMed1996

HCV transmission in family members of subjects with HCV related chronic liver disease.

To investigate the risk of sexual and intrafamilial transmission of HCV, 220 family members of 76 patients (index cases) with chronic type C viral liver disease were tested for serological markers of HCV. Of the family members, 129 were offspring, 64 sexual partners, 15 parents and 12 siblings of the index cases. Anti-HCV was tested in all the household contacts; HCV-RNA was tested in antibody positive samples. The serologic markers of HCV were tested in a control group of 168 family members of 81 patients with chronic hepatitis unrelated to HCV. The overall prevalence of anti-HCV was 8.2% compared to 0.6% in the control group (p < 0.001). Sexual partners were anti-HCV positive more frequently than the other contacts (20% vs 2.2%; p < 0.001), without any difference in males or females. No correlation was observed between the occurrence of HCV infection in contacts and age, severity of liver disease or risk factor for the acquisition of HCV in the index cases. Seven of the 18 (39%) anti-HCV positive family contacts had bio-chemical evidence of chronic liver disease, histologically confirmed in the 6 patients who underwent a liver biopsy. Liver chemistry was normal in all the HCV-negative contacts. Ten of the 18 anti-HCV positive contacts (55%) were HCV-RNA positive, Genotypes were the same (1b) in 4 of the 7 viremic couples of subjects: in 3 of the 6 couples of sexual partners and in the only mother/son couple. These data suggest the occurrence of intraspousal transmission of HCV, while intrafamiliar acquisition of HCV in non-sexual contacts seems to be rare.

Adolescent↗
PubMed1989

The transmission dynamics of the human immunodeficiency virus type 1 in the male homosexual community in the United Kingdom: the influence of changes in sexual behaviour.

This paper examines the transmission dynamics of human immune deficiency virus type 1 (HIV-1) in the male homosexual population in the U.K. via numerical studies employing a mathematical model representing the principal epidemiological process. The model is based on an assumption of proportionate mixing between different sexual-activity classes (defined by the rate of sexual partner change per unit of time) and incorporates heterogeneity in sexual activity, distributed infection and incubation periods and the recruitment of susceptibles to the sexually active population. The sensitivity of model predictions to various assumptions and parameter assignments is examined. Numerical studies of model behaviour focus on the influence of changes in the magnitudes of the transmission parameters, associated with three periods of infectiousness during the incubation period of acquired immune deficiency syndrome (AIDS), on the magnitude and duration of the epidemic and on the level of the endemic equilibrium state. Predicted temporal trends in the incidence of AIDS are shown to be particularly sensitive to changes in the intensities and durations of the stages of infectiousness. Most of the paper addresses the influence of changes in sexual behaviour on the magnitude and duration of the epidemic. Numerical simulations show that the manner in which behavioural changes occur and who is influenced by such changes (i.e. infecteds or susceptibles, the sexually active population or new recruits to this population) have a major impact on the future timecourse of the epidemic. The greatest reduction in the incidence of AIDS over the coming decades is induced by changes in the rate of sexual-partner change among the sexually active population, particularly those currently infected. The time periods at which changes in behaviour occur, in relation to the starting point of the epidemic (assumed to be 1979), are also of particular significance to the future pattern of the incidence of disease and infection. Changes in behaviour early on in the timecourse of the epidemic have a much greater impact than equivalent changes at latter time points. On the basis of limited data on the pattern of change in sexual behaviour among the male homosexual community in the U.K., numerical studies of model behaviour tentatively suggest that the epidemic is at, or near to, a period of peak incidence of the disease AIDS. Analyses suggest that, following the peak in incidence, there will be a period of slow decline over many decades provided recent changes in behaviour are maintained in the coming years.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1995

Determinants of high-grade dysplasia among women with mild dyskaryosis on cervical smear.

