ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundReasons for the strikingly increased rates of HIV and other sexually transmitted infections (STIs) among African Americans in the rural Southeastern United States remain unclear. Investigators have devoted little attention to the potential influence of the social and economic context on sexual behaviors.GoalTo examine the potential influence of these contextual factors on behaviors that promote the transmission of STIs.Study DesignFocus group interviews in which African Americans from rural North Carolina discussed life in their communities and contextual factors affecting sexual behavior.ResultsRespondents reported pervasive economic and racial oppression, lack of community recreation, boredom, and resultant substance abuse. Many perceived a shortage of black men because of their higher mortality and incarceration rates compared with whites, and believed this male shortage to be partly responsible for the concurrent sexual partnerships that they perceived as widespread among unmarried persons.ConclusionContextual features including racism, discrimination, limited employment opportunity, and resultant economic and social inequity may promote sexual patterns that transmit STIs.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundKaposi sarcoma-associated herpesvirus (KSHV) is transmitted by routes such as homosexual intercourse and is associated with HIV infection in industrialized countries. However, there is little information about its transmission in developing countries where Kaposi sarcoma is an endemic disease.GoalTo examine KSHV seroprevalence in young adults in a general, rural Ugandan population, and to compare this prevalence with rates of known sexually transmitted infections.Study DesignThe seroprevalence of KSHV was compared with the epidemiology of sexually transmitted diseases in 523 sexually active subjects aged 15 to 29 years who were randomly selected from a general population cohort in rural Rakai District, Uganda. Participants provided in-home interview data and specimens. Sera were tested for KSHV using immunofluorescence assay and immunoblot for lytically expressed recombinant KSHV ORF65.2. Sera were also tested for HIV type 1, herpes simplex virus type 2, and syphilis.ResultsThe prevalence of KSHV was significantly higher in participants 15 to 19 years compared with older persons 25 to 29 years (45.0% and 36.1%, respectively; adjusted odds ratio, 0.48; 95% CI, 0.28–0.82). In contrast, herpes simplex virus type 2 and HIV type 1 prevalence increased with age. Kaposi sarcoma-associated herpesvirus serostatus was not associated with HIV type 1, syphilis, herpes simplex virus type 2, or number of sexual partners. Homosexual and anal intercourse were reported by less than 1% of participants.ConclusionsKaposi sarcoma-associated herpesvirus does not appear to be a heterosexually transmitted infection in rural Uganda.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background and ObjectivesThe Cuban Ministry of Public Health plans to implement the syndromic approach to sexually transmitted diseases in persons with urethral or vaginal syndrome in Cuba using 500 mg ciprofloxacin as therapy. Although the emergence of clinical isolates ofNeisseria gonorrhoeaewith decreased susceptibility to ciprofloxacin have been sporadically detected in Cuba, there has been no report of isolates that exhibited significant resistance to this drug. This is the first report of the isolation of aN gonorrhoeaestrain resistant to ciprofloxacin in Cuba.Study DesignCase report.ConclusionsThis case emphasizes the need for awareness regarding the potential emergence of a clinically significant resistance ofN gonorrhoeaein Cuba. There is a need for continued antimicrobial susceptibility surveillance of Cuban isolates to ciprofloxacin and other fluoroquinolones.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundThe spread of heterosexual HIV in developing countries is heterogeneous. Factors that explain the wide diversity of HIV prevalences in different countries are undetermined. International aid organizations currently appear to be focusing activities mainly on women rather than on men.GoalTo identify critical determinants contributing to the high rates of heterosexual HIV transmission in developing countries through a review of studies investigating HIV per-act transmission rates, and to discuss how these factors might be prioritized through HIV-prevention interventions.Study DesignStudies investigating the per-act HIV transmission rate were identified through a MEDLINE search and a review of the abstracts of the Annual International AIDS Conferences.ResultsWhen the summary mean per-act HIV transmission rates were calculated, the ratio of female-to-male HIV transmission in developing countries compared with that in the developed world was 341, whereas that for male-to-female transmission was 2.9.ConclusionEnhanced female-to-male HIV transmission in male core groups is a critical determinant of high-prevalence HIV epidemics among heterosexuals in developing countries. In addition to condom promotion, there is a need for an increased emphasis on HIV-prevention activities in men to decrease their susceptibility in developing countries, particularly in the countries most affected by the epidemic.