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PubMed1993

[Clinical and microbiological study of acute pelvic inflammatory disease].

Upper genital tract infection was investigated in 46 women admitted to hospital with clinic diagnosis of acute pelvic inflammatory disease (PID) and 62 control women accepted to hospital for laparoscopy Fallopian tubes sterilization. Diagnosis was ratified by laparoscopy in mild and moderate salpingitis; culdocentesis and ultrasonography were performed in severe salpingitis and endometrial sample was made in endometritis. Microbiological specimens were taken from the cervix and abdomen. Antecedents and complete clinical studies were obtained. Patients were treated with antibiotic association sodic G penicillin, chloramphenicol and gentamicin. Risk factors to development PID were: single female (p < 0.05), multiple sexual partner (p < 0.01), previous PID (p < 0.05), infertility (p < 0.05), mean year of IUD use in severe salpingitis (p = 0.05) and mean years of age from women with sexually transmitted bacterias (STB) vs endogenous bacterias (EB) (p < 0.05). In the control group no abdomen bacterias were isolated. In patients with PID, C. trachomatis was detected by serology in 28.3%. N. gonorrhoeae was isolated from the cervix in 23.9% and from the abdomen 17.4%. Besides it was isolated from the abdomen: M. hominis 17.3% and E. coli 15.2%. STB were isolated in 54.3% and EB in 47.8% of the patients. Bacterial association was present on the 37%. Cervix isolation of G. vaginalis and Mycoplasma were not correlated with development of PID. Cervix microbiological samples were useful to know abdomen microbic etiology. They coincide with those in the 90.9%. EB were more frequently isolated from severe salpingitis (p = 0.05) and STB from mild and moderate salpingitis (p = 0.05). Antibiotic association cured all the mild and moderate salpingitis with independence of bacterial etiology. Failure occurred in 2 diffuse peritonitis and 13/14 tubo-ovarian abscesses. Surgery used in severe salpingitis and diffuse peritonitis, principally consisted in anexectomy, peritoneal toilet and drainages. No hysterectomies were performed. Colpotomy drainage was used as a laparotomy complement or as unique drainage. Severe complications of surgery occurred in 10.5%. Failure in antibiotic treatment, surgery and complications were present with preference in PID with EB. After PID 26.5% of women had both Fallopian tubes damaged; in 39.7% tube damage was not evaluated and in 34.2% one tube rested in health. Damage did not depend of bacterial etiology. Conclusion on the necessity of adequate prevention of this disease and it should need education related to the roll of STB and standards about the IUD use.

Abdomen↗
PubMed1993

Prevalence and epidemiologic correlates of sexually transmitted Chlamydia trachomatis infection in a selected population.

The incidence of Chlamydia trachomatis genitourinary infection was found by enzyme immunoassay antigen detection to be 10.0% in patients attending a sexually transmitted disease (STD) clinic, 3.0% in clients visiting an obstetrics-gynecology clinic, 20.8% in female prostitutes, and 1.3% in sexually active men. Predisposing factors for chlamydial infection were young age, multiple sexual partners, history of STDs, and coinfection with other STDs. Abnormal vaginal discharge and cervices in women, but not urethral manifestations in men, were significantly associated with chlamydial infection. Urethral gram stain had a certain value in identifying men infected with C. trachomatis.

Adult↗
PubMed1994

HIV infection and risk behaviors among heterosexuals in alcohol treatment programs.

OBJECTIVE: To measure the prevalence of human immunodeficiency virus (HIV) infection and high-risk behaviors among heterosexuals in alcohol treatment. DESIGN: Cross-sectional survey. SETTING: Five public alcohol treatment centers. SUBJECTS: Consecutive sample of 888 heterosexual clients entering treatment between October 1990 and December 1991. Respondents were 51% black, 10% Hispanic, 33% white, and 76% male. The overall response rate was 68%. MEASUREMENTS: Structured interview and serotesting for HIV antibodies. RESULTS: The overall seroprevalence of HIV infection was 5% (95% confidence interval, 3% to 6%). There were no significant differences in rates of infection by age, gender, or race. The prevalence of infection in heterosexual respondents without a history of injection drug use was 3% in men and 4% in women, several times higher than published estimates from a similar community-based heterosexual sample. Unsafe sexual practices were common: 54% of respondents reported multiple sexual partners in the previous year, 97% of nonmonogamous respondents did not use condoms during all sexual encounters, and few respondents consistently asked new sexual partners about previous high-risk behaviors. CONCLUSIONS: There is a substantial prevalence of HIV infection among heterosexual clients in San Francisco (Calif) alcohol treatment programs, much of which is not associated with injection drug use. Because of this and the high prevalence of unsafe sexual behaviors, there is a relatively high likelihood of heterosexual spread of HIV among the large population of clients seeking treatment for alcohol dependency. Interventions to prevent HIV spread should become a standard part of alcohol treatment programs.

