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PubMed1978

Repeated gonorrhea: an analysis of importance and risk factors.

This study was designed to assess the epidemiological importance of repeated infections due to Neisseria gonorrhoeae and to analyze variables potentially associated with repeated gonorrhea. The retrospective analysis was of 7,347 patients seen during one year, and the prospective study was of a stratified randomly selected sample of 429 patients. The 492 retrospectively identified repeaters constituted 0.06% of the county population and 6.7% of the clinic population. The 492 repeaters had 21.6% of the cases of gonorrhea reported from the county and 29.4% of the cases reported from the clinic. The repeaters tended to be younger than those without repeated infection (P less than 0.001), male (62%), black (81.7%), and residents of areas of lower socioeconomic status than those who were not repeaters (P less than 0.001). Most repeaters (73.5%) had not graduated from high school. Repeaters did not have significantly greater numbers of sex partners (P greater than 0.05) or greater exposure to prostitutes or clients than those who did not have repeated infections and less frequently had sexual contact while symptomatic. Intensive follow-up of the small number of high-risk repeaters and their contacts could result in a major reduction in the number of reported cases of gonorrhea.

Adolescent↗
PubMed1989

Determinants of emergence of antibiotic-resistant Neisseria gonorrhoeae.

Studies were carried out to evaluate the prevalence and risk factors for antibiotic-resistant Neisseria gonorrhoeae infections. Monthly surveillance of gonococcal isolates showed the prevalence of gonococci with high-level, plasmid-mediated tetracycline resistance (TRNG) to be about 15% for three consecutive 6-mo periods. Over the same period, the prevalence of gonococci with chromosomally mediated resistance to penicillin G steadily increased, from 0% to 9% and then to 21%. From April to July 1987, while chromosomally mediated penicillin resistance was rapidly increasing, a more intensive study was conducted. Patients infected with TRNG reported significantly more lifetime sexual partners (P less than .05) but otherwise resembled patients infected with antibiotic-sensitive gonococci. Patients infected with chromosomally mediated penicillin-resistant gonococci differed from other patients. In addition to reporting more lifetime partners (P less than .05), patients with chromosomally mediated penicillin-resistant gonorrhea were more likely to be older (P less than .05) and more often reported past episodes of gonorrhea (P less than .05), greater numbers of recent sexual partners (P less than .05), new sexual partners (P less than .05), prostitute contact (P = .06), and parenteral drug use or sexual partners who were drug users (P = .07). The introduction of antibiotic-resistant N. gonorrhoeae into communities may be attributable to a subset of patients who practice "risky behaviors" and who could be targeted for disease intervention activities.

Adolescent↗
PubMed1991

Cofactors in male-female sexual transmission of human immunodeficiency virus type 1.

In a study of human immunodeficiency virus type 1 (HIV-1)-uninfected African prostitutes, 83 (67%) of 124 seroconverted to HIV-1. Oral contraceptive use (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1-8.6; P less than .03), genital ulcers (mean annual episodes, 1.32 +/- 0.55 in seroconverting women vs. 0.48 +/- 0.21 in seronegative women; P less than .02) and Chlamydia trachomatis infections (OR, 3.6; CI, 1.3-11.0; P less than .02) were associated with increased risk of HIV-1 infection. Condom use reduced the risk of HIV-1 infection (OR, 0.11; CI, 0.05-0.27; P less than .0001). Stepwise logistic regression analysis confirmed independent associations between HIV-1 infection and oral contraceptive use, condom use, genital ulcers, and C. trachomatis. The presence of other sexually transmitted diseases may in part explain the heterosexual HIV-1 epidemic in Africa and may represent important targets for intervention to control HIV-1 infection.

Adult↗
PubMed1992

Human immunodeficiency virus type 1 infection in women attending a sexually transmitted diseases clinic in Kenya.

