Risk For Sexually Transmitted Diseases Research Articles

You've Got Mail (2010)

You've Got Mail (2010)

The Contraceptive Needs for STD Protection Among Women in Jail

We assessed the contraceptive needs of women in jails and their sexually transmitted disease (STD) history and risk to determine effective contraceptive methods for this population. A survey of demographics, sexual health, contraceptive use, and preferred method of contraception was completed by participants recruited at jails in a medium-sized metropolitan area. Results from 188 women indicated high rates of STDs, inconsistent contraceptive use, and use of unreliable and user-dependent contraception methods. Intended contraceptive use following release varied depending on women's ability to bear children. Women planning to use condoms after release were more likely to have had an STD and more sexual partners than were women not planning to use condoms. Racial differences were found for participants' sexual health and contraception histories. These women were at high risk for STDs and appeared to need education about contraception methods. Therefore, they might benefit from education on safe sex practices provided prior to release.

19 SEX WITH ANIMALS (SWA): CHARACTERISTICS AND POSSIBLE ASSOCIATIONS WITH PENILE CANCER AND SEXUALLY TRANSMITTED DISEASES. ACTUAL RESULTS OF A MULTICENTRIC BRAZILIAN CASE-CONTROL STUDY

19 SEX WITH ANIMALS (SWA): CHARACTERISTICS AND POSSIBLE ASSOCIATIONS WITH PENILE CANCER AND SEXUALLY TRANSMITTED DISEASES. ACTUAL RESULTS OF A MULTICENTRIC BRAZILIAN CASE-CONTROL STUDY

Health System and Personal Barriers Resulting in Decreased Utilization of HIV and STD Testing Services among At-Risk Black Men Who Have Sex with Men in Massachusetts

Testing for HIV and other sexually transmitted diseases (STD) remains a cornerstone of public health prevention interventions. This analysis was designed to explore the frequency of testing, as well as health system and personal barriers to testing, among a community-recruited sample of Black men who have sex with men (MSM) at risk for HIV and STDs. Black MSM (n = 197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered assessment, with optional voluntary HIV counseling and testing. Logistic regression procedures examined factors associated with not having tested in the 2 years prior to study enrollment for: (1) HIV (among HIV-uninfected participants, n = 145) and (2) STDs (among the entire mixed serostatus sample, n = 197). The odds ratios and their 95% confidence intervals obtained from this analysis were converted to relative risks. (1) HIV: Overall, 33% of HIV-uninfected Black MSM had not been tested for HIV in the 2 years prior to study enrollment. Factors uniquely associated with not having a recent HIV test included: being less educated; engaging in serodiscordant unprotected sex; and never having been HIV tested at a community health clinic, STD clinic, or jail. (2) STDs: Sixty percent had not been tested for STDs in the 2 years prior to study enrollment, and 24% of the sample had never been tested for STDs. Factors uniquely associated with not having a recent STD test included: older age; having had a prior STD; and never having been tested at an emergency department or urgent care clinic. Overlapping factors associated with both not having had a recent HIV or STD test included: substance use during sex; feeling that using a condom during sex is "very difficult"; less frequent contact with other MSM; not visiting a health care provider (HCP) in the past 12 months; having a HCP not recommend HIV or STD testing at their last visit; not having a primary care provider (PCP); current PCP never recommending they get tested for HIV or STDs. In multivariable models adjusting for relevant demographic and behavioral factors, Black MSM who reported that a HCP recommended getting an HIV test (adjusted relative risk [ARR] = 0.26; p = 0.01) or STD test (ARR = 0.11; p = 0.0004) at their last visit in the past 12 months were significantly less likely to have not been tested for HIV or STDs in the past 2 years. Many sexually active Black MSM do not regularly test for HIV or STDs. HCPs play a pivotal role in encouraging testing for Black MSM. Additional provider training is warranted to educate HCPs about the specific health care needs of Black MSM, in order to facilitate access to timely, culturally competent HIV and STD testing and treatment services for this population.

Providing Sexually Transmitted Disease Education and Risk Assessment to Disengaged Young Men Through Community Outreach

This study describes a community outreach project designed to increase access to reproductive health services to young African American men living in low-income urban neighborhoods. The project examined the effectiveness of providing community-based outreach and health education on increasing sexually transmitted disease (STD) screening. Outreach workers provided STD education and risk assessment in community settings, including street corners, parks, schools, and community centers. Data were recorded on outreach contacts, including client demographics, health education topics covered, and risk assessment results. Outreach workers conducted 9,701 contacts in a 176-week period. Most contacts (89%) were with African Americans, and most (84%) were with young men between 15 and 20 years old. Outreach workers discussed each health education item in their protocol at least 85% of the time and each risk assessment item at least 90% of the time. The majority of contacts (94%) reported being sexually active. Compared with the year prior to the project, actual STD testing of the target population doubled at the project clinics. This study suggests that going beyond traditional clinic-based testing to reach young, disenfranchised males constitutes a promising approach to reducing racial disparities in STD infections.