AIDS Serodiagnosis↗
PubMedDate not supplied

HIV seropositive cases presenting as urological patients at the Korle-Bu Teaching Hospital, Accra--a preliminary report.

Thirty-six patients (33 males, 3 females) were screened for HIV antibodies at the Urological clinics, at the Korle Bu Teaching Hospital, Accra because of chronic diarrhoea, unexplained weight loss, multiple sexual partners, recurrent sexually transmitted diseases, non resolution of symptoms or history of possible exposure to HIV. Ten patients (27.8%) were found to be HIV seropositive; 6 were confirmed as HIV-1, one as HIV-2 and 3 as both HIV-1 and HIV-2. The HIV seropositive patients presented as follows: recurrent cystitis and offensive vaginal discharge in 2 females, non-resolution or recurrence of urological symptoms and signs such as warts (genital, meatal and or urethral) in 4 males and recurrent penile ulcers in 4 males. This report indicates that physicians should be alert and screen high risk patients for both HIV-1 and HIV-2 antibodies.

Adult↗
PubMed1993

Hepatitis C virus infection among patients attending a clinic for sexually transmitted diseases.

OBJECTIVE: To evaluate the association between hepatitis C virus (HCV) infection and sexual behavior in a sexually active population. DESIGN: Cross-sectional study. SETTING: Inner-city clinic for sexually transmitted diseases. SUBJECTS: The study included 1292 patients attending the clinic for care during a 1-month period and having syphilis serologic tests performed. OUTCOME MEASURES: Antibody to HCV (anti-HCV) positivity as defined by a repeatedly-reactive enzyme immunoassay and a positive neutralization enzyme immunoassay (Abbott Laboratories, Chicago, Ill). RESULTS: Of 1292 patients screened for anti-HCV, 99 (7.7%) were positive. Logistic regression analysis found that patients who reported intravenous drug use, were positive for antibody to hepatitis B core antigen, reported a history of a blood transfusion, were black, or reported crack cocaine use were more likely to be anti-HCV-positive. Forty-five percent of patients who were anti-HCV-positive reported intravenous drug use. Sex with an intravenous drug user and a history of gonorrhea and syphilis were associated with anti-HCV positivity in a univariate analysis, but after controlling for confounding variables, no such associations remained. While having multiple sexual partners in the previous 3 months, being homosexual or bisexual, and engaging in receptive anal intercourse were associated with being positive for antibody to hepatitis B core antigen, those behaviors were not associated with anti-HCV positivity. CONCLUSIONS: While these results cannot exclude a role for the sexual transmission of HCV, they do suggest that, in this sexually active population, the sexual transmission of HCV occurs infrequently and that HCV is largely associated with intravenous drug use.

Adult↗
PubMed1993

Racial minorities at increased risk an Arkansas HIV/AIDS report: autumn 1992.

The demographics of the HIV epidemic continue to change. Rates among white homosexuals seem to be leveling off; but there does not appear to be a corresponding decline among black homosexuals. Additionally, having found its first foothold among heterosexual injection drug users, increases in reported infection can be seen among heterosexuals who engage in non-monogamous, unprotected sex. To date, this increase in heterosexual transmission has been more pronounced among black Arkansans than white Arkansans. However, there are definite growth trends among heterosexuals regardless of race. Individuals who engage in risky behavior, specifically injection drug use, unprotected sex, and sex with multiple sex partners, should now consider that the risk of contracting HIV increases daily. Persons who engage in such risky behavior should educate themselves on the transmission of HIV and attempt to minimize their chances of infection. Persons who believe that they may be at risk for HIV should seek immediate testing and treatment. Confidential testing is provided by the Department of Health and individuals may call local offices for times that testing is available.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Human immunodeficiency virus-1 infection among patients with sexually transmitted diseases in Bombay.

