Barriers To Contraceptive Use Research Articles

Contraceptive use and method mix dynamics in Sub-saharan Africa: time trends and the influence of the HIV pandemic

BackgroundContraceptive use dynamics continue to be of priority in sub-Saharan Africa because of persistently high levels of fertility. This paper focuses on the use of barrier versus non-barrier contraceptive use in sub-Saharan Africa hypothesizing that the HIV pandemic in the region would be responsible for increases in the use of barrier methods over time.MethodsThis paper uses Demographic and Heath Survey (DHS) data from 32 countries to conduct extensive analysis of trends in contraceptive use and method mix that refers to the distribution of contraceptive methods use among the sexually active population. The paper examines how contraceptive method mix dynamics have changed over time and whether the trends differ by marital status and gender using cross-tabulations. It furthers examines the determinants of method choice using logistic regressions.ResultsThe findings indicate that the use of barrier methods, most markedly for unmarried women and men, rose substantially between the late 1980s and late 2000s in the region in tandem with trends in HIV prevalence. The results further show marked differences in method mix by gender with men being more likely to report barrier method use than women.ConclusionsThe findings indicate shifting preferences in contraceptive choice. The time trend analyses highlight the importance of expanding the focus of contraceptive use studies beyond women in this context as the study finds differing trends for men.Graphical

Molnupiravir for Treatment of COVID-19 in Solid Organ Transplant Recipients.

Solid organ transplant recipients (SOTRs) are at a higher risk of progression of coronavirus disease 2019 (COVID-19).1,2 With the emergence of new viral-variants, the currently available antisevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibodies are losing their efficacy.3 Outpatient treatment of COVID-19 in SOTRs is limited by complicated logistics of administration of Remdesivir and drug–drug interactions with Nirmatrelvir/ritonavir. Molnupiravir acts as a substrate for SARS-CoV-2 RNA polymerase and impairs SARS-CoV-2 replication and infection.4 It retains antiviral activity against all known variants of SARS-CoV-2.3 In a recent clinical trial, patients treated with molnupiravir resulted in faster time to recovery and reduced viral detection and load.5 We present our data regarding the characteristics and outcomes of adult SOTRs with mild-to-moderate COVID-19 who were treated with oral dosage of 800 mg of molnupiravir twice a day for 5 d during the period from June 2022 to October 2022 and with at least 14 d of follow-up. During the study period, 98 SOTRs were diagnosed with COVID-19 in our institution. They received Bebtelovimab 54 (55%), molnupiravir 23 (23%), and no treatment for asymptomatic illness 21 (21%). Among 23 patients who received molnupiravir, they were at a mean of 5.5 y (range, 0.3–17.2) away from the transplant, with median duration of symptoms of 1.9 d (range, 1–4) and had variable vaccination status. Seven patients (30%) had received Tixagevimab/Cilgavimab, given at a mean of 170 d (range, 82–256) before the current diagnosis of COVID-19. Nine (39%) had a remote history of previous COVID-19. Eleven (48%) patients were on Tacrolimus monotherapy, and in the rest 12 (52%), mycophenolate was stopped for duration of COVID-19 symptoms. Considerations for use of molnupirivir were inability/unwilling to be scheduled for SARS-CoV-2 monoclonal antibodies infusion, 3 (13%); prior use of Tixagevimab/Cilgavimab prophylaxis, 7 (30%) and more recently starting October 2022; and less predictable activity of Bebtelovimab, 13 (57%) (Table 1). Pregnancy status of all women in childbearing age was reviewed before prescribing molnupiravir, and all recipients were advised on the use of barrier contraception. TABLE 1. - Characteristics and outcomes of solid organ transplant recipients treated with molnupiravir (N = 23) Age, mean (range), y 60 (41–73) Male sex, N (%) 13 (56%) Race Caucasian 14 (61%) African American 5 (22%) Hispanic 2 (8.6%) Asian 2 (8.6%) Type of organ transplant, N (%) Kidney 9 (39%) Heart 6 (26%) Liver-kidney 4(17%) Liver 3(13%) Heart-kidney 1 (4%) Time from transplant, mean (range), y 5.5 (0.3–17.2) Duration of symptoms before treatment, mean (range), d 1.9 (1–4) COVID-19 vaccination status, N (%) Unvaccinated 2 (8.7%) 1- 1-dose 1 (4%) 2- 2-doses 10 (43%) 3- 3-doses 9 (39%) Induction immunosuppression T-cell depletion 14 (61%) Steroids 7 (30%) Basiliximab 2 (8.6%) Lowered/stopped mycophenolate 12/12 (100) of eligible patients Follow-up period, mean (range), d 69 (15–178) Resolution of acute symptoms excluding cough, mean (range), d 3.6 (3–7) Progression of COVID-19 symptoms, N (%) 0 (0%) Hospitalizations not related to COVID-19 within 14 d of treatment, N (%) 1 (4%) arm swelling Associated graft rejection/dysfunction during the follow-up period, N (%) 0 (0%) Need for intensive care, N (%) 0 (0%) Death during at least 14-d follow-up, N (%) 0 (0%) Rebound of COVID-19 symptoms 0 (0%) COVID-19, coronavirus disease 2019. During the mean follow-up period of 69 d (range, 16–178), none of the patients reported progression of symptoms, and 1 patient (4%) was hospitalized for non-COVID illness. Molnupiravir was tolerated in all the patients with none of the recipients requiring discontinuation of therapy secondary to intolerance. No rebound COVID-19 symptoms were noted. No episodes of organ rejection associated with alteration of immunosuppression and COVID-19 were noted after completion of antiviral therapy during the study period. These acceptable outcomes are likely associated with very early initiation of antiviral therapy, overall lower immune suppression in setting of time away from transplant, and no recent treatment of allograft rejection, along with previous variable natural and acquired immunity. Limitations of our retrospective results include no comparator arm, diversity of patient population, and a small sample size. Although there is a chance these patients may have improved without any therapeutic intervention, but based on the unknown risk of progression and associated morbidity, all symptomatic SOTRs with COVID-19 are currently offered treatment along with optimization of immunosuppression. In the current setting of uncertain and limited choices, when initiated early in the disease course, molnupiravir may offer a safe and efficacious therapeutic option for the treatment of mild-to-moderate COVID-19 in certain SOTRs. To attain desired outcomes in the outpatient management of COVID-19, transplant centers should devise mechanisms for early diagnosis, prompt treatment, and mitigation strategies to provide equitable access to treatment for all transplant recipients.

