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PubMed2003

Comparison of STD burden and risk among men with and without regular doctors attending a southern urban STD clinic.

BACKGROUND: Studies addressing health-seeking behaviors among men at risk for STD are few; this study examines how having a regular doctor might influence risk-taking or STD prevalence. GOAL: The goal was to examine demographic, sexual, and health-seeking characteristics of male STD clinic attendees. STUDY DESIGN: Randomly selected men attending an STD clinic answered a questionnaire regarding the aforementioned characteristics. The men were stratified according to whether they reported having a regular doctor. RESULTS: Of 467 men, 32% reported a regular doctor. These men were more likely to be older, to be better educated, and to state they would seek care for a medical problem at a doctor's office. The two groups did not differ in STD history or prostitute exposure; men without doctors were more likely to have urethritis and STD, although the men with doctors had substantial STD rates. CONCLUSION: Public health clinics remain an important safety net for the management of STD, even for men who report a regular doctor.

Adult↗
PubMed1986

Outbreak of penicillinase-producing Neisseria gonorrhoeae with an African connection.

Previous outbreaks of penicillinase-producing gonococcal infection in the United States have generally been attributed to importation of Southeast Asian strains. During July 1982 through July 1983, 110 cases of gonorrhea caused by penicillinase-producing strains were reported in metropolitan Atlanta, Georgia. Among the 53 infected women, 14 (26%) had pelvic inflammatory disease (PID). Compared to other infected women, those with PID experienced a greater delay from the time of last sexual exposure (19.1 vs 8.1 days) to receipt of appropriate antibiotic therapy (P less than .01). At least 22 prostitutes were involved in the outbreak. Sixteen (76%) of 21 isolates tested were serogroup 1A; 15 required arginine and proline for growth; and 17 (81%) possessed a 3.2 megadalton plasmid. Our data suggest that this outbreak was associated with both African and Southeast Asian strains.

Adult↗
PubMed1990

Risk factors for human immunodeficiency virus infection among parenteral drug abusers in a low-prevalence area.

Information is scant regarding epidemiologic risk factors for human immunodeficiency virus (HIV) infection among parenteral drug abusers (PDAs) residing in areas of low seroprevalence. A detailed interview and HIV serologic testing were conducted among PDAs hospitalized at Detroit Receiving Hospital for reasons unrelated to HIV infection. The study involved 22 seropositive (17 men, 5 women) and 52 seronegative (34 men, 18 women) drug abusers in Detroit, Michigan, an area of relatively low HIV prevalence. The interviews included inquiries regarding risk factors such as duration of drug abuse, visits to "shooting galleries," use of "hit men," needle sharing, sterile injection techniques, use of "street" antibiotics, promiscuity, visits to prostitutes, homosexuality, history of sexually transmitted diseases, and history of travel to areas of high HIV prevalence. A strong association was noted between the number of risk factors present and HIV seropositivity. The presence of any three or more risk factors was significantly associated (P less than .05) with seropositivity. Awareness of epidemiologic risk factors for HIV infection among PDAs in a low-prevalence area is useful in identification of seropositive drug abusers and is crucial in designing educational interventional strategies to interrupt viral transmission.

Adult↗
PubMed1994

Outbreaks of syphilis in rural Texas towns, 1991-1992.

Between 1986 and 1990, rates of primary and secondary syphilis increased 134% in rural counties in the South. Reasons for the increases are speculative. During the 14 months ending in October 1992, outbreaks in four eastern Texas counties provided an opportunity to characterize syphilis in rural Texas. We reviewed records for 118 patients and 339 sex partners. Three outbreaks were concentrated in neighborhoods where crack cocaine dealers conducted business and exchange of sex for drugs or money was common; the fourth outbreak involved out-of-town prostitutes who visited undocumented alien workers. Among the 118 syphilis cases, 15 (13%) were primary, 35 (30%) were secondary. Most patients were black (105, 89%); the male-female ratio was 1:1. One woman gave birth to an infant with congenital syphilis. Almost half of the sex partners were infected. HIV pretest counseling was completed for only 55 patients (47%), and only 23 (19%) were tested for the human immunodeficiency virus. These four rural outbreaks of syphilis associated with crack cocaine and the exchange of sex for drugs or money mirror recent urban syphilis outbreaks. Patients in these rural syphilis outbreaks are at risk for HIV infection, but HIV testing has not been emphasized by public health workers.

