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PubMedDate not supplied

Penicillinase-producing Neisseria gonorrhoeae in Dade County, Florida: evidence of core-group transmitters and the impact of illicit antibiotics.

In 1985, 2,455 cases of infection due to penicillinase-producing Neisseria gonorrhoeae were reported from Dade County, Florida. These cases represent the largest concentration of PPNG infections reported to date in the United States. A zip code-based geographic analysis of morbidity caused by gonorrhea and PPNG identified a core area where the percentage of all gonorrhea cases due to PPNG was 31-36%. This percentage decreased in a radial pattern outward from the central core. A prospective study of patients presenting to the Dade County central clinic with gonorrhea found that men infected with PPNG were more likely to have medicated themselves with illicit antibiotics than were patients infected with penicillin-sensitive N. gonorrhoeae (odds ratio, 3.6; 95% confidence interval, 1.9-6.8). Of all self-medicated patients, 42% obtained antibiotics via illicit over-the-counter purchase at pharmacies in the hyperendemic area. In contrast to previous reports, PPNG infection was not associated with either narcotic- or prostitution-related activities. The results show that PPNG is endemic in Dade County and is arrayed in a core distribution. Antibiotic abuse may have played an important role in the Miami epidemic and in the establishment of PPNG as an endemic strain.

Adolescent↗
PubMedDate not supplied

Condom use and use-effectiveness in high-risk populations.

In vitro evidence strongly suggests that latex condoms provide an impenetrable barrier for the passage of infectious agents, but few have studied the use-effectiveness of condoms in preventing sexually transmitted diseases. In 1971, a prospective evaluation of the condom failed to demonstrate efficacy against infections with gonorrhea because users were exposed to infectious secretions before the condom was used. An ongoing multicenter study of female prostitutes in the United States shows that none of 22 women who always use condoms with all male partners has antibody to human immunodeficiency virus (HIV), but differences in HIV antibody status by patterns of condom use are not statistically significant. An educational campaign to promote the proper and consistent use of condoms as prophylactics is needed to stop the spread of gonorrhea, infections with HIV, and other sexually transmitted diseases.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

A voluntary serosurvey and behavioral risk assessment for human immunodeficiency virus infection among college students.

The authors conducted a voluntary serosurvey and educational campaign among 3394 undergraduate students attending the University of Maryland at College Park to determine the prevalence of and risk factors for human immunodeficiency virus type 1 (HIV-1) infection. Two students were seropositive (0.06%, 95% confidence interval 0-0.15%). Both were homosexual men with multiple sexual partners. Despite the low prevalence of infection, potential risk factors for transmission of HIV-1 were common, as assessed by a self-administered anonymous questionnaire. These included a previous sexually transmitted disease (12.6%), male homosexual intercourse (4.8% of men), heterosexual anal intercourse (25.3%), heterosexual intercourse with a person at risk (an HIV-1 infected person, a bisexual man, a parenteral drug user, a female prostitute, or a hemophiliac) (5.2%), multiple sexual partners (21% reported 10 or more lifetime partners), and intravenous drug use (1.3%). Assessment of the efficacy of our program by comparing responses on pre- and post-test questionnaires showed gains in knowledge about heterosexual transmission of HIV-1 and an increase in the reported frequency of condom use 1-2 months after participating in the survey. The authors conclude that HIV-1 infections are occurring among college students but in our study group remain confined to persons with known high-risk behavior; however, practices that may support transmission are common, and programs designed to diminish these behaviors among college students are needed.

Adolescent↗
PubMedDate not supplied

Urogenital infection due to meningococcus in men and women.

The authors report six cases of acute urethritis and three cases of acute cervicitis caused in all instances by Neisseria meningitidis group B. The patients, five heterosexual men, one homosexual man, and three female prostitutes were seen at a venereal clinic in Mexico City. All of them were initially diagnosed as having gonorrhea. Treatment with procaine-penicillin G cured all cases, both clinically and bacteriologically. These experiences reinforce the need to distinguish N. meningitidis from N. gonorrhoeae in the setting of sexually transmitted diseases.

Adult↗
PubMedDate not supplied

Heterosexual transmission of viral hepatitis and cytomegalovirus infection among United States military personnel stationed in the western Pacific.

