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Chlamydia trachomatis urethritis in university men: risk factors and rates.

This study reports the rates of Chlamydia trachomatis genital infection in two groups of university men. One hundred twenty-seven came to the student health center with genitourinary complaints, and 29 were identified as the sexual partners of women with chlamydia infections. Evidence of chlamydial infection was found in 29 (22.8 percent) of those presenting with complaints and in 6 (20.7 percent) who were contacts of chlamydia-infected women. Comparison of all symptomatic patients with sexually active controls without genitourinary complaints showed that the symptomatic patients had significantly more frequent exposures to different sexual partners and that they, or their partners, were more likely to have had a sexually transmitted disease. Chlamydial urethritis was significantly more frequent than "nonspecific" urethritis in symptomatic patients who claimed membership in a campus fraternity (P = 0.004). Complaints more likely to be noted with chlamydia included itching (P = 0.004), burning on urination (P = 0.0325), and purulent discharge (P = 0.036).

Adult↗

Prevalence and risk factors for lifetime exposure to Pap smear abnormalities in the Australian community.

BACKGROUND: This study examined the prevalence, correlates and consequences of abnormal Pap smears in a population-based survey of sexuality and health in the Australian community. METHODS: Cross-sectional telephone survey of 908 women aged 18-59 years randomly selected from the Commonwealth electoral roll. RESULTS: Most women (91%) reported having had at least one Pap smear test, a figure directly comparable with national estimates. Being single (prevalence ratio (PR) 4.61; 95% CI 2.09-10.17) and not having had sexual intercourse (PR 5.31, 95% CI 3.11-9.07) were strong predictors of never having been tested. One in four women (26%) who reported being screened also reported having had an abnormal Pap smear result, of whom 66% said they had further testing and 52% some form of treatment. A minority (19%) reported negative effects of treatment on their sex lives. Having been diagnosed with human papillomavirus (HPV) (PR 2.87, 95% CI 1.84-4.48), and to a lesser degree, having had a greater number of male sexual partners (PR 1.38, 95% CI 1.01-1.89), and experiencing sexual problems in the last year (PR 0.99, 95% CI 0.99-1.88) were independently associated with reporting of abnormal Pap smear results. CONCLUSIONS: Approximately one in four women self report lifetime exposure to Pap smear abnormalities. It is important that women are well prepared for this common experience. A causal association between multiple sexual partners and risk of acquiring HPV infection is supported by these data.

Adolescent↗

Prevalence of Chlamydia trachomatis infection among 'high risk' young people in New South Wales.

International research on homeless adolescents has found that incidence and prevalence of sexually transmissible infections is relatively high. This study reports on a chlamydia prevalence survey conducted among high-risk young people (14-25 years) in New South Wales. The participants were recruited from youth health centres, which target homeless and high-risk youth. Of 333 clients (42.6% male), 84.1% were sexually active and mean number of sexual partners over the preceding 3 months was 1.4. Among sexually active participants, 24.6% claimed to use condoms always and 25% never. Sixteen of 274 available urine samples tested positive for Chlamydia trachomatis infection. Further research is warranted to better define high-risk groups and clarify the nature of associations between various factors impacting on sexual health. Most importantly, research is now called for into effective strategies for engaging and attracting young people to screening, treatment and contact tracing.

Adolescent↗

HIV/AIDS prevalence among male patients in Kuwait.

