Tanning bed exposure increases the risk of malignant melanoma

BACKGROUND: Epidemiologic studies have associated tanning bed exposure and cutaneous melanoma. The relationship between the extent of tanning bed exposure and the risk of melanoma has not been elucidated in detail. METHODS: Surveys assessing the extent of tanning bed exposure and the history of skin cancer, including malignant melanoma, were collected from academic dermatology clinic patients (n = 1518). Of these, 551 (36.3%) completed all components of the survey. The available medical records, including pathology reports (n = 501; 33%), were reviewed to confirm cases of skin cancer. Data on potential confounding factors, including indoor vs. outdoor occupation and leisure activities, Fitzpatrick skin type, history of blistering sunburn, use of sunscreen and sun protective clothing, history of phototherapy, and level of education, were assessed and compared. RESULTS: Of the patients surveyed, 487 (32.1%) reported tanning bed exposure. Women aged 45 years or younger accounted for about 60% of all tanning bed users. Seventy-nine cases of malignant melanoma were reported, 22 in women aged 45 years or younger. In the entire cohort, the "ever-use" of tanning beds was found to be a significant risk factor for the development of melanoma [P < 0.05; odds ratio (OR), 1.64; 95% confidence interval (95% CI), 1.01-2.67]. The risk was greater in women aged 45 years or younger (P < 0.05; OR, 3.22; 95% CI, 1.01-11.46). Patients with a history of melanoma were significantly more likely to report tanning bed sessions exceeding 20 min (P < 0.01; OR, 3.18; 95% CI, 1.48-6.82); this association was even stronger for women aged 45 years or younger (OR, 4.12; 95% CI, 1.41-12.02). LIMITATIONS: The study was subject to recall bias, included only patients at a midwestern academic practice, and had a relatively low response rate. CONCLUSION: Exposure to tanning beds increases the risk of malignant melanoma, especially in women aged 45 years or younger. These findings reinforce the hazards of tanning bed exposure.     

Barriers to reproductive tract infection (RTI) care among Vietnamese women: implications for RTI control programs

BACKGROUND: Vietnamese women may be especially vulnerable to reproductive tract infections (RTIs) and their biological and social sequelae. Few data are available on the prevalence of and health-seeking behavior for RTIs among women in Vietnam. GOAL: To assess prevalence of RTI symptoms, describe treatment-seeking behaviors, and identify barriers to care among Vietnamese women. STUDY DESIGN: A population-based survey was conducted among 1163 Vietnamese women aged 18 years to 49 years. RESULTS: Five hundred seven women (43.6%) reported RTI symptoms in the previous 6 months, including abnormal vaginal discharge (78.3%), lower abdominal pain (46.7%), and genital ulcers (3.6%). Sixty-four percent of these women sought care at some type of medical venue: health station (i.e., government clinic; 24.7%), hospital (15.8%), pharmacy (15.2%), or private doctor (8.1%). The remaining women ignored symptoms (24.8%) or were self-treated (11.4%). In multivariate analysis, stigma associated with sexually transmitted infections (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.25-2.70); not seeking informal advice (OR = 2.90; 95% CI = 1.82-4.62); mildness of symptoms (OR = 3.01; 95% CI = 1.45-6.23); absence of perceived morbidity (OR = 3.56; 95% CI = 2.20-5.77); and short duration of symptoms (OR = 2.53; 95% CI = 1.04-6.16) were significantly associated with ignoring RTI symptoms. CONCLUSION: A substantial number of women in northern Vietnam who reported RTI symptoms did not seek care. Interventions to raise awareness about RTI symptoms and their consequences, dissipate negative stereotypes, and encourage open discussion about RTIs should facilitate appropriate care-seeking for RTIs.     

