Subsequent infection among adolescent African-American males attending a sexually transmitted disease clinic.

PURPOSE: To identify predictors of subsequent infection among a sample of 15- to 19-year-old African-American males attending an urban sexually transmitted disease (STD) clinic in the Midwest. METHODS: During a 14-month period, 562 youth participated in a brief STD prevention intervention designed to promote condom use. They completed self-administered questionnaires (baseline, posttest, 30-day and 6-month) on their sexual and condom use behavior in the past month. Infection data (baseline, 5 years before, and 12 months after baseline) were obtained from clinic and state surveillance records. Logistic regression was used to predict infection within 6 and 12 months of the baseline visit. RESULTS: Within 12 months of the baseline, 31.3% were treated for an infection, of whom 1.4% returned within 30 days, an additional 17.1% within 6 months, and the remaining 12.8% within the last 6 months. The 12-month rate was 1.6-1.7 times higher than the rates reported for older STD clinic attendees. Subsequent infection was positively associated with age at first intercourse, number of children fathered, infection prior to and at the index visit, exchange of sex for drugs in the past year, and perceived risk of infection within the year; it was negatively associated with frequency of condom use with one's steady partner. CONCLUSIONS: Sexually transmitted disease clinic staff routinely obtain information from young African-American males that can be used to identify individuals who are most likely to become reinfected. Because repeaters account for a disproportionate number of infections, prevention efforts tailored to their needs would have a corresponding impact on STD rates.     

HIV infection, genital ulcer disease, and crack cocaine use among patients attending a clinic for sexually transmitted diseases.

BACKGROUND. Recently there has been a rise in genital ulcer disease (GUD) in urban minority heterosexuals in the United States. The impact of these increased GUD rates on HIV transmission patterns in this population is unknown. METHODS. Sexually transmitted disease (STD) diagnoses were correlated with HIV antibody status and risk factor history in 194 patients who consented to HIV testing at an STD clinic in central Brooklyn. RESULTS. Of 36 HIV-positive patients, 23 (64%) denied HIV risk factors other than heterosexual contact with persons of unknown HIV status. HIV antibody was associated with GUD (odds radio [OR] = 2.72, 95% confidence interval [CI] = 1.20-6.24), multiple concurrent STDs (OR = 2.51, 95% CI = 1.08-5.81), and a history of crack cocaine use (OR = 2.98, 95% CI = inexact-9.61). Crack use was also associated with GUD (OR = 15.15, 95% CI = 3.27-inexact) and multiple simultaneous STDs (OR = 13.87, 95% CI = 4.62-inexact). In a log-linear model analysis, HIV infection was independently associated with GUD and crack use. HIV infection, genital ulcer disease, and crack cocaine use were more common in women than men. CONCLUSIONS. The association between HIV infection and GUD seen here may be secondary to high-risk sexual behavior, which in turn may be partially attributable to crack cocaine use and drug-related prostitution. The high rate of coinfection with HIV and GUD raises a concern about the increased efficiency of sexual transmission of HIV in this population.     

Genital herpes infection in outpatients attending a sexually transmitted disease clinic in Italy

Prevalence of Herpes Simplex, type 2, specific antibodies was estimated in sexually transmitted disease outpatients: 783 heterosexuals and 158 homosexual-bisexuals. The anti-HSV-2 prevalence rates were 69% in the homosexual-bisexuals and 35% in the heterosexuals. In both groups positive association with age of anti-HSV-2 prevalence was found: only in the homosexual-bisexuals negative as sociation with education level was detected. No difference exists between the two groups regarding the symptomatic/asymptomatic ratio of HSV-2 infection.     

Unrecognized HIV infection among patients attending sexually transmitted disease clinics

OBJECTIVES: This study examined voluntary HIV testing rates in sexually transmitted disease (STD) clinics. METHODS: Anonymous, unlinked surveys of HIV seroprevalence and medical chart abstractions were conducted in 28 STD clinics in 14 US cities in 1997. RESULTS: Among the 52 260 patients included in the anonymous HIV serosurveys, voluntary HIV testing rates by clinic ranged from 30% to 99% (median = 58%). Patients not tested were more likely to be HIV infected than were patients who were tested, even after those with documented HIV infection were excluded, regardless of demographic characteristics, risk group, or STD diagnosis. CONCLUSIONS: HIV infection is unrecognized in substantial numbers of patients with HIV infection visiting STD clinics. Efforts are needed to increase HIV testing and counseling of all patients visiting these clinics.     