Violence in Quilombola women living in rural communities in Brazil.

To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Prediction of the development of inflammatory complications in the postpartum period

Background. The main etiological reasons for the still high level of serious postpartum complications are frequent isolation of aggressive pathogenic microorganism associations, an increase in their virulence and antibiotic resistance, and an increase in the frequency of surgical methods of delivery.
 Aim. Assessment of the significance of clinical, instrumental and laboratory parameters in the diagnosis of early inflammatory complications of the postpartum period.
 Material and methods. To study the risk factors for the development of the inflammatory process, they were registered in the postpartum period during the examination of 150 patients who underwent inpatient treatment at the Scientific Research Institute of Obstetrics and Gynecology in Baku for the period 20172020. Depending on the presence or absence of the studied pathology, the patients were divided into two groups: the main group included puerperas with developed postpartum complications (n=100), the comparison group included puerperas with a physiological course of the postpartum period (n=50). The average age of puerperas in groups was 29.90.64 and 30.30.86 years, respectively (p=0.679). Complications were diagnosed based on the analysis of the results of clinical and laboratory studies, the study of anamnestic data and the results of ultrasound examination. The information content of the obtained data was determined by the Kullback method.
 Results. In the course of research, it was found that an important reason for the development of postpartum complications of an inflammatory nature is the long-term use of contraception. Women of the main group more often use means for intrauterine contraception and barrier contraceptives 24 and 29%, and in the comparison group 6 and 12% (p=0.006; p=0.024). When studying the structure of clinical manifestations of complications of the early postpartum period, pain in the lower abdominal cavity was most often recorded 89.03.13%, and in the comparison group 6.03.36% (p 0.0001). Among the studied ultrasound diagnostic criteria for inflammatory complications in the postpartum period, cases of an increase in the size of the uterus and thickening of the endometrium were detected in 98 and 97 out of 100 people in the main group and only in 1 case out of 50 patients in the comparison group (p 0.0001). The absolute number of T-lymphocytes, hemoglobin, the concentration of the pro-inflammatory cytokine interleukin-6, and the erythrocyte sedimentation rate are recognized as the most informative diagnostic indicators of biochemical studies in patients with postpartum complications.
 Conclusion. The reasons for the development of inflammatory complications in the postpartum period are the presence of a history of spontaneous abortions, intrauterine contraception and the use of barrier contraceptives.

