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PubMed1999

Risk factors for high-risk type human papillomavirus infection among Mexican-American women.

Minority women in the United States experience a disproportionately high burden of the more than 2 million yearly cases of squamous intraepithelial lesions of the cervix. Risk factors for squamous intraepithelial lesions of the cervix are infection with the sexually acquired human papillomavirus (HPV), an early age at first intercourse, history of multiple sexual partners, oral contraceptive use, high parity, lower socioeconomic status, poor diet, immunosuppression, and promiscuous male sexual partners. Although Hispanics are the largest growing minority population in the United States, few HPV risk factor studies have either included or focused on Hispanics in the United States. To determine risk factors for HPV infection among Mexican-American women, we conducted a cross-sectional study from 1992-1995. Nine hundred and seventy-one women, 18-47 years of age, with cytology results were included in this analysis. Overall, 13.2% of participants were HPV positive by the Hybrid Capture tube method for high-risk types 16, 18, 31, 33, 35, 45, 51, 52, or 56. Age [adjusted odds ratio (AOR) = 0.3 for ages >36 years compared with ages 18-20] and duration of oral contraceptive use (AOR = 0.4 for > or =4 years relative to nonusers) were inversely associated with these high-risk types of HPV infection. Marital status (AOR = 1.9 among single women compared with married) and lifetime number of sexual partners (AOR = 2.3 for women > or =5 partners relative to monogamous women) were positively associated with an increased risk. Participants born in Mexico were significantly (P < 0.05) older, had fewer sex partners, and older age at first intercourse. Despite this lower behavioral risk profile, women born in Mexico were significantly more likely (AOR = 1.9; CI = 1.2-3.2) to have an HPV infection compared with United States-born, Mexican-American women after adjustment for potential confounders. Collectively, these results suggest that an unmeasured factor, such as the sexual behavior of the male partner, may be influencing HPV risk. Further research is needed to define this factor and to assess cultural norms of sexual behavior.

Adolescent↗
PubMed1999

Treating vaginitis.

Vaginitis resulting from bacterial, fungal, or protozoal infections can be associated with altered vaginal discharge, odor, pruritus, vulvovaginal irritation, dysuria, or dyspareunia, depending on the type of infection. Bacterial vaginosis, which is primarily characterized by a malodorous discharge, is common in women with multiple sex partners and is caused by the overgrowth of several facultative and anaerobic bacterial species. Vulvovaginal candidiasis is characterized by pruritus and a cottage cheese-like discharge. Vaginal trichomoniasis, a sexually transmitted disease caused by an anaerobic protozoan parasite, is associated with a copious yellow or green, sometimes frothy, discharge. Differential diagnosis of these infections requires a thorough history, vulvovaginal examination, and simple laboratory tests, including microscopy of the vaginal discharge. The information obtained from this workup should enable an accurate diagnosis. Topical or oral metronidazole is the treatment of choice for bacterial vaginosis; terconazole, or other antifungals, for vulvovaginal candidiasis; and oral metronidazole for trichomoniasis.

Candidiasis, Vulvovaginal↗
PubMedDate not supplied

Socio-demographic characteristics and sexual behaviour of adolescents attending the STC, UCH, Ibadan: a 5 year review.

As a continuation of the on-going efforts to prevent and control the spread of sexually transmitted diseases (STDs) and the Acquired Immunodeficiency Syndrome (AIDS) in adolescents, this retrospective clinic-based study identifies the socio- demographic characteristics, describes the sexual practices, identifies the common STDs, including drug utilization patterns in this risk group at the special treatment clinic of the University College Hospital, Ibadan. Results reveal that adolescents constituted between 3.3% and 4.8% of the total number of patients seen each year. The characteristics of the subjects were as follows: 54 (38.3%) were aged 19 years, 133 (94.3%) were single, 79 (53.2%) were females and 103 (73.0%) were students. As regards sexual behaviour, 22 (15.71%) denied previous history of sexual intercourse. Vaginal intercourse was reported in all the sexually active youth, 2(1.71%) reported oral sex, while 10 (8.41%) admitted that they had multiple sexual partners. Gonorrhoea was diagnosed in 23 (21.51%) of sexually active youths. Among those who had used drugs before presentation ampicillin was the common drug used for treatment by 14 (26.4%). The importance of encouraging adolescents to present at STD clinics is highlighted. Health workers need to have a sympathetic attitude and assure them of confidentiality. The need for more community-based education is shown, including the importance of proper and complete documentation of hospital records.