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundDespite recent declines in syphilis rates nationally, recent outbreaks suggest that prevention of congenital syphilis remains an ongoing public health problem.GoalsTo identify missed opportunities for congenital syphilis prevention during prenatal care.Study DesignRetrospective medical record review of 157 live birth or stillbirth deliveries that involved cases of congenital syphilis from Grady Memorial Hospital (Atlanta, GA).ResultsThe hospital congenital syphilis prevalence was 8.2 cases per 1000 live births. Six percent of case patients were HIV positive. Opportunities for earlier maternal screening, treatment, or diagnosis were missed in 60% of case patients who received timely prenatal care. Congenital syphilis cases attributable to preventable missed opportunities were significantly more common among case patients with fewer prenatal visits (66% versus 28%,P= 0.01).ConclusionProvider efforts to reduce congenital syphilis in high-risk populations receiving prenatal care should focus on (1) screening patients at the first opportunity, at both the first prenatal visit and during the third trimester (i.e., 28 weeks); (2) performing on-site testing and same-day treatment; (3) providing appropriate treatment to infected women with penicillin allergy; (4) referring sex partners for treatment to prevent reinfection; and (5) screening all pregnant women attending emergency clinics.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundMost genital herpes simplex virus type 2 (HSV-2) infections are unrecognized, thus, strategies to reduce the sexual transmission of HSV-2 are partly dependent on serologic screening.GoalTo define performance characteristics of the Gull/Meridian glycoprotein G-based HSV-2 enzyme-linked immunosorbent assay among sexually transmitted disease clinic attendees and correlates of test acceptance.Study DesignThe cross-sectional study was conducted during two periods. Serologic testing was offered at a US $15 charge during the first period and at no charge during the second period. Sera were tested by a type-specific glycoprotein G enzyme-linked immunosorbent assay and Western blot analysis, with the latter test used as the reference standard.ResultsAcceptance of HSV-2 testing was associated with free testing (odds ratio, 7.5; 95% CI, 6.0–9.9), older age, and white race. Sensitivity of the HSV-2 assay was 80.5% and specificity was 98.5%. The HSV-2 positive and negative predictive values were 95.8% (95% CI, 91.6–98.0%) and 92.2% (95% CI, 89.6–94.2%), respectively. Antibodies to HSV-2 were detected in 25.9% of 606 persons with no history of genital herpes.ConclusionAcceptance of HSV-2 serologic testing was cost sensitive. In this high-prevalence population, the positive predictive value of the enzyme-linked immunosorbent assay was sufficient to warrant its use without a confirmatory test. This assay could be useful in the screening of sexually active adults to detect unrecognized HSV-2 infection.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundPatient-based partner referral (PBPR), which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs), has limited effectiveness.GoalThe authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala, Uganda.Study DesignA total of 383 patients (187 women, 196 men) with STDs were randomized to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown.ResultsThe two groups had similar background characteristics. Of the 237 partners elicited, 176 (74%) were reported treated in the PDPM group. In the PBPR group, in which 234 partners were elicited, 79 (34%) were referred to the treatment clinic. This difference was statistically significant (risk ratio [RR], 2.44; 95% CI, 1.95–3.07;P< 0.001). Furthermore, PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women, 86 of 103 partners in the PDPM group were reported treated, compared with 23 of 104 partners in the PBPR group (RR, 4.55; 95% CI, 2.92–7.08;P< 0.001). For casual partners, 18 of 51 (34%) were reported treated in the PDPM group, compared with only three of 45 partners (7%) who were referred in the PBPR group (RR, 1.43; 95% CI, 1.40–2.65;P< 0.01).ConclusionPatient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundAfter many years of decline, the incidence of gonorrhea in Sweden reached an all-time low of 2.4 cases per 100,000 inhabitants in 1996; however, the incidence has been increasing since 1997.GoalTo describe the reemergence of gonorrhea in Sweden using clinical epidemiologic data and microbiologic characterization of isolated strains ofNeisseria gonorrhoeae.Study DesignN gonorrhoeaestrains isolated in Sweden from February 1998 to January 1999 were serotyped and an epidemiologic data questionnaire was sent to each clinician reporting a case of gonorrhea.ResultsEpidemiologic and microbiologic data were obtained for 357 cases (91% of all cases diagnosed during the period). Domestic cases had significantly increased since 1997. Serovar IB-3 was the most common isolate in domestic cases of heterosexually exposed teenagers, and serovar IB-2 was the most frequent isolate in domestic cases of homosexually exposed men. Of the imported cases, 47% were exposed in Asia and 6.5% were exposed in Eastern Europe.ConclusionThe increase of gonorrhea in Sweden is due to an increase of domestic cases. Heterosexual teenagers and homosexual men were identified as core groups infected by different serovars ofN gonorrhoeae.

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0148-5717    

出版商:OVID    

年代:2001

数据来源: OVID