National seroprevalence and trends in herpes simplex virus type 1 in the United States, 1976-1994

OBJECTIVES: The objectives of this study were to estimate national seroprevalence of herpes simplex virus type 1 (HSV-1), describe trends in seroprevalence, and examine correlates of infection. GOAL: The goal of this study was to measure the burden of HSV-1 infection in the U.S. population. STUDY: We tested serum samples for HSV-1 antibody and analyzed questionnaire data collected for the second and third National Health and Nutrition Surveys (NHANES II, 1976-80; NHANES III, 1988-94). Seroprevalence estimates were weighted to represent the total U.S. population. RESULTS: At the time of NHANES III, two thirds (68%) of the U.S. population 12 years and older had HSV-1 antibody. Prevalence increased with age and varied by race/ethnicity; the majority of persons in all race/ethnic groups were HSV-1-seropositive by age 30. Overall, the national seroprevalence of HSV-1 decreased nonsignificantly by 2% in the years between NHANES II and III; decreases in HSV-1 seroprevalence in some population subgroups were balanced by increases in other groups. CONCLUSIONS: There was no overall change in the seroprevalence of HSV-1 in the U.S. population between NHANES II and III.     

Medical care expenditures for genital herpes in the United States

BACKGROUND: Approximately 45 million Americans have serologic evidence of HSV-2 infection and HSV-2 seroprevalence in the United States has increased 30% over the past two decades. Despite rapid increases in HSV-2 prevalence, the last estimate of the U.S. national direct medical cost for genital herpes (GH) was completed in 1985. The objective of this study is to assess the U.S. direct medical expenditures for GH and its complications to assist policy makers in allocating limited STD resources efficiently. METHODS: We estimated the number of GH-related clinical visits and pharmacy claims from several national and state sources, estimated the average direct medical cost per visit from two administrative claims databases, and calculated the U.S. national direct medical costs for GH by applying the average direct medical cost per visit to the number of clinical visits and pharmacy claims. RESULTS: The U.S. national number of GH-related clinical visits was estimated to be 499,655 and there were approximately 2,056,1180 pharmacy claims annually. Of those clinical visits, private office-based physician and public STD clinic visits alone accounted for 89%. The U.S. national direct medical costs were estimated at $166 million annually for 1992-1994, which represents $207 million in 1999 dollars. Of the total cost, medical care accounted for 36% and drug treatment for 64%. CONCLUSIONS: The medical costs of pharmacy claims and office-based physician visits account for the majority of the medical expenditures for GH. Our estimates, based on the best available data on medical expenditure, indicate that GH is a major public health problem with a substantial economic burden.     

Recurrent herpes simplex. The situation in the United States]

At present, there is no drug marketed in the United States for the treatment of herpes simplex, except for idoxuridine for the treatment of herpetic keratitis. The recent enthusiasm for the use of heterocyclice fluorescent dyes in conjunction with exposure to light (photodynamic inactivation) has diminished, and the efficacy of all available topical measures is being questioned. Of the numerous antiviral drugs being investigated, the following seem to show promise: idoxuridine, adenin arabinoside, trifluorothymidine, phosphonoacetic acid, and ribavirin. There are no vaccines available. Measures to stimulate immune response concern the use of levamisole hydrochloride, Interferon, Inosiplex and Transfer factor. Only adenine arabinoside will be available in the near future, and then only to serious life threatening infections. The marketing of other medications is several years in the future.     