Adolescent↗
PubMed1999

Prevalence of communicable disease among restaurant workers along a highway in Assam, India.

105 workers of 29 roadside restaurants along a highway in Assam were interviewed for their habits, educational status and were examined for their hygienic status and presence of communicable diseases (STDs,TB etc). Most of them were young, males with 40% literacy; more than half were unmarried. About 30% of them were alcoholic and smokers and 2.9% were addicted to cannabis. The hygienic conditions of the workers were poor. More than one third had sexual contact with multiple sex partners or commercial sex workers and 2% were engaged in homosexual activity. Most of them did not use condom. 25.7% of them had genital lesions suggestive of sexually transmitted disease, 11.8% showed gram negative diplococci in urethral smears and 5.1% were VDRL reactive. Skin infections followed by gastrointestinal disorders and respiratory tract infections were other prevalent problems. 70.6% were positive for intestinal parasites and 22.2% were sputum positive for acid fast bacilli. However all the collected blood samples were negative for HIV.

Adult↗
PubMed2000

Alcohol policy and sexually transmitted disease rates--United States, 1981-1995.

In the United States, adolescents and young adults are at higher risk for acquiring sexually transmitted diseases (STDs) than older adults. In addition, young persons who drink alcohol may be more likely than persons who abstain to participate in high-risk sexual activity, such as unprotected sexual intercourse or multiple sexual partners. If alcohol consumption promotes risky sexual behavior (disinhibition caused by the effects of alcohol), state government alcohol policies, such as alcohol taxation and minimum legal drinking age requirements, might reduce STD incidence among adolescents and young adults. Higher alcohol taxes and increases in the minimum legal drinking age have been associated with lower incidences of adverse alcohol-related health outcomes (e.g., motor-vehicle crash-related deaths, liver cirrhosis, suicide, and violent crime, including domestic violence). This report summarizes the findings of a study that suggest higher alcohol taxes and higher minimum legal drinking ages are associated with lower STD incidence among certain age groups.

Adolescent↗
PubMed2000

[Effect of oral contraceptive administration on the frequency of estrogen receptor and cervical intraepithelial neoplasia].

A study of 56 sexual active women with cervical intraepithelial neoplasia (CIN) was conducted in Mexico City, to determine wether the risk for this condition is altered by using oral contraceptives. Responses of a standardized questionnaire compared 29 patients under oral contraceptive (OC) treatment and 27 control subjects selected from the same screening program, though which the cases were detected. Estrogen receptor (ER) levels were determined in each hyperplastic tissue. The ER frequency was approximately the same in women under oral contraceptive (OC) treatment and in women without it. (P > 0.05). Among other risk factors, first intercourse at an early age, first pregnancy age, number of pregnancies and multiple sexual partners were consistently no significant (p > 0.05) when both groups were compared. In this study, we have found no evidence of an etiologic relationship between neither oral contraceptive usage or non usage and CIN.

Adolescent↗
PubMedDate not supplied

Prevalence of hepatitis C virus infection at three hemodialysis units in the western region of Puerto Rico.

OBJECTIVE: In the United States hepatitis C virus infection (HCV) affects approximately 20 percent of hemodialysis patients but its prevalence in Puerto Rico has not been established. We have sought to determine the prevalence of HCV infection in a homogeneous sample of patients on hemodialysis in the western region of Puerto Rico and to identify its risks factors. METHODS: All patients in the hemodialysis units of Aguadilla, Mayagüez and San Germán, during December 1997 to March 1998, completed a written questionnaire in which they were asked about transfusions, multiple sexual partners, i.v. drugs use, tattooing, occupation, imprisonment, organ transplantation and years on hemodialysis. Serum samples were analysed for HCV antibodies by an enzyme-linked immunoadsorbent assay (ELISA). Sera with positive results for HCV were subjected to a confirmatory test by the polymerase chain reaction (PCR). RESULTS: Thirteen of the 376 (3%) subjects had a positive ELISA (one patient died prior the confirmatory test with PCR). Six out of the twelve patients had a positive PCR. Two had been transfused. Three were illicit i.v. drug users and one had received a renal transplant. The liver biopsies in all patients showed chronic hepatitis and in two there was cirrhosis. CONCLUSIONS: Our prevalence was two percent. As reported elsewhere blood transfusion, organ transplantation and illicit i.v. drug abuse were the major risk factors for HCV infection in our patients. Nosocomial factors were irrelevant in the results.

