High Risk For Sexually Transmitted Diseases Research Articles

Partner referral by patients with gonorrhea and chlamydial infection. Case-finding observations.

To evaluate the outcomes of a partner referral program at the sexually transmitted disease (STD) clinic in Amsterdam that encourages gonorrhea and chlamydia patients to refer their own partners to medical examination. 355 patients with a confirmed infection cooperated in partner referral and gave specific details on their sexual contacts. Univariate and multivariate analyses were conducted to identify characteristics associated with the outcome of partner referral. The outcome of partner referral, expressed as the proportion of sex partners brought to evaluation or treatment, was 40%: 580 sex partners were identified of whom 20% attended the STD clinic, and medical follow-up could be confirmed for another 20%. No information was available for the remaining 60%. Patients with chlamydial infection referred more sexual partners than gonorrhea patients; women referred more partners than men. Sixty-three percent of the female contacts and 30% of the male contacts were found to be infected with gonorrhea, chlamydia, or both. Steady partners were more often referred by index patients than casual partners, especially if these latter were non-Dutch partners, clients of commercial sex workers, contacts met in less private settings, and "one night stands." Partner referral can be an effective strategy for reaching individuals at high risk for STD. The partner referral method was successful among certain populations but was inadequate for other groups. A mixed effort of provider referral in addition to partner referral may be appropriate to increase the efficacy of partner notification.

Sexually transmitted diseases in men who have sex with men. Acquisition of gonorrhea and nongonococcal urethritis by fellatio and implications for STD/HIV prevention.

Despite trends toward safer sex practices in homosexually active men, some such people remain at high risk for acquiring sexually transmitted diseases (STD). This study was designed to assess behavioral and demographic determinants of STD acquisition in men who have sex with men (MSM), to guide prevention interventions. A cross-sectional medical record review was undertaken of MSM who attended an urban STD clinic from January, 1993 through December, 1994. Gonorrhea, chlamydial infection, Chlamydia-negative nongonococcal urethritis (NGU), and newly documented human immunodeficiency virus (HIV) infection were analyzed in relation to demographic and behavioral variables. Among 1,253 MSM, 196 (15.6%) had nonchlamydial NGU, 105 (8.4%) had gonorrhea, 31 (2.5%) had chlamydial infection, and 162 (12.9%) had known or newly documented HIV infection. Known HIV infection was an independent predictor of urethral gonorrhea (odds ratio [OR] 2.3, 95% confidence interval [CI95] 1.2-4.8). Oral insertive intercourse was independently associated with urethral gonorrhea (OR 4.4, CI95 1.4-13.4) and nonchlamydial NGU (OR 2.2, CI95 1.3-3.7), and receptive anal intercourse was associated with newly documented HIV infection (OR 2.6, CI95 1.3-4.9). Neither number of sex partners nor condom use was associated with any incident STD outcome, including new HIV infection. MSM who attend STD clinics represent a subgroup of homosexually active men who remain at high risk for STDs, including HIV infection. Fellatio, commonly thought to be a "safe" sexual practice, is an independent risk factor for urethral gonorrhea and nonchlamydial NGU. A history of consistent condom use or of few sex partners should not dissuade clinicians from performing screening tests for HIV and other STDs. Repeated STD screening and counseling about safer sex are indicated for many HIV-infected MSM.

Herpes simplex virus type 2 in Brazil: seroepidemiologic survey.