Risk of human immunodeficiency virus infection and genital ulcer disease among persons attending a sexually transmitted disease clinic in Italy

To assess the relative importance of ulcerative and non-ulcerative sexually transmitted disease in the transmission of HIV, a seroprevalence study was conducted on 2210 patients at the sexually transmitted diseases (STD) clinic of the S. Maria e S. Gallicano Hospital in Rome, between 1989 and 1994. Among male patients, by univariate analysis, strong predictors of HIV infection were homosexuality, sexual exposure to a HIV-positive partner, hepatitis B virus infection, and positive syphilis serology. An increased risk was estimated for patients with past genital herpes (odds ratio (OR) 3.86, 95% confidence intervals (CI) 0.40-18.2), and primary syphilis (OR 5.79, 95% CI 0.59-28.6). By multivariate analysis, a positive association was found with homosexuality (OR 6.9, 95% CI 2.9-16.5), and positive syphilis serology (OR 3.5, 95% CI 1.3-9.2). An adjusted OR of 2.41 was calculated for current and/or past genital herpes. These results, although not conclusive, suggest a role of ulcerative diseases as risk factors for prevalent HIV infection, and indicate that positive syphilis serology is an unbiased criterion for identifying individuals at increased risk of HIV infection.     

Self-reported behavior patterns of patients attending a sexually transmitted disease clinic.

Records of the sexually transmitted disease (STD) clinic visits of 12,728 patients in Columbus, Ohio were analyzed to better understand the behavior patterns of these patients. Among heterosexual men, a greater proportion of Blacks than Whites reported a previous history of urethritis. After controlling for previous STD among heterosexual men with discharge or dysuria, we found that Black men sought treatment sooner and were more likely to curtail sexual activity than White men after becoming symptomatic with gonorrhea or nongonococcal urethritis.     

Some peoples' psychological experiences of attending a sexual health clinic and having a sexually transmitted infection

This study considers aspects of the experiences of a group of people attending a sexual health clinic and receiving the diagnosis of a sexually transmitted infection (STI). The study was conducted in the form of action research using a qualitative approach. Participants consisted of eight attenders at a sexual health clinic who had been diagnosed with a sexually transmitted infection. Counselling skills and techniques were used throughout semi-structured interviews to explore participants' feelings about these issues. Thematic analysis was used to generate themes of importance to the participants. Some people who had been to a sexual health clinic and received a diagnosis of a sexually transmitted infection were found to experience feelings of anxiety, stigma and isolation. This study is of value to all those working in the field of sexual health with an interest in understanding the issues that are important to the client group.     

Genital chlamydial infection among male attendees at a sexually transmitted disease clinic in urban Taiwan

OBJECTIVE: The aim of this study was to examine the epidemiology of genital Chlamydia trachomatis infection among male patients attending a sexually transmitted disease (STD) clinic in urban Taiwan. METHODS: From July 2003 to June 2004, all male attendees at an STD clinic were invited to participate in this study. Attendees provided a first-void urine sample for examination for C. trachomatis using polymerase chain reaction (PCR) assay. RESULTS: A total of 390 patients provided first-void urine specimens for testing for C. trachomatis. The overall prevalence of C. trachomatis was 17.7% (95% CI 16.3-19.1%). The age-specific prevalence was higher among patients aged under 20 years and lowest among those aged over 30 years. Approximately 40% of the infections were asymptomatic or subclinical. Younger age (aged 相似文献   

育龄妇女性病病原体感染分析

目的了解有生殖道感染症状与体征的已婚育龄妇女中5种性病病原体的感染情况。方法用PCR法对浙江省950例有生殖道感染症状与体征已婚育龄妇女的宫颈分泌物进行人乳头瘤病毒(HPV)16.18、HPV6.11、沙眼衣原体(CT)、解脲支原体(UU)、淋病奈瑟菌(NG)检测。结果该组人群的5种性病病原体总阳性率为69.05%(656/950),其中HPV6.11阳性率最高(45.47%),UU阳性率次之(42.95%),CT阳性率为8.50%,HPV16.18阳性率为2.20%,NG阳性率最低(0.32%),单一病原体感染率42%,混合感染率26.94%,性病病原体感染与受教育程度呈正相关(P<0.05),年龄差异与性病病原体感染无统计学意义(P>0.05)。结论本地区已婚育龄妇女存在不同程度5种性病病原体感染,应高度重视感染的控制问题。     

Seroprevalence of anti-Chlamydia trachomatis IgG in outpatients attending a sexually transmitted disease clinic in Italy

Prevalence of anti-Chlamydia trachomatis specific IgG antibodies was evaluated in a sexually transmitted disease outpatient population composed of 741 heterosexuals, 470 males and 271 females, and of 147 homosexual-bisexual men. The prevalence rates were 60.0% in heterosexual males, 50.6% in females and 73.5% in homosexuals-bisexuals. A positive association between age and antibody prevalence was found in males. Among heterosexuals there is an increasing trend of seropositivity with number of partners during the previous year. A significant association between anti-chlamydial and anti-herpes simplex, type 2, antibodies has been demonstrated.     