Hemodialysis Units, Hospital↗
PubMed2000

Effects of oral contraceptives in vaginal cytology.

Many literature studies have shown that long-term use of oral contraceptives (OC) is associated with lack of protection of the epithelium of the uterine cervix. Forty-five patients, from 18 to 35 years old, users of two contraceptive formulations, of different estrogenic concentration, took part in this study as volunteers to evaluate the predisposition of the cervix to pathologies. The results found before OC use were 11% of Chlamydia trachomatis infection and 13% of HPV infection. These pathologies were correctly treated and after 5 months of OC use we found total remission of Chlamydia trachomatis infection and 4% of persistent HPV infection. These data lead us to conclude that the OC studied here interfered very little with the presented pathologic results. The risk factors that we considered relevant were: 1) age group (the patients that presented HPV and C. trachomatis infections were young university students); 2) lifestyle (most patients certified that they did not combine the use of barrier contraceptives with the use of OC); 3) multiple sexual partners; 4) low socioeconomic condition.

Adult↗
PubMedDate not supplied

Adolescent sexual behavior: estimates and trends from four nationally representative surveys.

CONTEXT: Accurate information about trends over time in adolescent sexual behavior is essential to understand changes in adolescent pregnancy and sexually transmitted diseases and to monitor the progress of health promotion activities in the United States METHODS: Estimates from the National Survey of Family Growth (NSFG), the National Survey of Adolescent Males (NSAM), the Youth Risk Behavior Survey (YRBS) and the National Longitudinal Study of Adolescent Health (Add Health) were compared. While methodologies and populations varied by survey, adolescents aged 15-17 who attend high school were a common subpopulation among all four. For each survey, the prevalence of sexual intercourse, contraceptive use and multiple sexual partners was measured in this population. RESULTS: Trend comparisons fell into four categories. First, some similar significant trends were found across surveys. The proportion of all males and of white males who reported ever having had sexual intercourse decreased significantly, while condom use rose significantly among males in both the NSAM and the YRBS. For such behaviors as ever having had sexual intercourse (among Hispanic males and black females), using the pill and using the condom (among all females) and having four or more lifetime sexual partners (among white males), a significant trend was found in one survey while a similar but nonsignificant trend was found in another. Several trend comparisons were not significant in any survey. Finally, having had intercourse in the past three months (among all males and all females), having had two or more partners in the past three months (for males) and having had four or more lifetime sexual partners (among white females and all males) showed a significant trend in one survey but lacked a parallel nonsignificant trend in another. Prevalence estimates in 1995 differed significantly in at least one comparison of surveys for all behaviors except having four or more lifetime sexual partners (both genders) and having two or more recent sexual partners (females). Gender differences within the YRBS and between the NSFG and the NSAM generally were consistent. CONCLUSIONS: Trends over time and gender differences were similar across surveys, underscoring their value for tracking adolescent sexual behaviors. Differences in prevalence estimates across surveys probably result from differences in question wording, diverse interview settings and modes of data collection, and varying statistical power. These findings suggest a need to increase our understanding of how methodologies influence survey response in research on adolescents.

Adolescent↗
PubMed2000

Invasive and preinvasive cervical neoplasia in human immunodeficiency virus-infected women.

An association between human immunodeficiency virus (HIV) infection and cervical neoplasia in women has recently been recognized. Cervical cancer was designated as a diagnostic criteria for acquired immunodeficiency syndrome (AIDS) in HIV-infected women in 1993. The two conditions share a number of risk factors, including a history of multiple sexual partners and disproportionate effect on younger women and ethnic minorities. HIV appears to accelerate the pathogenesis of cervical neoplasia at the molecular level, although clinical evidence of disease progression is limited. The optimal strategy for screening HIV-infected women for cervical neoplasia is unclear, but should include at least an annual Papanicolaou (Pap) smear. Preinvasive cervical neoplasia in HIV-infected women should be treated with standard excisional/ ablative therapy, followed by vaginal 5-flourouracil cream. Invasive cervical cancer should be treated with standard surgical therapy or radiotherapy. Recurrence rates are high following treatment of either invasive or preinvasive disease, but are reduced in women undergoing highly active antiretroviral therapy.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Normative influence on condom use in the personal networks of female cocaine smokers.