OBJECTIVE: To determine the prevalence of human immunodeficiency virus infection among male patients with sexually transmitted disease in Kuwait with emphasis on the type of sexually transmitted diseases and sexual partners. METHODS: A sentinel surveillance was conducted among male sexually transmitted disease patients, randomly selected among all new sexually transmitted disease patients who visited the Family Planning Clinic during June 1996 to June 1997. The patient data was recorded by the attending physician on a specially designed questionnaire. RESULTS: A total of 1984 subjects were screened, out of which not a single human immunodeficiency virus/acquired immunodeficiency syndrome case was found. Among the screened, 69% were non-Kuwaitis. Most of the subjects (76%) belonged to the age group 15-34 years, were married (53%), were illiterate (37.5%) and belonged to the low SES group (70%). The most common sexually transmitted diseases were non-specific urethritis (45%) and gonorrhea (42%). With regard to sexual practices, the majority of the respondents showed preference for female prostitutes, both inside (50%) and outside (48%) Kuwait. CONCLUSION: The absence of any human immuno-deficiency virus positive case was probably due to the mandatory screening for granting residency in Kuwait, facilitating early detection of virus carriers among non-Kuwaitis. We, as researchers, are not sure if this study is true representation of human immunodeficiency virus/acquired immunodeficiency syndrome prevalence among Kuwaiti sexually transmitted disease patients in this country who might seek treatment in private clinics. Moreover, the absence of prostitution as professional trade also tends to show the absence of indigenous circulation of the virus. Nevertheless, continuous surveillance is necessary to maintain and prevent the groups with risky behaviors from contracting the virus through sexual transmission. There is a distinct need to develop public education and awareness programs to serve as measures of prevention and protection.

Acquired Immunodeficiency Syndrome↗

[Study of HIV seroprevalence in patients with pulmonary tuberculosis in 1999 in Chad].

Tuberculosis is the most common opportunistic disease occurring in the course of human immunodeficiency virus (HIV) infection. With the development of HIV infection in Chad, tuberculosis has quickly become a major public health concern. The purpose of this cross-sectional study in two tuberculosis centres (Moundou and Ndjamena) was to evaluate HIV seroprevalence, epidemiological characteristics and risk factors in patients with tuberculosis. All patients with positive sputum-smears who had never been treated for tuberculosis previously were eligible. A total of 466 patients (sex ratio M/F: 1.96) were included during the six-month period between January and June 99. Each subject was asked to fill out an anonymous standardized questionnaire with detailed information on demographic characteristics, sexual behavior and other risk factors for HIV infection. Data were compared using the Chi-square test, Student's T test and multivariate analysis (logistic regression). One third (33.2%) of patients was seropositive for HIV-1. Mean age was 31.1 years in HIV-positive group and 33.6 years in the HIV-negative group (p = 0.02). The age groups with the highest risk for HIV were 20-29 years and 30-39 years (p < 0.01). Women were more often seropositive that men (39.5% versus 30.1%; p = 0.04). Seropositive patients were more likely to have multiple sexual partners (mean: 1.76; p < 0.01) and a history of sexually transmitted disease (19.9% versus 8.1%; p = 0.01). The mean age at the time of first sexual relations was 16.3 years in the HIV group and 17.1 years in the control (p < 0.01). The percentage of seropositive patients was 39.6% at Moundou and 29.8% at N'djamena (p > 0.01). Multivariate analysis showed that early age of first sex relation (OR = 0.85; 95% IC: 0.74-0.97), higher number of sexual partners (OR = 1.8; 95% CI: 1.4-2.4) and level of education were strongly correlated with HIV infection. The prevalence of HIV in tuberculosis patients is a good indicator of HIV-infection in developing countries. Prevalence of HIV infection is high in tuberculosis patients in Chad. Surveillance for tuberculosis and AIDS must be strengthened in Chad. Mores cooperation is needed between tuberculosis and AIDS control programs. Emphasis should be placed on screening for tuberculosis, early tuberculosis treatment and diagnosis of HIV in tuberculosis patients.

Adolescent↗

A method for estimating HIV transmission rates among female sex partners of male intravenous drug users.

There are few data available on the dynamics of heterosexual human immunodeficiency virus (HIV) transmission among women whose only risk factor is sexual contact with intravenous drug-using males. Unlike models which rely on unconfirmed estimates regarding sexual partner selectivity and contact rates between infected and uninfected populations, data from a survey conducted between November 1988 and February 1989 of 1,842 women in New York City provide empirical values for these variables which the authors use in a straightforward estimation model. The authors estimate that the number of new infections among women aged 15-44 years in New York City during 1988 was between 876 and 1,668 and that the number of women already infected through heterosexual contact with male intravenous drug users is between 5,390 and 10,230 among the 1,844,285 women in this age group. These conclusions indicate that male-to-female transmission in New York City is of substantial magnitude and that prevention efforts among male intravenous drug users and their female sexual partners must be appropriately directed.