A cross-sectional study was conducted among women attending a sexually transmitted diseases clinic in Nairobi, kenya, to determine the prevalence of and associated risk factors for human immunodeficiency virus (HIV) type 1 infection. HIV-1 antibody was detected in 13.8% of 600 women. This virus was found most frequently in prostitutes (odds ratio [OR], 7.2), in women reporting a history of genital ulcers (OR, 2.3), and in those with a current diagnosis of genital ulcers (OR, 5.1). Lifetime duration of oral contraceptive use was significantly greater in HIV-1-positive women. Multivariate analysis revealed an association between genital ulcers and HIV-1 infection (OR, 3.8). The strongest association for HIV-1 infection, however, occurred with genital ulcers in combination with the use of oral contraceptives (OR, 25.7).

Adult↗
PubMed1992

Genotypes and sequence variants of human papillomavirus DNAs from human immunodeficiency virus type 1-infected women with cervical intraepithelial neoplasia.

Human papillomavirus (HPV) DNA was found in cervicovaginal lavage fluids from 9 of 11 human immunodeficiency virus type 1 (HIV-1)-seropositive female prostitutes with cervical intraepithelial neoplasia (CIN) in Kinshasa, Zaire. Since 7 yielded complex nucleic acid hybridization results consistent with mixed HPV infections, limited sequencing of HPV DNA was used to identify the HPVs present. Three of HPV 16 and 1 each of HPV 18, 31, 33, and 56 and ME180-HPV were identified by sequencing in 8 samples. Each of these genotypes has been found in specimens from HIV-1-seronegative women with CIN. Some DNAs had nucleic acid and amino acid sequence variations relative to the reference HPVs, but the variants were closely related to variants that have been found in HIV-1-seronegative women. Variant amino acids were found predominantly at three positions in one 40-amino-acid segment of the L1 open reading frame sequenced. The predominant HPV 16 variant observed has been found rarely in other countries.

Amino Acid Sequence↗
PubMed1993

Prevalence of human immunodeficiency virus types 1 and 2 infections in Nigeria.

The prevalence of human immunodeficiency virus (HIV) types 1 and 2 infections in Nigeria was estimated from 3854 serum samples collected at 21 locations from 1985 to 1990. Seventy-eight samples (2.0%) were reactive for HIV-1 and 49 (1.3%) for HIV-2 antibodies; 5 samples were reactive for both viruses. The prevalence of HIV-1 and -2 infections, respectively, was highest among 60 female prostitutes, with 10% and 6.7% positive. For other groups the respective rates of positivity were 4.1% and 3.4% in 610 patients with sexually transmitted diseases, 3.6% and 1.4% in 140 tuberculosis patients, 1.6% and 0.6% of 1253 other medical patients, and 1.2% and 0.9% of 1640 volunteer blood donors. Of 153 health care workers, 1.3% were positive for HIV-1 only. The age group from 20 to 29 years had the highest prevalences of HIV-1 (3.3%) and -2 (2.2%). In Nigeria, antibody prevalence for both viruses appears to have increased > 10-fold between 1986 and 1990.

Adolescent↗
PubMed1995

Frequent use of menfegol spermicidal vaginal foaming tablets associated with a high incidence of genital lesions.

Menfegol is a spermicide with in vitro activity against human immunodeficiency virus (HIV). A randomized placebo-controlled safety study covered the use of menfegol foaming tablets for 14 days at increasing frequencies of insertion by 125 prostitutes in Dakar, Senegal. The frequencies of colposcopically diagnosed genital lesions were 5.0%, 11.8%, 27.8%, 49.7%, and 29.4% among menfegol recipients when tablets were used once every other day or 1, 2, 4, or 8 times a day, respectively (P < .05). Among placebo recipients, frequencies were 11.1% and 23.5% when tablets were used < 8 times daily and 8 times daily, respectively. There was no association between subjective genital symptoms and the incidence of colposcopically detected lesions. The high incidence of genital lesions when menfegol foaming tablets were used more than once daily suggests that their frequent use should not be recommended to prevent HIV transmission. In use at low frequency, the tablets' toxicity might be balanced by anti-HIV properties. Safety studies on vaginal microbicides should use objective methods, such as colposcopy, to assess the incidence of lesions.