Gonorrhea prevalence and coinfection with chlamydia in women in the United States, 2000

BACKGROUND: No recent national data address the prevalence of gonorrhea. GOAL: The goal was to describe gonorrhea prevalence and chlamydial coinfection among women aged 15 to 24 years. STUDY DESIGN: Data were analyzed from tests for chlamydia and gonorrhea at family planning, STD, and prenatal clinics in 2000. Gonorrhea positivity, chlamydia positivity among women with gonorrhea, and the median and interquartile ranges (IQRs) were calculated. RESULTS: The median state-specific gonorrhea positivity among women aged 15 to 24 years was 0.9% (IQR, 0.7%-1.7%) in family planning clinics, 7.0% (IQR, 4.1%-10.4%) in STD clinics, and 1.0% (IQR, 0.8%-1.6%) in prenatal clinics. Gonorrhea positivity was higher among females aged 15 to 19 years than among those aged 20 to 24 years. Median chlamydia positivity for females infected with gonorrhea was highest among those aged 15 to 19 years (46%). CONCLUSIONS: Gonorrhea positivity was consistently highest among women aged 15 to 19 years; almost half of women aged 15 to 19 years with gonorrhea also had chlamydia.     

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.     

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.     

Factors related to infertility in the United States, 1965-1976

Although the overall rate of infertility among American women of reproductive age remained fairly constant between 1965 and 1976, the percentage of young black women who were infertile increased very sharply. In 1976, 18% of black women of reproductive age were infertile, whereas only 9% of white women of the same age were infertile. With use of national data bases, the relationships between sexual activity, complications of pregnancy, sexually transmitted diseases, pelvic inflammatory disease, use of contraception, and infertility were examined. Available evidence shows a strong association between sexually transmitted diseases, pelvic inflammatory disease, and infertility trends. Our projections indicate that sexually transmitted diseases operating through pelvic infections account for much of the race differential in infertility as well as for one-half to one-third of the increase. In 1976 5-8% of 20-29-year-old black women were estimated to suffer infertility attributable to sexually transmitted diseases. Among white women the estimated incidence of infertility caused by sexually transmitted diseases was 0.7-1%.     

Decreasing age disparities in syphilis and gonorrhea incidence rates in the United States, 1981--2005

BACKGROUND: Compared to older age groups, teenagers and young adults in the United States are at high risk of acquiring sexually transmitted diseases (STDs). Although the disparity in STD rates across age groups is well documented, changes in the degree of disparity in STD rates across age groups over time have not been examined in detail. METHODS: We examined age-, sex-, and race-specific incidence rates of syphilis and gonorrhea in the United States (excluding New York owing to incomplete age- and race-specific data) from 1981 to 2005. STD rates in younger age groups (ages 15-29 years) were compared to STD rates in older age groups (ages 40-54 years) for each year over the 25-year period. We used regression analyses to examine the trend in the age rate ratio (STD rate in the younger age group divided by STD rate in the older age group) over time, adjusting for autocorrelation. RESULTS: The age disparity in syphilis and gonorrhea declined from 1981 to 2005. The estimated annual decline in the age rate ratio was 5.3% for syphilis and 2.0% for gonorrhea for all races overall (P <0.01). Overall, the age disparity in STD rates was more pronounced for females than males. CONCLUSIONS: Future research is needed to clarify the main determinants of the relative decline in STD rates in younger persons and to inform programmatic responses to the changing age disparity in STD rates.     

Incidence of cutaneous T-cell lymphoma in the United States, 1973-2002

OBJECTIVE: To describe incidence trends for cutaneous T-cell lymphoma (CTCL) in the United States. DESIGN: Population-based study. SETTING: Data were obtained from 13 population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute from 1973 through 2002. PARTICIPANTS: A total of 4783 cases of CTCL were identified for the period 1973 through 2002. MAIN OUTCOME MEASURE: Diagnosis of CTCL. RESULTS: The overall annual age-adjusted incidence of CTCL was 6.4 per million persons. Annual incidence increased by 2.9 x 10(-6) per decade over the study period. Incidence was higher among blacks (9.0 x 10(-6)) than among whites (6.1 x 10(-6)) and was higher among men (8.7 x 10(-6)) than among women (4.6 x 10(-6)). The racial differences in incidence decreased with age, while the sex differences increased with age and decreased over time. Substantial geographic variation in incidence was found. Incidence was correlated with high physician density, high family income, high percentage of population with a bachelor's degree or higher, and high home values. Changes in International Classification of Diseases for Oncology (ICD-O) morphologic definitions have resulted in the redistribution of the cases of CTCL among specific subclassifications. CONCLUSIONS: The continued rise in incidence of CTCL is substantial, and the cause of this increase is unknown. The racial, ethnic, sex, and geographic differences in incidence may be of etiologic importance. Changes in ICD-O definitions have made it difficult to evaluate incidence trends for subclassifications of CTCL such as mycosis fungoides. In addition, these changes resulted in the creation of ambiguous histologic codes, which may have caused coding errors. These errors along with the lack of independent verification are limitations of our study. An epidemiological investigation using population-based data is important to better understand this disorder.     