Risk factors for incomplete excision of basal cell carcinomas

Incomplete excision of basal cell carcinomas (BCCs) may be followed by recurrence of the tumor. In order to detect risk factors for incomplete excision of BCCs we performed a cross-sectional study of 1278 patients who underwent a primary excision of BCCs, during a four-year period, within an ambulatory and hospital plastic surgery department setting. Incomplete excision occurred in 159 of 1478 primary excisions of BCCs (10.8%) and was significantly associated with location of the tumors in the eyelids (OR 3.64, 95% CI 1.96-6.71), ears (OR 2.51, 95% CI 1.25-4.94), naso-labial folds (OR 2.26, 95% CI 0.99-5.04) and nose (OR 1.88, 95% CI 1.30-2.71). There was an inverse association with location of the tumors in the upper limbs (OR 0.44, 95% CI 0.21-0.90), back (OR 0.12, 95% CI 0.02-0.48) or chest (OR 0.09, 95% CI 0.00-0.57). Baso-squamous differentiation was associated with incomplete excision of BCCs (p = 0.03). No association was observed between incomplete excision of BCCs and gender, age, setting of the operation (ambulatory vs. hospital), clinical appearance of the lesion (suspected BCCs vs. other diagnoses) or diameter of the lesions. In conclusion, incomplete excision of BCCs was associated with location of the tumors in the eyelids, ears, naso-labial folds and nose. We recommend that in patients with BCCs located in these sites, surgeons should commence particular surgical measures to avoid inadequate excisions of the tumors.     

Characteristics of dermatologists who read dermatopathology slides

BACKGROUND: The characteristics and prevalence of dermatologists reading dermatopathology slides are not well understood. METHODS: We surveyed 1406 members of the American Academy of Dermatology (AAD), including all 497 who were also members of the American Society of Dermatopathology (ASDP) along with a random sample of the remaining AAD members who were not ASDP members. Seven hundred and thirty of 1406 (51.9%) responded with a usable survey. Logistic regression was used to analyze responses by ASDP member dermatologists, non-ASDP member dermatologists and in a weighted analysis for dermatologists as a whole. RESULTS: A total of 32.7% of dermatologists as a whole generated at least one final microscopic diagnosis in the preceding year. Multivariate analysis demonstrated that men were significantly more likely to read dermatopathology slides (odds ratio (OR) = 1.90; 95% confidence interval (CI) 1.16-3.12; p = 0.01). Additionally, there was significant variation by region (p < 0.001); compared with dermatologists in the Midwest, dermatologists in the Southeast (OR = 0.39; 95% CI 0.19-0.80) were significantly less likely to read slides, while those in the Mountain (OR = 3.09; 95% CI 1.10-8.72) and West (OR = 2.01; 95% CI 1.04-3.90) regions were significantly more likely. There were no significant associations found between reading slides and the year of residency completion, the number of patients seen per week or being primarily in academics. CONCLUSIONS: The practice of dermatologists reading dermatopathology slides is relatively common, with significant regional and sex differences.     

Relationship of treatment delay with surgical defect size from keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma of the skin)

Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24%). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size (R(2) = 0.39) and were used as control variables. Self-reported delay between initial physician examination and MMS predicted defect size (p = 0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3-3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7-8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5-18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5-83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5-15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.     

Factors associated with palmoplantar or plantar pompholyx: a case-control study

BACKGROUND: Disydrosis or pompholyx is a chronic and recurrent form of dermatosis that poses a number of therapeutic issues. The etiopathology of the condition is unclear. The aim of this study was to identify factors associated with the palmoplantar and plantar dysidrosis. PATIENTS AND METHODS: This was a prospective case-control study conducted between June 2001 and February 2004 at the University Hospital of Lome (Togo). Each case (palmoplantar or plantar pompholyx) was matched for age (+/- 5 years) and sex with two controls. Examination for tinea pedis was performed in all participants (patients and controls) but mycologic culture alone was done in patients with interdigital-plantar intertrigo. RESULTS: One hundred patients with pompholyx were matched with 200 controls. Mean age was 32.8 +/- 14.8 years in the patient group and 31.4 +/- 14.8 years in the control group. For univariate analysis, the main factors associated with pompholyx were: personal atopy (OR = 12.6; CI95%: 6.4 - 25.1) and familial atopy (OR = 5.8; CI95%: 3.2 - 10.5); history of eczema (OR = 5.4; CI95%: 2.6 - 11.4); hyperhidrosis (OR=4.5; CI 95%: 5.5 - 40.7), sport (OR = 8.8; CI 95%: 3.9 - 20.8); tinea pedis (OR = 15.6; CI 95%: 7.5 - 32.9). In multivariate analysis, atopy (OR = 10.5; CI95%: 8.4 - 20.8) and tinea pedis (OR = 18; CI95%: 10.5 - 25.2) were the only factors associated with pompholyx. Trichophyton rubrum was the most common etiology of tinea pedis in both patients and controls.DISCUSSION: The results of this study show atopy and tinea pedis as factors statistically associated with palmoplantar or plantar pompholyx. However, only cohort studies can determine the precise causal relationship between tinea pedis and pompholyx.     