Social network strategies in HIV medicine

The article contains a review of domestic and foreign literature on the use of social networking technologies — analysis of social networks and network interventions — in HIV medicine as promising, cost-effective and sustainable measures to improve HIV prevention and treatment outcomes in the framework of UNAIDS 90–90–90 program. The article described practical experience of using social network analysis to explain differences in the prevalence of HIV infection, including evaluation the behavioral risk levels among persons injecting drugs and the frequency of use of barrier contraceptives. The review reflects examples of the use of the most popular network interventions such as peer education and the Popular Opinion Leader for HIV prevention and for engaging people living with HIV into the medical monitoring and care. In addition, the experience of using innovative social network technologies in St. Petersburg in Russia is described.

Risk factors modulating the course of low-grade squamous intraepithelial lesions in women of reproductive age

Background. Infection with oncogenic types of human papillomavirus (HPV) is the leading cause of cervical cancer and its immediate precursors – squamous intraepithelial lesions. However, the persistence of HPV may not be sufficient for the occurrence of malignant transformation, and there may be other exogenous or endogenous factors that, in combination with the virus, increase the risk of developing and progressing cervical neoplasia.Objective: identification of risk factors that modulate the course of low-grade squamous intraepithelial lesions (LSIL) in women of reproductive age.Materials and methods. In 110 women aged 18 to 45 years with a diagnosis of LSIL, we evaluated the impact of risk factors (sexual behavior, reproductive function, contraceptive methods, smoking, HPV infection) on the course of the process (recovery, persistence or progression) during the 12-month follow-up period. HPV testing was performed by real-time PCR.Results. The average age of the study participants was 31.55 ± 7.17 years. Our observations showed that frequent artificial abortions, the practice of risky sexual behavior (early sexual debut, frequent change of sexual partners) increased the risk of persistence and progression of mild cervical cytological abnormalities. The use of oral contraceptives, barrier contraception and smoking did not affect the outcome of the disease.The prevalence of HPV among women with LSIL was 70.91 % (78/110). The predominant types were HPV 16 (35.45 %), HPV 33 (12.73 %) and HPV 18 (12.73 %). HPV 16 was more common in the progression group (62.50 %) than in the regression and persistence groups (14.63 % and 43.40 %, p <0.05). Progression of neoplasias was more often observed in patients with signs of multiinfection of the cervical epithelium with HPV. Single HPV infection was higher in the group of recovered women.Conclusions. The study found that a large number of induced abortions, the practice of risky sexual behavior, the presence of HPV type 16 and multiple HPV infection are factors contributing to the persistence of LSIL and progression to HSIL. These data may be useful for the management of women with mild cervical cytological abnormalities.

Effectiveness of Sex Education in Adolescents

Adolescence is the time during which the personal and sexual identity develops. The specific characteristics of adolescents and the lack of maturity facilitates the acquisition of sexual risk behaviors such as relaxation in the use of barrier contraceptives or the use of toxic substances, alcohol or drugs during sexual relations, increasing of sexually transmitted infections (STIs) and unwanted pregnancies. Health education in sexuality is one of the best ways to prevent risk behaviors and to promote healthy and responsible sexuality. While there have been different works in sex education in adolescents, there is still a lack of a comprehensive systematic literature review that including randomized and non-randomized clinical trials and quasi-experimental pre-post studies addressing education programs that provide information on healthy and responsible sexuality. Further, it is noted that a protocol drafted in consideration of the existing approaches is needed to present a basis for a systematic literature review in this area. This article, therefore, proposes a review protocol that will evaluate the impact of comprehensive sex education programs in the level of knowledge about STIs, behavioral level concerning the frequency of use of effective contraceptive methods and level of knowledge about sexual identity, diversity and/or responsible sexuality, after the intervention.