BACKGROUND: Patients with sexually transmitted diseases form a particularly vulnerable group for infection with the human immunodeficiency virus (HIV-1), and serological surveillance is a sensitive tool for assessing the prevalence of this disease. METHODS: We carried out a serological survey for the detection of antibody to HIV-1 among persons belonging to various high-risk groups in Bombay from 1987 to 1989. Among these were 599 patients with various sexually transmitted diseases. RESULTS: Thirty-nine patients (5.2%) were found to be HIV-1 antibody seropositive by the ELISA and Western blot tests. An increase in HIV-1 antibody seropositivity among both the male and female patients with sexually transmitted diseases was detected from 1987 to 1989 and seropositivity was maximally associated with condylomata acuminata, genital herpes and chancroid. CONCLUSION: HIV-1 is established in this sentinel population and needs to be controlled vigorously.

AIDS Serodiagnosis↗
PubMedDate not supplied

Epidemiology of cervical carcinoma in Brunei Darussalam. Analysis of data on 27,208 women screened with cytologic examinations.

During the five-year period from January 1985 to December 1989 a total of 27,208 women, representing 44.0% of the total female population over age 15 years in Brunei Darussalam, underwent a cytologic examination. The majority of them were Malays (62.32%), followed by Chinese (22.23%), while the remainder were the expatriate population living in the country. High grade squamous intraepithelial lesion (moderate dysplasia) was detected in 88 women (3.3/1,000), high grade squamous intraepithelial lesion (carcinoma in situ) was seen in 32 women (1.22/1,000), and invasive carcinoma was found in 43 women (1.37/1,000). The overall detection rate for cervical cancer was 2.79/1,000 women in the population screened. In Brunei Darussalam Malay women marry at an early age, 44% by the age of 19 years, leading to sexual contact before the age of 20. However, the incidence of cervical cancer is low among them. This could be because they belong to the Orthodox Muslim Society, in which promiscuity is not permitted. Hence, multiple sex partners could be an important factor in the etiology of cervical cancer, confirming the current trend of thought that cervical cancer is a sexually transmitted disease. A comparison of the epidemiologic risk factors among the various races living in Brunei Darussalam is made.

Adolescent↗
PubMed1996

Continued sexual risk behavior among HIV-seropositive, drug-using men--Atlanta; Washington, D.C.; and San Juan, Puerto Rico, 1993.

Behaviors associated with increased risk for sexual transmission of human immunodeficiency virus (HIV) by infected persons include unprotected intercourse, multiple sex partners, use of crack cocaine, failure to disclose serostatus to sex partners, and trading sex for money or drugs. Some sexually active, HIV-infected persons in the United States continue to practice risky behaviors. To characterize continued sexual risk behaviors among HIV-positive, illicit-drug using men, in 1993 CDC analyzed data from such men recruited for a small group-intervention program in three cities - Atlanta; Washington, D.C.; and San Juan, Puerto Rico. This report summarizes the results of that analysis, which indicate that some seropositive men continue to engage in unprotected sex.

Adult↗
PubMedDate not supplied

What causes human cancer?

1. Lung cancer is the leading cause of cancer death in American men and has now surpassed breast cancer as the leading cause of cancer death among American women. 2. Heavy alcohol consumption is associated with increased cancer risks. 3. Intercourse at an early age and multiple sexual partners have been linked to an increased risk of cervical cancer. 4. The most widespread environmental carcinogen, accounting for the majority of superficial skin cancers and some types of melanoma, is ultraviolet radiation from the sun.

Causality↗
PubMed1996

Periodic health examination, 1996 update: 2. Screening for chlamydial infections. Canadian Task Force on the Periodic Health Examination.