Patterns of Single and Multiple Claims of Epididymitis Among Young Privately-Insured Males in the United States, 2001 to 2004

Patterns of Single and Multiple Claims of Epididymitis Among Young Privately-Insured Males in the United States, 2001 to 2004

Dural Ectasia in Marfan Syndrome: A Case Control Study

Dural ectasia (DE) is one of the major criteria of Marfan syndrome (MFS). Our aim was to establish the prevalence of DE in an adult population fulfilling the Ghent criteria for MFS and to assess definitions of DE. One hundred five adults with suspected MFS were included. MR imaging at 1.5T was performed unless contraindicated; then CT was obtained. Lumbosacral anteroposterior vertebral body diameters (VBD) and dural sac diameters (DSD) were measured. Dural sac ratios (DSR = DSD/VBD) at levels L3 through S1 were calculated. Anterior meningoceles, herniations of nerve root sleeves, and scalloping were characterized. One hundred one sex- and age-matched patients were included as controls. We identified 3 patient groups: 1) fulfilling Ghent criteria independent of DE (n = 73), 2); fulfilling Ghent criteria dependent on DE (n = 14), and 3); and suspected MFS, not fulfilling Ghent criteria (n = 18). DE was found in 86% of group 1. At levels L4-S1, mean DSRs were significantly higher in group 1 than in group 3 and controls (P < .001). Herniations of the nerve root sleeves were present in 73% in group 1 versus 1% in controls. Anterior meningoceles were found in 37% and 14% in groups 1 and 2, respectively, but not in group 3 or controls. The diagnosis of DE on MR imaging or CT should be based on the presence of at least 1 of the following criteria: anterior meningoceles or nerve root sleeve herniation, DSD at S1 or below larger than DSD at L4, and DSR at S1 >0.59.

Diagnósticos de gonorrea en un centro de infecciones de transmisión sexual y su relación con el virus de la inmunodeficiencia humana y otras infecciones de transmisión sexual, Madrid 2005

The objective of this study is to describe the cases of gonorrhea infection recorded in a center for sexually transmitted diseases (STD) and the factors associated with HIV coinfection. Retrospective, descriptive study of all cases of gonorrhea infection diagnosed in 2005. Among 134 cases of gonorrhea, 124 occurred in men who have sex with men. The factors associated with HIV coinfection were a prior history of STD and sexual risk practices under the effects of alcohol and/or drugs (OR, 13.4; 95% CI 1.3-139.1; OR, 39.8; 95% CI 1.3-1194.3). An increase in the number of cases of gonorrhea infection is reported, predominantly in the population of men who have sex with men.

Detecting, preventing, and treating sexually transmitted diseases among adolescent arrestees: an unmet public health need.

Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the "front end" of the juvenile justice system than are detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender- and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD testing among new arrestees. With integrated linkages to treatment and prevention after release, this model could greatly reduce the STD burden in this underserved, high-risk population.

Sexual Partner Characteristics and Sexually Transmitted Diseases Among Adolescents and Young Adults

Among adolescents and young adults, the extent that partner characteristics account for sexually transmitted diseases (STDs) in context of individual sexual activities and demographic characteristics is unclear. Sexual partner characteristics, individual sexual activities, and STD diagnosis were assessed among 15 to 24-year-old STD clinic attendees from 1999 to 2002 (n = 412). We used exact logistic regression to calculate odds ratios (OR) for several sexual partner characteristics (age discordance, incarceration, STD diagnosis, other partners, alcohol problem, marijuana problem, and a calculated composite variable) adjusting for demographics and individual sexual activities, including condom use. Sexual partner characteristics associated with STD diagnosis were >or=5 years age discordance [OR = 2.6 (95% confidence interval (CI) = 1.6, 4.5)] and STD in the past year [OR = 3.4 (95% CI = 2.0, 5.7)]. Even when considering individual sexual activities, composite partner risk was associated with STD diagnosis [intermediate to low OR = 2.1 (95% CI = 1.0, 4.2) and high to low OR = 3.4 (95% CI = 1.6, 7.0)]. Composite individual sexual activities was associated with STD diagnosis when considering demographics [intermediate to low OR = 1.8 (95% CI = 1.0, 3.2), high to low OR = 2.3 (95% CI = 1.2, 4.5)], but not when also considering partner characteristics [intermediate to low OR = 1.6 (95% CI = 0.9, 2.8), high to low OR = 1.8 (95% CI = 0.8, 3.9)]. Among this sample of 15 to 24-year-olds, sexual partner characteristics identified individuals at increased risk of prevalent STDs and were more predictive of STDs than an individual's sexual activities.