OBJECTIVE: To identify the epidemiologic characteristics of women who have mild dyskaryosis on cervical smear but cervical intraepithelial neoplasia (CIN) grade II or III at biopsy. METHODS: We analyzed information from 291 women (median age 33 years, range 17-69) observed for the first time with a single smear test showing mild dyskaryosis. All subjects underwent colposcopy, and histologic confirmation was obtained by biopsy. We compared the characteristics of women who had CIN I or no evidence of CIN with those of women with CIN II or III at biopsy. RESULTS: Twenty-eight women (10%) had CIN I at biopsy, 46 (15%) CIN II, and 23 (8%) CIN III. The frequency of CIN II or III tended to decrease with increasing education; compared with women reporting 11 or fewer years of education, the multivariate odds ratios (OR) of CIN II or III lesions was 0.5 (95% confidence interval [CI] 0.3-0.9) in those reporting 11 years of education or more. Compared with nulliparas, the OR of CIN II or III was 1.8 (95% CI 1.1-3.5) for parous women. Furthermore, compared with never-smokers, the OR of CIN II or III was 2.3 (95% CI 1.0-5.4) for current smokers. Ex-smokers were at increased risk, too; the estimated multivariate OR was 3.8 (95% CI 1.9-7.6). Compared with women reporting one sexual partner, the multivariate ORs of CIN II or III were 1.4 and 2.3 for women reporting two to three or four or more sexual partners, respectively (chi 2(1) trend = 6.65, P < .05). CONCLUSION: Our results show that smoking is a risk indicator of CIN II or III in women with a single smear showing mild dyskaryosis. Parous women, those of low social standing, and those reporting multiple sexual partners also are at increased risk of CIN II or III.

Adolescent↗
PubMed1993

Factors associated with human papillomavirus infection in women encountered in community-based offices.

OBJECTIVE: To assess risk factors for cervical human papillomavirus (HPV) infection in women presenting to community-based offices because of vaginal symptoms or for preventive screening. DESIGN: Cross-sectional analysis of history, physical examination, and microbiological infection variables. SETTING: Two community-based family practice offices in southeastern Michigan. PATIENTS: Two hundred seventy-three women, 18 to 50 years of age, presenting to the study sites because of vaginal symptoms or for a pelvic examination for preventive screening. MAIN OUTCOME MEASURE: Human papillomavirus infection of the uterine cervix as determined by polymerase chain reaction testing. RESULTS: Human papillomavirus infection was detected in 21.2% of the women (24.9% and 13.1% of women with and without vaginal symptoms, respectively); 34% of these infections were HPV types 16 or 18. Fifty-four percent of the women with HPV infection who underwent colposcopy had condyloma or cervical intraepithelial neoplasia verified on biopsy. Independent associations were found between HPV infection and the following female risk factors: the presence of vaginal itching, odor, or swelling; knowing the current sexual partner less than 24 months; age less than 40 years; household income of $14,000 or less; and ever having had six or more sexual partners. CONCLUSIONS: In addition to three previously described risk factors for genital HPV infection, two previously unrecognized risk factors were identified in this lower-risk population. These risk factors included the presence of vaginal symptoms of itching, odor, or swelling and having known the current sexual partner less than 24 months. Nevertheless, using risk factors alone, two thirds of the women infected with HPV in this population were not identified as being at high risk of infection. No subset of sexually active women was identified who were at no risk of HPV infection.

Adolescent↗
PubMed2000

Associations of sociodemographic, psychosocial, and behavioral factors with sexual risk and sexually transmitted diseases in teen clinic patients.