Providing medical care by family doctors in family planning services and prevention of unwanted pregnancies

Purpose of the study: to identify the types of medical services for family planning and prevention of unwanted pregnancies that should be provided by family doctors, and competencies they should have to provide, as well as to identify benefits and possible risks for family planning services at the primary level.Materials and methods. 50 obstetricians and gynecologists and 50 family doctors were interviewed as experts with the help of a specially designed questionnaire. Research results were analyzed using the method of structural-logical analysis.Results. The list of medical services for family planning and prevention of unwanted pregnancies to be provided by family doctors includes: formation of safe sexual behavior in adolescents and young people, formation of responsible attitude to reproductive health in adolescent girls, explanation to married couples about use of barrier contraception and emergency contraception immediately after sexual intercourse, information activities aimed at promoting a healthy lifestyle, formation of responsible parenthood, strengthening family and marital relations.The advantages of providing these services at the primary level are increased physical availability of medical care for family planning, possible reduction of unwanted pregnancies, early onset of sexual relations culture and higher opportunities for adolescents to develop a responsible attitude to reproductive health. Among the risks of providing family planning services at the primary level experts noted the low level of professionalism of family doctors and nurses, lack of motivation to provide this area of medical services, low level of interaction between primary and obstetric care services, low public confidence in family doctors.Conclusion. Applying of expertly defined list of services for family planning and prevention of unwanted pregnancies at the primary level of medical care when family doctors acquire the necessary competencies will increase the availability and effectiveness of this type medical care.

An Overview of Seminal Plasma Hypersensitivity and Approach to Treatment

Seminal plasma hypersensitivity (SPH) presents with localized vaginal and/or systemic allergic symptoms on exposure to protein components of seminal plasma. Although the true incidence is unclear, it is a likely underdiagnosed but an important cause of vulvovaginitis and dyspareunia that affects women across the entire globe. Systemic SPH is likely elicited by an IgE-mediated reaction to seminal plasma proteins other than spermatozoa. Localized reactions are likely mediated by a non-IgE immunologic mechanism. The diagnosis of both conditions is made clinically. Clinical presentation typically involves local vaginal discomfort and/or systemic symptoms including urticaria, angioedema, wheezing, dyspnea, gastrointestinal symptoms, or frank anaphylaxis. In roughly half of cases of localized SPH, reactions occur after first-time intercourse. Use of a condom prevents reactions, which aids confirming a diagnosis. In addition to a detailed history, skin prick and/or serologic testing may assist in making the diagnosis. Both local and systemic SPH are managed by the use of barrier contraception or intravaginal graded desensitization. Although SPH has not been shown to directly cause infertility, it may make conception challenging due to the discomfort or systemic symptoms caused by unprotected vaginal intercourse. Data indicate that women with localized reactions have variable fertility outcomes, although the majority are able to have resolution of symptoms after desensitization and have normal term pregnancies. This review provides a step-by-step approach for evaluating and treating women with localized or systemic SPH.

Reproductive aspirations, contraception use and dual protection among adolescent girls and young women: the effect of motherhood and HIV status.

IntroductionThere is a growing interest in adolescent motherhood and HIV among policymakers and programme implementers. To better shape services and health outcomes, we need evidence on reproductive aspirations and contraception use in this high‐risk group, including the effect of motherhood and HIV status. We report data from a large survey of adolescent girls and young women conducted in a mixed rural‐urban district in South Africa.MethodsQuantitative interviews were conducted with 1712 adolescent girls and young women (ages 10 to 24): 336 adolescent mothers living with HIV (AMLHIV), 454 nulliparous adolescent girls living with HIV (ALHIV), 744 HIV‐negative adolescent mothers (control adolescent mothers) and 178 HIV‐negative nulliparous adolescent girls (nulliparous controls) in 2018 to 2019. Standardized questionnaires included socio‐demographic measures, reproductive health and contraception experiences. Reproductive aspirations were measured as the number of children participants wanted to have. Dual protection was computed as use of both hormonal and barrier contraception or abstinence. Multivariate logistic regression and marginal effects models in STATA 15 were used to test associations between HIV status, adolescent motherhood and outcomes of reproductive aspirations, contraception use and dual protection, controlling for covariates.Results and discussionNearly 95% of first pregnancies were unintended. Over two‐thirds of all participants wanted two or more children. Hormonal contraception, condom use and dual protection were low across all groups. In multivariate regression modelling, ALHIV were less likely to report hormonal contraception use (aOR 0.55 95% CI 0.43 to 0.70 p ≤ 0.001). In marginal effects modelling, adolescent mothers – independent of HIV status – were least likely to report condom use at last sex. Despite higher probabilities of using hormonal contraception, rates of dual protection were low: 17.1% among control adolescent mothers and 12.4% among AMLHIV. Adolescent mothers had the highest probabilities of not using any contraceptive method: 29.0% among control mothers and 23.5% among AMLHIV.ConclusionsAmong adolescent girls and young women in HIV‐endemic communities, reproductive aspirations and contraceptive practices affect HIV risk and infection. Tailored adolescent‐responsive health services could help young women plan their pregnancies for when they are healthy and well‐supported, and help interrupt the cycle of HIV transmission by supporting them to practice dual protection.