OBJECTIVE: To update the 1984 recommendations of the Canadian Task Force on the Periodic Health Examination on the routine screening of asymptomatic patients for infection with Chlamydia trachomatis. OPTIONS: Screening, with the use of culture or nonculture tests, of the general population, of certain high-risk groups or of all pregnant women; or no routine screening. OUTCOMES: Rates of asymptomatic and symptomatic chlamydial infection, perinatal complications, longterm complications of infection (i.e., pelvic inflammatory disease, infertility and ectopic pregnancy), coinfection with other sexually transmitted diseases, disease spread, hospital care, complications of therapy and costs of infection and of screening. EVIDENCE: Search of MEDLINE for articles published between Jan. 1, 1983, and Dec. 31, 1995, with the use of the major MeSH heading "chlamydial infections," references from recent review articles and recommendation by other organizations. VALUES: The evidence-based methods of the Canadian Task Force on the Periodic Health Examination were used. Advice from reviewers and experts and recommendations of other organizations were taken into consideration. Prevention of symptomatic disease and decreased overall costs were given high values. BENEFITS, HARMS AND COSTS: The greatest potential benefits of screening asymptomatic patients for chlamydial infections are the prevention of complications, especially infertility and perinatal complications, and the prevention of disease spread. There is no evidence that screening of the general population for chlamydial infections leads to a reduction in complications, and screening may increase costs. However, there is evidence that annual screening of selected high-risk groups and of pregnant women during the first trimester is beneficial in preventing symptoms and reducing the overall cost resulting from infection. RECOMMENDATIONS: There is fair evidence to support screening and treatment of pregnant women during the first trimester (grade B recommendation) as well as annual screening and treatment of high-risk groups (sexually active women less than 25 years of age, men or women with new or multiple sexual partners during the preceding year, women who use nonbarrier contraceptive methods and women who have symptoms of chlamydial infection: cervical friability, mucopurulent cervical discharge or intermenstrual bleeding; grade B recommendation). There is fair evidence to exclude routine screening of the general population (grade D recommendation). VALIDATION: These recommendations are similar to those of the US Preventive Services Task Force and the US Centers for Disease Control and Prevention, Atlanta. SPONSOR: These guidelines were developed and endorsed by the Canadian Task Force on the Periodic Health Examination, which is funded by Health Canada and the National Health Canada and the National Health Research and Development Program. The principal author (H.D.D.) was supported in part by the Ontario Ministry of Health and the Canadian Infectious Diseases Society Lilly Fellowship.

Chlamydia Infections↗
PubMed1996

[Chlamydia trachomatis infection: risk factors].

UNLABELLED: Genital Chlamydia Trachomatis (CT) infections are the most common cause of tubal infertility. Its prevalence is variable between the authors, but seems to be more frequent in the young population. OBJECTIVE: Evaluate the CT genital infection rate in a population consulting either in a sexually transmitted disease center (STD) or in a family planning unit (FPU). --Judge the interest of a routine screening, and by which technic. --Estimate the information level of population about STD and their prevention. METHODS: 270 men and 331 women were detected by uretral or endocervix sample with an immunofluorescence method (Syva Microtrack). CT serology were also realised. RESULTS: 18.5% of man samples, 20% of woman samples in the STD center and 17.9% of woman samples in the FPU were positive for CT. There is a strong correlation between CT positivity and cervical discharge or cervicitis (RR = 4.64, p < 0.01). Serology was positive in 45.5%, 32.5% and 21.2% respectively for STD center's men, STD center's women and PFU's women. The correlation between samples and serology was 62%. Positive samples were more frequent in the 15-30 years old population and positive serology in the over 30 years old population (RR = 3.57, p < 0.01). There is a correlation between CT positive samples and nulliparity, multiple sexual partner and history of genital infection. CONCLUSION: The high prevalence of CT genital infection observed in our centers justify a routine screening especially in the young population.

Adolescent↗
PubMed1996

Self-reported risk factors for AIDS among homeless youth.

This study assessed HIV risk behaviors in a sample of homeless youth in a large urban area and examined factors associated with these behaviors. Self-reported behaviors were assessed via interviews with 196 homeless youth in Chicago in all 10 urban shelters serving this group and in 5 street locations. Overall, 83.7% reported at least one of these risk factors: multiple sex partners; high-risk partners; inconsistent condom use; history of sexually transmitted disease; anal sex; prostitution; and/or intravenous drug use. An index of these behaviors was associated with being male, having unmet personal needs, being interviewed in street locations, and having a history of sexual abuse. Findings suggest that strategies that may decrease risk behaviors among homeless youth include the elimination of their need to rely on illicit activities for income, provision of basic needs, education regarding existing services, increased outreach efforts, and early identification of and protection from childhood sexual abuse.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Diagnostic and therapeutic approach to sexually transmitted diseases].

In an ongoing study we evaluated 71 males and 32 females attending our sexually transmitted diseases (STD) clinic. Intraurethral or endocervical swab specimens were cultured for Neisseria gonorrhea (NG), Ureaplasma urealyticum (UU), Mycoplasma homines (MH), Herpes simplex virus (HSV) and Chlamydia trachomatis (CT), using an ELISA technique and the polymerase chain reaction (PCR). HIV antigen, hepatitis B (HBV) and Treponema pallidum (TP) seropositivity were tested by ELISA. Mean age was 33.4 and range 15-72 years. 83 patients (81%) used condoms only rarely, 35 (35%) had multiple sexual partners and 83 (81%) were treated empirically prior to evaluation. Dysuria and urethral discharge were found in 47 (45.6%), of whom 34 (33%) were males; the majority of females were asymptomatic. A specific etiology for STD was found in 53 patients (51.4%) and 1/3 had more than 1 pathogen. CT, UU, MH, HSV, NG and TV were found in 27, 24, 5, 3, 2 and 1, respectively. 8 patients were seropositive for HBV and 1 for TP; all were seronegative for HIV. CT was the most prevalent pathogen found. All patients with STD symptoms should be screened for all sexually transmitted pathogens, since many of them have more than 1 pathogen. STD clinics in Israel should be developed in conjunction with microbiology laboratories for better management of STD in the community.