A serosurvey of United States military personnel presenting to a sexually transmitted diseases (STD) clinic or reporting for routine physical examination in the Philippines was conducted to determine the risk factors for hepatitis B (anti-HBc), hepatitis C (anti-HCV), and cytomegalovirus (anti-CMV) infection. Among 470 male study subjects, 74 (15.7%) were positive for anti-HBc, five (1.1%) were positive for anti-HCV, and 232 (49.4%) were positive for anti-CMV. A history of a STD (odds ratio [OR] = 7.7) and contact with a female prostitute (OR = 2.3) were significantly associated with anti-HBc seropositivity after adjusting for age, race/ethnicity, foreign birth, and classification as either a STD or routine examination patient. Anti-CMV seropositivity was significantly associated with a history of a STD (adjusted OR = 2.0). These data suggest that in this military population, heterosexual activity was a risk factor for acquiring hepatitis B and CMV infection. United States military personnel stationed in high-risk areas of the western Pacific, particularly patients presenting to STD clinics, may need to be targeted for hepatitis B vaccination.

Adolescent↗
PubMedDate not supplied

Comparison of DNA-probe test and culture for the detection of Neisseria gonorrhoeae in genital samples.

BACKGROUND AND OBJECTIVES: The nonisotopic DNA probe assay (PACE 2) was evaluated for the detection of Neisseria gonorrhoeae in urethral and endocervical specimens and compared quantitatively and qualitatively using recommended culture methods. GOAL OF THIS STUDY: To evaluate whether culture methods could be replaced by the DNA probe assay for the diagnosis of N. gonorrhoeae. STUDY DESIGN: A total of 502 men and women were studied, including 42 non-registered and 132 legally registered prostitutes and 115 male and 213 female STD patients. RESULTS: The overall concordance of culture and the PACE 2 assay was 98.4%. Of the tested persons, 9.6% were positive for N. gonorrhoeae by culture technique compared with 11.2% using the DNA probe assay. All samples that were positive in culture were positive in the Gen-Probe test. Of samples positive in Gen-Probe, 14.3% (8/56) were negative in culture. Three of these results were determined false-positives and five were true positives when evaluated by further analysis. The sensitivity and specificity were 90.6% and 100%, for the culture technique, and 100% and 99.3% for the DNA probe assay, respectively, when compared with true positive and negative results. CONCLUSION: The data indicate that the DNA probe assay serves as a suitable screening and diagnostic test for the diagnosis of N. gonorrhoeae in symptomatic and in asymptomatic men and women. When the performance of culture technique is not possible or unreliable, the DNA probe assay can be used for testing those at high risk for gonorrhea. In borderline cases with a low value of RLU, the DNA test should be confirmed to avoid false positive results, especially in women.

Bacteriological Techniques↗
PubMedDate not supplied

Gonococcal infection of the neovagina in a male-to-female transsexual.

BACKGROUND AND OBJECTIVES: To describe a case of asymptomatic gonococcal infection of the surgically constructed vagina of a male-to-female transsexual prostitute. STUDY DESIGN: Case report. CONCLUSION: Although the stratified squamous epithelium that lines the neovagina is normally resistant to infection with Neisseria gonorrhoeae, this diagnosis should be considered in this population, particularly if working in the commercial sex industry.

Adult↗
PubMedDate not supplied

Seroepidemiological studies of Haemophilus ducreyi infection in Ethiopian women.