RISK FACTORS OF PRE-CANCER CERVICAL DISEASES IN WOMEN OF REPRODUCTIVE AGE

Relevance. Today, the nature of the impact of the inflammatory process caused by Trichomonas infection on the persistence of HPV and immune response, as a consequence of the progression of intraepithelial lesions of the cervix, is not fully understood.
 Objectives: based on a retrospective clinical and statistical analysis to determine the risk factors for cervical dysplasia in women of reproductive age.
 Materials and methods. A clinical and statistical analysis for 392 medical records of patients of reproductive age with verified HPV and Trichomonas Vaginalis, who received pathogenetic therapy at the clinical bases of the Bogomolets National Medical University Obstetrics and Gynecology № 3 Department and LLC "Clinic Profimed" for 2015-2019. As a result of a retrospective study of patients systematized by age, complaints, the presence of genital and extragenital pathology, reproductive history and the state of reproductive function, social status.
 Results. According to the analysis of anamnesis indicators, the main risk factors for precancerous cervical conditions were: early onset of sexual life, menstrual disorders (29.1%), high incidence of childhood infectious diseases (63.5%), somatic pathology (71.2 %), irregular use of barrier contraception (19.9%), genital diseased caused by sexually transmitted infections (STD), including HPV and Trichomonas Vaginalis, frequent abortions (41.6%) and childbirth with cervical trauma, low level of medical and sexual cultures and smoking (65.3%). The systemic negative impact of numerous risk factors on the body contributed to cervical intraepithelial neoplasia (CIN) development in women of reproductive age.
 Conclusion. The retrospective study proves the need for stratification of patients with for CIN risk, requires management of cervical pathology in women with HPV and detected Trichomonas Vaginalis, which will increase the effectiveness of diagnosis, treatment and recurrence prevention.

Sedative/Tranquilizer Misuse is Associated With Alcohol and Illicit Drug Problems, Mental Health Issues, and Impulsivity and Compulsivity in University Students.

Background:This study examined the prevalence of sedative/tranquilizer misuse among university students and its associations with psychosocial correlates.Methods:Nine thousand four hundred forty-nine students received a 156-item anonymous online survey, which assessed the use of prescription sedative/tranquilizer (ever or past year), alcohol and drug use, mental health issues, and impulsive and compulsive traits. Sedative/tranquilizer misuse was defined as intake of these prescription drugs by individuals who had not been prescribed them.Results:Three thousand five hundred twenty-five university students (57.7% women) responded to the survey. The prevalence of past 12-month prescription sedative/tranquilizer misuse was 2.1%, with 2.8% reporting having used more than 12 months ago. Prescription sedative/tranquilizer misuse was associated with the use of multiple other drugs (eg, alcohol, opiates each P < 0.001). Those who misuse sedative/tranquilizers were significantly more likely to have mental health histories (P < 0.001), engage in riskier sexual behavior (ie, earlier sexual acts [P < 0.001] and less frequent use of barrier contraception [P = 0.001]), report low self-esteem (P = 0.001), and endorse traits of impulsivity (P < 0.001) and compulsivity (P < 0.001). Effect sizes were small to medium.Conclusions:Misuse of prescription sedative/tranquilizers was reported by 2% to 3% of university students and was associated with a variety of mental health and drug use problems. Clinicians should be aware that certain mental health conditions are more likely in those who misuse sedatives. This study indicates the need for longitudinal research into the effects of chronic sedative use on brain function and mental health, especially in young people. Such research should address the extent to which impulsive traits predispose to various substance use problems, versus the direct effects of sedatives (and other substances) on mental health

