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PubMed2005

Genital herpes in young adults: changing sexual behaviours, epidemiology and management.

Genital herpes is a common sexually transmitted infection throughout the world. The majority of new infections occur in adolescents and young adults, although prevalence rates generally increase with age and cumulative sexual experience. In young adults, herpes simplex virus 1 (HSV-1) infection is becoming a more common cause of genital herpes. Reasons for this trend include changing sexual practices, notably oral-genital exposure and the use of condoms for intercourse. Important implications of having genital herpes include the risk of transmission to sexual partners and the increased risk of acquiring and transmitting HIV. Genital herpes infections are often unrecognized, and transmission to uninfected partners is likely to occur during asymptomatic shedding. A diagnosis of herpes may also affect psychosexual development, particularly in adolescents. Such factors contribute to the growing global HSV prevalence and suggest a need to implement better screening programmes in young adults. Recognizing and treating HSV early offers benefits to patients and their sexual partners by reducing the frequency and severity of outbreaks, limiting the likelihood of disease transmission, and preventing new infections.

Herpes Genitalis↗

PubMed2004

Drinking patterns in mid-adolescence and psychosocial outcomes in late adolescence and early adulthood.

AIMS: To describe the pattern of drinking at age 16 and to relate this to outcomes at 16-21 years and 21-25 years across a number of psychosocial domains. DESIGN: A prospective birth cohort study with annual follow-up until age 16 then at 18, 21 and 25 years. SETTING: Christchurch, New Zealand. PARTICIPANTS: Of 1265 subjects, 953 were interviewed at age 16. MEASUREMENTS: Multiple measures of family background were collected from birth to 16 years. Alcohol consumption was measured in terms of frequency, usual or last quantity drunk and most drunk per occasion. Problems were also recorded. Questions about psychiatric symptoms enabled Diagnostic and Statistical Manual (DSM) criteria to be applied. Detailed reports on educational outcomes, employment, sexual behaviours and offending were collected. FINDINGS: Four latent classes were required to describe drinking at age 16, but these appeared to lie along a single dimension which strongly predicted outcomes at ages 16-21 and 21-25 across all domains (alcohol-related, substance dependence, mental health, education, sexual relationships and offending). After controlling for background and correlates only a small number of outcomes were still related consistently to drinking at age 16 over both periods: most alcohol-related outcomes, the number of sexual partners and the extent of violent offending. CONCLUSIONS: Drinking at age 16 is a clear indicator of future life-course over most domains in late adolescence and early adulthood. Many of these associations are due to other covariates. Outcomes specific to drinking at age 16 are alcohol outcomes, number of sexual partners and violence.

Adolescent↗

PubMedDate not supplied

Temporal and social aspects of gonorrhea transmission: the force of infectivity.

Theoretical consideration of the epidemiology of sexually transmitted diseases (STD) suggests that the key determinants of transmission dynamics are the duration of infectiousness and the extent to which subgroups in the population interact sexually. We used two empirical correlates to represent these concepts: (1) the force of infectivity, calculated by summing all the days of potential infectivity (the time between last sexual exposure and treatment of the contact) generated by a given case, and then summing the days for all cases within a given subgroup; (2) self-selection, representing the observed probability that members of a given subgroup select sexual partners from within their own group. Using data gathered in Colorado Springs, Colorado, we estimated that a single group i.e., black, male, heterosexual, military personnel residing in the core areas, generated 27% of the force of infectivity. Subgroups that select greater than 50% of their sexual partners from outside their sociodemographic boundaries generated a rate for the force of infectivity that was 4.5 times higher than the rate for self-selectors. These findings confirm the core group theory and suggest strategies for control of STD.

Adult↗

PubMed2005

Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China.