Sexually Transmitted Diseases Diagnosed Among Travelers Returning from the Tropics

Data are lacking on the spectrum of sexually transmitted diseases (STDs) diagnosed in returning travelers. All consecutive travelers consulting our tropical unit between November 1, 2002 and October 31, 2003 were included if they presented within 1 month after their return from the tropics, with mucocutaneous signs suggesting STDs. Forty-nine patients (12 women and 37 men; median age 36.4 y, 35 heterosexuals) were included. Four patients had traveled with their usual sexual partner and 45 patients had casual sex while abroad (31 with locals and 14 with other tourists). The main diagnoses were gonococcal urethritis (n = 18), herpes simplex virus 2 infection (n = 12), urethritis of undetermined origin (n = 9), Chlamydia trachomatis infection (n = 4), primary syphilis (n = 4), and primary human immunodeficiency virus infection (n = 2). These results illustrate the broad spectrum of STDs contracted by travelers to the tropics. They suggest the need to also inform travelers of the risks of STD and to promote the use of condoms in case of casual sex while abroad.

The Contribution of a Urine-Based Jail Screening Program to Citywide Male Chlamydia and Gonorrhea Case Rates in New York City

With noninvasive specimen types, males can be more easily screened for Chlamydia trachomatis and Neisseria gonorrhoeae infections. Long-standing universal screening of males attending New York City (NYC) sexually transmitted diseases (STD) clinics has yielded a substantial number of chlamydia cases. In 2005, screening was expanding to another large group at high risk for STD: males </=35 years old entering 6 adult jails. Surveillance data and data from laboratory practice surveys were examined to evaluate changes in the reported burden of chlamydia and gonorrhea in NYC males over time. Citywide data for male chlamydia and gonorrhea cases were analyzed by report year and provider type (STD clinic, adult jail, juvenile detention, private-sector provider) from 2004 through 2006. In the first year of the adult jail screening program, the number of chlamydia cases among males </=35 years old reported from the jails increased by 1636%, surpassing all other providers in numbers of cases contributed, and increasing the citywide reported male chlamydia case rate by 59%. Adult jails reported 40% more cases than all 10 NYC public STD clinics combined. In 2006, adult jails continued to contribute a similar proportion to citywide male chlamydia case reports. In the first year of the jail screening program, there was an approximately 10-fold increase in the number of gonorrhea cases reported from jails. Young men in adult jails have a large burden of chlamydial infection. Correctional screening and treatment programs present an important opportunity to improve the health of inmates and interrupt disease transmission.

Prevalence and risk factors of the whole spectrum of sexually transmitted diseases in male incoming prisoners in France

Sexually transmitted diseases (STD) are a public health issue in prison. As inmates are eventually released, it is also a community concern. There are very few data on the entire spectrum of STDs, particularly condyloma among prisoners. To determine the prevalence of all STDs: infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), Chlamydia trachomatis, Neisseria gonorrhoea, syphilis, and condyloma among entering inmates. A cross-sectional study was conducted in France from November 2000 to June 2003. Male adults entering a prison remand center in Caen had a medical consultation and physical examination including external genital organs and perianal area for condyloma and herpes infection, a urethral swab for Chlamydia trachomatis and Neisseria gonorrhoea detection, and a blood sample for HBV, HCV, HIV, and syphilis serology. Five hundred and ninety-seven inmates agreed to participate in the study. Sixteen percent had at least one STD: 4.0% had condyloma, 4.0% chlamydia infection, and 4.9% were positive for HCV antibodies. Two had early syphilis and 1 had acute HBV, but no HIV infection, neither genital herpes nor gonorrhea. The analysis of the STD risk behaviors did not show any difference between the infected and uninfected participants, except that HCV-positive participants were more likely to be intravenous drug users. Results suggest that a systematic screening of all STDs should be at least proposed to every entering inmate since no demographic or sexual characteristics are consistently associated with STDs.