A Rare Case of Primary Herpes Esophagitis in an Immunocompetent Young Adult

Introduction Herpes Simplex Viral (HSV) esophagitis is an opportunistic infection that is seen in patients with impaired immunity. It is rarely seen in immunocompetent individuals. It may result from direct spread to the esophagus from an oro-pharyngeal infection or can occur in patients with latent HSV by reactivation of the virus and dissemination to the esophageal mucosa via the vagus nerve. A few cases of HSV in immunocompetent individuals have been reported. We present a case of primary HSV esophagitis in an immunocompetent young adult whose biopsy was positive for both HSV 1 & 2. Clinical Vignette A 21 y/o male presented to the ED with complaints of sore throat, odynophagia and chest pain. Symptoms started as low grade fevers and viral-like illness and then progressed to throat soreness followed by severe odynophagia. Other symptoms included nausea, vomiting, subjective fevers, abdominal pain with radiation to the back during swallowing. Patient had no known past medical history, no history of cold sores and endorsed heterosexual activity with approximately twenty lifetime sexual partners and denied use of barrier contraception or engaging in oral sex. Physical examination was remarkable tonsillar erythema and edema, with mild pharyngeal erythema & exudates on tonsils. Blood tests were remarkable for positive HSV 1 &2 IgM and negative for HIV, CMV & EBV. CT neck showed bilateral tonsillitis, thickening of the esophagus, no evidence for peritonsillar abscess. Upper endoscopy revealed esophagitis manifested as edema, erosion and friable mucosa with spontaneous bleed on contact. Biopsy and pathology results was positive for herpes virus 1 &2. Further work up for underlying immune deficiencies and autoimmune diseases was negative. Patient was treated with oral acyclovir for 7days with resolution of symptoms. Discussion Very few cases of HSV esophagitis in immunocompetent individuals have been reported. It is mostly seen in immunocompromised individuals such as HIV carriers, transplant recipients, people on immunosuppressive agents and those with cancer. Initial symptoms usually include a viral prodrome followed by sore throat with odynophagia. Other common manifestations are dysphagia, retrosternal chest pain, weight loss, fever, nausea and vomiting. It is diagnosed via endoscopic inspection and histopathology findings. Treatment is with acyclovir, famiciclovir or valaciclovir. Symptoms may resolve over time with symptomatic treatment.1709_A Figure 1. Endoscopic findings1709_B Figure 2. Histology of HSV infected cells1709_C Figure 3. Immunohistochemical staining showing HSV infected cells

Persistent Zika Virus Detection in Semen in a Traveler Returning to the United Kingdom from Brazil, 2016

Zika virus is normally transmitted by mosquitos, but cases of sexual transmission have been reported. We describe a patient with symptomatic Zika virus infection in whom the virus was detected in semen for 92 days. Our findings support recommendations for 6 months of barrier contraceptive use after symptomatic Zika virus infection.

The relationship between social, policy and physical venue features and social cohesion on condom use for pregnancy prevention among sex workers: a safer indoor work environment scale

BackgroundThis study aims to report on a newly developed Safer Indoor Work Environmental Scale that characterises the social, policy and physical features of indoor venues and social cohesion; and using...

Evaluation of risk factors in patients attending STI clinic in a tertiary care hospital in North India.

In the past few years, the interest in STDs and their management has increased tremendously because of their proven role in facilitation of HIV infection, which, in turn, also increases the risk of acquiring STIs. Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS. (i) To screen the new patients attending the STI clinic for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) and (ii) to evaluate the role of various risk factors in the prevalence of STIs. The present study was conducted on 200 patients attending the STI clinic. They were evaluated for the prevalence of HIV and bacterial STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) along with the role of risk factors particularly circumcision. The prevalence of HIV was 7% and prevalence of other STI was 20%. The causative agents were Chlamydia 8%, Gonorrhea 7.5%, Bacterial Vaginosis 2.7% and Syphilis 2%. The factors found to be significantly associated with the prevalence of STI were circumcision, positive HIV status, education, religion, multiple sexual partners, contact with Commercial sex workers (CSW), non use of contraception, profession involving long stay away from home, and past history of STI. The present study suggests that circumcision is a protective factor for acquisition of STIs but other factors like sexual behavior, use of barrier contraceptives, drug abuse etc., also play a role.