BACKGROUND: The migrant population in China is at high risk for sexual risk behavior and alcohol intoxication. Information about the prevalence of alcohol intoxication and its association with sexual risk behavior among migrants is needed for designing effective intervention prevention programs for reduction in alcohol abuse and HIV infection. METHODS: Cross-sectional data were collected from 2153 sexually experienced young rural-to-urban migrants in Beijing and Nanjing, China, in 2002. RESULTS: Approximately one-third of the participants had been intoxicated with alcohol at least once during the previous month, with more males than females reporting intoxication (40.2% versus 23.7%, p<0.001). Compared to non-intoxicated participants, respondents with alcohol intoxication in previous 30 days reported more psychological problems, including higher depression scores, lower levels of satisfaction with life and work, and higher perception of peer involvement in risk behavior. Intoxicated respondents were more likely to engage in premarital sex than non-intoxicated respondents (76% versus 60.2%, p<0.001), have multiple sexual partners (13.4% versus 5.2%, p<0.001), purchase sex (12.6% versus 4.9%, p<0.001), and sell sex (10.1% versus 3.7%, p<0.001). However, there was no association between alcohol intoxication and inconsistent/non-use of condoms. Multivariate analysis controlling for depression, peer risk involvement, age, gender, and other socio-demographic variables indicated that alcohol intoxication was independently correlated with premarital sex, multiple sexual partners, and buying and selling sex. CONCLUSIONS: Compared to the general Chinese population, levels of intoxication were elevated among Chinese rural-to-urban migrants. Alcohol intoxication was associated with sexual risk behaviors. HIV/AIDS prevention and intervention efforts should include components of alcohol use/abuse prevention for an effective reduction of sexual risk among young rural-to-urban migrants in China.

Adolescent↗

PubMed2005

Effect of bottlenecking on evolution of the nonstructural protein 3 gene of hepatitis C virus during sexually transmitted acute resolving infection.

Sexual partners of patients infected with the hepatitis C virus (HCV) often have detectable HCV-specific T-cell responses in the absence of seroconversion, suggesting unapparent, spontaneously resolving infection. To determine whether differences in the evolutionary potential of bottlenecked inoculum may explain the low rate of HCV persistence after sexual exposure, we have investigated changes in the entire HCV nonstructural 3 (NS3) gene over time in a chronic carrier and compared his viral quasispecies with that of the acute-phase isolate of his sexual partner, who developed acute resolving hepatitis C. The overall rate of accumulation of mutations, estimated by regression analysis of six consecutive consensus NS3 sequences over 8 years, was 1.5 x 10(-3) mutations per site per year, with small intersample fluctuations related to changes in environmental conditions. Comparison of quasispecies parameters in one isolate of the chronic carrier with those of the acute-phase isolate of the infected partner revealed a higher heterogeneity and lower proportion of nonsynonymous mutations in the former. All NS3 sequences from the acute-phase isolate clustered with a single sequence from the chronic isolate, despite complete HLA mismatch between the patients, suggesting bottlenecking during transmission. The low risk of viral persistence after sexual exposure to HCV may be related to the selection of a limited number of viral particles carrying a particular combination of mutations which may further limit the potential of a relatively homogeneous quasispecies to rapidly diversify and overcome the immune response of the exposed host.

Acute Disease↗

PubMed1999

Victims as victimizers: physical aggression by persons with a history of childhood abuse.

BACKGROUND: Substance abuse has been called the dominant characteristic of families involved in child abuse cases, but the frequency with which childhood victims become adult victimizers remains uncertain. OBJECTIVE: To examine whether a history of childhood sexual or physical abuse is associated with becoming a victimizer (ie, abusing or assaulting others) as an adult. METHODS: Interview data were collected from 439 persons in Providence, RI, from July 1997 through March 1998 who had a history of intravenous drug use. Victimizers were defined as adults who had ever physically abused or assaulted a family member or sexual partner (eg, kicked, hit, choked, shot, stabbed, burned, or held at gunpoint). We compared persons who had a history of victimizing others with those who did not have such a history by bivariate and multivariate analyses. Variables included demographic factors as well as a history of sexual or physical abuse before the age of 16 years. abuse was 51% for women and 31% for men. Seventeen percent of our subjects reported being victimizers. Among persons who reported being victims of either physical or sexual childhood abuse, 28% victimized others; among those who denied a history of childhood abuse, 10% victimized others. Two thirds of victimizers reported being intoxicated while assaulting others. When we used logistic regression to control for sex, having children, education, race, and history of incarceration, childhood abuse was significantly and independently associated with becoming a victimizer (odds ratio, 3.6; 95% confidence interval, 2.1-6.1). CONCLUSIONS: Large numbers of intravenous drug users, both men and women, have victimized family members or sexual partners. We confirm a high rate of childhood abuse among this population and demonstrate that among intravenous drug users past abuse is associated with becoming a victimizer as an adult. Primary care providers should be alert to this cycle of violence.

