Characterization of sexually transmitted disease clinic patients with recent human immunodeficiency virus infection

The serologic testing algorithm for recent human immunodeficiency virus (HIV) seroconversion (STARHS) distinguishes between recent acquisition of HIV infection (seroconversion, on average, in the past 129 days) or long-standing infection. STARHS was offered to sexually transmitted disease clinic patients to estimate HIV incidence and determine correlates of recent infection from October 1998 through December 1999. Of the 5227 patients tested, 116 (2.1%) were HIV infected, and 28 had recent infections. The incidence was highest among homosexual men (5.3%/year; 95% confidence interval [CI], 2.6%-10.0%), those who had HIV-infected partners (8.6%/year; 95% CI, 2.9%-21.1%), and those who had gonorrhea (6.7%/year; 95% CI, 1.5%-20.3%). Among homosexual men, African American (odds ratio [OR], 3.61; 95% CI, 1.13-11.55) or Latino (OR, 3.08; 95% CI, 1.11-8.55) race/ethnicity, and having unprotected anal intercourse (OR, 2.98; 95% CL, 1.20-7.45) or gonorrhea (OR, 3.03 95% CI, 1.07-8.63) predicted the predominance of a recent seroconversion. HIV infections in San Francisco may be shifting from white men who have sex with men to men of color who have sex with men.     

Human immunodeficiency virus type 1 infection in women attending a sexually transmitted diseases clinic in Kenya.

A cross-sectional study was conducted among women attending a sexually transmitted diseases clinic in Nairobi, kenya, to determine the prevalence of and associated risk factors for human immunodeficiency virus (HIV) type 1 infection. HIV-1 antibody was detected in 13.8% of 600 women. This virus was found most frequently in prostitutes (odds ratio [OR], 7.2), in women reporting a history of genital ulcers (OR, 2.3), and in those with a current diagnosis of genital ulcers (OR, 5.1). Lifetime duration of oral contraceptive use was significantly greater in HIV-1-positive women. Multivariate analysis revealed an association between genital ulcers and HIV-1 infection (OR, 3.8). The strongest association for HIV-1 infection, however, occurred with genital ulcers in combination with the use of oral contraceptives (OR, 25.7).     

Human papillomavirus infection in men attending a sexually transmitted disease clinic

Human papillomavirus (HPV) is the main etiologic agent of anogenital cancers, including cervical cancer, but little is known about the type-specific prevalence of HPV in men. Participants were men aged 18-70 years attending a sexually transmitted disease clinic. Penile skin swabs were assessed for HPV DNA using polymerase chain reaction with reverse line-blot genotyping. Of 436 swabs collected, 90.1% yielded sufficient DNA for HPV analysis. Men with inadequate swab samples were significantly more likely to be white and circumcised than men with adequate swab samples. The prevalence of HPV was 28.2%. Oncogenic HPV types were found in 12.0% of participants, nononcogenic types were found in 14.8% of participants, multiple types were found in 6.1% of participants, and unknown types were found in 5.9% of participants. The most prevalent subtypes were nononcogenic 6, 53, and 84. HPV positivity was not associated with age. These results indicate that HPV infection among men at high risk is common but that characteristics of male HPV infection may differ from those of female infection.     

Correlates of human immunodeficiency virus infection risk behavior in male attendees of a clinic for sexually transmitted disease.

Human immunodeficiency virus (HIV) infection risk behavior was evaluated in a cross-sectional survey of 400 male active-duty US Army personnel who presented at a sexually transmitted disease (STD) clinic with symptoms of acute urethritis. High-risk partners were common, and nearly one-quarter of the sample had previously had STDs. Logistic regression models examined correlates of HIV exposure risk, of inconsistent condom use, and of having partners with increased risk of HIV infection. Frequent partner turnover, sex "binging," negative attitudes toward condom use, and engaging in sex during military leaves were important correlates of risk. Individuals with HIV infection risk behavior generally were cognizant of their risk for HIV infection. Implications for intervention are discussed.     

Cytomegalovirus infection in women attending a sexually transmitted disease clinic

To evaluate prospectively the relationship between current and past sexual practices and seroprevalence of cytomegalovirus (CMV) in adult women, 1481 women (1101 white, 301 black, 79 other) attending a sexually transmitted disease clinic underwent a standardized interview and genital examination. CMV seroprevalence was higher in black (78%) than in white (59%) women. In logistic regression models that adjusted for age and years of education, CMV seropositivity in white women was associated with younger sexual debut (P = .001), more lifetime sex partners (P = .025), recent new partner(s) (P = .003), and parity (P = .002), and was inversely associated with use of barrier contraception (P = .006). In black women, after adjustment for demographic characteristics, CMV antibody was associated with greater numbers of recent sex partners (P = .007), new sex partners (P = .04), and with cervical infection with Chlamydia trachomatis (P = .05). This study confirms that sexual activity is an important determinant of CMV infection in both white and black women; however, the relative contributions of sexual and nonsexual transmission of CMV apparently vary and require further investigation.     