Adolescent↗

Smoking and invasive cervical cancer risk. Results from a case-control study.

The association between cigarette smoking and risk of invasive cervical cancer was investigated in a case-control study conducted in four hospitals in Leipzig, German Democratic Republic in 1983-1985. Analyses were based on 225 women aged 64 years or younger with newly diagnosed invasive cervical cancer and 435 age-matched controls with orthopedic or skin diseases. The crude relative risk of invasive cervical cancer was significantly elevated for women who had ever smoked (relative risk (RR) = 1.5, 95% confidence interval (CI) = 1.1-2.1). Adjustment for number of sexual partners reduced the risk to RR = 1.2 (95% CI = 0.8-1.6). Furthermore, the risk for smokers depended significantly on number of sexual partners (p less than 0.05) and was increased only among women with no partner or one partner (RR = 2.7, 95% CI = 1.2-6.1).

Adult↗

Manifestations of anogenital HPV infection in the male partners of women with anogenital warts and/or abnormal cervical smears.

The prevalence and manifestations of anogenital human papillomavirus (HPV) infection in 154 men, all of whom were the sexual partners of women with either overt anogenital warts or cervical HPV-related abnormalities, were assessed using clinical, histopathological and molecular criteria. Detailed examination of the anogenital region using a colposcope was supplemented by the use of 5% acetic acid to detect possible foci of subclinical HPV infection. Biopsies of warts and aceto-white lesions were examined histopathologically and by HPV DNA hybridization using radiolabelled HPV 6/11 and 16/18 DNA probes. More than two-thirds of the men had clinical indications of genital HPV infection: 37% had apparent macroscopic warts, almost invariably in combination with aceto-white lesions; while 34% had aceto-white lesions only. The overwhelming majority of these lesions (92%) were located on the penis only. However, only 49% of the macroscopic and 29% of the aceto-white lesions showed histological features consistent with a conclusive diagnosis of HPV infection; while the corresponding figures for HPV DNA positivity were 72% and 56% respectively. Current HPV infection was strongly associated with a past history of anogenital warts, but there was little or no correlation between the manifestations of HPV infection in the male and female sexual partners.

Adult↗

Psychosocial, behavioral, and cultural predictors of sexual risk for HIV infection among Latino men who have sex with men.

This study sought to replicate and extend an investigation by Diaz et al. (1999) on determinants of HIV risk among Latino gay and bisexual men living in San Francisco who were predominantly English-speaking. Compared to the Diaz et al. study, the current study sample consisted of predominantly Spanish-speaking MSM, who resided outside of HIV/AIDS epicenters and whose countries of origin were primarily Central & South American. The relationships of unprotected anal sex and multiple sexual partners with demographic, developmental, behavioral, cultural and psychosocial variables were examined. Data were collected in a convenience sample of 250 participants (primarily immigrants from El Salvador) residing in Virginia. Most men in the sample had more than one sexual partner in the last 3 months (62%) and more than a third had unprotected anal sex with a casual partner in the same time period. Communication about HIV, sexual attraction, machismo, and experiences of discrimination based on homosexual behavior were predictive of HIV risk behaviors. The findings support an integrative approach to investigating HIV risk among Latino MSM. Implications for prevention programs are discussed.

Adult↗

The impact of AIDS in a rural Ugandan community.

Three AIDS related surveys have been conducted on a community based cohort in the Kasangati defined area, Uganda, during 1987, 1990 and 1992. The 1987 baseline survey recruited 1990 adults, and in addition to assessing levels of knowledge, attitudes and practices, HIV serology was done on all the study participants. During the 1992 survey, our objectives were threefold: (i) to assess the attitudes and behaviours relevant to AIDS and to evaluate the magnitude of any changes since 1987, (ii) to assess the socioeconomic impact of AIDS and, (iii) to assess the effect of AIDS on the mortality trends in the area. It was found that the percentage of people who had ever used a condom increased from 4% in 1987 to 10% in 1992, but those who used condoms frequently remained the same at 1%. Sexual partner change was measured over a six month period and the percentage of people who had two or more sexual partners in this period was found to be 7% in 1992 compared to 26.4% in 1987. The five year mortality rate among the persons initially HIV positive was 44.7% compared to 8.7% among those initially sero-negative. AIDS has substantially increased the mortality rate in this community leading to reduced incomes for the families of persons dying from the disease, increased expenditure on medical treatment, and a new breed of orphans. The overall five year mortality rate was 10.6% (128/1204) but if the persons reported to have died from AIDS are excluded it is only 6.1% (73/1204).