Adult↗
PubMed1994

Syphilitic endometritis causing first trimester abortion: a potential infectious cause of fetal morbidity in early gestation.

This report describes a 30-year-old woman with a history of prostitution and "crack" cocaine use during pregnancy. After an incomplete abortion at 11 weeks' gestation, a suction dilatation and curettage of uterine contents was done. Histopathologic examination revealed lymphoplasmacytic deciduitis and decidual necrosis, as well as rare first trimester chorionic villi. Silver staining using the Steiner technique showed numerous spirochetes, morphologically consistent with Treponema pallidum, in the decidualized endometrial tissues. This case of syphilitic endometritis, which appears to be the first reported, suggests that treponemal infection can cause fetal morbidity during early gestation.

Abortion, Spontaneous↗
PubMed2003

Smoking, alcohol, diet, dentition and sexual practices in the epidemiology of oral cancer in Poland.

The effect of smoking, drinking, diet, dental care and sexual habits on the risk of oral and pharyngeal cancer was investigated in a case-control study conducted in Warsaw, Poland. The study comprised 122 patients (including 44 females) aged 23-80 years with histologically confirmed cancer of oral cavity and pharynx. Controls were 124 subjects (including 52 females) admitted to the hospital for different non-neoplastic conditions unrelated to tobacco and alcohol consumption, with frequency matched to cases by age and sex. Smoking and drinking were strongly associated with an increased risk of oral cancer. Among consumers of both products, risks of oral cancer tended to combine in a multiplicative fashion and were increased more than 14-fold among those who consumed more than 15 cigarettes and seven or more drinks per day. Cessation of smoking was associated with reduced risk of this cancer. The risks varied by type of cigarettes smoked, being lower among those consuming filtered cigarettes only (OR = 1.6) than nonfilter (OR = 6.5) or mixed (OR = 4.2) cigarettes. High fruit intake was associated with significantly decreased risk (OR = 0.4) with the strongest significant inverse association found for fruit juices and citrus fruits ( < 0.01). After adjustment for tobacco smoking and alcohol drinking, poor dentition as evidenced by missing teeth, frequency of dental check-ups and frequency of teeth brushing emerged as a strong risk factor. Number of missing teeth and frequency of dental check-ups and frequency of tooth brushing showed increased ORs of 9.8, 11.9 and 3.2, respectively. Denture wearing did not affect oral cancer risk. No differences were detected in sexual practices (including oral sex and intercourse with prostitutes). In terms of attributable risk, smoking accounted for 57% of oral cancer cases in Poland, alcohol for 31% and low fruit intake for 12%. Attributable risks for low frequency of tooth brushing and dental check-ups were 56% and 47%, respectively. In conclusion, smoking and drinking cessation and increase of fresh fruit intake are likely to be effective preventive measures against oral cancer. These findings indicate also that poor oral hygiene may be an independent risk factor.

Adult↗
PubMed1996

Sources of stigma associated with women with HIV.

In the United States many women infected with the human immunodeficiency virus (HIV) are poor women of African American or Hispanic American descent. Women with HIV have experienced many forms of oppression and discrimination and have been blamed as the victims of HIV and labeled as drug users, prostitutes, and carriers of acquired immune deficiency syndrome (AIDS). They have been stigmatized for their gender, their sexuality, their minority status, and their poverty, as well as for their HIV-positive status. Stigma theory is used in this article to explore the sources of stigma associated with this vulnerable group of clients.

Female↗
PubMed1998

Understanding women's risk of HIV infection in Thailand through critical hermeneutics.

Approximately 20% of all new AIDS cases in Thailand are women of childbearing age. Women are particularly vulnerable to HIV infection because of the social and sexual practices of men frequenting prostitutes, even after marriage, and the inability of women to exert control on decisions regarding sexual health. Women's oppression in Thailand is discussed and a position made of the moral imperative to use counterhegemonic methodologies in the study of HIV risk and prevention in Thai women. Interpretive and critical research methodologies are reviewed, and a case is made for using critical hermeneutics as an approach for investigating women's oppression in Thailand and their vulnerability to HIV infection.

Female↗
PubMed1996

The phylogeny and molecular epidemiology of human T-cell lymphotropic virus type II.