中国16个城区男男性行为人群梅毒感染情况及影响因素分析

目的 了解中国6个省（自治区、直辖市）的16个城区的男男性行为人群（MSM）的梅毒感染情况及其影响因素。方法 于2007年在开展绘制MSM活动场所地理分布图及人群规模估计的基础上，用分类的非概率抽样方法在MSM中开展横断面调查；通过问卷调查收集人口学、危险行为以及梅毒感染等信息。用SPSS软件对数据进行单因素及多因素Logistic回归分析。结果 2007年共收集4211份有效问卷。所调查的MSM平均年龄为28岁，自报为同性恋占66.7%，未婚占72.5%，高中及其以上教育程度占76.4%。近6个月MSM的性行为调查结果显示：8.7%有10个以上的男性性伴，5.6%曾买男性性服务，11.3%曾为男性提供商业性服务，18.9%曾与女性发生过性关系，与男性肛交性行为中的安全套坚持使用率仅为36.3%。所调查MSM的梅毒感染率为10.6%。多因素Logistic回归分析结果显示：年龄 > 25岁［调整OR（AOR） = 1.7，95% CI：1.3 ~ 2.0］、本市户籍（AOR = 1.3，95% CI：1.0 ~ 1.7）、调查地区、酒吧/公园招募对象（AOR = 1.3，95% CI：1.1 ~ 1.7）、买男性性服务（AOR = 1.5，95% CI：1.0 ~ 2.1）、男男肛交行为中不坚持使用安全套（AOR = 1.2，95% CI：1.0 ~ 1.5）和自报性病史（AOR = 1.3，95% CI：1.0 ~ 1.7）是梅毒感染的独立相关变量。结论 16个城区MSM的梅毒感染率已达一定水平、男男商业性服务及不安全性行为的流行率较高，亟待加强MSM的梅毒防治工作，包括梅毒和ＨＩＶ筛查、推广使用安全套等综合干预措施。     

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35%, 47%, and 55% in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis infection were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95% confidence interval (CI) = 1.2-3.9; p = 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95% CI = 1.4-10.6; p = 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95% CI = 1.8-6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence of C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk.     

Changes in the prevalence of HIV-related behaviors and perceptions among 1832 injecting drug users in Sichuan, China

OBJECTIVE: To evaluate overall effectiveness of human immunodeficiency virus-related prevention programs among injecting drug users in Sichuan, China. DESIGN: Behavioral surveillance data were analyzed. RESULTS: The coverage rates for various service types increased from 2002--2004. The prevalence of using other's used syringes in the last month decreased from between 24.7% and 54.1% in the baseline years (2002 or 2003) to between 11% and 18.9% in 2004 [odds ratio (OR) = 0.1, 95% confidence interval (CI): 0.06-0.2 to OR = 0.6, 95% CI: 0.4-0.9, P <0.05]. Improvements were observed in prevalence of giving used syringes to others for drug injection in the last month (OR = 0.1, 95% CI: 0.06-0.1 to OR = 0.7, 95% CI: 0.5-0.9 in 3 counties, P <0.05) etc. Increase in prevalence of condom use with commercial sex partners or nonregular partners were observed in 3 counties (2004 vs. baseline year: OR = 0.2, 95% CI: 0.1-0.5 to OR = 0.4, 95% CI: 0.2-0.9, P <0.05) but not for prevalence of condom use with regular sex partners. CONCLUSION: The results supported the claim that harm reduction programs targeting injecting drug users have been effective.     