Adolescent↗
PubMedDate not supplied

[Preliminary study on low-trait genital infection and cervical epithelial dysplasia in women from the Parakanä tribe of South America].

BACKGROUND: We evaluated the occurrence of low-trait genital infection and cervical epithelial dysplasia in women from a South-american indian tribe in the Brazilian Amazonia. METHODS: Cross-sectional study of women older than 10 years from two indian settlements of the Parakanã tribe: Paranatinga and Maroxewara. Demographic data and information about sexual behavior as well as obstetric/gynaecological history were recorded. Two gynecologists examined 80 patients (89.9%), and collected vaginal and cervical specimens of 69 indians for further laboratory analysis, by Gram stain and Papanicolaou method. Fourteen (20.3%) women resulted to be pregnant. RESULTS: Parakanã women begin sexual activity early, after menarche; they have multiple sexual partners; are multiparous. Some of his partners already had intercourse with women of our society. In Paranatinga, vaginal discharges were a very frequent sign and not age-related, and women presented high frequency of disturbances on lactobacilli flora, greater than among inhabitants of Maroxewara. Pap smears in 91.5% of all patients showed inflammatory pattern. When found an possible etiologic agent (61.3%), in 63.4% it was Gardnerella vaginalis, in 7.3% Trichomonas vaginalis and in 4.9% Candida sp. In 23.2% of smears cythophatic signs related to infection by human papillomavirus were identified. One case had morphological changes compatible with cervical intraepithelial neoplasia grade I, another with CIN II and, in a 48 year old indian, cervical cancer. CONCLUSIONS: Near all women had some grade of cervical disease. Measure HPV-infection prevalence among Parakanã indians with adequate methods may improve our understanding about worldwide occurrence of HPV infections. Established risk factors for cancer of the cervix and sexually transmitted diseases were common in this tribe.

Adolescent↗
PubMedDate not supplied

Papanicolaou test status among inner-city adolescent girls.

BACKGROUND: The English medical literature for the past decade lacks any reports on Papanicolaou (Pap) test status among inner-city adolescent girls. Our objectives were (1) to assess the pattern of Pap test status among inner-city adolescent girls and (2) to ascertain the association of the Pap test status with their knowledge, beliefs, and behaviors. METHODS: All 3,980 inner-city senior high school adolescent female students in two cities in New Jersey were included in the survey. Response rate was 84%; 89% of respondents were minority adolescents. RESULTS: The factors that significantly increased the probability of obtaining a Pap smear were physician recommendation for Pap test, being knowledgeable of Pap test, awareness that other family members had obtained Pap tests, family income and parents' education levels. The age of initiation of first Pap test almost always was before 18 years of age; 13% of sexually active girls were smokers. The major barriers for never having had a Pap test were lack of physician's recommendation, ignorance about the Pap test, cost of the test, lack of information on how and where to obtain it, belief that they were not at risk for cancer, and embarrassment over requesting the test. CONCLUSION: Inner-city predominantly minority adolescent girls who have considerable sexual activity, multiple sex partners, initiation of intercourse at an early age, and smoking are at high risk for cervical cancer. It makes sense to initiate Pap screening for such high-risk adolescents. Individualized Pap test educational intervention programs adopted to the adolescents' barriers to undergoing Pap testing and physicians' recommendations for this preventive care are needed to encourage high-risk adolescent girls to undergo regular Pap tests and appropriate follow-up.

Adolescent↗
PubMed1996

A neglected lesbian health concern: cervical neoplasia.

Many health care providers believe that lesbian women do not need routine Papanicolaou smears. This erroneous assumption fails to recognize that the majority of lesbian women have had prior heterosexual relationships and thus may be at risk for developing cervical neoplasia. The following case report describes a lesbian woman who denied prior heterosexual intercourse but who developed cervical intraepithelial neoplasia grade 2 (CIN 2) associated with a high oncogenic risk human papillomavirus (HPV) type. Sexual contact with multiple lesbian partners who had previous heterosexual relationships likely explains her cervical disease.

Adult↗