Phylogenetic analysis of long terminal repeat (LTR) sequences from 29 human T-cell lymphotropic virus type II (HTLV-II) strains from endemic and nonendemic populations led to the proposition of three HTLV-IIa phylogroups (A-I, A-II, and A-III) and four HTLV-IIb phylogroups (B-I, B-II, B-III, B-IV). B-I and B-II represented sequences from U.S. and European intravenous drug users, and B-IV included Amerindian sequences from the Guaymi and Wayuu. Interestingly, sequences from an African Pygmy and Seminole and Pueblo Indians and other non-India U.S. samples clustered together in B-III. Similarly, sequences from the Kayapo Indians from Brazil, a Brazilian blood donor, a Cameroonian, and a Ghanaian prostitute clustered together in A-II. Sequences from non-Indian U.S./European samples and a Pueblo Indian formed A-III. A restriction fragment length polymorphism (RFLP) assay was developed to identify rapidly the prevalence of the A and B phylogroups in 246 HTLV-II samples. The RFLP results suggest that A-III and B-II may represent cosmopolitan subtypes because of global distribution in urban areas. In contrast, B-IV and A-II infections were restricted primarily to Central and South America. The phylogenetic data suggest a possible Amerindian origin for B-III, A-II, and A-III infections in non-Indians and an evolution into A and B subtypes that preceded population migrations to the Americas.

Genetic Variation↗
PubMed1997

Incidence of HIV and HTLV-1 infection among sexually transmitted disease clinic attenders in Jamaica.

Of 970 sexually transmitted disease (STD) patients enrolled at the Comprehensive Health Centre, Kingston, Jamaica, between November 1990 and January 1991, 710 (73%, 333 men and 377 women) were reexamined between January 1992 and July 1993 to estimate the incidence of HIV and HTLV-I infection and to identify risk factors for infection. Of those reexamined, 20% were recruited passively when they returned to the clinic of their own accord, and 80% were recruited actively through field visits to their homes. Passively recruited persons were significantly more likely than active recruits to have had a sexually transmitted disease since enrollment or at their follow-up visit. Seven men and one woman became HIV positive during the period of follow-up. The overall HIV incidence rate was 0.7 per 100 person years (95% confidence interval [CI] = 0.3 to 1.4), 1.4 (CI = 0.6 to 2.8) for men and 0.2 (CI = 0.004 to 0.9) for women. Four of 270 men and 4 of 318 women were HTLV-I positive, an overall incidence of 0.9 per 100 person years (CI = 0.4 to 1.7), 1.0 for men and 0.8 for women. HTLV-I infection was associated with an age of 30 years or older (p < 0.01). The presumed lower transmission probability for HTLV-I may combine with a higher prevalence of HTLV-I in sexual partners to produce similar overall incidence rates for the two infections. The HIV and HTLV-I incidence rates may have been underestimated, because the study subjects who did not return to the clinic may have had a somewhat higher risk. On univariate analysis, there were significant associations between HIV infection in men and drinking alcohol before sex, cocaine use, total number of sex partners, sex with a prostitute since enrollment, ever accepting money for sex, the average number of sex partners per month, bruising during sex, and genital ulcers found on follow-up examination. This analysis needs to be interpreted with caution in view of the small number of seroconverters, which did not allow testing for independent effects in a logistic regression model.

Adult↗
PubMed2002

Spectrum of commercial sex activity in Burkina Faso: classification model and risk of exposure to HIV.

OBJECTIVE: Before designing a sexually transmitted infection (STI)/HIV intervention study targeting female commercial sex workers in Bobo Dioulasso, Burkina Faso, we conducted a socioanthropologic survey to analyze the prostitution network in the city in 1998. According to social characteristics, women were classified in six different categories, including four groups of nonprofessional sex workers. The aim of the current study is to assess HIV exposure across this classification model. METHODS: A total of 447 women belonging to the six categories were enrolled in the study. After collection of social and behavioral data by means of a questionnaire, each woman received a physical examination and a blood sample was taken for HIV serologic testing. RESULTS: The category of "seaters" was the most often infected, with an HIV prevalence of 57% (58 of 101 women). Nonprofessional "sellers" and "bar waitresses" were more often infected than professional "roamers," with an HIV prevalence of 37% (24 of 65 women), 40% (27 of 67 women), and 29% (27 of 92 women), respectively, despite a much lower number of clients per week (average of 2.6 clients, 3.3 clients, and 18.6 clients, respectively). Finally, "students" and "cabarets" (women making and selling local beer in huts) were infected with an HIV prevalence of 15% (9 of 62 women and 9 of 60 women, respectively), which remains higher than the prevalence measured recently in the general female population in the city (6.4%). CONCLUSION: Our results highlight the high level of vulnerability of nonprofessional sex workers, who need to be considered in the design of any program targeting this population for STI/HIV control purposes.