Adult↗

PubMed1994

Predictors of injecting and injecting risk-taking behaviour among methadone-maintenance clients.

A sample of 222 methadone maintenance clients were interviewed regarding current injecting and needle risk-taking in order to ascertain factors associated with these behaviours. Just over half (55%) of subjects had injected in the month preceding interview. Current injecting was associated with being female, having a regular sexual partner who was a current injecting drug user, polydrug use and higher levels of global psychopathology. Approximately 15% of subjects had shared needles in the month preceding interview, predominantly with one other person. Needle sharing was associated with having a regular sexual partner who was a current injecting drug user, current criminality and injecting at places other than home. Needle-sharing episodes in the study period were considered safe by practically all sharers. The implications of these findings are discussed.

Adolescent↗

PubMed1992

[Prevalence of HIV-1 and other sexually transmitted diseases among Spanish prostitutes].

BACKGROUND: Many studies in Western countries point to the high prevalence of HIV infection in groups of prostitutes especially among those using intravenous drugs (IVDA). Furthermore, there appears to be a low but increasing number of heterosexually infected prostitutes. METHODS: A cross-sectional study was carried out in a sample of 374 prostitutes selected by collaborating groups in 11 provinces with the aim of studying the prevalence of HIV and its associated risk factors in Spanish prostitutes. Furthermore, the prevalence of other sexually transmitted diseases (HIV-2, HTLV-I/II, hepatitis B and syphilis), the frequency of different sexual activities and the use of condoms were investigated in this group. The data were collected by interview using a previously tested questionnaire. RESULTS: Serological analysis demonstrated that 54 persons were positive for HIV-1 (16%), none for HIV-2, 1 for HTLV-I/II, 113 for hepatitis B (46%) and 84 for syphilis (25%). The main risk factor for HIV infection was IVDA; 60% of this group was positive vs 3% of the non IVDA (OR = 47.6; confidence interval 18.4-128.0). Consistent condom use in this population is low, although it varies according to the type of relation and sexual partner. Forty-nine percent of the women having vaginal relations with their customers reported using condoms at all times or almost all times vs 36% for anal relations and 22% for oral relations. These percentages were reduced to 10%, 6% and 3%, respectively with private sexual partners. CONCLUSIONS: Studies concerning HIV prevalence and its associated risk factors in Spanish prostitutes should be continued in order to monitor trends in HIV infection and the use of protective measures.

Adolescent↗

PubMed1985

The Vancouver Lymphadenopathy-AIDS Study: 4. Effects of exposure factors, cofactors and HTLV-III seropositivity on number of helper T cells.

Results of testing for antibody to human T-lymphotropic virus (HTLV-III) and absolute numbers of helper T cells in 219 participants in the Vancouver Lymphadenopathy-AIDS (acquired immune deficiency syndrome) Study were analysed. The mean absolute helper T-cell counts in the 141 HTLV-III seronegative and the 78 seropositive men were 897/mL and 659/mL respectively (p less than 0.001). Established AIDS risk factors such as elevated lifetime number of male sexual partners and frequent receptive anal intercourse did not appear to have any significant effect on number of helper T cells that was independent of HTLV-III antibody status. Seropositive men with less than 100, 100 to 500 or more than 500 male sexual partners in their lifetime had mean absolute helper T-cell counts of 667/mL, 651/mL and 662/mL respectively. Most other risk factors, as well, did not appear to exert any effect on absolute number of helper T cells that was independent of the effect of HTLV-III antibody status. However, independent effects of a history of mononucleosis or hepatitis and of cigarette smoking were noted. The data support the hypothesis that no immune dysfunction beyond that due to the initial infection alone arises from repeated exposure to HTLV-III. Most risk factors appear to act as exposure factors, exerting their effect on the immune system merely by increasing the probability of contact with the agent. The independent effects of a history of mononucleosis or hepatitis suggest that viral agents may be cofactors in the production of immune dysfunction.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Hepatitis B and C among adolescents at an STD clinic on the US-Mexico border.