Contraceptive needs of women seeking care from a publicly funded sexually transmitted infection clinic

Objectives

To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC.

Methods

An anonymous survey was administered to 197 women seeking services at one Chicago Department of Public Health STI clinic.

Results

After excluding women unlikely to become pregnant within the next year because of age, sexual orientation, hysterectomy and those who desired pregnancy (n=47), data from 150 women were available for analysis. Thirteen percent were using “very effective” contraception (intrauterine contraception, implant or sterilization) and 26% were using “effective” contraception (contraceptive pill, patch, ring or injectable). Approximately 23% (95% CI 16.5–30.0%) may have benefited from immediate use of EC as they reported at least one act of unprotected intercourse within the past 5 days.

Conclusion

Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population.     

Comparative behavioral epidemiology of gonococcal and chlamydial infections among patients attending a Baltimore, Maryland, sexually transmitted disease clinic.

Between April 1988 and May 1989, 400 males and 400 females attending a Baltimore, Maryland, sexually transmitted disease clinic were enrolled in a study evaluating and comparing behaviors associated with culture-proven gonococcal or chlamydial infection. The subjects were enrolled consecutively, and were all seen by the same clinician. Among participants of each sex, gonorrhea but not chlamydia was associated with increasing numbers of recent (the past 30 days) sexual partners. Compared with males with neither infection, factors independently associated with increased risk of gonorrhea included age less than 20 years (odds ratio (OR) = 1.93), the presence of genitourinary symptoms (OR = 8.07), and recent exposure to a new sexual partner (OR = 2.78); risk for chlamydial infection in males was associated with genitourinary symptoms (OR = 2.83) and was significantly reduced in those reporting multiple recent (OR = 0.19) or new (OR = 0.07) sexual partners. Among females, age less than 20 years was independently associated with gonococcal (OR = 1.86) and chlamydial (OR = 7.79) infections in comparison with females with neither infection. No other behavioral factors were associated with chlamydial infection for females in this study; however, having a regular sexual partner was associated with significantly elevated risk of gonorrhea (OR = 3.85), while the presence of genital tract symptoms was associated with diminished risk (OR = 0.29) for gonorrhea. These data suggest that there are differences in the behaviors associated with gonorrheal and chlamydial infections and that different strategies may be useful in efforts to control these infections.     

Factors associated with forced sex among women accessing health services in rural Haiti: implications for the prevention of HIV infection and other sexually transmitted diseases

The goals of the current study were to: (1) estimate the prevalence of forced sex among women accessing services at a women's health clinic in rural Haiti; and (2) examine factors associated with forced sex in this population. Based on data from a case-control study of risk factors for sexually transmitted diseases (STDs), a cross-sectional analysis to examine factors associated with forced sex was performed. A number of factors related to gender inequality/socioeconomic vulnerability placed women in rural Haiti at higher risk of forced sex. The strongest factors associated with forced sex in multivariate analyses were: age, length of time in a relationship, occupation of the woman's partner, STD-related symptoms, and factors demonstrating economic vulnerability. The findings suggest that prevention efforts must go beyond provision of information and education to the pursuit of broader initiatives at both local and national levels. At the community level, policy-makers should consider advancing economic opportunities for women who are vulnerable to forced sex. Improving access to community-based income-generating activities may begin to address this problem. However, the viability of these local projects depends largely upon Haiti's 'macro-economic' situation. In order to ensure the success of local initiatives, external humanitarian and development assistance to Haiti should be supported. By broadening the definition of "prevention" interventions, we may begin to address the systemic problems that contribute to the occurrence of forced sex and the increasing incidence of HIV infection throughout the world, such as gender inequality and economic vulnerability. Taking into account factors influencing risk at the local level as well as the macro-level will potentially improve our capacity to reduce the risk of forced sex and the spread of STDs, including HIV infection, for millions of women living in poverty worldwide.