Dietary restriction and supplementation in children with atopic eczema

Issues on empirical dietary restriction or supplementation are important but inadequately studied in children with atopic eczema (AE). The dietary habits of children with AE followed at a paediatric dermatology clinic (n = 179) were compared with those without eczema (n = 78). The mothers of 53% of the patients with or without eczema did not breastfeed their children. Common food items avoided by parents whose children have moderate-to-severe AE included fish or seafood [64% vs. 32% of controls, odds ratio (OR) 3.84, 95% CI 2.12-6.95], beef (42% vs. 17%; OR = 3.57, 95% CI 1.79-7.11), eggs (34% vs. 14%; OR = 3.05, 95% CI 1.46-6.34) and cows' milk (18% vs. 4%; OR = 5.56, 95% CI 1.61-19.12); whereas their avoidance was less frequent in children with noneczematous diseases. The avoidance of these foods were often based on belief, but 66% of all AE patients who had avoided any of the above foods reported previous experience of eczema exacerbation by these items. Patients with moderate-to-severe AE were more likely to have consumed 'bird's nest' soup and traditional Chinese medicines. It is important to evaluate whether the AE patients are genuinely 'allergic' to some of these food items. Management is suboptimal if children with food allergy and severe disease continue to consume the culprit food. Conversely, avoidance of common foods in children without food allergy could result in food faddism or malnutrition.     

Indoor tanning attitudes and practices of US dermatologists compared with other medical specialists

OBJECTIVE: To compare the indoor tanning attitudes and practices of dermatologists with physicians in other medical specialties (internal medicine, pediatrics, and family medicine) commonly providing sun safety counseling to patients. DESIGN: Cross-sectional study. SETTING: Questionnaire mailed to randomly selected US dermatologists, internists, family practitioners, and pediatricians. RESULTS: The overall response rate was 38% (364/949): 71% indicated that patients had asked their opinions about indoor UV tanning, 80% believed that UV tanning was unsafe, and 90% agreed they would counsel patients against nonmedical indoor UV tanning. Many supported increased UV tanning legislation, including minimum age restrictions (91%) and parental consent requirements (90%). Dermatologists were significantly more likely than other physicians to respond to the survey (52% vs 31%, P<.001), speak with patients about indoor UV tanning (odds ratio [OR], 26.5; 95% confidence interval [CI], 9.5-74.1]), believe that indoor UV tanning is unsafe (OR, 14.0; 95% CI, 5.0-39.4), and support increased regulation (OR, 11.7; 95% CI, 1.5-88.5). Women discouraged indoor UV tanning more than men (OR, 5.2; 95% CI, 1.8-15.2). Physicians who had used indoor UV tanning (19%) more often agreed that non-UV tanning lotion (OR, 2.0; 95% CI, 1.1-3.8) and airbrush tanning (OR, 1.9; 95% CI, 1.1-3.4) were safe but did not differ in attitudes regarding UV tanning safety. Physicians practicing in the Northeast and Midwest were more likely to support UV tanning to improve mood (OR, 2.0; 95% CI, 1.1-3.5) and more commonly believed that UV tanning could help treat depression (OR, 2.6; 95% CI, 1.5-4.6) or prevent vitamin D deficiency (OR, 1.7; 95% CI, 1.0-2.8). CONCLUSIONS: Physicians, especially dermatologists, are frequently asked about and generally discourage indoor UV tanning. Dermatologists regard indoor UV tanning more negatively compared with other physicians. Physician sex and geographic location were associated with specific indoor UV tanning attitudes.     