The incidence of genital herpes is increasing worldwide. Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcerations among the sexually transmitted diseases (STDS). In order to investigate the sexual transmission of genital herpes infection in Brazil, the prevalence of specific antibodies to HSV-2, in populations of high and low risk for STDS was evaluated. The population at low risk for STDS was composed of 155 voluntary blood donors at the University Hospitals between February and August, 1994. The population at high risk for STDS was composed of 85 HIV-seropositive persons, consisting of homosexual and promiscuous heterosexual men. A group of 20 highly active prostitutes was also studied between May and July, 1994. All blood samples were screened using an enzyme-linked immunosorbent assay (ELISA) that detects type-specific antibodies to HSV-2 glycoprotein G. Before donating blood, all persons in the study group were given a questionnaire concerning risk factors for acquisition of STDS and suitable to show the socioepidemiologic characteristics of the subjects. The prevalence of ELISA showing HSV-2 infections among HIV-seroposite persons, was 73% (P < 0.01). In the whole group at high risk for STDS, the prevalence was 72% (P < 0.05). Infection with HSV-2, as determined by seroprevalence, was significantly and independently associated with years of sexual activity, history of previous STDS, number of sexual partners in the previous month, number of pregnancies, and previous induced abortions, as well as the percentage of sexual acts involving receptive anal intercourse. The current strategy for diagnosing genital HSV-2 infection misses many cases. Newly developed type-specific serologic methods can identify cases of unrecognized or subclinical infection. With the high seroprevalence rates detected, routine screening for HSV-2-specific antibodies should be considered in populations at high risk for STDS.

Reliability of partner reports of sexual history in a heterosexual population at a sexually transmitted diseases clinic.

In epidemiologic research, information about sexual frequency and condom use is by necessity based on self-reports. This study investigated the reliability of self-reported sexual behavior in 162 heterosexual partnerships. Subjects were part of a larger study of condom use and sexually transmitted diseases (STD) conducted in two Baltimore STD clinics from 1990 to 1992. Partners were enrolled on the same day and were interviewed separately. Information about sexual activity and condom use was collected using a retrospective calendar for the 30 days before enrollment. Participants were predominantly young, unmarried African-Americans. Based on Spearman's correlation coefficients and kappa statistics, the authors found only fair agreement (K = 0.43; r = 0.51) between partner reports of overall condom use for the 30-day period before the interview. Correlation coefficients ranged from 0.43 for frequency of any sexual activity to 0.56 for number of days on which vaginal intercourse occurred. Partner agreement for condom use and frequency of sexual activity decreased as the recall period increased. Higher partner agreement was observed for questions with definite answers compared to the more open-ended sexual behavior questions. These findings indicate potential reporting bias in self-reports of sexual behavior in a population at high risk for STDs.

Condom use and fertility among divorced and separated women.

Sexually active divorced and separated women constitute a significant population at risk for sexually transmitted diseases. With components of the Interaction Model of Client Health Behavior (IMCHB) used as the conceptual framework, a convenience sample (N=254) of women--mostly educated, White, and in their 30s (20 to 49 years)--was examined relative to condom use and individual and social context characteristics. To explore the effect of fertility on condom use, the sample was divided into fertile and infertile subsamples. The IMCHB explained 49% of the variance in infrequent condom use by the fertile women (n=93) and 21% of the variance in less frequent condom use by the infertile women (n=161).

Partner referral as a component of integrated sexually transmitted disease services in two Rwandan towns.

To document partner referral rates at health centres with improved STD services, and to determine factors contributing to successful referral. Partner referral was initiated as part of the upgrading of STD services in primary care health facilities in two semi-urban Rwanda towns. After syndromic management of the presenting complaint, index patients received prevention education and condom demonstration, and were urged to refer sexual partners to the health centre for a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitate referral; no identifying information was collected on partners from the index patients. Three quarters of the symptomatic patients seen at the two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patients accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular partners. Most index patients and partners were married and only four index patients referred more than one partner. Women index patients, especially when pregnant, were more successful in referring partners than men. Index patients who referred partners tended to be older than those who did not. Awareness of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of partner referral. Efforts to improve rates of partner referral should begin at the clinic level with improved counselling to convince more index patients of the importance of partner referral. Partner symptom recognition may be useful for increasing rates of partner referral. Supplementary strategies are needed to reach non-regular partners. When syndromic management is used, counselling should take into account the lower predictive values of identifying STD in women in order to avoid partner accusation. Despite limitations, patient referral of sexual partners can be an effective strategy for reaching a population at high risk for STD with minimal additional investment in health worker staff time.