Trends in HIV- and STD-Related Risk Behaviors Among High School Students—United States, 1991-2007

Persons who engage in unprotected sexual intercourse or use injection drugs are at increased risk for human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs). Changes in HIV- and STD-related risk behaviors among high school students in the United States during 1991-2005 were reported previously. To update these analyses through 2007, CDC analyzed data from nine biennial national Youth Risk Behavior Surveys (YRBS). This report summarizes the results of that analysis, which indicated that, during 1991-2007, the percentage of U.S. high school students who ever had sexual intercourse decreased 12%, the percentage who had sexual intercourse with four or more persons during their lifetime decreased 20%, and the percentage who were currently sexually active decreased 7%. Among students who were currently sexually active, the prevalence of condom use increased 33%. However, these changes in risk behaviors were not observed in some subgroups. In addition, no changes were detected in the prevalence of sexual risk behaviors from 2005 to 2007, and many students still engaged in behaviors that place them at risk for HIV infection and STDs. Additional efforts to reduce sexual risk behaviors, particularly among black, Hispanic, and male students, must be implemented to meet the Healthy People 2010 national health objective for adolescent sexual behaviors (objective no. 25-11) and to decrease rates of HIV infection and STDs.

Recently Arrested Adolescents are at High Risk for Sexually Transmitted Diseases

Adolescent offenders may be at high risk for sexually transmitted diseases (STDs). With previous research and interventions focused on incarcerated adolescents, data are needed on STD prevalence and risk factors among newly arrested youth released to the community, a far larger subgroup. Participants were recruited from all arrested youth processed at the Hillsborough County, Florida Juvenile Assessment Center during the last half of 2006 (506 males, 442 females). Participants voluntarily providing urine samples for drug testing as part of standard protocol were also consented to having their specimens split and tested for chlamydia and gonorrhea, using an FDA-approved nucleic acid amplification test. STD prevalence was similar to those previously reported among incarcerated adolescents: 11.5% tested positive for chlamydia, 4.2% for gonorrhea, and 13.2% for either or both infections. Prevalence was significantly higher among females: 19.2% of females had either or both infections compared with 10.5% of males. Prevalence was higher for 17 to 18 year olds (15.2% of males, 25.5% of females), blacks, detained youths, drug users, and those engaged in sexual risk behaviors. Previous STD testing experience was limited. The study indicated that a voluntary STD screening protocol is feasible for arrested youth entering the juvenile justice system, and these offenders are at high risk for STDs. Because most arrested youths are released back to the community, routine testing and treatment of recently arrested youths, and expanded access to risk reduction and prevention programs, can yield substantial public health benefits.

Sexual behavior and sexually transmitted diseases in street-based female sex workers in Rajshahi City, Bangladesh

We analyzed the sexual behavior and sexually transmitted diseases (STDs) of street-based female sex workers (SFSWs) of Rajshahi city and examined their socio-demographic profiles. Among the SFSWs attending three drop-in centers (DIC) named PIACT, PROVA, and Suraksha Madhumita in Rajshahi, 150 self-motivated and willing individuals were interviewed through a structured questionnaire to obtain obstetric histories and socio-demographic information. Among these SFSWs, 56.7% were infected with two or more pathogens of STDs, with gonorrhea, chlamydia, herpes, syphilis, and trichomoniasis observed in 23.3, 27.3, 24.0, 17.3, and 20.0%, respectively. We found a strong association between the prevalence of STDs among SFSWs and their socio-demographic profiles. Illiterate and comparatively older SFSWs who spent very little money for health purposes, had larger numbers of children, and used condoms inconsistently were observed to be at higher risk of STDs. These results observed with bivariate analysis were also confirmed by logistic regression analysis.

Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy

Purpose The role that sex education plays in the initiation of sexual activity and risk of teen pregnancy and sexually transmitted disease (STD) is controversial in the United States. Despite several systematic reviews, few epidemiologic evaluations of the effectiveness of these programs on a population level have been conducted. Methods Among never-married heterosexual adolescents, aged 15–19 years, who participated in Cycle 6 (2002) of the National Survey of Family Growth and reported on formal sex education received before their first sexual intercourse (n = 1719), we compared the sexual health risks of adolescents who received abstinence-only and comprehensive sex education to those of adolescents who received no formal sex education. Weighted multivariate logistic regression generated population-based estimates. Results Adolescents who received comprehensive sex education were significantly less likely to report teen pregnancy (OR adj = .4, 95% CI = .22– .69, p = .001) than those who received no formal sex education, whereas there was no significant effect of abstinence-only education (OR adj = .7, 95% CI = .38–1.45, p = .38). Abstinence-only education did not reduce the likelihood of engaging in vaginal intercourse (OR adj = .8, 95% CI = .51–1.31, p = .40), but comprehensive sex education was marginally associated with a lower likelihood of reporting having engaged in vaginal intercourse (OR adj = .7, 95% CI = .49–1.02, p = .06). Neither abstinence-only nor comprehensive sex education significantly reduced the likelihood of reported STD diagnoses (OR adj = 1.7, 95% CI = .57–34.76, p = .36 and OR adj = 1.8, 95% CI = .67–5.00, p = .24 respectively). Conclusions Teaching about contraception was not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education.