Prevalence and risk factors for herpes simplex virus type 2 antibodies among low- and high-risk populations in Indonesia

OBJECTIVES/GOAL: Data on prevalence of herpes simplex virus type 2 (HSV-2) infections are limited in Asia. This study investigated the seroprevalence of, and risk factors for, antibodies to HSV-2 among low- and high-risk, predominantly asymptomatic populations in Indonesia. STUDY DESIGN: We screened women attending maternal and child health, obstetric, gynecology, and sexually transmitted infection (STI) clinics; men attending STI clinics; and female sex workers (FSWs) for type-specific HSV-2 antibodies using the HerpesSelect 2 enzyme-linked immunosorbent assay IgG and Western blot. RESULTS: HSV-2 antibodies were detected in 153 of 176 FSWs (86.9%; 95% confidence interval [CI], 81.0-91.5); increasing age was the only significant independent risk factor (odds ratio [OR], 1.15; 95% CI, 1.06-1.24; P = 0.001). Among non-sex worker females, HSV-2 antibodies were detected in 78 of 418 (18.7%; 95% CI, 15.0-22.7); significant independent associations were any contraceptive use (OR, 2.24, 95% CI = 1.33-3.85, P = 0.003), symptoms or signs of genital ulcer (OR, 2.69; 95% CI, 1.27-5.70; P = 0.01) and younger age of sexual debut (OR, 0.92; 95% CI, 0.86-0.99; P = 0.03). HSV-2 antibodies were detected in 25 of 116 men (21.6%; 95% CI, 14.5-30.1). CONCLUSIONS: HSV-2 seroprevalence reported here is in the upper range of that reported in nearby regions. Health promotion is needed to encourage affected individuals to recognize symptoms of genital herpes and seek care and advice on reducing transmission. The high seroprevalence among FSWs has potentially serious implications for the HIV epidemic in Indonesia.     

Warts, swimming pools and atopy: a case control study conducted in a private dermatology practice

OBJECTIVE: Our purpose was to study two risk factors of warts, i.e., swimming pool frequentation and atopy. PATIENTS AND METHODS: A case-control study was performed in four dermatologists' private offices. The cases were patients consulting for the first time for warts; the controls were patients consulting for the first time for acne. RESULTS: Univariate analysis performed in 153 questionnaires (including 86 cases and 67 controls) showed an association between warts with swimming pool frequentation one year before consulting and between warts and history of atopy. Multivariate analysis showed an association between warts and history of atopy (OR: 4.20; confidence interval at 95 p. 100 = (1.52-11.6). The link between warts and frequentation of swimming pool one year before is not significant (OR: 1.81; confidence interval at 95 p. 100 = (0.78-4.21)) but shows a tendency. DISCUSSION: This last point should be confirmed in further studies. Additionally, this study showed that this kind of clinical research can be carried out in dermatologist private practice.     

HIV - associated and non - HIV associated types of Kaposi's sarcoma in an African population in Tanzania. Status of immune suppression and HHV-8 seroprevalence

In this study 77 patients with histologically confirmed Kaposi's sarcoma (KS) were seen at the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. Sixty six patients (85.7%) were HIV-seropositive KS-patients (40 males, 26 females; male: female ratio 1.5:1), whereas another 11 (14.3%) KS-patients, all males, were found HIV-seronegative, thus corresponding to the endemic African KS-type. In both groups the CD4+ cell counts were generally low, the CD8+ population increased and the CD4+/CD8+ ratio inverted. Immune suppression was, however, more prominent in the HIV-seropositive group.HHV-8 seroprevalence was high in patients with HIV-associated KS (94.6%), nevertheless, 3 (5.4%) patients in this group remained HHV-8 seronegative. All nine patients with the HIV-seronegative African type of KS were found positive for HHV-8. Of the entire group seen, males were more likely to be HHV-8 seropositive than females (OR = 3.348 95% CI, 0.96-11.65; p < 0.05). The relative risk to develop KS in individuals seropositive to both HIV and HHV-8 was high (OR = 10.6, 95% CI; 2.981-37.688; p < 0.001).Overall, HIV-associated KS differed from the non-HIV-associated by its widespread clinical dissemination on the trunk, the frequent involvement of the oral mucosa and the craniofacial region, and its more rapidly progressive course. No histological differences between the two KS-groups were seen, although spindle cell infiltrates were more often found in the HIV-associated KS-group.     

Psychosocial predictors of hepatitis B vaccination among young African-American gay men in the deep south

BACKGROUND: Despite recommendations for vaccination against hepatitis B virus (HBV) of men who have sex with men (MSM), most remain unvaccinated. GOAL: The goal of this study was to identify attitudes and beliefs associated with vaccination against HBV among black MSM. STUDY DESIGN: The Birmingham Vaccine Acceptance Questionnaire was used to collect data from gay bar patrons. RESULTS: Of the 143 participants, nearly 42% reported at least one dose of HBV vaccine. In multivariable analysis, characteristics associated with vaccination were a decreased perception of barriers to HBV vaccination (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.22-0.61; P = 0.001); increased perceived medical severity (OR, 5.34; 95% CI, 2.38-11.96; P = 0.001) and personal severity (OR, 2.22; 95% CI, 1.38-3.56; P = 0.006) of HBV infection; and increased perceived general medical self-efficacy (OR, 9.22; 95% CI, 3.52-24.11; P = 0.0001) and personal self-efficacy (OR, 2.3; 95% CI, 1.14-4.63; P = 0.008) to complete the three-dose series. CONCLUSIONS: Our findings underscore the need to increase vaccination through innovative approaches to reduce perceived barriers to vaccination while increasing perceived severity of HBV infection and self-efficacy to complete the vaccine series.     

Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease

OBJECTIVE: The objective of this study was to assess the risk profile for chronic pelvic pain (CPP) after pelvic inflammatory disease (PID). STUDY: Multivariate logistic regression was used to assess risk factors for CPP in a longitudinal study of 780 predominately black, urban women with clinically suspected PID: complaints of acute pain (<30 days); a clinical finding of pelvic tenderness; and leukorrhea, mucopurulent cervicitis, or untreated gonococcal or chlamydial cervicitis. CPP was defined as pain reported at >or=2 consecutive interviews conducted every 3 to 4 months for 2 to 5 years. RESULTS: Nonblack race (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.31-3.58), being married (OR, 2.06; 95% CI, 1.02-4.18), a low SF-36 mental health composite score (OR, 2.71; 95% CI, 1.69-4.34), >or=2 prior PID episodes (OR, 2.84; 95% CI, 1.07-7.54), and smoking (OR, 1.65; 95% CI, 1.01-2.71) independently predicted CPP. Histologic endometritis or evidence of endometrial Neisseria gonorrhoeae or Chlamydia trachomatis infection was negatively associated with CPP (OR, 0.69; 95% CI, 0.44-1.10). CONCLUSIONS: A range of demographic, clinical, historical, and behavioral factors predict CPP after PID.     

Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics

OBJECTIVES: The objectives of this study were to describe patterns of alcohol and drug use disorders among young persons attending a public sexually transmitted disease (STD) clinic and to determine their associations with sexual risk behaviors and STDs. STUDY DESIGN: Four hundred forty-eight men and women aged 15 to 24 who were attending an urban STD clinic completed an interviewer-administered questionnaire that assessed a broad range of substance use in general and for alcohol and marijuana use disorders. RESULTS: Overall, 42.9% had an alcohol or marijuana use disorder (51.6% of males and 34.2% of females), whereas 30.6% had a confirmed STD. Participants with a substance use disorder were significantly more likely to have multiple sexual partners (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.5-3.4), to be inconsistent condom users (OR = 3.1; 95% CI = 1.5-6.3), and to have an STD (OR = 1.7; 95% CI = 1.1-2.6). CONCLUSIONS: Among young STD clinic attendees, substance use disorders were more common than confirmed STDs. STD clinics may be an appropriate setting to screen for and address substance use disorders in young persons.     

Prevalence and predictors of skin disease in the Women's Interagency HIV Study (WIHS)

OBJECTIVE: We attempted to determine the prevalence and predictors of skin disease in a cohort of women with and at risk for HIV infection. METHODS: We analyzed baseline data from a multicenter longitudinal study of HIV infection in women. RESULTS: A total of 2018 HIV-infected women and 557 HIV-uninfected women were included in this analysis. Skin abnormalities were reported more frequently among HIV-infected than uninfected women (63% vs 44%, respectively; odds ratio [OR] 2.10; 95% confidence interval [95% CI], 1.74-2.54). Infected women were also more likely to have more than 2 skin diagnoses (OR, 3.27; 95% CI, 1.31-8.16). Folliculitis, seborrheic dermatitis, herpes zoster, and onychomycosis were more common among HIV-infected women (P < .05). Independent predictors of abnormal findings on skin examination in the infected women were African American race (OR, 1.38; 95% CI, 1.07-1.77), injection drug use (OR, 2.74; 95% CI, 2.11-3.57), CD4(+) count less than 50 (OR, 1.68; 95% CI, 1.17-2.42), and high viral loads (100,000-499,999 = OR, 1.77; 95% CI, 1.32-2.37; > 499,999 = OR, 2.15; 95% CI, 1.42-3.27). CONCLUSION: HIV infection was associated with a greater number of skin abnormalities and with specific dermatologic diagnoses. Skin abnormalities were also more common among women with CD4(+) cell depletion or higher viral load.     

Time to recurrence after surgical excision of atypical fibroxanthoma-updated systematic review and meta-analysis

Atypical fibroxanthoma (AFX) remains a rare cutaneous dermally based fibrohistiocytic tumour with high rates of local recurrence. Mohs micrographic surgery (MMS) and wide local excision (WLE) with margins 1–2 cm are two surgical options. It is unclear whether timing of recurrence following surgical excision of AFX differs according to technique. A systematic review and meta-analysis were performed according to PRISMA guidelines. There was a total of 188 MMS cases and 783 WLE cases. The pooled proportion of MMS cases of recurrence is 6.6% (95% CI 3.6–11.9%), compared with WLE 11.3% (95% CI 7.1–16.5%), which was not significantly different (P = 0.12) Pooled time to recurrence of MMS for AFX to be 14.2 (95% CI 11.6–16.8%) months, compared to 13.3 (95% CI 9.99–16.6%) months (P = 0.86). Our findings suggest that recurrence rates are similar between MMS and WLE techniques and that timing of recurrence is similar regardless of surgical technique employed.     

Epidemiology of vulvar vestibulitis syndrome: an exploratory case-control study

BACKGROUND: Vulvar vestibulitis syndrome (VVS) is a chronic, persistent syndrome characterised by vestibular pain, tenderness, and erythema. The aetiology of VVS is unknown and few of the hypothesised risk factors have been tested in controlled studies. METHODS: Using a matched case-control study design, medical, sexual, health behaviour, and diet history of 28 women with VVS were compared with 50 friend controls without VVS to identify possible causal factors. RESULTS: Cases were more likely than controls to report every vaginal and urinary symptom at the time of interview measured, particularly vaginal soreness or pain (60.7%) and pain during intercourse (64.3%). There were no significant differences between cases and controls with respect to sexual behaviour. Cases were more likely than controls to report self reported history of physician diagnosed bacterial vaginosis (OR = 22.2, 95% CI = 2.8, 177.2, p value = 0.0001), vaginal yeast infections (OR = 4.9, 95% CI = 1.4, 18.0, p value = 0.01), and human papillomavirus (OR = 7.1, 95% CI = 0.6, 81.2, p value = 0.08). There were no differences between cases and controls with respect to dietary intake of oxalate. Cases were more likely than controls to report poor health status (OR = 5.7, 95% CI = 1.1, 28.7, p value = 0.02) and history of depression for 2 weeks or more during the past year (OR = 4.4, 95% CI = 1.6, 12.3, p value = 0.002). CONCLUSION: Self reported history of bacterial vaginosis, yeast infections, and human papillomavirus were strongly associated with VVS. An infectious origin for VVS should be pursued in larger controlled studies, using questionnaire and laboratory measures.