Adult↗
PubMed1995

Chancroid epidemiology in New Orleans men.

Epidemiologic, clinical, and microbiologic data were collected from 299 men with nonsyphilitic genital ulcer disease. One hundred eighteen (39%) were culture-positive for Haemophilus ducreyi, 57 (19%) were culture-positive for herpes simplex virus, and 124 (41%) were culture-negative. Patients with chancroid were significantly more likely than those with genital herpes to have been frequent users of alcohol (44% vs. 23%, P = .006). They were also more likely recently to have used cocaine (25% vs. 9%, P = .013), had sex with a prostitute (17% vs. 5%, P = .035), traded drugs for sex (16% vs. 2%, P = .005), and had a sex partner who used drugs (38% vs. 13%, P = .001). Culture-negative patients were similar to chancroid patients with respect to most epidemiologic risk factors. Despite the epidemiologic similarities, the clinical features of culture-negative ulcers resembled those of culture-proven herpes ulcers more closely than they did those of culture-proven chancroid ulcers. These data establish a link between chancroid in the United States and the use of crack cocaine.

Adolescent↗
PubMed1996

The epidemiology of Chlamydia trachomatis within a sexually transmitted diseases core group.

Female sex workers in Nairobi were prospectively evaluated for risk factors of incident Chlamydia trachomatis infection. Independent risk factors included cervical ectopy (P=.007), gonococcal infection (P=.002), human immunodeficiency virus (HIV) seropositivity (P=.003), HIV seroconversion (P=.001), and duration of prostitution (P=.002). Eighteen different C. trachomatis outer membrane protein (omp1) genotypes were identified, with the allelic composition of the C. trachomatis population changing significantly over time (P=.005). Seventeen of 19 reinfections > or = 6 months apart were with different C. trachomatis omp1 genotypes. Women with HIV infection had an increased proportion of visits with C. trachomatis infection (P=.001) and an increased risk of reinfection (P=.008). Overall, the data demonstrate significant fluctuations in the genotype composition of the C. trachomatis population and a reduced rate of same-genotype reinfection consistent with the occurrence of strain-specific immunity.

Amino Acid Sequence↗
PubMed1996

The development and use of the concept of a sexually transmitted disease core.

A small proportion of people experiencing a sexually transmitted disease (STD), who are frequently infected or often transmit the infection, has been referred to as the "core." Though a prominent paradigm in the epidemiology of STDs, there is confusion about the meaning of the core. The term has been used to refer variously to people who are infected a large proportion of the time, infect more than one other person, are repeatedly infected, or are prostitutes or their clients and to geographic areas with large numbers of cases. Three perspectives that have contributed to the development of the concept of an STD core were identified: mathematical, clinical-epidemiologic, and sociocultural. These different perspectives share the common aim of identifying strategic points of intervention to reduce STDs. The value of the concept of an STD core will ultimately derive from its utility in lowering STD rates.

Gonorrhea↗
PubMed1996

Successful eradication of sexually transmitted diseases in the People's Republic of China: implications for the 21st century.

The global control of sexually transmitted diseases (STDs) represents a daunting task, and there have been very few examples of success. The scope of the STD problem in China before the formation of the People's Republic and the effects of a governmental STD control program were reviewed. In major cities, 10% of the population had syphilis, reaching 50% prevalence in some rural minorities. By 1964, STDs in China were virtually eliminated through a program that destigmatized STDs, provided an infrastructure for case finding and therapy, and eliminated prostitution. The People's Republic of China demonstrated the possibility of eliminating STDs, at least for some period of time. Although the Chinese approach may not be ideal for Western democracies, understanding some features of the Chinese program may help in designing a strategy for the eradication of human immunodeficiency virus when or if treatment becomes available.

China↗
PubMed1991

Assessment of the prevalence and risk factors for human immunodeficiency virus type 1 (HIV-1) infection among college students using three survey methods.