BACKGROUND AND OBJECTIVES: To measure prevalence of anti-Haemophilus ducreyi antibodies in sera from Ethiopian female attendees, and to determine significant socioeconomic associations. STUDY DESIGN: A modified ELISA immunoassay was used to test sera of 1,831 Ethiopian women attending gynecological, obstetric, and family planning clinics in Addis Ababa. RESULTS: Overall seropositivity was 19.4%. Prevalence rates for seropositivity for antibodies to H. ducreyi were significantly associated with ethnic group and religion, older age (> or = 50 years: 28%), early age at first coitus (< 13 years: 28%) and first coitus before the menarche (25%), being divorced (27%) or a prostitute (24%), longer duration of marriage (> 20 years: 27%) and sexual life (> 20 years: 24%), number of lifetime sexual partners (2 to 5 partners: 27%) and self-reported history of both syphilis and gonorrhea (31%). Of these factors, the two most significant were first coitus before the menarche (P < 0.0001) and not being still married to the first husband/sexual partner (P < 0.001). Differences in seropositivity according to ethnic group and religion may be explained by the number of women within each group who had only one lifetime sexual partner. Women with serological evidence of exposure to another sexually transmitted disease (STD) had a greater risk of exposure to H. ducreyi. The odds ratio for H. ducreyi seropositivity in women with syphilis or gonorrhea was 3.6, for women with genital chlamydial infection, 2.3, and for those with HBV or HSV-2, 1.4 and 1.3 respectively. CONCLUSIONS: This study illustrates the usefulness of the modified ELISA immunoassay for measuring exposure to H. ducreyi, and the usefulness of H. ducreyi as a marker for cumulative sexual exposure. Further studies on the association of HIV transmission and H. ducreyi in Ethiopia are now indicated.

Adolescent↗
PubMed1997

New approaches to syphilis control. Finding opportunities for syphilis treatment and congenital syphilis prevention in a women's correctional setting.

BACKGROUND: With prostitution and drugs the most common reasons for arrest among New York City (NYC) women, female arrestees are at high risk for acquiring syphilis and delivering congenitally infected babies. Despite routine syphilis screening of all NYC inmates, many are released before the need for treatment is recognized, and once released, few could be found for treatment. GOALS: To improve syphilis treatment rates among female correctional inmates in NYC. STUDY DESIGN: At a women's correctional health clinic, on-site, rapid, qualitative nontreponemal syphilis testing (STAT rapid plasma reagin [RPR]) and on-line access to the local syphilis case registry were introduced to supplement the usual admission medical evaluation. Treatment decisions made using the authors' jail protocol were compared with treatment criteria used in NYC's sexually transmitted disease (STD) clinics. Patients consisted of a consecutive sample of 685 remandees admitted one or more times during the day shift, March 24, 1993, to July 31, 1993, who had a full complement of mandatory admission medical tests. Using the study protocol, syphilis treatment decisions were made and needed treatment was furnished at the end of the admission medical evaluation. The main outcome measures were correct identification and treatment of syphilis in this population, compared with standard NYC Department of Health (DOH) STD clinic practice, as well as the effect of the jail protocol on pregnancy outcomes and need to treat offspring for congenital syphilis. RESULTS: Compared with NYC DOH STD clinic practice, the study protocol was 95% sensitive and 88% specific in arriving at appropriate treatment for syphilis. Treatment at the end of the admission medical evaluation increased syphilis treatment rates from 7% to 84% of women with indications for treatment and to 88% of pregnant women with indications for treatment. Prospective follow-up for birth outcomes revealed no spontaneous abortions and eight live births. Seven of the eight did not need congenital syphilis treatment because their mothers were adequately treated while incarcerated. CONCLUSIONS: Qualitative (or STAT) RPR testing and access to DOH syphilis case registry data provide prompt and accurate diagnostic information that can lead to an overall increase in the number of inmates appropriately treated (with a minimum amoung of overtreatment) in a women's correctional facility. This protocol may be applicable in other high-risk, transient populations.

Algorithms↗
PubMed1998

Rates of and risk factors for trichomoniasis among pregnant inmates in New York City.

BACKGROUND: Trichomonas vaginalis is a common pathogen that is associated with adverse pregnancy outcomes and may serve as a cofactor in human immunodeficiency virus (HIV) transmission. GOAL: To define the epidemiology of trichomoniasis in a population of newly incarcerated pregnant women in New York City. STUDY DESIGN: Prospective study of 213 pregnant prisoners attending prenatal clinic. Patients participated in an interview regarding sexual and drug-related behaviors, and underwent direct culture for T. vaginalis in addition to routine testing for syphilis, gonorrhea, and chlamydia. RESULTS: The prevalence of trichomoniasis was 46.9%. On univariate analysis, there was a significant association between trichomoniasis and older age, crack use, prostitution, known HIV infection, and positive serological test for syphilis. Multivariate analysis showed a significant association of trichomoniasis with crack use and positive serological test for syphilis. CONCLUSION: Trichomoniasis is highly prevalent in pregnant prisoners in New York City. The extent of disease observed may justify a formal program of testing and treatment and emphasizes the urgent need for harm reduction education and expanded HIV counseling and testing services in this high-risk population.