Risky sexual behavior and drug use are factors associated with acquisition of hepatitis B and C. This cross-sectional study investigated hepatitis B and C among 296 adolescents at a sexually transmitted disease clinic in El Paso, Texas, between April 1, 1997, and February 1, 1998. Questionnaires, medical record abstraction, and serum antibody tests provided data on demographics, risk factors, and seroprevalence status. Only 15% of participants always used condoms, 23% had a previous sexually transmitted disease, 46% had more than 1 sexual partner in the last 6 months, and 7% used intravenous drugs. Results showed low seroprevalence of hepatitis B (4.1%) and hepatitis C (3.1%). No significant risk factors were associated with hepatitis B seroprevalence. In contrast, male gender, speaking Spanish, not attending school, having more than 1 sexual partner, and injection drug use were all associated with hepatitis C. Hepatitis B and C seroprevalence rates among high-risk adolescents are lower in El Paso than in other similar US populations, presenting an ideal climate for prevention programs.

Adolescent↗

PubMed1992

Recurrent bacterial vaginosis: association with vaginal sponge use.

A hypothesis-generation study was conducted to examine risk factors for bacterial vaginosis recurrences among women participating in a randomized controlled trial of male sexual partner treatment. Of the 140 women enrolled in the trial, 72 had a normal vaginal gram-stained slide at the first follow-up visit and were included in this analysis. Nineteen of the 72 (26.2%) women developed a bacterial vaginosis recurrence documented by a vaginal gram-stained slide during the 6-week follow-up period. Of the 19 women, 4 of 6 sponge users (66%) developed a bacterial vaginosis recurrence (RR 2.93, 95% CI: 1.43-6.02). Logistic regression analysis supported the association between sponge use and bacterial vaginosis recurrences (adjusted RR 2.71, 95% CI: 1.06-6.99) but revealed that an apparent protective effect of diaphragm use was due to the confounding effect of sexual partner treatment. Our hypothesis is that bacterial vaginosis recurrences may be due to factors other than sexual transmission, such as sponge use. Further studies are needed to examine risk factors for bacterial vaginosis recurrences. In the interim, physicians might suggest another form of contraception to their sponge-using patient with frequent bacterial vaginosis infections.

Adolescent↗

PubMedDate not supplied

Associations between forced sex, sexual and protective practices, and sexually transmitted diseases among a national sample of adolescent girls.

OBJECTIVE: The main objective of this study is to better understand the associations between forced sex history and history of sexually transmitted disease (STD) infection. Three research questions are investigated. Is history of forced sex associated with risk-taking behaviors? Are these risk-taking behaviors associated with history of STD? Is history of forced sex independently associated with history of STD? METHODS: Information on the sexual and STD histories is obtained from 3,579 sexually active adolescent girls using data from the National Longitudinal Study of Adolescent Health. Weighted logistic and OLS regressions are employed, using techniques that account for the complex sampling design. RESULTS: Girls with a history of forced sex are significantly more likely to have a greater number of sexual partners, be younger at first sex, and be more likely to use alcohol or drugs at last sex; there is no difference in condom use at last sex. These factors, in turn, are significantly associated with a positive STD history. Condom use at last sex is negatively associated with ever having had an STD. When all five sexual and protective practices are investigated simultaneously, history of forced sex remains significantly associated with STD history (odds ratio [OR] = 1.39, p =.014); number of sexual partners and early onset of sex remain significant. Condom use and substance use at last sex reduce to marginal significance. CONCLUSIONS: These results suggest that a history of forced sex is independently associated with a history of STD among sexually active adolescent girls. Programmatic strategies aimed at reducing STDs through encouraging responsible sexual behavior would potentially benefit from also including a component that addresses sexual victimization.

Adolescent↗

PubMed1990

Discriminant attitudes and beliefs about condoms in young, multi-partner heterosexuals.