To evaluate the seroprevalence and risk factors for human immunodeficiency virus type 1 (HIV-1) infection among undergraduate college students, the authors simultaneously conducted three types of surveillance on a large university campus (27,902 undergraduates) in the Baltimore-Washington metropolitan area: a voluntary HIV-1 serosurvey with a linked risk assessment questionnaire (n = 3,394), a blinded serosurvey using blood specimens collected for routine purposes in the Student Health Center (n = 1,829), and a random sample risk assessment and case identification mail survey (n = 1,017 respondents of 3,000 solicited). The proportion of students belonging to a known risk group (a homosexual or bisexual man, intravenous drug user, or a sexual partner of a bisexual man, an HIV-1-infected person, a female prostitute, or an intravenous drug user) was 5.9% in the mail survey and 8.8% in the voluntary serosurvey. Whereas no infections were detected in the blinded serosurvey, two infected persons were identified in the mail survey (0.2%) and two in the voluntary serosurvey (0.06%), all among high-risk persons. Although derived from independent samples and subject to different biases, these three survey methods yielded a consistent pattern of HIV-1 epidemiology on this campus, whereby the overall prevalence of infection was low and confined to members of high-risk groups, despite the common occurrence of behaviors that might facilitate sexual transmission of HIV-1 among many other students.

Data Collection↗
PubMed1993

Sexually transmissible diseases and travel.

Sexually transmissible diseases (STDs) continue to be the most common notifiable infectious conditions worldwide. Their unacceptably high incidence is underlined by the recent emergence of a (presently) incurable and lethal STD, human immunodeficiency virus (HIV) infection, which merits its description as a pandemic, and with which other STDs interact in an epidemiological synergy. Certain travellers, by virtue of their behavioural interactions with 'core-groups' of efficient transmitters, may have a high relative risk of acquisition of an STD. This risk can be virtually eliminated by avoiding penetrative sexual intercourse with casual partners, especially injecting drug users and persons who have had multiple sexual partners (particularly prostitutes), or reduced by the use of condoms. The risk of parenteral exposure can be reduced by avoiding parenteral drug use and behaviour that is likely to lead to injury and by seeking facilities with adequate capabilities to screen blood donors and to sterilize instruments.

Female↗
PubMed1988

Pregnancy and AIDS.

Since the first cases of a new acquired immunodeficiency syndrome (AIDS) described by Oleske et al. and Rubinstein et al. in children in 1983, we have witnessed an ever-increasing number of such observations. As serology is not being performed on all pregnant women in many European countries, obstetricians must try to identify those belonging to risk groups: intravenous drug abusers, natives of affected regions or women having travelled to these areas, women having numerous sexual partners, presenting with other sexually transmitted diseases or living with infected individuals, prostitutes, transfused women. If the woman belongs to risk groups, HIV antibody testing is to be done at the beginning of pregnancy. The risks for the mother remain ill-defined, due in part to the difficulties inherent in keeping track of heroin abusers. Aggravation is certain if the mother is affected with AIDS or an associated syndrome called ARC (AIDS-related complex). It is debatable and at least rarer if the mother presents no clinical symptoms. Infant risks are becoming better known. The existence of materno-fetal contamination by transplacental route is undebatable. However, contamination during delivery or during the passage through the maternal genital tract cannot be excluded. The proportion of contaminated infants is approximately 40%. The disease in the infant is highly dangerous. According to these data, the procedure adopted by most obstetricians is the following: abortion is recommended at the first trimester of the pregnancy, a free choice is left open for the woman at the second trimester and at the third trimester delivery is carried out naturally. Caesarean sections are only done when there are obstetrical indications.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1993

Determination of antisperm antibodies in serum samples by means of enzyme-linked immunosorbent assay--a procedure to be recommended during infertility investigation?