Adolescent↗
PubMed2003

Comparison of clients of a mobile health van and a traditional STD clinic.

The objective of this study was to determine if there were any demographic, behavioral, and clinical differences between clients seen aboard a mobile sexually transmitted disease (STD)/HIV clinic compared with those seen in a traditional municipal STD/HIV health clinic for receipt of STD/HIV services. Clients seen in the two different settings were interviewed about demographic characteristics, reasons for their visit, STD history, their HIV/STD risk factors, and the risk factors of their sex partners. Clients in both settings were also offered testing for syphilis, gonorrhea, chlamydia, and HIV. Results suggested that clients seen at the mobile clinic were older, more likely to be injecting drug users themselves and/or to have sex partners who were, or had engaged in prostitution for money or drugs. Over half (54.4%) of the mobile clinic clients sought testing for HIV, and they were far less likely to be seeking care for symptoms of an STD. In contrast, only 7.1% of municipal clinic clients indicated HIV testing as the reason for their visit, whereas nearly two thirds (64.5%) reported symptoms of disease. Two percent of municipal clinic clients and 5.4% of mobile clinic clients had a positive HIV test ( p<.001), and 17.8% of STD clinic clients and 5.6% of mobile van clients had a positive gonorrhea and/or test ( p<.001). These data suggest that a mobile STD/HIV clinic may be an effective strategy to reach individuals at high risk for HIV who are not being served by traditional municipal STD/HIV health clinics.

Adult↗
PubMed2004

Seroepidemiology of HTLV-I/II in Argentina: an overview.

In this report, the results of seroepidemiologic studies of human T-lymphotropic virus type I (HTLV-I) and type II (HTLV-II) infections in different population groups in Argentina have been compiled. The studies have shown a high prevalence of HTLV-I/II infection in blood donors in the provinces in the north of Argentina (1.0% in Jujuy, 0.7% in Salta, and 0.6% in Formosa) and a low prevalence in the provinces in the central region of the country (<or=0.1%). High rates of HTLV-I (0.45%-2.78%) and HTLV-II (2.78%-21.9%) infections have been documented in Native Indian groups and have highlighted the importance of sexual and mother-to-child transmission of the viruses. The presence of HTLV-I/II antibodies in HIV-infected individuals indicates that both viruses are circulating in certain high-risk population groups. HTLV-I/II was detected in intravenous drug users (2.56%-21.7%), homosexual men (0.5-1.33%), prostitutes (0.8%), and hemophiliacs (2.8%). In conclusion, HTLV-I/II infection is circulating in low- and high-risk populations in Argentina, and these findings would support the view that selective screening for HTLV-I/II should be implemented to reduce the spread of infection.

Argentina↗
PubMed2006

Risk factors for infectious disease in corneal transplant screening.

PURPOSE: To identify potential medical and behavioral risk factors associated with infectious disease seropositivity in potential corneal donors using an extensive questionnaire completed by the next of kin. METHODS: Retrospective review of medical history and behavioral risk assessment questionnaire and microbiology data for potential corneal donors seropositive for hepatitis B, hepatitis C, human immunodeficiency virus, human T-cell leukemia virus and syphilis as compared to controls. RESULTS: Tobacco use, cigarette smoking, chest pain and heart disease are each associated with corneal donor seropositivity (P < 0.05). Vaccination in the last twelve months is inversely associated with infectious disease (P < 0.05). Statistically significant factors associated with hepatitis C positive donors include: cigarette use, illicit drug use, chest pain, cardiac medications, kidney stones and lung disease (P < 0.05). Factors most often associated with transmission of this disease panel (such as intravenous drug use, sexual contact with prostitutes and history of blood transfusion) are often not identified by the next of kin in the questionnaire. CONCLUSIONS: While there are questionnaire identified risk factors associated with seropositivity in this study, their clinical usefulness is unclear. Many factors crucial to the elimination of potentially infectious donor tissues are not identified in the posthumous history typically completed by next of kin. These questionnaires alone do not provide exclusion criteria for elimination of potentially infectious tissues from the donor pool.