Attitudes-norms research (the theories of planned behavior and reasoned action) has been successful in accounting for many types of behavior change. One of the strengths of this approach has been to combine individual beliefs and normative influences in the explanation of behavior change. However, the conceptualization of normative influence in these theories makes very strong assumptions about self-awareness in the selection of normative referents. These assumptions are particularly problematic when applied to female cocaine smokers, who report frequent sex while under duress or while cognitively impaired. In this study the original conceptualization of normative influence and two alternatives (assuming emotion-based and interaction-based selection of normative referents) are operationalized to evaluate stage of change for condom use among women who are heavy crack cocaine users with multiple sex partners. Results show that stage of change for use of condoms with nonmain partners is best accounted for by interaction-based selection of normative referents.

Adult↗
PubMed2000

Sexual activity and contraceptive use among female adolescents--a report from Port Harcourt, Nigeria.

Seven hundred and sixty-eight randomly selected single senior secondary school girls from Port Harcourt (mean age 16.32 years) were surveyed on aspects of sexual activity and contraceptive use. Two hundred and ten pregnancies (24 deliveries and 186 induced abortions) had occurred in 142 out of 605 girls (78.8%) who admitted being sexually exposed. The mean, modal and youngest ages of initiation into sexual activity were 15.04, 15 and 12 years respectively. At the time of the survey, 190 girls (24.7%) were sexually active and 74.2% of their male consorts were older working men, suggesting financial gains as a motive for the girls' sexual activity. Other findings were high awareness (72.4%) of the relationship between sexual activity and sexually transmitted diseases; a rather low level (56%) of knowledge of effective contraceptive methods, and limitation of contraceptive method use by sexually active girls, largely to the rhythm and withdrawal methods. Exposure to multiple sexual partners and a high level of parental approval of subjects' use of contraception were also present. In view of our findings, it is suggested that active efforts to promote sexuality education and contraceptive use should be intensified among Nigerian adolescents.

Abortion, Induced↗
PubMed2000

Adult vaccination, part 2: vaccines for persons at high risk. Teaching Immunization for Medical Education (TIME) Project.

The morbidity and mortality from vaccine-preventable diseases are high among adults with underlying medical conditions. Influenza vaccination is recommended annually, optimally between October and mid-November, for all persons 50 years of age and older and those with cardiac disease with potential for altered hemodynamics, diabetes mellitus, immunocompromising conditions, pulmonary disease, or renal disease. This season, because of production delays, influenza vaccination campaigns are planned for November. Pneumococcal polysaccharide vaccination is recommended for all persons 65 years and older and for those with alcoholism, asplenia, cardiac disease, cirrhosis, diabetes mellitus, immunocompromising conditions, pulmonary disease, or chronic renal disease. Indications for hepatitis B vaccination include chronic renal disease and hemodialysis, as well as employment in health care or employment as a mortician or public safety officer. It is also recommended for homosexual men, those who have multiple sex partners or a sexually transmitted disease, and injection drug users.

Adolescent↗
PubMedDate not supplied

Self-reported risk factors and perceived chance of getting HIV/AIDS in the 1990s in Alberta.

This paper examines self-reported risk factors and perceived chance of getting HIV/AIDS using five representative surveys of adult Albertans obtained in 1990, 1992, 1994, 1995, and 1996. The findings from this trend analysis demonstrate that less than 10% of respondents perceived their chance of getting HIV/AIDS to be medium or high. Persons with multiple sex partners tended to perceive themselves to be at risk. Almost 20% of respondents reported one or more new sex partners in the last two years prior to the survey. Condom use with new sex partners increased substantially. Fifteen percent of respondents reported two or more sex partners in total in the last two years prior to the survey. Fourteen percent reported having two or more sex partners including at least one casual sex partner, and of these 61% reported always using condoms with their casual sex partner(s). Finally, the most striking finding is the perception among health care workers that they are at risk for contracting HIV/AIDS.

Adolescent↗
PubMedDate not supplied

[Cervix uteri lesions and human papiloma virus infection (HPV): detection and characterization of DNA/HPV using PCR (polymerase chain reaction].