Four hundred and eight people aged 15-35 years who reported having more than one sexual partner of the opposite sex in the past year or who thought it likely that they would do so in the next year were surveyed about their sexual behaviour, concern about acquired immunodeficiency syndrome and sexually transmitted diseases and attitudes to condom use. Differences in concerns and attitudes between regular and non- or irregular condom users and between men and women are reported. Three conceptually coherent factors (condom use as positive action; condom use as cue to embarrassment; and condom use as antithetical to good sex) discriminated between users and non-users. Implications for health promotion campaigns designed to promote condom use are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Past reproductive and sexual characteristics of women with tubal infertility at Kenyatta National Hospital.

Past reproductive and sexual characteristics of patients with tubal sterility (cases) and currently fertile women (control group) were studied. The ages at first coitus and the number of sexual partners were significantly more (p less than 0.01) in the cases than in the controls. Most cases (56.0%) had only primary school education whereas most of the controls (68.7%) had secondary school education. Nearly 70% of the cases had had the first sexual intercourse by 16 years compared with about 40% in the controls. Pre-menarcheal sexual intercourse occurred in 1/4 of the cases compared with less than 1/10 in the controls (p less than 0.001). Of those with secondary infertility; 33.3% had had the first pregnancy by the age of 16 years compared with 12.0% in the controls (p less than 0.001); and in 83.3% of the cases, the first pregnancy was not by the current husband compared with 26.0% in the controls (p less than 0.001). In addition, the cases had more abortions before marriage (p less than 0.001), more induced abortions (p less than 0.001) and had medically diagnosed sexually transmitted diseases more often (p less than 0.01). It is concluded that the reproductive and sexual events that occur during the teen-age determine the future prospects of fertility. Intensification of educational programs by the government and all relevant organisations, with emphasis on the relationship between sexual behaviour during adolescence and future reproductive problems, is strongly recommended.

Abortion, Induced↗

PubMed2025

Prevalence and associated risk factors of bacterial vaginosis among women of reproductive age living with, and without HIV in Lagos, Nigeria.

BACKGROUND: Bacterial vaginosis (BV) is a vaginal dysbiosis of public health significance in reproductive-aged women. BV is associated with an increased risk of pelvic inflammatory disease, cervicitis, HIV infection and other obstetric complications like premature rupture of membranes, preterm labour and post-partum endometritis. This study aimed to determine the prevalence and risk factors of BV among women of childbearing age living with, and without HIV in Nigeria. METHODS: This was a cross-sectional study conducted among non-pregnant women of childbearing age (18-49 years), living with and without HIV in Lagos, Nigeria. Participants were counselled and informed consent was obtained before vaginal swabs were collected. BV was defined using Amsel’s criteria, which uses 3 out of 4 diagnostic criteria to diagnose BV and Nugent scoring. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 27.0. RESULTS: Two hundred and fifty-two (252) women of childbearing age including 198 (78.6%) living with HIV (WLHIV), and 54 (21.4%) without HIV were included in the study. The mean age was 41 ± 6 years with a range from 21 to 49 years. The overall prevalence rate of BV was 36.1%. Prevalence of BV was higher in WLHIV (37.9%) compared to those without HIV (29.6%) although this was not statistically significant (OR = 1.36; 95% CI: 0.67 – 2.79). Prevalence of BV among HIV-positive women with CD4 > 200 cells/mm3 was 36.9%, as against 54.5% for those whose CD4 was ≤ 200 cells/mm3 (OR = 1.40; 95% CI: 0.33–5.96). Having more than one sexual partner predisposed the women to BV (OR = 1.89; 95% CI: 1.01–3.53) while women who douche had a 1.7-fold increased risk of having BV than those who do not (OR = 1.65; 95% CI: 0.95- 2.88). CONCLUSION: The findings of this study indicate that women of reproductive age are equally susceptible to BV irrespective of their HIV status, with multiple sexual partners identified as a significant risk factor. These results underscore the need for targeted public health interventions aimed at reducing the prevalence of BV within this population, thereby reducing the risk of transmission of HIV and other sexually transmitted disease among this group.

Humans↗

PubMed1984

Sociological and psychological predictors of STD infection in homosexual men: a study of four countries.