Adolescent↗
PubMed2001

HIV infection among foreign transsexual sex workers in Rome: prevalence, behavior patterns, and seroconversion rates.

BACKGROUND: The Azienda Sanitaria Locale Roma E (ASL-RME) outpatient clinic is the main reference center in Rome for HIV testing of foreign people. GOAL: To define the prevalence and incidence of HIV infection among foreign transsexual sex workers attending the center. STUDY DESIGN: A cross-sectional, follow-up study was conducted. RESULTS: Between 1993 and 1999, 353 transsexuals attended the ASL-RME. They were from Colombia (n = 208), Brazil (n = 122), and other countries (n = 23). Most of these transsexuals reported having 5 to 10 partners per day. The overall HIV prevalence was 38.2%, which multivariate analysis found to be associated with origin from Brazil and a higher number of sex partners. The observed HIV seroconversion rate was 4.1 per 100 person-years, and non-regular condom use was the only factor related to seroconversion. CONCLUSIONS: The data from this study suggest that promotion of safer sex practices and regular condom use still is the main priority among marginalized population subgroups, such as foreign prostitutes, involved in sex activities that put them at risk for HIV infection.

Adult↗
PubMed2001

Seroprevalence of HIV, hepatitis B virus, and syphilis in women at their first visit to public antenatal clinics in Vitória, Brazil.

BACKGROUND: In some countries, HIV infection in pregnancy has become a common complication of pregnancy. GOAL: To determine the seroprevalence of HIV, hepatitis B virus, and syphilis among pregnant women, and to assess risk factors for these infections. STUDY DESIGN: A cross-sectional study was performed. METHODS: Pregnant women attending antenatal clinics of Vitória Municipality from March to December 1999 were included in this study after giving written informed consent. The women were systematically interviewed. During the interview, their demographics and patterns of risk behavior were explored. A blood sample was collected for testing HIV, hepatitis B virus, and syphilis. RESULTS: The participants in this study were 1608 pregnant women. The prevalence of HIV infection was 0.8% (95% CI, 0.4-1.2), hepatitis B virus carriers 1.1% (95% CI, 0.8-1.3), and syphilis 3% (95% CI, 2.6-3.5). The potential risk behaviors were found to be a history of STDs (6.5%), condoms never used (52.8%), prostitution (0.5%), noninjection drug use (6.3%), blood transfusion (1.5%), and intravenous drug abuse (0.7%). CONCLUSION: These results show the necessity of implementing programs aimed at preventing transmission of these infections in women and their children.

Adolescent↗
PubMed2002

The Bali STD/AIDS Study: evaluation of an intervention for sex workers.

BACKGROUND: Prostitution has been an important factor in the spread of HIV infection in Asia. Interventions need to be developed to reduce the risk of transmission of sexually transmitted infections in this area. GOALS: To educate female sex workers about sexually transmitted infections and assess the impact of the educational intervention. STUDY DESIGN: Brothel areas in Denpasar, Bali, Indonesia, were divided into areas of high and low program (interventional) effort. The intervention included educational sessions for sex workers, treatment of sex workers for sexually transmitted disease (STD), condom distribution, and printed information for clients of the sex workers. A high-effort area was one in which a more intensive educational intervention occurred. A clinic was available for STD treatment in both areas. Behavioral surveys and STD testing were used to evaluate the programs. Six hundred female sex workers participated in behavioral surveys and STD examinations every 6 months for four rounds of data collection. Each round, about half of the women were new to the study. A total of 1586 women participated in at least one evaluation round. Changes were evaluated in AIDS knowledge, STD knowledge, and condom use, as well as in the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, and Trichomonas vaginalis. Testing for HIV was conducted anonymously. RESULTS: Improvements were noted in the knowledge of sex workers about AIDS and STDs and in the reduction of some bacterial STDs. Women who remained in the study area for more than one round had increased knowledge of HIV infection/STDs and condom use and had reduced levels of syphilis, gonorrhea, and trichomonas infection (P < 0.01). The additional education received by women in the high-effort program area was associated with a reduction in the prevalence of syphilis. Prevalence of HIV remained low throughout the study. The high level of turnover of female sex workers contributed to the maintenance of significant levels of STDs in this population. CONCLUSIONS: Developers of HIV/STD prevention programs for sex workers need to consider the mobility of the sex worker population. Interventions combining behavioral and medical approaches can contribute to prevention of these diseases.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Screening for syphilis in arrestees: usefulness for community-wide syphilis surveillance and control.