Alcohol screening in young persons attending a sexually transmitted disease clinic

OBJECTIVE: To compare the ability of 3 brief alcohol screens (Alcohol Use Disorders Identification Test [AUDIT], CRAFFT, and CAGE) to identify adolescents and young adults with a current alcohol use disorder (AUD) and to determine whether there are gender-based or race-based differences in screening performance. DESIGN, PARTICIPANTS, AND SETTING: Cross-sectional study of 358 young persons (55% males; 49% blacks; age range, 15-24 years; mean age, 20.6 years) who were attending an urban clinic for sexually transmitted diseases and reported alcohol use during the past year. MEASUREMENTS: Receiver operating characteristic (ROC) curve analysis was used to determine the ability of the 3 screens to discriminate between participants with and without AUDs detected in the Structured Clinical Interview for DSM-IV (SCID). RESULTS: One third (33%) of participants met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for a current AUD (24% with alcohol abuse and 9% with alcohol dependence). The AUDIT performed best at a cut score of 9 (sensitivity, 0.76; specificity, 0.79), CRAFFT at a cut score of 2 (sensitivity, 0.94; specificity, 0.33), and CAGE at a cut score of 1 (sensitivity, 0.69; specificity, 0.63). The AUDIT had the best overall performance (area under the curve [AUC], 0.84), followed closely by CRAFFT (AUC, 0.79) and then CAGE (AUC, 0.70). Performance of screens did not differ by gender. The AUDIT performed slightly better in whites than blacks, but no race-based differences were observed for the CAGE or CRAFFT. CONCLUSIONS: Clinicians should use the AUDIT or CRAFFT, rather than the CAGE, to screen young persons for AUDs. The AUDIT performs best, but its length may limit its utility in this setting. The CRAFFT is a suitable alternative, with excellent sensitivity and no gender-based or race-based differences.     

The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic

BACKGROUND: The spectrum of genital herpes (GH) has been understudied in men, especially African American men. METHODS: Consecutive men attending a sexually transmitted diseases clinic were enrolled in a study of GH epidemiology. Consenting participants answered questionnaires detailing their sexual and social activities and underwent serological testing for herpes simplex virus types 1 and 2 (HSV-1 and -2) and collection of genital swabs for viral detection. RESULTS: Of the 516 men enrolled, 465 (90%) were African American. Antibodies to HSV-1 were present in 315 (61%) of participants, and 233 (45%) had antibodies to HSV-2. Factors associated with HSV-2 infection included older age and African American race. HSV was detected in genital swabs from 52 men; 43 (82.7%) swabs were HSV-2 positive, and 9 (17.3%) were HSV-1 positive. The overall viral shedding rate among men (n = 247) with evidence of GH (HSV-1 or HSV-2 infection) was 21.1%, and the asymptomatic shedding rate in this same group was 5.2%. The sensitivities of culture for detection of HSV-1 and HSV-2 were .22 and .58, respectively, compared with that of polymerase chain reaction. CONCLUSIONS: Genital HSV infections are common and largely unrecognized among this segment of the population. HSV-1 infection constitutes a nontrivial proportion of GH in these men.     

性病门诊单纯疱疹病毒2型特异性抗体血清学调查

目的了解性病门诊患者单纯疱疹病毒2型(herpes simplex virus type 2,HSV-2)感染情况。方法用ELISA法检测我院性病门诊1215例患者HSV-2型特异性抗体,并对不同性别和不同年龄组的HSV-2 Ig g G抗体阳性情况进行对比研究。结果 1215例患者中,HSV-2 Ig g G抗体阳性者共291例,阳性率为23.95%,男性阳性率为21.34%(197/923),女性阳性率为32.19%(94/292),女性阳性率高于男性,二者比较差异有统计学意义(P0.05)。年龄以31~40岁最多,为119例(男性81例,女性38例);其次为21~30岁,为85例(男性54例,女性31例)。结论 HSV-2型特异性抗体检测率存在男女差异,女性高于男性。生殖器疱疹易发于21~40岁性活跃人群。HSV-2型特异性抗体血清学检测具有快速、简便、灵敏度高等优点,适用于临床检测。     