Adult↗

[Contribution to the understanding of the sexuality of partners of people with permanent colostomy].

The general purpose of the present investigation was to describe the sexual interactions involving colostomized individuals, aiming at understanding this experience. The authors aimed also at identifying the mode regarding sexual procedures used by colostomized individuals and the possible effects of colostomy on these procedures. Therefore, a semi-structured interview, recorded or not, was applied to partners of colostomized subjects. The interviews were transcribed and analyzed according to the content analysis technique. Authors divided the results in 39 subcategories with 4.361 speech units that were gathered in three main categories. The category I "Precedence of the crisis" included 4 subcategories with 113 (36.67%) speech units. The category II "Crisis" comprised 17 subcategories with 1599 (36.67%) speech units and Category III "Crisis' Results" comprehended 18 subcategories with 2649 (60.74%) speech units. Data were validated by an expert on content analysis and the conclusion was that the main concern of health professionals is to keep subjects with a definitive colostomy alive, providing orientations focussing on the stoma, its care and gastrointestinal function. The speech of partners showed a clear presence of post-crisis results, representing a great danger to their general and sexual integrity and to their general and sexual adaptation on a short, medium and long-term basis.

Colostomy↗

Documented male-to-female transmission of HIV-1 after minimal vaginal exposure in the absence of other cofactors for infection.

AIDS cases attributable to heterosexual vaginal intercourse constitute a growing proportion of new AIDS cases in the United States. Major cofactors that possibly increase the efficiency of heterosexual transmission of HIV-1 include genital ulcer disease, multiple sexual exposures, lack of male circumcision, and primary and advanced stages of HIV-1 disease. I report the case of a 33-year-old woman who was recently infected with HIV-1 after one to three nontraumatic episodes of vaginal intercourse with a healthy-appearing, HIV-1-infected, bisexual man. An investigation of her exposure history revealed the precise time frame during which infection occurred. The patient developed a primary HIV-1-infection syndrome and became seropositive for HIV-1 within eight weeks of her last sexual contact with the infected man. An epidemiological and laboratory evaluation of the index patient and her sexual partner identified only one risk factor for enhanced HIV-1 transmission: the patient's use of oral contraceptives. Her partner was immunologically intact, HIV-1 antigen negative, and circumcised. Both of the individuals were from Minnesota, as were their recent sexual partners. This case illustrates that HIV-1 infection by vaginal intercourse can occur in the absence of the major risk factors believed to increase the efficiency of transmission. Even in a low HIV-1 prevalence area like Minnesota, efforts to promote awareness of HIV-1 status, abstinence, non-penetrative sex, or barrier protection need to be expanded and the behaviors adopted by sexually active persons if HIV-1 transmission is to be minimized.

Adult↗

Injecting and sexual risk-taking behaviour among regular amphetamine users.

A sample of 301 regular amphetamine users were interviewed regarding injecting and sexual risk-taking behaviours. Two-thirds of subjects were injecting the drug, with males being 1.8 times more likely to do so. Nearly half (41%) of injectors had shared injecting equipment in the preceding month. Females were twice as likely as males to report recent needle sharing. Having a regular sexual partner who injects amphetamines, using benzodiazepines and experiencing higher levels of psychopathology were independently associated with needle sharing. The number of sexual partners in the preceding six months was independently associated with having had paid sex in that period, and higher levels of polydrug use.

Adolescent↗

[The forms and analysis of the results of work in preventing HIV infection among youth].

Specialists of the AIDS Centre distributed questionnaires, specially developed by them, among a group of students of the Pedagogical University. The questionnaire contained 35 questions; of these, 21 questions were intended to find out what information on HIV infection and AIDS the students had and 14 questions dealt with their sexual history and their attitude to the problem. The answers to the questionnaires distributed among 100 students (68% were females and 32% were males) showed that 58% of the respondents had previous sexual experience. 68.5% of the respondents had sexual intercourse after taking alcohol, 7.4% always used condoms, 38.8% seldom and 53.7% never used condoms. The behavior of 68.8% of the respondents was not influenced by information on HIV infection they received, 16% reduced the number of casual sexual partners, 8.6% started using condoms, 6.5% reduced the number of sexual partners.