Condom use by Norplant users at risk for sexually transmitted diseases.

Norplant is highly effective for long-term pregnancy prevention. Norplant users might not use condoms, and they may acquire human immunodeficiency virus (HIV) and other sexually transmitted diseases as a consequence. The goal of this study was to assess condom use among Norplant users at risk for sexually transmitted diseases. Telephone interviews were conducted with 177 sexually active Norplant users to measure risk for sexually transmitted disease and condom use. According to the measures used in this study, 42% of the study subjects were at risk for sexually transmitted disease and 38% of those at highest risk did not use condoms. Intervention to protect Norplant users from sexually transmitted disease is indicated.

Prevalence of antibodies to hepatitis C virus in populations at low and high risk for sexually transmitted diseases in Rio de Janeiro.

In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of specific antibodies in populations at high and low risk for sexually transmitted diseases (STDs) was evaluated. The population at low risk for STDs was composed of persons who voluntarily donated blood at the Hospital Universitário Clementino Fraga Filho (HUCFF) between July and November, 1990 (n = 2494). The population at high risk for STDs was drawn from an ongoing study on the natural history of Human Immunodeficiency Virus (HIV) infection (n = 210, 187 with sexual risk factors for HIV infection). All samples were screened using a first generation ELISA. Repeat reactive samples were then tested in a second generation RIBA. For all ELISA positive samples, two sex and age-matched ELISA negative controls were selected. Data pertaining to the presence of antibodies to the Hepatitis B core antigen (anti-HBC antibodies) and to Treponema pallidum were abstracted from the medical records. The prevalence of RIBA 2 confirmed HCV infection among the blood donors was 2.08%, which is well above the reported prevalence in similar populations from developed western countries. Among the HIV infected homosexuals, the encountered prevalence was 7.96% (p < 0.0005). For the whole group with sexually acquired HIV infection, the prevalence was 8.02% (p < 0.000005). Anti-HBc antibodies were more frequently present in anti-HCV RIBA-2 confirmed positive blood donors than in controls (p < 0.001). 33.3% of the HCV-positive blood donors and 11.04% controls were found to be anti-HBc positive (p < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Assessing Prior History of Sexually Transmitted Disease

<h3>To the Editor.</h3> —The letter by Fleisher et al¹raises significant questions regarding the reliability of identifying women at risk for acquiring human immunodeficiency virus (HIV) infection by assessing prior history of sexually transmitted disease (STD). Their work clearly shows how women at high risk for STD do not know what infections constitute STD and may incorrectly answer the global question: "Have you ever had an STD?" As physicians treating adolescents who are also high risk for acquiring STD and HIV, it is our experience that even fewer than the 25.8% cited by Fleisher et al may indeed know that they have been found to have and been treated for STD. This is especially true for those infected with chlamydia, trichomonas, and venereal warts (human papillomavirus). Given the importance and difficulty in obtaining a good general medical history for adolescents, it is likely that there is often less information

Sexually transmitted diseases in homosexual adolescents

In 1986, an estimated 13 million cases of sexually transmitted diseases (STDs) were diagnozed in the United States, with the highest incidence rates within the adolescent age group. Homosexual adolescent men are at particularly high risk for STDs. Because of the myriad clinical of STD in gay men, these diseases are often not recognised as sexually transmitted. In this paper, the epidemiology and clinical features of STDs in gay adolescents are discussed. The sexual history is emphasized as an integral tool in developing a differential diagnosis. A priori, the sexual history also can give a risk-assessment profile for STD. Clinical aspects of STD are reviewed using a syndrome approach, and the diagnostic workup is outlined for the etiologic agents most likely implicated in each syndrome. Clinical signs and symptoms of urethritis, genital ulcers and papular lesions, pharyngitis, and hepatitis are reviewed. Sexually acquired gastrointestinal disorders are described. As the AIDS epidemic continues, disease prevention, risk reduction, and patient education are becoming more important. Current recommendations for “safer sex” practices are reviewed.