The prevalence of diagnosed cutaneous manifestations during ambulatory diabetes visits in the United States, 1998-2002

BACKGROUND: The prevalence of diabetes has been rapidly increasing. Previous reports indicated that diabetics are prone to certain cutaneous diseases. OBJECTIVE: To determine the frequencies of diagnosed skin conditions during ambulatory diabetes visits in the USA. METHODS: We evaluated two national ambulatory medical care surveys between 1998 and 2002 and compared the diagnoses of 7 categories of skin conditions in diabetics (n = 9,626) to patients with hypertension (n = 15,997) or gastroesophageal reflux disease (GERD; n = 2,362) using chi2 tests and multivariate logistic regressions. RESULTS: Diabetics were prone to chronic skin ulcers (odds ratio = 62.5, 95% confidence interval = 3.95-989 compared to GERD; 9.97, 6.34-15.7 compared to hypertension), bacterial skin infections (5.95, 2.86-12.4 compared to GERD; 5.15, 3.74-7.08 compared to hypertension) and fungal skin infections (2.66, 1.15-6.16 compared to GERD; 1.99, 1.32-3.01 compared to hypertension) but not to other skin conditions. These findings remained true during primary care physician visits. CONCLUSION: Chronic skin ulcers, bacterial and fungal skin infections are more frequently diagnosed in diabetics. We could not verify that other skin conditions are associated with diabetes, in part due to potential underdiagnosis and underreporting.     

Trends in molluscum contagiosum in the United States, 1966-1983

We analyzed data on molluscum contagiosum infection in the United States from two sources: the National Disease and Therapeutic Index Survey of private patients, collected during 1966-1983; and two sexually transmitted disease clinics, collected during 1977-1981. Patient visits to private physicians for molluscum contagiosum increased 11-fold from 1966 to 1983. Over the same time span, the proportion of private patient visits also increased: from 1.2 to 11.0 per 100,000 total clinic visits. Clinic patients, however, showed stable trends in proportions of individuals infected over the period 1977-1981. Clinic patients 15-24 years old and private patients aged 20-29 years were more likely to present with molluscum contagiosum than patients in other age categories. Like the prevalence of other viral sexually transmitted diseases in the private medical community, that of molluscum contagiosum infections appears to have increased dramatically over the 18-year span covered by this study.     

Antichlamydial antibodies in pelvic inflammatory disease

The role of Chlamydia trachomatis in pelvic inflammatory disease (PID) diagnosed without laparoscopy was assessed by measuring antichlamydial antibodies in the patient's serum and by comparing the results with those in patients with uncomplicated non-specific genital infection (NSGI) and gonorrhoea and in non-infected controls. A modified microimmunofluorescence test was used. Patients with severe PID had significantly more positive antichlamydial IgG and IgM results than did control subjects, patients with gonorrhoea, and patients with NSGI. Less severe PID was associated with significantly raised levels of antichlamydial IgG antibodies compared with NSGI and controls and with raised levels of IgM antibodies compared with controls. Two patients with PID had lower genital tract gonorrhoea, one of whom had raised antichlamydial antibody levels. These findings may indicate a mixed infection and therapy should be reviewed in such patients. A serological diagnosis of chlamydial infection is relatively easy and cheap and enables a rapid diagnosis of chlamydial infection to be made.     

Antichlamydial antibodies in pelvic inflammatory disease.

The role of Chlamydia trachomatis in pelvic inflammatory disease (PID) diagnosed without laparoscopy was assessed by measuring antichlamydial antibodies in the patient's serum and by comparing the results with those in patients with uncomplicated non-specific genital infection (NSGI) and gonorrhoea and in non-infected controls. A modified microimmunofluorescence test was used. Patients with severe PID had significantly more positive antichlamydial IgG and IgM results than did control subjects, patients with gonorrhoea, and patients with NSGI. Less severe PID was associated with significantly raised levels of antichlamydial IgG antibodies compared with NSGI and controls and with raised levels of IgM antibodies compared with controls. Two patients with PID had lower genital tract gonorrhoea, one of whom had raised antichlamydial antibody levels. These findings may indicate a mixed infection and therapy should be reviewed in such patients. A serological diagnosis of chlamydial infection is relatively easy and cheap and enables a rapid diagnosis of chlamydial infection to be made.     

Human immunodeficiency virus (HIV) seroprevalence in persons attending STD clinics in the United States, 1985-1987

We reviewed published and unpublished studies on seroprevalence of HIV antibody in persons attending sexually transmitted disease (STD) clinics in the United States from 1985 through 1987. We identified 23 studies from 16 states; nine studies determined risk factors for HIV. Overall, 899 (4.2%) of the 21,352 clinic attendees were seropositive; the seroprevalence rate was higher for men (5.9%) than for women (1.7%). Clinic seroprevalence ranged from 0.5% to 15.2% (median, 3.5%), reflecting in part the proportion of all attendees who were homosexual or bisexual, intravenous-drug users (IVDUs), or heterosexual partners of bisexual men or IVDUs (median proportion, 21.8% for the nine sites with this information). Most HIV-seropositive persons were at recognized risk (median for the same nine studies, 85.3%). Homosexual/bisexual men had the highest seroprevalence (median, 32.2%), followed by heterosexual IVDUs (median, 3.6%). Heterosexuals who denied intravenous-drug use had a median rate of 0.9%, which strongly correlated with rates in IVDUs in the same clinics (r = 0.88). We conclude many STD clinic attendees are infected with HIV. Because AIDS is an STD and seroprevalence has been associated with other STDs, STD clinics are important sites for HIV surveillance and risk-reduction education.     