Evaluation of risk factors in patients attending STI clinic in a tertiary care hospital in North India

Background:In the past few years, the interest in STDs and their management has increased tremendously because of their proven role in facilitation of HIV infection, which, in turn, also increases the risk of acquiring STIs. Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS.Aims:(i) To screen the new patients attending the STI clinic for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) and (ii) to evaluate the role of various risk factors in the prevalence of STIs.Materials and Methods:The present study was conducted on 200 patients attending the STI clinic. They were evaluated for the prevalence of HIV and bacterial STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis) along with the role of risk factors particularly circumcision.Results:The prevalence of HIV was 7% and prevalence of other STI was 20%. The causative agents were Chlamydia 8%, Gonorrhea 7.5%, Bacterial Vaginosis 2.7% and Syphilis 2%.Conclusion:The factors found to be significantly associated with the prevalence of STI were circumcision, positive HIV status, education, religion, multiple sexual partners, contact with Commercial sex workers (CSW), non use of contraception, profession involving long stay away from home, and past history of STI. The present study suggests that circumcision is a protective factor for acquisition of STIs but other factors like sexual behavior, use of barrier contraceptives, drug abuse etc., also play a role.

The Association Between Contraceptive Use at the Time of Conception and Hypertensive Disorders During Pregnancy: A Retrospective Cohort Study of Prams Participants

Each year approximately 7 % of women experience hypertensive disorders during pregnancy which can result in adverse events for both the mother and child. Previous research suggests that contraception at the time of conception can also predispose one to hypertensive disorders during pregnancy. The objective of this study was to examine the association between contraceptive use at the time of conception and hypertensive complications during pregnancy. A total of 2,395 women aged 18-45 years participated in the 2007-2009 Michigan Pregnancy Risk Assessment Monitoring System. Contraception at the time of conception was self-reported by participants and classified as barrier, nonbarrier, or non-use. Information on hypertensive disorders during pregnancy was primarily from birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95 % confidence intervals (CIs) to model the contraception-hypertensive disorder association. After adjustment for age and race/ethnicity, there was no strong association between use of barrier contraception at the time of conception and hypertensive disorders during pregnancy as compared to non-users (OR 1.09, 95 % CI 0.62-1.92). After adjustment for the same variables, nonbarrier users had 1.22 times the odds of experiencing hypertensive disorders during pregnancy as compared to non-users (95 % CI 0.75-1.98). Although we did not find an association between contraceptive use at the time of conception and hypertensive disorders during pregnancy, additional studies with larger sample sizes and more explicit categorization of the outcome variable are needed to confirm these findings.

A Painful Periurethral Mass

A 17-year-old female presents with vaginal ‘‘pain and a bump.’’ Her last menstrual period ended 1 day earlier. She denied vaginal bleeding, discharge, abdominal pain, fevers, hematuria, dysuria, post-void dribbling, incontinence, history of sexual transmitted infections, or change in hygiene products. She is currently finishing a course of nitrofurantoin for a urinary tract infection (UTI). She admits to sexual activity without use of barrier contraception. Recent gonorrhea and chlamydia testing were negative. On examination, she is afebrile with normal vital signs, and her abdomen is nontender. External genitalia demonstrated a small, somewhat firm irritated-appearing 1-cm midline mass anterior to the vaginal introitus just posterior to the urethra (Fig. 1). Compression yielded no urine or purulent discharge.

Co-infection of human immunodeficiency virus and sexually transmitted infections in circumcised and uncircumcised cases in India

Background:Acquired Immunodeficiency Syndrome (AIDS), is now one of the greatest challenges facing the world. Sexual transmission is the primary route of human immunodeficiency virus infection worldwide. Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS.Material and Methods:The present study was conducted on 200 HIV positive clients. They were screened for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis).Results:There were 138 males and 62 females. The males were examined and the circumcision status was observed. In the females, circumcision status of their male partners was observed. The coinfection of HIV and STIs in circumcised and uncircumcised cases was found out. Diagnosis was made using standard tests. A total of 23% cases were diagnosed to have HIV –STI coinfection. Most common diagnosed diseases were Chlamydia (10%), Gonorrhoea (9%), Bacterial Vaginosis (4.8%) and Syphilis (2.5%). The coinfection rate in uncircumcised cases was found to be higher (29.2% in males and 39.2% in females) as compared to the circumcised cases (14.2% in males and 13.6% in females).Conclusion:The present study suggests that circumcision is a protective factor for acquisition of STIs in HIV positive clients but other factors like sexual behaviours, use of barrier contraceptives, drug abuse etc also play a role.