PURPOSE: To examine the influence of sociodemographic characteristics, sexually transmitted disease (STD)/human immunodeficiency virus knowledge, and psychosocial and behavioral risk factors on sexual risk and STDs in adolescents using constructs from the Information, Motivation, and Behavioral Skills model (IMB). METHODS: A convenience sample of 303 sexually experienced, racially diverse adolescents (mean age 16.7 years, 57.9% female) who were seeking health care at a general health maintenance organization teen clinic were recruited for the study and completed a self-reported questionnaire which assessed sociodemographic, knowledge, and psychosocial factors, risk behaviors, and history of STDs. Multiple regression analyses were used to assess factors associated with sexual risk behavior and STD history. RESULTS: Many of the study participants were at risk for STDs; 43.8% had four or more lifetime sexual partners, 62.8% did not consistently use condoms, 21.1% had a history of pregnancy or impregnation, and 28.2% had a history of STDs. A multiple linear regression model to assess factors associated with sexual risk behavior (a nine-item index) indicate that perceptions of higher STD risk, perceptions that friends engage in risk behaviors, perceptions that friends will not support their STD risk-reduction efforts, knowing someone of a similar age who has had an STD, and having no intention of using condoms in the future are significantly associated with sexual behavioral risk (R(2) =.22, p <.000). A logistic regression model to examine history of STDs reveals that teens who are female, African-American, frequently use marijuana, have an older steady sexual partner, have a history of pregnancy or impregnation, have a greater number of lifetime sexual partners, and perceive that monogamy will not decrease STD risk are significantly more likely to report a history of STDs. CONCLUSIONS: Sociodemographic factors and constructs of the IMB model are associated with adolescents' risk and acquisition of STDs. Teens with such risk profiles should be targeted for risk-reduction intervention.

Adolescent↗
PubMed2006

General practitioners' perception of risk factors for cervical cancer development: consequences for patient education.

OBJECTIVE: The introduction of human papillomavirus (HPV) detection in cervical screening will make it necessary to provide appropriate information to the general public. Only 3% of Flemish women could name HPV as the viral agent involved in cervical cancer development. The aim of this study was to investigate whether general practitioners (GPs) have appropriate knowledge of the relationship between HPV and cervical cancer to be able to inform women. METHODS: A questionnaire was developed to measure perception of 20 risk factors for cervical cancer development, on a scale of 1 (unimportant) to 5 (very important). Respondents were also asked to give an estimate of the chances of survival for women, diagnosed with cervical cancer detected by screening. RESULTS: Sixty GPs and 28 trainees filled in the questionnaire. The five most important risk factors in the perception of the respondents were, in order of decreasing importance, viral infection, number of sex partners, sexual behaviour of the partner, unsafe sex, and early start of sexual activity. Fifty-six percent of the GPs expected the chance of survival to be between 80 and 100%, compared to only 31% of the trainees. CONCLUSION: Most GPs are well aware of sexual habits as risk factors for cervical cancer development, including the role of HPV as the viral agent in the etiology. However, they seem to underestimate the role of smoking and are unable to identify the correct chance of survival for women in whom cervical cancer is detected within the frame of the cervical smear program. PRACTICE IMPLICATIONS: Attention should be given to education of medical students and practitioners, in order to allow them to supply patients with sufficient background information to make an informed choice on participating in cervical cancer screening.

Attitude of Health Personnel↗
PubMed2003

Enhanced feminine sexual behavior and infertility in female rats prenatally treated with an antiestrogen.

An attempt to elucidate the possible role of prenatal estrogen on the development of feminine sexual behavior and reproductive function was made by treating females with the antiestrogen CI628 prenatally on days 13-19. Control females were prenatally treated with saline or remained untreated. The animals were delivered by caesarian section on day 22 of pregnancy and placed with foster mothers whose newborn pups had been previously removed. Intact peripubertal females in each treatment group were observed for several reproductive measures, including the capacity to become pregnant. Other females were ovariectomized in adulthood and treated with estradiol benzoate (EB) (1, 1.5, 2 or 4 micro g/rat) and 0.5 mg progesterone and tested for receptivity, proceptivity and sexual partner preference. Two weeks after the completion of these tests, the females were injected daily for 7 days with 0.25 mg testosterone and tested for sexual partner preference and mounting behavior. The results obtained showed accelerated vaginal opening, and infertility in the antiestrogen-treated intact females and enhanced receptivity and proceptivity in response to 1 micro g EB in the antiestrogen ovariectomized females. Sexual partner preference and mounting behavior did not differ between groups. These results suggest an involvement of prenatal estrogen on the development of female reproductive function, but not on behavioral differentiation.

Animals↗