Associations between Mycoplasma genitalium,Chlamydia trachomatis,and pelvic inflammatory disease

OBJECTIVE: To evaluate the association between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease (PID) METHODS: A case-control methodology was used. Swab eluates were processed using the QIAamp DNA mini kit. Polymerase chain reaction (PCR) for M. genitalium was carried out using a real time in-house 16S based assay. An endocervical swab was taken and tested for the presence of C. trachomatis (ligase chain reaction, Abbott Laboratories), and a high vaginal swab was taken and tested for the presence of Neisseria gonorrhoeae and bacterial vaginosis. RESULTS: Of the PID cases 13% (6/45) had evidence of M. genitalium infection compared to none of the controls (0/37); 27% (12/45) of the cases had C. trachomatis infection compared to none of the controls; and 16% (7/45) of cases only had serological evidence of C. trachomatis infection compared to 5% (2/37) of controls. Cases were more likely to present with M. genitalium and/or C trachomatis than controls (p<0.001). CONCLUSIONS: This study indicates that there may be an association between M. genitalium and PID, and that this relation is largely independent of C. trachomatis. Future studies need to investigate the pathological basis of the relation between M. genitalium and PID using samples from women with PID diagnosed using laparoscopy and endometrial biopsy. Little is known about the epidemiology of M. genitalium: large scale epidemiological investigations are needed to determine the prevalence, incidence, and factors associated with this emerging infection.     

Comparison of acute and subclinical pelvic inflammatory disease

OBJECTIVE: The objective of this study was to compare the demographic, clinical, and microbiologic findings in women with subclinical pelvic inflammatory disease (PID) and women with acute PID. STUDY: A cross-sectional study was performed using cohorts from 2 separate studies of 1293 women at risk for PID. Most participants were recruited from emergency departments, sexually transmitted disease clinics, and family planning clinics in metropolitan centers. We compared demographic, clinical, and microbiologic findings among women with acute PID, women with subclinical PID, and women without endometritis (controls). Statistical analyses included chi-square for categorical variables, calculation of odds ratio and 95% confidence intervals, and polychotomous logistic regression when appropriate. RESULTS: Similar proportions of women with acute and subclinical PID tested positive for cervical Chlamydia trachomatis (odds ratio [OR], 1.1; 95% confidence interval, 0.6-2.0) and had bacterial vaginosis (OR, 0.7; 95% CI, 0.2-1.8). The rate of cervical Neisseria gonorrhoeae infection in women with subclinical PID was intermediate between the rates in women with acute PID and controls (21% vs. 49% vs. 7%, respectively, P <0.001, test for trend). Endometrial recovery of N. gonorrhoeae and C. trachomatis in women with subclinical PID was also seen at intermediate levels. Similar distributions of teenagers, women who smoked or used illicit drugs, and women engaging in sexual intercourse during menses were found in each group. Proportions of women with subclinical PID who were black and with lower education levels were intermediate between the proportions of these characteristics in women with acute PID and controls. CONCLUSION: Demographic and microbiologic characteristics of women with subclinical and acute PID are comparable. These findings suggest that the pathophysiological mechanisms of acute and subclinical PID are similar.     

The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health

OBJECTIVES: Bacterial vaginosis (BV), a disturbance of vaginal microflora, is a common cause of vaginal symptoms and is associated with an increased risk of acquisition of sexually transmitted infections, HIV, and with adverse pregnancy outcomes. We determined prevalence and associations with BV among a representative sample of women of reproductive age in the United States. STUDY DESIGN: Women aged 14-49 years participating in the National Health and Nutrition Examination Survey 2001-2004 were asked to submit a self-collected vaginal swab for Gram staining. BV, determined using Nugent's score, was defined as a score of 7-10. RESULTS: The prevalence of BV was 29.2% (95% confidence interval 27.2%-31.3%) corresponding to 21 million women with BV; only 15.7% of the women with BV reported vaginal symptoms. Prevalence was 51.4% among non-Hispanic blacks, 31.9% among Mexican Americans, and 23.2% among non-Hispanic whites (P <0.01 for each comparison). Although BV was also associated with poverty (P <0.01), smoking (P <0.05), increasing body mass index (chi2 P <0.0001 for trend), and having had a female sex partner (P <0.005), in the multivariate model, BV only remained positively associated with race/ethnicity, increasing lifetime sex partners (chi2 P <0.001 for trend), increasing douching frequency (chi2 P for trend <0.001), low educational attainment (P <0.01), and inversely associated with current use of oral contraceptive pills (P <0.005). CONCLUSION: BV is a common condition; 84% of women with BV did not report symptoms. Because BV increases the risk of acquiring sexually transmitted infections, BV could contribute to racial disparities in these infections.     