A Randomized Trial of Metronidazole in Asymptomatic Bacterial Vaginosis to Prevent the Acquisition of Sexually Transmitted Diseases

ABSTRACT Bacterial vaginosis (BV)—the most common form of vaginitis throughout the world—has been associated with adverse outcomes including HIV infection and other sexually transmitted diseases (STDs). One reason for this may be the absence of hydrogen peroxide-producing lactobacilli that inhibit bacterial growth. At present, treatment of asymptomatic BV is not routinely recommended. This goal of this prospective study was to determine whether treating BV lessens the risk of STDs. Participants were 107 African American women with asymptomatic BV whose mean age was 25 years. Fifty-three of them were assigned randomly to apply intravaginal metronidazole gel at bedtime for 5 days and subsequently twice a week for 6 months. These women and the 54 who were only observed were followed up for a total of 12 months. Significantly longer times preceded the development of STD in women using metronidazole gel. Six-month rates of STD were 2.29 per person-year in the observed group and 1.58 per person-year in the actively treated women, a statistically significant difference. No such difference was apparent in the last 6 months of the study after treatment ended. Overall rates of STD for the entire 12-month period were 1.64 and 1.31, respectively, in the observation and treatment groups. The only significant difference in the distribution of individual pathogens was a greater frequency of chlamydia infection in the observed group. This is the first study to demonstrate that the prevention and treatment of asymptomatic BV lowers the risk of chlamydia infection. While it remains necessary to confirm these findings, especially in more diverse populations, the present findings suggest that routine treatment be considered for women with BV even if there are no symptoms.

Intimate partner violence and sexually transmitted disease symptoms in a national sample of married Bangladeshi women

Objectives To assess associations of intimate partner violence (IPV) with women’s sexually transmitted disease (STD) symptoms, and to clarify biological and behavioral mechanisms underpinning heightened STD rates among abused women. Methods A cross-sectional investigation of married couples ( n = 2865) sampled via the Bangladesh Demographic Health Survey. Results Over one third (38%) of married Bangladeshi women experienced physical or sexual IPV in the 12 months preceding the survey. Victimization was bivariately associated with vaginal irritation/discharge, pelvic pain during intercourse, genital sores/ulcers, and vaginal discharge with odor (OR 1.39–2.09). IPV demonstrated an independent effect on vaginal irritation with discharge (adjusted OR 1.34) and vaginal discharge with odor (adjusted OR 2.08) after accounting for STD exposure (i.e., husbands’ recent STD). Conclusions IPV elevates married Bangladeshi women’s STD symptoms beyond the risk represented by husbands’ STD alone, suggesting that high rates of STD among abusive men and the context of violence itself both relate to abused women’s STD risk.

Sexually transmitted disease and HIV prevalence and risk factors in concentrated and generalized HIV epidemic settings.

In many developing countries, the threat of nascent HIV epidemics expanding rapidly requires immediate and appropriate HIV prevention activities. Inexpensive and sustainable interventions are especially relevant in resource-constrained environments. In 2001, we assessed the prevalence and behavioral risk of sexually transmitted disease (STD) and HIV among at-risk populations in five developing countries in preparation for a community-randomized controlled trial, the NIMH Collaborative HIV/STD Prevention Trial. Using a standardized protocol, more than 1000 participants in each country (China, India, Peru, Russia, and Zimbabwe) were selected by random sampling methods, completed a behavioral risk assessment, and provided biological specimens using a common laboratory protocol. Sample characteristics were studied within each country, and risk factors for HIV/STD acquisition were evaluated using logistic regression models. HIV rates were low (<1%) in China, India, Peru, and Russia but were high (26%) in rural Zimbabwe. STDs were generally twice as common in women as men, and serological evidence of herpes simplex virus type 2 infection was the most frequently detected STD. Behavioral data showed high rates of multiple partners in the Russian sample, and very low condom use rates in India and China. Among participants who reported ever having sex, female sex and having two or more sex partners were the factors most frequently associated with an increased risk of prevalent STD. Behavioral or biological risks were of sufficient magnitude in the locations selected in China, Russia, and Zimbabwe to implement the community-based randomized trial. Higher-risk subsets of community residents in India and Peru were identified before beginning the Trial.