Asymptomatic urethral infection in male sexually transmitted disease clinic attendees

The purpose of this study is to determine the prevalence of asymptomatic male patients with urethral infections attending a government sexually transmitted infection clinic in Hong Kong and their microbiological profile. A total of 274 consecutive male patients without any symptoms for urethral infections were recruited. A questionnaire was used to record the symptoms, sexual history and demographics. Further assessment, including urethral smear for Gram stain, gonococcal culture and polymerase chain reaction (PCR) for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) were performed. In 274 asymptomatic patients, 36 patients had non-gonococcal urethritis (NGU) and two patients had positive gonococcal culture. Among the asymptomatic patients with NGU, there were 6 (16.6%), 10 (22.8%) and five (13.9%) patients with positive PCR for CT, UU and MG, respectively. In addition, there were 14 asymptomatic patients with positive PCR for CT but without evidence of NGU. In conclusion, urethral infections were identified in a significant number of asymptomatic male patients and therefore, routine screening for this group is warranted.     

Acyclovir-resistant genital herpes among persons attending sexually transmitted disease and human immunodeficiency virus clinics

BACKGROUND: Genital herpes is epidemic in the United States; long-term acyclovir therapy is common; and long-term use of antimicrobials in suppressive doses favors development of resistance. OBJECTIVE: To determine the prevalence of and risk factors for acyclovir-resistant genital herpes. METHODS: We identified and attempted to enroll all patients 18 years or older with suspected genital herpes who attended 22 sexually transmitted disease and human immunodeficiency virus (HIV) clinics in the United States between October 1996 and April 1998. We conducted standardized interviews of all consenting patients. Lesions were cultured, and isolates were typed as herpes simplex virus (HSV) 1 or HSV-2 and tested for acyclovir sensitivity (using a 50% inhibitory concentration of 2 microg/mL) by plaque reduction, which was independently confirmed. RESULTS: Herpes simplex virus was isolated from 2088 of 3602 patients, and 90.2% of isolates were HSV-2. Fifteen isolates, all HSV-2, were acyclovir resistant. Three (0.18%) of 1644 HIV-negative patients had acyclovir-resistant isolates (95% confidence interval [CI], 0.04%-0.5%); resistance was associated with oral (P<.006) and topical (P<.001) acyclovir use. Twelve (5.3%) of 226 HIV-positive patients yielded resistant HSV isolates (95% CI, 2.8%-9.1%); resistance was associated with oral acyclovir use (P<.001), duration of the current episode (P<.001), history of recurrent genital herpes (P<.01), and low CD4 cell count (P<.05). CONCLUSIONS: In the 15 years following licensure of acyclovir, resistance to the drug remains low among immunocompetent patients. However, 5% of HIV-positive patients had resistant HSV-2 isolates. Continued surveillance is essential to monitor changes in acyclovir resistance and to characterize the clinical and public health importance of acyclovir-resistant HSV.     

The epidemiology of cytomegaloviral infection in women attending a sexually transmitted disease clinic

To test the hypothesis that cytomegalovirus (CMV) is sexually transmitted, we examined the association of CMV infection with indices of sexual activity in 347 women attending a sexually transmitted disease (STD) clinic. Stepwise multivariate logistic regression analysis showed that seropositivity to CMV (complement-fixation antibody titer, greater than or equal to 1:8) was most closely associated with number of sex partners in the subjects' lifetime (P less than .0001), young age at first sexual intercourse (P = .0002), and nonwhite race (P = .0007). Among seropositive women, cervical shedding of CMV was most strongly associated with younger age (P = .0001) and the presence of cervical chlamydial infection (P = .016). Among 84 seronegative women followed up for a mean of 18.4 weeks, 11 (13%) developed primary CMV infections, an annual incidence of 37%. Sexual contact seems to be an important mode of acquisition of CMV in some young women.     

