摘要:

BackgroundCervical cancer, a human papillomavirus (HPV)-caused neoplasia, is highly prevalent in Mexico.GoalTo determine the prevalence of HPV infection in female sex workers (FSW) from Mexico City and to assess the association between HPV infection and the characteristics of these women.Study DesignA questionnaire was applied to 495 FSW. Cervical cell specimens were obtained for DNA amplification and hybridization to detect 27 HPV types. A risk factor analysis was performed.ResultsThe overall prevalence of HPV infection was 48.9%. The prevalence of high-risk HPV types was 43%, whereas that of low-risk types was 24.6%. A total of 18.8% of study participants was infected with both high-risk and low-risk HPV types, and 28.5% were infected with two or more HPV types. Younger age and failure to use a condom were independently associated HPV risks (odds ratio, 7.3 and 2.3; 95% CI, 3.5–15.0 and 1.2–4.4, respectively).ConclusionsInfection with high-risk and multiple HPV types is high among Mexican FSW. This study corroborated a higher infection rate in younger women. A higher risk of HPV infection is also observed in women who have been involved with sex work for less than 1 year. However, condom use showed a protective effect against HPV infection.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundSyphilis rates began to decline in 1991 and have decreased every year since. In 1998, 6,993 cases of primary and secondary syphilis were reported in the United States, for a national incidence of 2.6 cases per 100,000 population. Although syphilis rates are at an historic low, focal outbreaks still occur. On October 7, 1999, the Division of Sexually Transmitted Disease Prevention of the Centers for Disease Control and Prevention, in collaboration with federal and community partners, presented the National Plan for Elimination of Syphilis from the United States. One of the five key strategies of the plan is rapid outbreak response.MethodsMethods for outbreak assessment and response were reviewed in the literature, synthesized, and adapted for use in syphilis outbreaks.ResultsKey elements of outbreak assessment and response are detection, surveillance data review, hypothesis generation, intervention development, and the evaluation of clinical, public health, and laboratory services.ConclusionsOutbreak response necessitates community participation and a coordinated interdisciplinary effort to determine social and behavioral contributors to the outbreak and to develop targeted interventions.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundTreatment of gonorrhea is complicated by widespread resistance ofNeisseria gonorrhoeaeto antimicrobial agents of choice, including decreased susceptibility to ciprofloxacin.GoalTo demonstrate the efficacy and safety of gatifloxacin, a novel 8-methoxy fluoroquinolone antibiotic, compared with ofloxacin in treating patients with uncomplicated gonococcal infection.Study DesignIn a double-blind, randomized (2:2:1), controlled trial, 340 men and 388 women with uncomplicated gonorrhea who were 16 years or older received a single oral dose of gatifloxacin (400 mg or 600 mg) or ofloxacin (400 mg). Primary analysis of efficacy was based on bacteriologic eradication from sites of infection. Secondary analyses examined clinical response and adverse event profiles.ResultsBacteriologic eradication rates for gatifloxacin in evaluable men with urethral gonorrhea were 99% (400 mg) and 100% (600 mg) versus 100% for ofloxacin (n = 117, 122, and 55, respectively;P= ns). Eradication rates in evaluable women with endocervical gonorrhea were 99% for both 400 mg and 600 mg gatifloxacin versus 100% for ofloxacin (n = 101, 104, and 55, respectively;P= ns). Eradication rates were 100% for both rectal (n = 43) and pharyngeal (n = 31) infection across all treatment groups. All three drug regimens were well tolerated and exhibited similar clinical response profiles.ConclusionGatifloxacin is safe and effective as a single 400-mg or 600-mg dose for the treatment of uncomplicated gonorrhea. Similar efficacy rates were observed with the 400-mg and 600-mg doses. A single 400-mg dose can be recommended for treatment of uncomplicated gonorrhea.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundDomestic violence occurs across all social, demographic, and economic strata of society, though women who report it are disproportionately young, unmarried, live with a male friend or family member other than a husband, engage in substance abuse, and are poor.GoalTo assess the prevalence of domestic violence among a sample of women presenting for care at a sexually transmitted disease (STD) clinic, and to identify behavioral and clinical correlates of domestic violence in this group.Study DesignWomen attending an inner-city STD clinic were asked to complete a self-administered questionnaire that ascertained demographic, clinical, and behavioral information. Questions regarding recent and lifetime physical and verbal abuse by a social intimate were included. Standard diagnostic tests and therapy for a variety of genitourinary infections were provided when indicated as a matter of routine care.ResultsThree hundred and seventy-five female clinic attendees completed the questionnaire. One hundred and forty one (37.6%) women reported ever having experienced physical assault by an intimate, and 123 (32.8%) reported verbal threats of violence. Fifty-eight (15.5%) women reported at least one episode of physical abuse in the year preceding participation. A report of physical violence was associated with drug use, STD history, and a history of a serious medical condition (P< 0.05).ConclusionThe high prevalence of domestic violence among women seeking care at an inner-city STD clinic suggests that these sites may be important for the detection of abuse victims. Clinic staff should be trained to inquire about domestic violence. On-site or referred resources (e.g., legal, social, clinical) should be made available to these women.