Adolescent↗

The relationship between psychosocial factors and condom use among African-American adolescents.

The present investigation explored the relationship between psychosocial factors and condom use by African-American adolescents. Two hundred twenty-nine males, aged 14 to 19 years, responded to a health behavior survey that gathered information on demographics, HIV knowledge, perceived certainty of future condom use, present and past use of condoms, and intention to use condoms in the next six months. Several psychological variables, including sexual self-efficacy and self-esteem, were also measured. It was found that the majority of participants were sexually active by age 13, had four or more lifetime sexual partners, and were using condoms regularly. Multiple linear regression analysis indicated that sexual self-efficacy predicted perceived certainty of condom use. In addition, self-esteem and sexual self-efficacy predicted intention to use condoms. These findings highlight the need to develop HIV prevention curricula for African-American male adolescents that not only emphasize the potential risks associated with having multiple sexual partners, but also include components to enhance self-worth and sexual self-efficacy.

Adolescent↗

The relationship between source of sexual information and sexual behavior among female adolescents.

INTRODUCTION: The relationship between the source of sexual information and adolescent sexual behavior is not well understood. MATERIALS AND METHODS: As part of a larger study, 892 sexually active female adolescents between 15 and 18 years of age completed a paper-and-pencil survey which assessed discussions about sexual intercourse, contraceptive use and condom use among friends and family members and their own sexual behavior. Multivariate logistic regression analyses were performed to examine associations while controlling for key demographics. RESULTS: Adolescents who had never used condoms were less likely to report having had discussions about sexual intercourse with their friends [adjusted odds ratio (AOR) = 0.2]. Discussions about condom use among friends and family members were associated with condom use in the past 3 months, with adolescents who used condoms at least half of the time being more likely to report hearing discussions relative to adolescents who never used condoms (AORs 2.0-3.8). Furthermore, the number of sexual partners was related to whether the adolescent had heard discussions among her family about condom use; the higher the number of sexual partners, the more likely the adolescent was to have heard discussions. For adolescents reporting 2-3, 4-5 and 6 or more partners (relative to one partner), the AORs were 1.7, 2.3 and 2.7, respectively. DISCUSSION: Adolescents exposed to information about condom use among the primary individuals in their lives are more likely to be engaging in this behavior themselves.

Adolescent↗

Role of sexual and non-sexual practices in the transmission of hepatitis B.

Medical, social, and sexual histories were taken from 198 men attending a department for sexually transmitted diseases. Their blood was tested for hepatitis B surface antigen and its antibody, and also for syphilis and liver function. Infection with hepatitis B virus was found to be common among practising homosexuals and to occur much more frequently in them than in heterosexuals. Hepatitis B appeared to be transmitted sexually rather than by other means, but it was not possible in this study to link its transmission with any particular homosexual practice. However, risk of infection increased considerably with the number of sexual partners and nearly half of those with more than 40 sexual partners had been infected.

Hepatitis B↗

Importance of human papillomavirus endemicity in the incidence of cervical cancer: an extension of the hypothesis on sexual behavior.

The risk of cervical cancer for a woman depends largely on the probability of being infected with some specific types of Human Papillomavirus (HPV). In the control groups of four case-control studies in Colombia and Spain we have shown a strong correlation between the number of sexual partners of males and females and HPV DNA prevalence in the genital tract. Our results suggest that the lifetime number of sexual partners in both sexes are surrogates of the probability of HPV infection and, as such, insufficiently explain the geographical variation in the incidence of cervical cancer. It is proposed that the high rates of cervical cancer in Latin America are linked to the largely unknown characteristics of the HPV endemicity in the population and to the absence of widespread screening for cervical neoplasia. Reliable surveys on the HPV prevalences in selected social groups (i.e., young males and prostitutes) as well as in populations in countries at different risk of cervical cancer are required.

Adult↗