BACKGROUND: Syphilis screening of jail arrestees has been promoted as an effective method for both disease control and surveillance. GOALS: To evaluate the yield of the East Baton Rouge Parish Jail screening program in detecting previously undiagnosed syphilis, to evaluate the program as a means for monitoring community syphilis rates, and to characterize arrestees at greatest risk for syphilis infection. STUDY DESIGN: From July 1994 to December 1998, arrestees brought to the East Baton Rouge Parish Jail were screened for syphilis. Annual early syphilis prevalence in screened arrestees was calculated and compared with the annual period prevalence of early syphilis in the general population of East Baton Rouge Parish, as reported by laboratories and health providers. A case-control study of cases detected at the jail from 1995 to 1997 and contemporary controls was conducted. RESULTS: A total of 50,941 arrestees were booked into the East Baton Rouge Parish Jail, of whom 38,573 (76%) were screened for syphilis. Of the 38,573 arrestees screened, 494 (1.3%) were diagnosed with untreated syphilis. Of these, 299 (61%) were treated for syphilis before release. The estimated prevalence of early syphilis in arrestees decreased by 68% during the study period, from 0.79% in 1994 to 0.25% in 1998. During this time, the East Baton Rouge Parish community rates decreased by 79%, from 150 cases per 100,000 to 31 cases per 100,000. In female arrestees, a booking charge of prostitution was associated with syphilis (odds ratio [OR] 7.0; 95% CI, 1.5, 39.3). In male arrestees, a booking charge of felony theft was associated with syphilis (OR 4.8; 95% CI, 1.8, 13.8). However, only 15 (12%) of the early syphilis cases would have been detected if screening had been based on the booking charges found to be associated with syphilis in this study. CONCLUSIONS: Routine syphilis screening and treatment in jail settings is feasible and identifies many persons with syphilis. Monitoring of syphilis prevalence among arrestees is a useful method for monitoring community prevalence of syphilis. Analysis of booking charges may be useful for determining factors associated with syphilis infection, but not for developing screening criteria.

Adult↗
PubMed2002

Epidemics due to imported syphilis in Finland.

BACKGROUND: Russia and other states of the former Soviet Union experienced a huge increase in syphilis beginning in the early 1990s. At first these epidemics were not well known in neighboring countries such as Finland. STUDY DESIGN: In 1995 the incidence of syphilis in Finland doubled to 3.3/100,000 and a local cluster of 18 cases was detected in the city of Tampere. The reasons for this epidemic were analyzed and the occurrence of syphilis was carefully monitored up to 2001. RESULTS: The main reason for the increased incidence in Finland was the import of syphilis from Russia; only a few cases were acquired from Estonia or elsewhere. The source partners of Finnish men who contracted syphilis abroad were mostly sex workers or other casual partners. Mobile prostitution to Finland was not involved in the transmission. Most syphilis cases were found sporadically in southern Finland, in areas where foreign travel is frequent. Secondary transmission in Finland was usually limited to one or two partners. The only isolated cluster was further away and developed due to unawareness of the risk of syphilis by the cases and local healthcare providers. From 1995 onward, syphilis was carefully monitored by national reporting and a special sexually transmitted disease (STD) surveillance network, and the incidence remained at a constant level even though travel to and from Russia more than tripled. Nationwide serologic surveillance in STD and maternity clinics and among blood donors showed no major changes in the prevalence of syphilis. CONCLUSION: An epidemic of syphilis imported mainly by heterosexual men from Russia caused one sporadic cluster in Finland in 1995. Thereafter, general awareness by the public and healthcare providers about the risks of contracting syphilis from abroad, in addition to effective use of national surveillance and notification systems, was needed to protect the country from further spread of syphilis to an endemic infection.