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundHepatitis B virus infection causes substantial morbidity and mortality in the United States. Sexual activity is the most commonly reported risk factor among persons with acute hepatitis B, yet hepatitis B vaccine coverage among adolescents and adults with high-risk sexual practices is low. Sexually transmitted disease (STD) clinics are potentially efficient settings for vaccine administration to persons with high-risk sexual practices; however, little is known about hepatitis B vaccination activities in these settings.GoalTo gain information about policies and activities for vaccinating against hepatitis B in STD clinic settings.Study DesignIn April 1997, a questionnaire was sent to managers of 65 federally funded STD programs in state and local health departments. A similar survey was sent to 89 STD clinic managers in November 1997.ResultsThe response rate among program managers was 97% (63/65). Forty-eight percent considered hepatitis B prevention a program responsibility; 21% had developed and distributed written policies to prevent hepatitis B through vaccination; and 27% had developed policies to encourage hepatitis B education activities. The response rate among clinic managers was 82% (73/89). Forty-five percent reported that their STD clinics had implemented policies recommending hepatitis B vaccination and health education activities. Program managers and clinic managers reported that lack of funding to cover the cost of the vaccine, and lack of resources to provide prevaccination counseling, administer vaccine, and track clients for vaccine series completion were the primary barriers to the implementation of hepatitis B vaccination programs.ConclusionsTo enhance hepatitis B vaccination in STD clinics, existing funding sources must be accessed more effectively. Supplemental funding mechanisms for the cost of vaccine and resources for implementing vaccination programs also need to be identified. Additionally, STD clinics and programs should continue to propose and implement hepatitis B vaccination policies.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundChlamydia trachomatisis the most common bacterial sexually transmitted disease (STD) in the United States. The development of nucleic acid amplification tests forC trachomatisin urine specimens allows for screening outside traditional clinic settings. Persons visiting an HIV counseling and testing site may be at increased risk for STDs, includingC trachomatis.GoalTo measure the acceptance ofC trachomatisurine screening and the prevalence ofC trachomatisinfection among clients at an HIV counseling and testing site.Study DesignSite HIV counselors offered urineC trachomatisscreening to clients, administered a questionnaire, and collected urine samples.ResultsOf 808 counseling and testing site clients approached forC trachomatisscreening, 572 (71%) accepted. The most common reasons for declining screening were absence of symptoms (33%) and recent STD testing (32%). Men were more likely to accept urine screening than women (risk ratio, 1.31; 95% CI, 1.06–1.62), as were clients who practiced oral sex, had a history of STD, or who had never been screened for STD. Of 560 urine specimens processed, only 8 (1.43%; 95% CI, 0.66–2.91%) were infected withC trachomatis.ConclusionsSites offering HIV testing and counseling are a feasible alternative to clinical settings forC trachomatisscreening. Prevalence may be too low for screening to be cost effective unless higher-risk subpopulations can be identified.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundDespite reports of unusual clinical presentations and therapeutic responses among HIV-infected patients with syphilis, syphilis has not been regarded as a serious opportunistic infection that predictably progresses among most HIV-coinfected patients.GoalTo define and describe differences in the presentation and response to treatment of early syphilis among HIV-infected and HIV-uninfected patients, to describe any differences by gender, and to determine if clinical presentation of central nervous system involvement predicted serologic failure.DesignA prospective, multicenter, randomized, controlled trial of enhanced versus standard therapy to compare the benefit of enhanced therapy, the clinical importance of central nervous system involvement, and the clinical manifestations of early syphilis infection among HIV-infected and HIV-uninfected patients.ResultsThe median number of ulcers was significantly greater among HIV-infected and HIV-uninfected patients, as was the percent of