The prevalence of human papillomavirus (HPV) genotypes was estimated by the polymerase chain reaction (PCR), in archival paraffin was embedded tissues. The case group consisted of 84 women aged 21-67 years (mean, 40 years) who were referred to the Department of Gynaecology (Oncology Centre, Coimbra) with citopathologically abnormal smears. This group was selected from a population of women who had undergone a screening programme (1990/94) in Central Region of Portugal. All these patients (n = 84) had a colposcopic directed cervical biopsy. HPV detection and typing was performed by the PCR method in the Department of Virology (National Health Care Institute, Lisbon). The prevalence of DNA/HPV found, concerning all epithelial cervical lesions studied and classified as squamous intra-epithelial lesions (SIL) and cervical cancer was 97.8%. On the basis of the data presented in this study, it was estimated that there was a statistically significant prevalence of low risk HPV types (HPV 6/11) in low grade SIL, 83.3%, and a statistically significant prevalence of high risk HPV types (HPV 16,18,31,33,51) in high grade SIL, 58.4%, as well as cervical cancer lesions in 100%. We conclude that there was a statistically significant difference between women with low and high grade SIL for HPV infection, with low and high risk HPV types, respectively. The risk factors for cervical cancer investigated (age at first sexual intercourse, multiple sexual partners, parity, use of oral contraceptives) were not associated to statistically significant differences concerning low grade SIL and high grade SIL. The clinical and therapeutic procedures were evaluated for the same five years (1990/94). It may be concluded that there would be no significant difference in clinical procedure for high grade lesions and cervical cancer, in which the treatment had been frequently radical (cone biopsies, simple or radical hysterectomy) and in which the HPV infection persisted frequently and was associated to high risk types (HPV 16 in 50% of these cases). On the other hand, it may be concluded that HPV detection in cervical biopsies, especially for low grade SIL lesions, which were evaluated in this study with a more conservative procedure (clinical evaluation only, punch biopsies, loop diathermy, CO2 laser vaporisation, cone biopsies), could identify women with high risk HPV types who might be at risk of developing dysplasia and cervical cancer.

Adult↗
PubMed2000

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic.

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 +/- 2.5 years); unprotected sexual intercourse (only 4% used condoms consistently); multiple sexual partners (mean 3.8 +/- 2.4 and 1.8 +/- 1.2 for boys and girls, respectively) were found. Marijuana, used by 60% of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95% CI, 1.6-3.4). Repeated episodes of STD (33%), coinfection with HIV (1.2%), syphilis (1.2%) and teenage pregnancy (13%) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.

Adolescent↗
PubMed1999

Risk profiles for sexually transmitted diseases among patients attending the venereal disease clinic at Alexandria Main University Hospital.

Risk factors for sexually transmitted diseases (STDs) were assessed among 54 male and 36 female patients attending a venereal disease clinic. Sociodemographic data and information on sexual behaviour/STD history were collected. Patients were examined and specimens taken for laboratory diagnosis. Multivariate logistic regression analysis revealed that the significant predictors of genital infections among the male patients were: being unmarried, having multiple sexual partners, exposure to a symptomatic sexual partner, high frequency of intercourse per week, having repeated episode(s) of STDs and practising coitus interfemoris. In the female patients, exposure to a symptomatic sexual partner and high frequency of intercourse per week were the only significant predictors.

Adolescent↗
PubMed2001

Prevalence of risk behaviors for HIV infection among adults--United States, 1997.

Human immunodeficiency virus (HIV) prevention programs are directed to persons at risk for acquiring and transmitting HIV because of their sexual behaviors or drug use. Effective HIV prevention requires monitoring risk behaviors among persons who are infected, persons who are at highest risk for infection, and the general population. The Behavioral Risk Factor Surveillance System (BRFSS) provides behavioral data at the state level. Because sexual behavior questions are not part of the BRFSS core instrument, in 1997, an optional module was developed and used by 23 states and Puerto Rico. This report summarizes the analysis of these data, which indicates that 11% of respondents had multiple sex partners and 4.2% reported other high-risk behaviors. These findings underscore the continued need for education about behaviors that place persons at risk for HIV infection, promotion of HIV testing among those who engage in these behaviors, and counseling to reduce risk.

Adult↗