Prevalence of human papillomavirus infection in women attending a sexually transmitted disease clinic

The purpose of this study was to determine the prevalence of infection due to human papillomavirus (HPV) types of high and intermediate oncogenic risk, which was most frequently associated with uterine cervical neoplasia. The subjects were 236 prostitutes who visited a sexually transmitted diseases (STD) clinic in a metropolitan area in 1998. Another 95 women who visited a university hospital were selected as a normal control group. A swab sample collected from the uterine cervix and external os was subjected to hybrid capture assays for low-oncogenic-risk HPV types (HPV A; including types 6, 11, 42, 43 and 44) and high- and intermediate-oncogenic-risk HPV types (HPV B; including 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68). Chlamydia trachomatis and Neisseria gonorrhoeae. Fisher's exact test was used for statistical analyses. Among the microorganisms tested, the positive rate for HPV B was the highest both in the women attending the STD clinic (STD group) and in the control group. The positive rate for HPV B in the STD group was 47.5% (112 of 236), and this was significantly higher than the 5.3% (5 of 95) in the control group (p < 0.0001). These findings suggest that HPV examination is recommended for women who visit an STD clinic to assess the future risk of cervical neoplasia.     

Two cases of Klinefelter's syndrome diagnosed at a sexually transmitted infection clinic

Klinefelter's syndrome is an important genetic cause of infertility in males. Two cases are described, which were picked up at the sexually transmitted infection (STI) clinic because of the finding of unusually small testes. Physicians at STI clinics are uniquely placed to detect this condition as they examine the genitalia of thousands of healthy young men each year as part of a sexual health check up. Benefit of early diagnosis and treatment includes improved quality of life and avoidance of serious complications.     

Reducing risk of sexually transmitted disease (STD) and human immunodeficiency virus infection in a military STD clinic: evaluation of a randomized preventive intervention trial.

Three single-session preventive interventions for reducing sexually transmitted disease (STD) and human immunodeficiency virus infection risk behaviors were evaluated with a sample of 400 men who attended a large military STD clinic. A quasi-experimental, pre-evaluation/postevaluation design was used, comparing standard clinic care alone versus standard care combined with 1 of 3 experimental interventions: health-risk appraisal, interactive video, and targeted situational behaviors. Questionnaire data were collected at baseline and during follow-up visits at 2 weeks and 2 months. Findings indicated that the health-risk appraisal and interactive video increased adherence with clinic recommendations to abstain from sex (chi(2)3199=19.67; P<.001) and increased readiness to change "risky" partner-selection behavior (chi(2)2194=6.42; P<.04). Follow-up data suggested that STD-related risk behavior was particularly resistant to change but that the single-session intervention had some impact, which could be viewed as a "priming" effect that enhances multisession interventions.     

Seroprevalence of Entamoeba histolytica infection in female outpatients at a sexually transmitted disease sentinel clinic in Tokyo, Japan

From 2003 to 2006, we surveyed the seroprevalence of amoebic infection in female outpatients at a gynecologist's office, which was designated as a sexually transmitted disease sentinel clinic by the Tokyo Metropolitan Government, using an enzyme-linked immunosorbent assay (ELISA). The annual rate of anti-Entamoeba histolytica (HM-1:IMSScl6 strain; HM-1) antibody-positive cases as detected by ELISA increased during that period, and anti-Chlamydia trachomatis antibodies were detected in 60%, i.e., 24 of 40 anti-HM-1 antibody-positive individuals, suggesting sexual transmission of E. histolytica. We designed an ELISA with better sensitivity using the antigen extracted from the virulence-augmented E. histolytica strains (LHM-1 and LLA526 strains) by liver-passaging in hamsters. The average ratios of the S/N value (optical density [OD] of sample/OD of negative control) of ELISA with either the LHM-1 or LLA526 antigen and that of ELISA with the HM-1 antigen were significantly higher in intestinal amoebiasis cases with low S/N values than in amoebic liver abscess cases. In the present study of the seroprevalence of E. histolytica infection, the sera testing positive with low S/N values (<10) by ELISA with HM-1 antigen exhibited higher S/N values by ELISA using LHM-1 and LLA526 antigens. This modification of the antigen preparation for ELISA is expected to be effective in detecting anti-E. histolytica antibodies from such asymptomatic patients who have low antibody titers.     

Seroprevalence of human T-lymphotropic virus type I or II in sexually transmitted disease clinic patients in the USA

Serum specimens from patients attending sexually transmitted disease (STD) clinics in Denver and several southeastern US cities were tested for antibody to human T-lymphotropic virus type I or II (HTLV-I/II). In Denver, 8 (2.1%) of 384 patients with a history of intravenous (IV) drug use, versus none of 201 non-IV-drug users, were HTLV-I/II seropositive. Only 2 (0.18%) of 1095 STD clinic patients from the southeastern USA had antibodies to HTLV-I/II. These data document a low prevalence of HTLV-I/II in STD clinic patients from the southeastern USA and confirm that IV drug use is an important risk factor for HTLV-I/II in the USA.