HIV-infected patients with multiple ulcers. Among patients diagnosed with secondary syphilis, a higher percentage of HIV-infected patients presented with genital ulcers [13/53 (25%)] than did HIV-uninfected patients [27/200 (14%)]. No differences between HIV-infected and HIV-uninfected patients were detected for other secondary syphilis manifestations. Although women presented more frequently with secondary syphilis than did men, no other gender differences in clinical manifestations were noted. Neurologic complaints were reported most frequently among patients with secondary syphilis [103/248 patients (42%)] compared with patients with primary syphilis [32/136 (24%)] and early latent syphilis [48/142, (34%)] (P< 0.05), but no differences in neurologic complaints were apparent by HIV status or CSF abnormalities. No neurologic complaints were significantly associated with serologic treatment failures at 6 months.ConclusionsOverall, HIV infection had a small effect on the clinical manifestations of primary and secondary syphilis. Compared with HIV-uninfected patients, HIV-infected patients with primary syphilis tended to present more frequently with multiple ulcers, and HIV-infected patients with secondary syphilis presented with concomitant genitals ulcers more frequently.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background and ObjectivesClients attending sexually transmitted disease (STD) clinics are at risk for multiple infections (e.g., STDs, HIV, and infectious viral hepatitis). Risk assessment and serosurveys can document the need for hepatitis screening and vaccination services.GoalTo determine hepatitis C and B virus seroprevalence, identify predictive risk factors, and provide a rationale for integrating hepatitis services in an STD clinic.MethodsDuring various periods in 1998, consecutive clients completed a self-administered risk assessment and were offered screening for markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection (HBV core antibody and anti-HCV [enzyme-linked immunosorbent assay 3.0, confirmed by recombinant immunoblot assay 2.0]).ResultsSixteen percent of 300 clients tested for an anti-HBV core were positive, with injecting-drug users (IDUs) and men who have sex with men (MSM) having higher prevalences (50% and 37%, respectively). Of 615 clients tested for anti-HCV, 21 (3.4%) were positive. Injecting-drug users (n = 34) had a 38% anti-HCV prevalence compared with 1.1% for non-IDUs. Of 66 non-IDU MSM tested, none was HCV infected. IDUs had a high prevalence of past STDs (> 50%) and unsafe sexual behavior.ConclusionsInjecting drug users and MSM are at high risk for STDs, HIV, and hepatitis infections and could benefit from a “one-stop” STD clinic that included hepatitis prevention services.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundLittle is known about sex practices that increase the risk of contracting HIV infection or the level of HIV and AIDS knowledge among sexually transmitted disease (STD) patients in China.ObjectiveTo describe AIDS and HIV knowledge, sexual practices, and factors associated with never using condoms among patients at an STD clinic in Jinan, China.Study DesignClinic patients (n = 498) were randomly sampled to answer AIDS and HIV knowledge questions and to report sexual practices, including condom use.ResultsPatients had low levels of AIDS and HIV knowledge and engaged in high-risk sex behaviors. The majority of patients reported having had multiple sex partners. When having sex, few men and no women reported always using condoms. Gender, age, residence, AIDS and HIV knowledge, and having multiple sex partners were significantly associated with never using condoms.ConclusionSTD clinic patients report having engaged in high-risk sex behaviors. More research is needed to better understand the factors relevant to developing risk-reduction interventions for these patients in China.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundThe modes of transmission of human herpesvirus 8 (HHV-8) remain unclear.GoalTo study HHV-8 seroprevalence and risk factors among young men.Study DesignThe Young Men’s Survey was a multisite cross-sectional HIV seroprevalence and behavioral risk survey of men aged 15 to 22 years who attended public venues frequented by young men who have sex with men (MSM). Blood specimens were tested for HHV-8 by using an immunofluorescence assay at a 1:40 dilution among 488 participants in Seattle-King County, WA.ResultsTotal HHV-8 seroprevalence was 6% among MSM and 5% among men who have sex only with women (MSW). In multivariate analysis, unprotected receptive anal sex during the past 6 months, injection drug use, and cytomegalovirus infection were associated with HHV-8 seropositivity in MSM.ConclusionThe HHV-8 seroprevalence among these young MSM was similar to the HHV-8 seroprevalence among young MSW, but lower than seroprevalence estimates in earlier studies of older MSM. The association of MSM between HHV-8 infection and unprotected receptive anal sex supports previous findings that HHV-8 is sexually transmitted. Although CMV infection and injection drug use may be markers for unsafe sexual practices, it is also possible that these are independent risk factors for acquiring HHV-8.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID