Seropositivity against HPV 16 capsids: a better marker of past sexual behaviour than presence of HPV DNA.

OBJECTIVES: To assess if seropositivity to human papillomavirus type 16 capsids is a better marker of sexual history than the presence of HPV DNA. STUDY DESIGN: A population based age stratified random sample of 234 Norwegian women (mean age 32.8 years, range 20-44) was examined for HPV serum antibodies, cervical HPV DNA, cytology and age in relation to sexual behaviour. RESULTS: Neither age nor age at first sexual intercourse was associated with HPV 16 antibodies. Adjusted ORs for 4-5; 6-10 and > 10 versus 0-1 lifetime sexual partners, were 13.1 (95% CI 1.5-110.8), 8.2 (1.0-69.6) and 10.5 (1.2-94.0) for HPV 16 seropositivity, respectively; and 2.6 (0.2-27.8), 3.4 (0.4-31.7) and 4.1 (0.4-42.8) for HPV 16 DNA positivity, respectively. CONCLUSION: Seropositivity to HPV 16 capsids is positively associated with the number of sexual partners, suggesting that HPV 16 is predominantly sexually transmitted. The fact that serology had a stronger association with number of sexual partners than viral DNA suggests that seroreactivity is a better measure of lifetime history of HPV infection.     

Sexual behavior, human papillomavirus type 16 (HPV 16) infection, and HPV 16 seropositivity

BACKGROUND: Sexual behaviors have been linked to seropositivity for human papillomavirus (HPV) but not with the magnitude of the seroreactivity. GOALS: The objective of this analysis was to examine the association of sexual behavior, cervical HPV 16 DNA positivity at enrollment (past) and at diagnosis (current), and other potential determinants with the likelihood and magnitude of HPV 16 seropositivity at diagnosis. STUDY DESIGN: With use of stored specimens from an incidence case-control study at Kaiser Permanente (Portland, OR), women were tested for seroreactivity to HPV 16 by enzyme-linked immunosorbent assay with virus-like particles at diagnosis and were tested for past and concurrent cervical HPV 16 DNA positivity with MY09/MY11 L1 consensus primer PCR. Questionnaire data were used to ascertain past sexual behavior. RESULTS: Increased lifetime number of sex partners (P(Trend) < 0.001), past HPV 16 DNA positivity (odds ratio = 6.9; 95% confidence interval = 1.5-31), and a current cytologic diagnosis (P(Trend) < 0.03) were independently associated with HPV 16 seropositivity. Among the seropositive, only lifetime number of sex partners (P(Trend) < 0.001) and past HPV 16 DNA positivity (P = 0.003) were independently associated with mean signal strength (optical density) in an age-adjusted analysis. Women negative for past and concurrent HPV 16 DNA had a significant trend of increasing optical densities associated with greater numbers of lifetime partners (P(Trend) < 0.001). Conversely, the mean signal strength for those women who were ever HPV 16 DNA-positive during the study did not depend on lifetime numbers of sex partners (P(Trend) = 0.36). CONCLUSIONS: HPV 16 seropositivity is a surrogate for past HPV 16 infection. Circulating levels of antibodies to HPV 16 may reflect recent HPV 16 infection or the frequency of past HPV 16 infection.     

Prevalence, Incidence, and Risk Factors for Human Papillomavirus 16 Seropositivity in Australian Homosexual Men

BACKGROUND:: Human papillomavirus 16 (HPV16) has been causally associated with approximately 70% of anal cancers. This cancer is markedly increasing among homosexual men. There is limited knowledge of the epidemiology and natural history of anal HPV infection in homosexual men. METHODS:: Behavioral data and sera for antibodies to HPV16 L1 were collected annually for 1427 HIV-negative and 245 HIV-positive Australian homosexual men. Seroprevalence, seroincidence, and risk factors were calculated. RESULTS:: Among HIV-negative men, 25.4% were HPV16 seropositive at baseline compared with 44.3% of HIV-positive men. HPV16 seroincidence was 3.1/100 person-years among HIV-negative men and 1.3/100 person-years among HIV-positive men. Seroincidence among HIV-negative men remained >3% per year until 45 years of age, before declining. In multivariate analyses of data from HIV-negative men, seroprevalent HPV16 was associated with sexual risk behaviors and seropositivity for several viral sexually transmissible infections. Seroincident HPV16 was associated with younger age and unprotected anal intercourse with HIV-positive partners. Among men who predominantly practiced insertive anal intercourse, circumcision was associated with a 57% reduction in seroincident HPV16 (hazard ratio = 0.43, 95% confidence interval: 0.21-0.88, P = 0.021). CONCLUSIONS:: HPV16 seroincidence remained common in men until their mid 40s suggesting that vaccination may be protective in sexually active young gay men. Both HPV16 seroprevalence and seroincidence correlated well with markers of higher risk sexual activity, particularly receptive anal sexual practices. An association between circumcision and decreased HPV16 seroconversion in HIV-negative men who preferred the insertive position in anal sex was observed.     

Prevalence and correlates of herpes simplex virus type 2 infection in a population-based survey of young women in low-income neighborhoods of Northern California. The Young Women's Survey Team

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is one of the most common sexually transmitted infections and may enhance transmission of HIV. However, population-based estimates of HSV-2 prevalence and correlates of infection are rare. GOALS: To obtain population-based estimates of HSV-2 prevalence and to identify demographic and sexual behavioral correlates of infection among women in low-income communities of Northern California. STUDY DESIGN: A randomized, single-stage, cluster sample, cross-sectional survey of women age 18 to 29 years who reside in 1990 US Census block groups at the lowest tenth percentile for household income. RESULTS: The survey-weighted prevalence of HSV-2 infection was 34.8% (95% CI, 30.4-39.2). Factors independently associated with HSV-2 seropositivity were black race, older age, lower income, parity, greater number of lifetime male sexual partners, earlier onset of sexual intercourse, sex work, history of sexually transmitted disease (STD), and cocaine use. CONCLUSION: The high prevalence of HSV-2 and the strong correlation with sexual risk underscores the potential for further spread of STD, including HIV, in this young population.     

Immunoglobulin A, G, and M responses to L1 and L2 capsids of human papillomavirus types 6, 11, 16, 18, and 33 L1 after newly acquired infection

OBJECTIVES: We performed a study to establish the pattern of serological reactivity for immunoglobulins (Ig), to capsids of human papilloma virus (HPV) after new HPV infection in two groups of subjects. METHODS: The pattern of serological reactivity after acquisition of infection with HPV was investigated by measuring IgA, IgM, and IgG antibodies to capsids containing L1 and L2 proteins of HPV types 6, 11, 16, 18, and 33 in longitudinal studies of groups with different patterns of sexual activity. Individuals who tested negative for HPV DNA by the polymerase chain reaction at enrolment, but who became HPV DNA positive during follow up, were examined for antibodies to HPV capsids by enzyme linked immunosorbent assay. One group consisted of 15 young girls (with eight controls who remained HPV DNA negative) who were becoming sexually active and the other comprised 12 male (with five controls) and 35 female (with seven controls) heterosexual attenders of a sexually transmitted disease clinic who had had multiple sexual partners. RESULTS: The sexually inexperienced girls showed IgA and IgG responses, but seldom an IgM response to infection with HPV types 6/11, 16, and 18. No consistent pattern of serological reactivity was apparent for the heterosexuals with multiple partners. The lack of association between current HPV DNA positivity and detectable antibodies in these individuals was possibly related to the duration of infection or to prior exposure to HPV. For the latter group serological reactivity to HPV capsids was significantly greater in women than in men (p = 0.001, p = 0.003, and p = 0.024, for IgG to HPV 6, 11, and 16, respectively). CONCLUSION: The sex difference in antibody response detected in previous studies with assays based on peptide antigens was thus corroborated in the present study with capsid based serological assays. This sex difference might reflect a difference in sexual activity and prior exposure to HPV between men and women in this particular group.     

Prevalence of sexually transmitted infections and high-risk sexual behaviors in heterosexual couples attending sexually transmitted disease clinics in Peru

OBJECTIVES: The objectives of this study were to determine the prevalence of sexually transmitted infection (STIs) in heterosexual couples and the sexual behaviors associated with their acquisition. GOAL: The goal of this study was to better direct educational efforts to decrease STI among heterosexual couples in Lima, Peru. STUDY DESIGN: We conducted a case-control study in 195 heterosexual couples without HIV infection who attended 2 sexually transmitted disease clinics in Lima, Peru. A case was defined as an individual with one or more newly diagnosed STIs such as gonorrhea, chlamydia, trichomoniasis, herpes simplex, syphilis, mycoplasma, or ureaplasma. RESULTS: Thirty-three percent of individuals (41 men and 89 women) had at least one STI and 26 couples (13%) had the same STI detected. Men who have sex with men (MSM) accounted for 13% of all men, had higher rate of STIs and higher risk behaviors than non-MSM. Ureaplasma infection was the most prevalent STI found in both men and women and was associated with oral sexual contact. In heterosexual pairs, condom use during anal sex occurred less than 10% of the time. CONCLUSIONS: The heterosexual couples in sexually transmitted disease clinics have high-risk behaviors and STIs are frequent. The educational effort concerning prevention of STIs requires higher effort.     

Prevalence of sexually transmitted infections among antenatal women in Vanuatu, 1999-2000

BACKGROUND: The epidemiology of sexually transmitted infections (STIs) and HIV in Vanuatu is poorly defined. GOAL: The goal was to determine the prevalence of laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, syphilis seroreactivity, and HIV among pregnant women in Vila, Vanuatu. STUDY DESIGN :A cross-sectional survey of 547 pregnant women attending a first-visit antenatal hospital clinic in Vila. Laboratory testing included polymerase chain reaction on tampons for chlamydia, gonorrhea, and trichomoniasis; testing of sera for syphilis with rapid plasmid reagin; and enzyme-linked immunosorbent assay for HIV. RESULTS: The prevalence of trichomoniasis was 27.5% (150); of chlamydia, 21.5% (117); of gonorrhea, 5.9% (32); and of syphilis, 13 (2.4%). No HIV cases were detected; 214 women (40%) had > or =1 STI. Young age and single marital status were both significantly associated with infection (P < 0.001). CONCLUSION: Chlamydial infection and trichomoniasis are hyperendemic among pregnant women in Vila. Young, single women are at greatest risk for infection.     

Sexual relationships, risk behaviour, and condom use in the spread of sexually transmitted infections to heterosexual men.

OBJECTIVE: To examine the effect of patient defined non-regular sexual relationships and other risk behaviours on the incidence of sexually transmitted infections in heterosexual men and the role of condom use in the prevention of their spread. DESIGN: A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis. SETTING: A genitourinary medicine clinic in west London. SUBJECTS: 957 consecutive newly attending heterosexual men who completed a sexual behaviour questionnaire in 1993/94. MAIN OUTCOME MEASURES: Variables relating to sociodemographic status, sexual behaviour, condom use, sexually transmitted infections and testing for HIV infection, stratified by the reporting of non-regular partners. RESULTS: We found that the 65% of men who reported non-regular sexual partners were more likely to be white collar class (d = 7.5%, 95% CI = 1.3, 13.7) and to have had sexual intercourse with non-United Kingdom born women (d = 7.8%, 95% CI = 3.5, 12.2). They also reported coitarche before 16 years of age (d = 13.4%, 95% CI = 8.0, 18.8) and many more sexual partners both in the last year (d = 13.1%, 95% CI = 10.2, 16.0) and in their lifetime (d = 27.9%, 95% CI = 21.6, 34.2). They were significantly more likely to practise anal intercourse (d = 8.7%, 95% CI = 3.3, 14.1), to smoke (d = 16.3%, 95% CI = 9.8, 22.6), to drink alcohol (d = 4.9%, 95% CI = 1.2, 8.6), and to have chlamydial infection (d = 5.7%, 95% CI = 2.2, 9.2), of which 30% was subclinical. Increasing condom use with regular partners correlated with decreasing incidence of urethral infection (gonorrhoeal and/or chlamydial infection) (p < 0.03) and candidal balanitis (p < 0.03) and a greater likelihood of no infection being detected (p = 0.0002). Use of condoms with non-regular partners was much more frequent than with regular partners (d = 21.4%, 95% CI = 16.7, 26.1). However, we found evidence of oral transmission of urethral gonorrhoea and chlamydial infection among men who reported always using condoms. HIV infection was found in only two men (0.2%), both of whom reported intercourse with non-United Kingdom born women. CONCLUSIONS: Heterosexual men who reported non-regular sexual relationships compensated for their increased risk lifestyle by using condoms more frequently and showed only an increased incidence of chlamydial infection. More consistent condom use with regular partners was significantly associated with the absence of sexually transmitted infection. These findings suggest that transmission between regular partners has been underestimated.     

Human immunodeficiency virus and female prostitutes, Sydney 1985.

One hundred and thirty two female prostitutes and 55 non-prostitutes who were tested for antibodies to human immunodeficiency virus (HIV) were surveyed by questionnaire at this centre. The two groups were well matched for age and were very similar in other except for numbers of their sexual partners. Questions were asked about drug taking, sexual practices, general health, and episodes of sexually transmitted diseases (STDs). None of the women in the survey was found to be seropositive, but both groups were found to be seriously at risk of HIV infection through using intravenous (IV) drugs, having unprotected sexual intercourse with men who used IV drugs, having unprotected sexual intercourse with bisexual men, or exposure to several STDs.     

Trends in gonorrhoea in nine western European countries, 1991-6. European Study Group

OBJECTIVE: To present, describe, and assess trends in gonorrhoea in western Europe between 1991 and 1996. METHODS: A European Union concerted action was initiated in 1990 to monitor the prevalence of HIV among patients with a sexually transmitted infection in sentinel networks in western Europe. Data from this concerted action were used to assess trends in gonorrhoea between 1991 and 1996. Where possible, the trends were validated by comparing them with national laboratory reports or data from more extensive sexually transmitted infection surveillance networks. RESULTS: 7192 episodes of gonorrhoea were recorded at 38 sentinel sites in nine countries between 1991 and 1996. In most networks, there was a decline in the number of cases of gonorrhoea among heterosexual men and women. The decline was most marked in the Scandinavian countries. Decreases were also observed among men having sex with men, but in some networks--England and Wales, Netherlands, and Scotland--an increase was observed in more recent years. This increase was mainly the result of an increase in cases among the older age group (25 years and above). The trends observed in six of the sentinel networks were confirmed by trends in national laboratory reports or data from more extensive sexual transmitted infection surveillance systems. CONCLUSIONS: These data indicate that, overall, there was a decline in the number of gonorrhoea cases in western Europe between 1991 and 1996. The results, however, also indicate that in more recent years there was an increase in the number of gonorrhoea cases among men having sex with men in some countries. Further investigations are necessary to determine if this observation is due to an increase in risky sexual behaviours in this population group.     

Coital bleeding and HIV risks among men and women in Cape Town, South Africa

BACKGROUND: South Africa has one of the world's fastest growing HIV epidemics. Genital bleeding during sexual intercourse may play a role in facilitating HIV transmission in South Africa. PURPOSE: The purpose of this study was to examine the prevalence and sources of coital bleeding among men and women living in a Cape Town South Africa township. METHODS: A purposive sample of 464 men and 531 women completed anonymous street intercept surveys of HIV risk history and sexual behaviors. RESULTS: Thirty-one percent of men and 26% of women had a lifetime history of engaging in sexual intercourse that involved genital bleeding, and 21% of men and 16% of women reported coital bleeding in the previous 3 months. Over 75% of coital bleeding was attributed to menses. Across genders and controlling for demographic, sexual behavior, and life history factors, coital bleeding in the previous 3 months was associated with being an indigenous African, having multiple sexual partners, and higher rates of unprotected intercourse during that time period. People who reported coital bleeding were over 3 times more likely to have been diagnosed with a sexually transmitted infection even after controlling for having had genital ulcers. CONCLUSIONS: Coital bleeding may be common in South Africa. Prevention messages that promote condom use or refraining from sex when there is genital bleeding are therefore needed.     

Prevalence of asymptomatic sexually transmitted infections among high-risk patients attending a free anonymous HIV-screening center

INTRODUCTION: The aim of this study was to assess the prevalence of sexually transmitted infections among patients attending an anonymous HIV Screening Center. PATIENTS AND METHODS: This prospective study was performed in the HIV Screening Center of University hospital in Reims (France) from May 1997 to December 1997. The inclusion criteria were the asymptomatic clinical presentation and the presence of risk factors for sexually transmitted infections referring to WHO criteria. The methods included clinical examination after application of acetic acid and urethral and endocervical swabs to identify:Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, Trichomonas vaginalis in specific culture. Treponema pallidum and HIV-1 infection were both detected by Enzym Linked Immuno Sorbent Assay (ELISA). RESULTS: One hundred and one patients (62 men and 39 women) were included in the study. Their mean age was 27 +/- 4 Years. Risk factors for sexually transmitted infections were: multiple sexual partners 81 p. 100; homo or bisexuality 16 p. 100; intravenous drug use 3 p. 100. The sexually transmitted infections were: HIV-1 infection 1 p. 100;Ureaplasma urealyticum 25 p. 100; genital warts 5 p. 100;Chlamydia trachomatis 3 p. 100; Gardnerella vaginalis 3 p. 100; Mycoplasma hominis 2 p. 100; Treponema pallidum 0 p. 100; Neisseria gonorrhoeae 0 p. 100; Trichomonas vaginalis 0 p. 100. The prevalence of sexually transmitted infections was significantly higher among women (p<0.05). DISCUSSION: Classical sexually transmitted infections and HIV infection were rarely detected in this study; but prevalence of other sexually transmitted infections (genital warts, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum) was high. Ureaplasma urealyticum is considered as a possible pathogenic agent in pregnant women (preterm delivery, decrease of birth weight, chorioamniotitis). These results suggest that other than sexually transmitted infections in high risk patients attending a HIV Screening Center other sexually transmitted infections should also be systematically screened for.     

Influence of age and geographical origin in the prevalence of high risk human papillomavirus in migrant female sex workers in Spain

OBJECTIVES: To estimate the prevalence and risk factors of high risk human papillomavirus (HPV) infection in migrant female sex workers (FSW) according to age and geographical origin. METHODS: Cross sectional study of migrant FSW attending a sexually transmitted infection (STI) clinic in Madrid during 2002. Information on sociodemographic characteristics, reproductive and sexual health, smoking, time in commercial sex work, history of STIs, HIV, hepatitis B, hepatitis C, syphilis, and genitourinary infections was collected. High risk HPV Infection was determined through the Digene HPV Test, Hybrid Capture II. Data were analysed through multiple logistic regression. RESULTS: 734 women were studied. Overall HPV prevalence was 39%; 61% in eastern Europeans, 42% in Ecuadorians, 39% in Colombians, 29% in sub-Saharan Africans, and 24% in Caribbeans (p = 0.057). HPV prevalence showed a decreasing trend by age; 49% under 20 years, 35% in 21-25 years,14% over 36 years% (p<0.005). In multivariate analyses, area of origin (p = 0.07), hormonal contraception in women not using condoms (OR 19.45 95% CI: 2.45 to 154.27), smoking, age, and an interaction between these last two variables (p = 0.039) had statistically significant associations with HPV prevalence. STI prevalence was 11% and was not related to age or geographical origin. CONCLUSIONS: High risk HPV prevalence in migrant FSW is elevated and related to age, area of origin, and use of oral contraceptives in women not using condoms. These data support the role of acquired immunity in the epidemiology of HPV infection and identifies migrant FSW as a priority group for sexual health promotion.     

The association between knowledge of HPV and feelings of stigma, shame and anxiety

OBJECTIVES: To test the hypotheses that (1) women who know that human papillomavirus (HPV) is sexually transmitted will expect to experience higher levels of stigma, shame and anxiety if they test positive for the virus than women who are not aware of the mode of transmission and (2) women who are aware of the high prevalence of HPV infection will expect to experience lower levels of stigma, shame and anxiety than women who underestimate its prevalence. METHODS: A web-based survey in which information about HPV was manipulated to generate a 2 x 2 design (awareness that HPV is sexually transmitted v no awareness; awareness of the high prevalence of HPV v no awareness). Participants (n = 811) were female students. They were asked to imagine that they had tested positive for HPV. Outcome measures were expected stigma, shame and anxiety. RESULTS: Great differences were observed in emotional reactions to imagining testing HPV positive between the four groups based on knowledge of HPV. Knowledge of the prevalence was associated with lower levels of stigma, shame and anxiety. Knowledge that HPV is sexually transmitted was associated with higher levels of stigma and shame, but not anxiety. Women who knew that HPV is sexually transmitted but not that it is highly prevalent had the highest scores for stigma and shame. CONCLUSIONS: Raising public awareness of the sexually transmitted nature of HPV has the potential to increase women's feelings of stigma and shame if they test positive for the virus. However, our findings suggest that ensuring women's awareness of HPV being common may reduce these feelings and also reduce anxiety, perhaps by "normalising" the infection.     

性病门诊无症状男性就诊者高危型人乳头瘤病毒检测结果分析

目的:探讨性病门诊男性无症状就诊者高危型人乳头瘤病毒感染的临床意义。方法:从807例性病门诊男性无症状就诊者不同身体部位收集样本,应用聚合酶链反应(PCR)检测高危型HPV(16,18)和低危型HPV(6,11)。结果:高危型HPV检测的阳性率为6.7%,男性龟头、包皮、尿道部位的HPV感染率差异无统计学意义(P>0.05),41-50年龄组的HPV感染率最高。结论:高危型HPV男性患者要定期进行生殖道的检查,预防生殖器肿瘤的发生。     

Human papillomavirus infection in men who have sex with men participating in a Dutch gay-cohort study

BACKGROUND: To develop strategies for prevention and early treatment of human papillomavirus (HPV) anal and penile cancer, a better understanding of related sexual behavior risk factors is needed. GOAL: The goal of this study was to establish the prevalence of anal and coronal sulcus HPV in a group of men who have sex with men participating in a Dutch gay-cohort study, to identify risk factors associated with HPV infection in this group, and to investigate the presence of identical HPV types in couples with stable relationships. STUDY DESIGN: A cross-sectional study of 241 HIV-negative and 17 HIV-positive men who have sex with men visiting the sexually transmitted disease clinic of the Erasmus MC for a regular and scheduled examination. Participants underwent a routine venereological examination including HIV serologic analysis, and swabs were taken from the coronal sulcus and anus for HPV DNA testing. All subjects were asked to complete a questionnaire on sexual risk behavior. RESULTS: HPV DNA was detected at the coronal sulcus in 23.5% of the HIV-positive men and in 15.8% of the HIV-negative men (P=0.492). In anal specimens, HPV DNA was detected in 64.7% of the HIV-positive men and 32.8% of the HIV-negative men (P=0.015). High-risk HPV types (P=0.007) and 2 or more different HPV genotypes (P=0.006) were seen more often in anal specimens of HIV-positive persons than in specimens of HIV-negative persons. A factor possibly associated with the presence of anal HPV infection was a concomitant anal infection with Chlamydia trachomatis, gonococci, or herpes simplex virus (P=0.059). In only 16.7% of HPV-positive steady couples, both companions showed the presence of one or more identical HPV genotypes. CONCLUSION: In this study, anal HPV DNA was detected more often than HPV DNA at the coronal sulcus. HIV positivity was associated with a higher prevalence of high-risk, but not with low-risk HPV types, at the anus. No association was found between HIV positivity and presence of high-risk HPV at the coronal sulcus. No sexual behavioral determinants for the presence of HPV could be identified. Concomitant anal infection with C trachomatis, gonococci, or herpes simplex virus may be associated with HPV infection. In the majority of steady couples, partners were infected with different HPV types.     

Hepatitis C virus infection in a male homosexual cohort: risk factor analysis.

BACKGROUND: Hepatitis C virus (HCV) infection is a major cause of morbidity throughout the world. Parenteral exposure to infected blood accounts for the majority of cases. Sexual transmission is suggested by the higher prevalence of infection in sex workers and homosexual men. Sexual practices which contribute to HCV infection need to be identified. METHODS: The social and medical history, and HCV serostatus of 1058 homosexual men in the Pittsburgh arm of the Multicenter AIDS Cohort Study were analysed. Multivariate analysis was used to determine risk factors for HCV seropositivity. RESULTS: 31 men were HCV seropositive by enzyme immunoassay and recombinant immunoblot assay (2.9%). They were more likely to be HIV seropositive (39%) than the HCV seronegative men (19%). Needle sharing and illegal drug use were the most important risk factors for HCV seropositivity. Statistically significant sexual factors (p < 0.05) included a history of syphilis, rectal gonorrhea, anal insertive intercourse with ejaculation, and douche or enema use before anal receptive intercourse. The number of sexual partners was not a significant risk factor. CONCLUSIONS: HCV infection is associated with specific sexually transmitted diseases (STDs) and sexual practices in the male homosexual population. The evidence of high risk behavior should be incorporated into ongoing educational efforts to decrease the incidence of STDs.     

Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians

BACKGROUND AND OBJECTIVES: Sexual transmission of bacterial and viral sexually transmitted disease has been reported between women. No data are available on seroprevalence of herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2) among lesbians. GOAL: The goal was to define prevalence of infection with HSV-1 and HSV-2 among lesbians, and associated risk factors. STUDY DESIGN: Women who reported sex with another woman in the preceding year were eligible. Medical and sexual histories were obtained. Serum was tested for HSV-1 and HSV-2 antibodies using Western Blot assay. RESULTS: Among 392 subjects, antibodies to HSV-1 were detected in 46% and to HSV-2 in 8%. Increasing age predicted higher seroprevalence to both HSV types, and HSV-2 seropositivity was associated with a history of male partner with genital herpes. Of 78 women reporting no prior sex with men, 3% were HSV-2-seropositive. Most HSV-2-seropositive subjects (71%) reported no history of genital herpes. HSV-1 seroprevalence increased significantly with an increasing number of female sex partners. CONCLUSIONS: HSV-2 infection occurs in nearly 1 in 10 lesbians and is not predicted by report of sex with men or sexual identity. Most lesbians infected with HSV-2 are not aware of their infection. Sexual transmission of HSV-1 may occur more frequently among lesbians than among heterosexual women.     

Adolescents, sexual behaviour and implications for an epidemic of HIV/AIDS among the young.

OBJECTIVE--To determine the patterns of sexual behaviour, condom use and sexually transmitted diseases among young New Zealanders, and the characteristics of those with many sexual partners. SUBJECTS--A cohort of young people enrolled in a longitudinal cohort study, and followed up since age three. METHODS--Subjects were interviewed at age 18 years as part of a multidisciplinary health and development study. Questions about sexual behaviour were presented by computer. RESULTS--Overall 862/1027 (83.9%) surviving in the cohort was interviewed. Only 1.4% declined to answer the section on sexual behaviour. Sexual intercourse in the previous 12 months was reported by 57.6% of the young men and 67.9% of the young women. Amongst those who were sexually active more of the young men reported multiple partners than the young women (59.8% v 46.5% p < 0.001). There was a trend for increasing number of partners with indices of lower school achievement but no significant association with socio-economic status. Condom use decreased with increasing number of partners for the young women, and for the young men there was no association. Sexually transmitted diseases were reported more commonly with increasing number of sexual partners for both men and women. The rates of sexual activity were substantially higher than reported in a comparable survey 20 years ago. CONCLUSIONS--The pattern of sexual behaviour and condom use, and the occurrence of sexually transmitted diseases in this sample give cause for concern about the spread of sexually transmitted diseases including the possibility of an epidemic of HIV among heterosexual young people in New Zealand. The findings should help in targeting health promotional activities within this age group.     

Seropositivity to multiple sexually transmitted infections is not common

BACKGROUND: Seropositivity for several sexually transmitted infections (STIs) is often used as a surrogate measure of sexual behavior. The authors assessed the concomitant seropositivity for STIs in women. GOAL: To estimate the excess of concomitant seropositivity for four STIs among fertile-aged women assuming no coinfections above what would be expected at random. STUDY DESIGN: Antibodies to herpes simplex virus type 2, human papillomavirus type 16, HIV, Chlamydia trachomatis, and Treponema pallidum were determined from a random sample of 1110 pregnant women in Tallinn, Estonia. RESULTS: A total of 310 combinations of the concomitant seropositivity were observed, whereas only 193 were expected by chance. Among persons seropositive for two STIs, 78 extra combinations were observed, whereas for three STIs, 35 extra combinations were observed. For four STIs, 3.8 extra combinations were found. CONCLUSIONS: Seropositivity to multiple STIs is not common. This fits the concept of different transmission probabilities and the spread of the STIs, and suggests that seropositivity alone should be used with caution as a surrogate to sexual behavior in women.