I investigated over 600 homosexual men in four countries (Sweden, Finland, Ireland, and Australia) regarding the number of times they had contracted a sexually transmitted disease (STD) and several psychological variables including masculinity and feminity, sex role conservatism, relationships with parents, number of sexual partners, attitudes towards homosexuality, and involvement in the homosexual subculture. Using multiple linear regression in each country, it was found that 19-42% of the variance of number of times infected could be accounted for by psychosocial factors, seven of which were common to all countries. The number of sexual partners was not a significant variable in any country. These data strongly suggest that numbers of infections in homosexual men are best predicted by psychological factors, and this has considerable implications for preventative and treatment programmes for homosexuals.

Adult↗

PubMed2006

Prevalence and determinants of human papillomavirus infection in men attending vasectomy clinics in Mexico.

Large studies of genital human papillomavirus (HPV) infection in men are few and mainly include high-risk groups. We interviewed 779 men who requested a vasectomy in 27 public clinics in 14 states of Mexico. Exfoliated cells were obtained from the scrotum, the shaft of the penis, the top of the penis including the coronal sulcus, the glans and the opening of the meatus. HPV testing was performed using biotinylated L1 consensus primers and reverse line blot. Unconditional logistic regression was used to estimate odds ratios (ORs) of being HPV-positive and corresponding 95% confidence intervals (CIs). The prevalence of any type of HPV was 8.7%. HPV positivity was highest among men below age 25 (13.6%), and lowest among men aged 40 years or older (6.0%). The most commonly found HPV types were, in decreasing order, HPV59, 51, 6, 16 and 58. Lifetime number of sexual partners was associated with HPV positivity (OR for > or = 4 vs. 1 partner = 3.7, 95% CI: 2.0-6.8), mainly on account of the strong association with number of occasional and sex-worker partners. Condom use with both regular (OR = 0.4, 95% CI: 0.1-1.0) and sex-worker (OR = 0.1, 95% CI: 0.0-0.3) partners and circumcision (OR = 0.2, 95% CI: 0.1-0.4) were inversely associated with HPV positivity. HPV prevalence in Mexican men was similar to the prevalence found in Mexican women of the same age groups. The association between HPV positivity and lifetime number of sexual partners in the present low-risk male population is one of the strongest ever reported in studies in men. Condom use and circumcision were associated with a strong reduction in HPV prevalence.

Adult↗

PubMed2004

Using patient history to predict high-grade cervical dysplasia and cancer in women with borderline cervical cytologic results.

OBJECTIVE: To determine whether demographic and lifestyle factors can be used to triage women with borderline cervical cytologic results. MATERIALS AND METHODS: Demographic and medical information were collected from women undergoing colposcopy for a cytologic result read as atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion in the gynecology clinic of an urban public hospital between July 1, 1996, and December 1, 1999. Colposcopy and subsequent histologic results were reviewed. Multivariate analysis was used to define predictors of high-grade cervical disease. RESULTS: From among 1725 eligible women, 283 women (16%) with ASCUS or low-grade squamous intraepithelial lesion results were found to have high-grade cervical disease (113 women with ASCUS results [13%] and 170 women with low-grade squamous intraepithelial lesion results [21%]). In multivariate analysis, pregnant women were less likely to have high-grade disease (odds ratio, 0.36; 95% CI, 0.17-0.79). Women with three or more lifetime sexual partners were more likely to have high-grade disease (odds ratio, 1.75; 95% CI, 1.31-2.34). However, a triage scheme tracking pregnant women with fewer than three lifetime partners to observation without colposcopy would have excluded only 51 of the 1725 women eligible (3%). Other combinations of risk factors had inadequate sensitivity or specificity for high-grade disease. Separate models for ASCUS showed that only having fewer than three lifetime sexual partners was associated with lower risk of high-grade histologic results (odds ratio, 0.56; 95% CI, 0.36-0.89), but excluding women with fewer partners would have missed 27 of 110 cases (25%) of high-grade disease. CONCLUSIONS: History and demographic information are inadequately sensitive for use in triage of women with borderline cytologic findings. Colposcopy or triage using human papillomavirus DNA tests remain indicated.

Journal Article↗