Communicable Diseases↗
PubMed2004

Syphilis outbreak among Hispanic immigrants in Decatur, Alabama: association with commercial sex.

BACKGROUND: Despite national progress in syphilis control, increases in rates have recently occurred, and syphilis is still an endemic problem in the southern United States. An outbreak of infectious syphilis among Hispanics was identified in Decatur, Alabama. GOAL: An investigation was initiated to describe the outbreak and to assist with prevention activities. STUDY DESIGN: We reviewed case interview records and syphilis surveillance data. The Morgan County Health Department (MCHD) performed voluntary door-to-door syphilis screening in neighborhoods where a large number of cases had been identified. During screening activities, sociodemographic and behavioral data were collected. RESULTS: From June 2000 to February 2001, 49 cases of syphilis were reported; 26 (53%) were primary or secondary, 17 (35%) were early latent, and 6 (12%) late latent. Of the early syphilis cases, 70% were male and half were Hispanic; 93% of cases were linked to commercial sex and 70% of female cases reported crack cocaine use. During the screening, 172 individuals completed a questionnaire; 70% of participants were male, 83% were Hispanic, 17% of Hispanic participants spoke English, 21% reported sex with a commercial sex worker, and 8 (5%) had positive syphilis serology. Among men, factors associated with commercial sex were not having a regular partner (odds ratio [OR], 3.9; confidence interval [CI], 1.1-14.3), not living with a family member in the United States (OR, 4.5; CI, 1.6-12.8), and having visited their country of origin since arrival to the United States (OR, 9.2; CI, 2.3-36.5). CONCLUSIONS: Factors contributing to this outbreak were crack cocaine use and increased prostitution in close proximity to the Hispanic community. At present, there are an increasing number of Hispanic immigrants in the United States, the majority of whom do not speak English. To prevent similar outbreaks in the future, public health officials need to be aware of the health and health education needs of these populations.

Adolescent↗
PubMed2005

Social and geographic distance in HIV risk.

OBJECTIVE: The objective of this study was to examine the relationship between social distance (measured as the geodesic, or shortest distance, between 2 people in a connected network) and geographic distance (measured as the actual distance between them in kilometers [km]). STUDY: We used data from a study of 595 persons at risk for HIV and their sexual and drug-using partners (total N = 8920 unique individuals) conducted in Colorado Springs, Colorado, from 1988 to 1992--a longitudinal cohort study that ascertained sociodemographic, clinical, behavioral, and network information about participants. We used place of residence as the geographic marker and calculated distance between people grouped by various characteristics of interest. RESULTS: Fifty-two percent of all dyads were separated by a distance of 4 km or less. The closest pairs were persons who both shared needles and had sexual contact (mean = 3.2 km), and HIV-positive persons and their contacts (mean = 2.9). The most distant pairs were prostitutes and their paying partners (mean = 6.1 km). In a connected subset of 348 respondents, almost half the persons were between 3 and 6 steps from each other in the social network and were separated by a distance of 2 to 8 km. Using block group centroids, the mean distance between all persons in Colorado Springs was 12.4 km compared with a mean distance of 5.4 km between all dyads in this study (P <0.0001). The subgroup of HIV-positive people and their contacts was drawn in real space on a map of Colorado Springs and revealed tight clustering of this group in the downtown area. CONCLUSION: The association of social and geographic distance in an urban group of people at risk for HIV provides demonstration of the importance of geographic clustering in the potential transmission of HIV. The proximity of persons connected within a network, but not necessarily known to each other, suggests that a high probability of partner selection from within the group may be an important factor in maintenance of HIV endemicity.

Cluster Analysis↗
PubMed1990

Clinical survey of syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with special reference to the recent clinical manifestations and evaluation of IgM antibodies to Treponema pallidum.

One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA + IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.

Adolescent↗
PubMed1992

Sex, HIV and the injecting drug user.

There is considerable evidence that drug injectors are reducing their HIV risk, but changes in syringe sharing behaviour have been greater than those in sexual risk behaviour. This paper reviews the literature on sexual risk behaviour in injecting drug users. It focuses on the major areas of concern: HIV prevalence among drug injectors; sexual risk behaviour; the potential for heterosexual transmission; condom use; sexual risk and women; pregnancy; male homosexual activity and drug use; the effect of drugs on sexual behaviour and prostitution. The paper also considers some of the difficulties in changing sexual risk behaviour and suggests some ways forward for intervention and prevention.

Female↗