Prevalence and incidence of pelvic inflammatory disease in incarcerated adolescents

BACKGROUND: Few recent studies have determined the prevalence and incidence of pelvic inflammatory disease (PID) among adolescents. GOAL: The goal of this study was to determine these parameters among incarcerated youths. STUDY DESIGN: Both on admission and during incarceration, consecutive adolescents entering the Harris County, Texas, Juvenile Detention Center were evaluated for symptoms of PID. One of two experienced clinicians examined adolescents with possible PID. For the diagnosis of PID, we used the minimal criteria of the CDC. RESULTS: In sexually active heterosexual or bisexual adolescents (N = 313), the prevalence of PID at admission was 4.5%; during the first 31 days of incarceration, the incidence density of PID was 3.3 cases/100 person-months, and the cumulative incidence was 2.2%. The prevalence among these youths of chlamydial and/or gonorrheal infection, as determined by urine or cervical testing, was 24.9%. CONCLUSION: The high prevalence and incidence of PID underscore the need for effective programs to eradicate chlamydial and gonorrheal infections in high-risk youths.     

Risk factors for pelvic inflammatory disease in inner-city adolescents

OBJECTIVE: To determine risk factors associated with pelvic inflammatory disease (PID) among inner-city adolescents. STUDY DESIGN: A case-control study was performed from 1994 to 1997 in an inner-city hospital. METHODS: Seventy-one adolescent girls diagnosed with PID and 52 sexually active adolescents girls without PID participated in a confidential face-to-face interview using a questionnaire about risk behaviors. Established criteria were used for the diagnosis of PID. Data were analyzed using t tests, chi-square tests, and stepwise logistic regression. RESULTS: Persons with PID were significantly more likely to show younger age at first intercourse, older sex partners, involvement with a child protection agency, prior suicide attempt(s), consumption of alcohol before last sex, and a current Chlamydia trachomatis infection. There were no significant differences between the two groups regarding number of lifetime sex partners, condom use, rape, syphilis, prior PID, hepatitis B, hepatitis C, or HIV infection. CONCLUSIONS: Not previously noted in the literature are the association of PID with older sex partners, prior involvement in a child protection agency, and a prior suicide attempt. Confirming prior studies are the association of PID with earlier age at first sex, alcohol use, and C trachomatis infection.     

Enhanced erythrocyte aggregation in clinically diagnosed pelvic inflammatory disease

OBJECTIVE: Enhanced erythrocyte aggregation, revealed using a simple bedside test, has been found recently in several inflammatory conditions. The diagnosis of pelvic inflammatory disease (PID) is at times difficult because of the vague symptoms and signs, but is crucial because even mild PID can have future reproductive consequences. Our objective was to determine the degree of erythrocyte aggregation in PID. The demonstration of an increase in aggregation could be of additive value in cases in which the diagnosis is difficult. STUDY DESIGN: A prospective case-control study was conducted. Fifteen consecutive women diagnosed clinically as having PID based on Centers for Disease Control and Prevention criteria, and 15 matched controls were enrolled. Blood samples were drawn for hematologic indices, C-reactive protein, fibrinogen levels, and red cell aggregation. We studied the degree of red cell aggregation using a simple slide test and image analysis. The variable measured was the erythrocyte percent (EP), equivalent to the slide area covered by erythrocytes. RESULTS: Erythrocyte percent was 59.6 +/- 4.2 and 80.0 +/- 3.6 for the study group and controls, respectively (P <0.001). A significant difference was noted also for the other hematologic and biochemical markers of inflammation between patients and the controls. CONCLUSIONS: We conclude that the degree of erythrocyte aggregation is increased in PID. Its simplicity, rapidity, and low cost should be further evaluated as a diagnostic tool in the context of this frequent disease.     

Trends in nonmelanoma skin cancer mortality rates in the United States, 1969 through 2000

The purpose of this population-based study was to assess trends in mortality rates for nonmelanoma skin cancer (NMSC) in the United States. Particular emphasis was placed on the subgroup of malignancies arising on genital skin. Nearly 75,000 deaths in the United States were attributed to NMSC from 1969 to 2000. The age-adjusted US mortality rate for NMSC arising on nongenital skin from 1969 to 2000 was 0.69/10(5)/year; the rate among men was twice that among women. Mortality rates among white men exceeded that of black men by a factor of two; the same was observed among women, but by a smaller multiple. Corresponding mortality rates for malignancies arising from genital skin (penis, scrotum, vulva) were higher in women (0.54) than in men (0.30). In contrast to nongenital NMSC, mortality rates among black men were twice that of white men; however, rates for white and black women were similar. These results suggest that greater emphasis could be placed on reducing mortality from genital NMSC while continuing to stress reduction of excess sun exposure.