The clinical significance of antispermatozoal antibody (ASA) testing in serum samples with an enzyme-linked immunosorbent (ELISA) technique using a commercially available kit was evaluated in 95 randomly chosen couples under infertility investigation. Results were related to many other parameters of male and female fertility, e.g. outcome of sperm analysis, testing of sperm functional capacity including the crossed in-vitro sperm-cervical mucus penetration test (SCMPT), results of a microbial screening in genital secretions, testing for local IgG- and IgA-class sperm antibodies in semen by means of the mixed antiglobulin reaction (MAR) and the subsequent pregnancy rate in a prospective study. Results of ASA testing did not show any relationship with medical history and results of clinical examination, the semen quality including sperm function tests and seminal cultures, outcome of the crossed SCMPT, and local ASA. All patients with MAR (IgG or IgA) positive ejaculates were ELISA negative in serum samples. No significant difference with regard to circulating ASA (ELISA) was found in couples with and without a subsequent pregnancy. Furthermore there was no significant difference of antibody levels in subfertile female patients, virgins (n = 36), 'normal' pregnant women (n = 39) and prostitutes (n = 40). In summary, the results of this study clearly demonstrate that the use of this method for detection of antisperm antibodies during infertility investigation cannot be recommended.

Antibodies↗
PubMed2004

'A field for private members': The Wolfenden committee and Scottish homosexual law reform, 1950-67.

The proceedings and report of the Wolfenden Committee on Prostitution and Homosexual Offences (1954-7) figure prominently in the historiography of homosexuality in later twentieth-century Britain. However, in the main, research has centred on the social politics of the Committee and its implications for sexual law reform in England, and there is a notable lack of regional studies. Using a range of government archives, this article focuses on the written and oral evidence of Scottish witnesses to the Committee. It documents the pre-existing legal and medical provisions for the treatment of 'homosexual offences' in Scotland, and surveys the Scottish evidence for and against the decriminalization of homosexual practices. Thereafter, it examines the views of the Scottish members of the Committee in the context of the Wolfenden Report. The article then surveys the wide-ranging opposition to homosexual law reform within Scotland in the period 1957-67, culminating in its exclusion from the 1967 Sexual Offences Act. Finally, it evaluates the implications of the Scottish experience and concludes that, in some important respects, it does not conform to the innovative and transitional picture advanced in many previous interpretations of the Wolfenden Committee and its aftermath.

Governing Board↗
PubMed1991

The man in the scarlet cloak. The mysterious death of Peter Anthony Motteux.

Peter Anthony Motteux (1663-1718), a Huguenot refugee in London, established a literary reputation by completing Sir Thomas Urquhart's translation of Rabelais' Gargantua and Pantagruel, then Cervantes' Don Quixote. He later became an import-export merchant. On his 55th birthday he donned his scarlet cloak and went out on the town. He picked up a prostitute and after some dalliance returned to her bordello. Shortly thereafter he was found dead, although the evidence is that he was in good health when he arrived. Literary evidence is that he died from assisted erotic asphyxia, a variant of autoerotic asphyxia, cf. the case of Frantisek Koczwara (Am J Forensic Med Pathol 5:145-149, 1984.)

Asphyxia↗
PubMed1988

Genital ulceration as a risk factor for human immunodeficiency virus infection.

Among 115 heterosexual men who presented with genital ulcers to a sexually transmitted disease clinic in Nairobi, Kenya, the prevalence of serum antibody to HIV was 16.5%. A past history of genital ulcers was reported by 12 (63%) of 19 men with antibody to HIV versus 30 (31%) of 96 without antibody (P = 0.008). HIV infection was also positively associated with lack of circumcision, but was not associated with the etiology of the current genital ulcer. Logistic regression analysis (adjusted for age, number of recent sex partners, recent prostitute contact, circumcision, tribal ethnic identity, past history of urethritis, and current diagnoses) confirmed only the association between prior history of genital ulcer disease and HIV infection; (P = 0.04, odds ratio 2.35, 95% confidence limits, 1.01-5.47). The incidence of genital ulcers, particularly chancroid, is much higher in parts of Africa than in Europe or North America. This may contribute to the increased risk of heterosexual transmission of HIV in Africa. Aggressive control of chancroid and syphilis may offer one very feasible approach to reducing transmission of HIV in this region.

Acquired Immunodeficiency Syndrome↗