Adult↗
PubMed2003

Hepatitis C seroprevalence and risk behaviors in patients attending sexually transmitted disease clinics.

BACKGROUND: Hepatitis C virus (HCV) is a major global problem, transmitted primarily by percutaneous exposure to contaminated blood. GOAL: The goal of the study was to determine the seroprevalence of and risk factors for HCV among patients attending two urban STD clinics in Alberta. STUDY DESIGN: Anonymous unlinked serosurveys were performed with use of leftover sera. Self-administered questionnaires collected information on demographics, sexual behaviors, and drug use. RESULTS: The seroprevalence of HCV was 3.4% (209 of 6,668 patients). Univariate analysis revealed that infection was higher among nontherapeutic needle users (RR = 80.9), those coinfected with HIV (RR = 8.09), individuals over the age of 20 years (RR = 6.68), those of aboriginal ethnicity (RR = 5.54), those with a history of STD (RR = 3.43), men (RR = 2.2), and bisexuals (RR = 2.23). Not utilizing condoms and engaging in prostitution or exchanging money or drugs for sex were also risk factors. In multivariate analysis, nontherapeutic needle use remained highly significant (RR = 60.54-65.51). Other significant factors included sex, age, ethnicity, a history of STD, and HIV infection (RR = 1.72, 4.62, 3.18, 1.69, and 2.56, respectively). Sexual orientation and sexual practices were not significant without a history of drug use. CONCLUSION: Nontherapeutic needle use is the strongest predictor of HCV infection.

Adolescent↗
PubMed2003

Prevalence of and risk factors for HIV infection in individuals testing for HIV at counseling centers in Brazil.

BACKGROUND: Risk factors for HIV infection have been scarcely studied in developing countries. GOAL: The goal was to examine the seroprevalence and the risk factors for HIV infection among individuals submitting to voluntary and anonymous testing at counseling and testing centers in Porto Alegre, Brazil. STUDY DESIGN: In this cross-sectional study HIV infection was diagnosed by enzyme-linked immunosorbent assays (ELISAs) and indirect immunofluorescence. Risk factors for HIV infection were investigated and fitted to logistic regression models according to a hierarchical framework. RESULTS: The overall prevalence of HIV infection was 11.9%. It was greater among homosexual men, individuals with an HIV-positive partner, and intravenous cocaine users. The factors independently associated with risk for HIV infection were: history of detention, homosexual or bisexual orientation, positive VDRL, sex with male prostitutes, HIV-positive sex partner, sex with injectable drug user (IDU), use of cocaine, and sharing needles or syringes. CONCLUSION: A high prevalence of HIV infection among individuals attending anonymous testing centers was related to sexual behavior and IDU. Other risk factors might be just proxies of true risk behaviors.

Adult↗
PubMed2003

Phthirus pubis in a sexually transmitted diseases unit: a study of 14 years.

BACKGROUND: There have been few epidemiologic studies of pubic lice in recent times, and the exact incidence is unknown. GOAL: The goal was to determine the trends of pubic lice infestation in a risk group of males and female prostitutes in an STD unit in Spain. STUDY DESIGN: This was a prospective 14-year study, from 1988 to 2001, of all patients attending the STD unit in Gijón (Asturias, Spain), investigating crab lice and other STDs. RESULTS: One hundred ninety-seven patients (2.2%) had pubic lice, with a male/female proportion of 1.8/1. The yearly infestation rate ranged from 1.3% to 4.6%. The mean age was 30.3 years, and 18.8% of patients were older than 35 years. There were more cases involving men who had sex with men (MSM) (P < 0.001) than those involving heterosexual men. Reinfestation occurred in 7.6% of patients, more often in males (P < 0.05) and mainly in MSM (P < 0.01). CONCLUSION: Infestation rates were stable during the period of study, with more older patients involved than reported previously, and infestation frequently was associated with STDs. MSM were infested and reinfested more often than heterosexual men, and in general reinfestations occurred more frequently in males than in females.

Adolescent↗