妊娠期生殖器疱疹和新生儿疱疹

生殖器疱疹是病毒性性传播疾病之一.孕妇妊娠期感染该病可能引起严重不良后果并可能导致新生儿疱疹.由于新生儿疱疹死亡率很高,因此,成为公众健康关注的焦点.妊娠期生殖器疱疹通常无典型临床表现,诊断比较困难,PCR技术因具有高敏感性,有可能代替病毒培养而成为单纯疱疹病毒感染的诊断标准.抗病毒抑制疗法能有效减少妊娠晚期的皮损复发和病毒排出,从而有效减少新生儿疱疹的发生.     

Contact allergy in male construction workers in Sao Paulo, Brazil, 2000-2005

There are no recent data on allergens in the construction industry in Brazil; apparently there were no changes in allergenic substances. The objective of this study was to identify sensitization to allergens in adult males working in the construction industry. A cross-sectional study with adult males submitted to patch tests from May 2000 to December 2005. Out of 169 male patients, 83 were construction workers. The five most frequent allergens among the construction workers were potassium dichromate (57%), carba-mix (34.9%), cobalt chloride (30.2%), thiuram-mix (27.9%) and neomycin (19.8%). There is a significant sensitization to potassium dichromate, cobalt, carba-mix, and thiuram-mix, demonstrating that cement and rubber gloves of personal protection equipment still account for allergic contact dermatitis in construction industry workers.     

Seroprevalence of herpes simplex virus-2 in suburban primary care offices in the United States

OBJECTIVE: The objective of this study was to estimate herpes simplex virus-2 (HSV-2) seroprevalence from a weighted sample of adults attending relatively affluent, suburban primary care physician (PCP) offices. GOAL: Many PCPs in relatively affluent areas do not believe national estimates of HSV-2 seroprevalence are representative of their patient populations. This study aimed to measure HSV-2 seroprevalence in these patient populations. STUDY DESIGN: We conducted a cross-sectional study with approximately 5400 individuals aged 18 to 59 years. Individuals were recruited at 36 PCP offices in 6 U.S. cities and tested for HSV-2 using Focus enzyme-linked immunosorbent assay. A computer-assisted questionnaire was used to assess risk behaviors associated with genital herpes. RESULTS: Among 5452 individuals who provided an analyzable blood sample, the overall weighted HSV-2 seroprevalence was 25.5% (95% confidence interval, 20.2-30.8%). Only 11.9% of HSV-2-seropositive patients reported a history of genital herpes. CONCLUSIONS: Results illustrate the need for greater suburban PCP and patient awareness of the high HSV-2 seroprevalence in this setting.     

Early syphilis in the United States identified in corrections facilities, 1999-2002

BACKGROUND: Corrections facilities offer public health practitioners an opportunity to gain access to large numbers of persons at risk for syphilis and other sexually transmitted diseases. GOALS: The goals of this study were to estimate the number of early syphilis cases (primary, secondary, early latent) identified from corrections facilities from 1999 to 2002 and to determine characteristics of persons likely to be identified with syphilis in corrections facilities. STUDY DESIGN: We determined the proportion of cases identified from corrections facilities for the entire United States using case reports by state health departments to the Centers for Disease Control and Prevention (CDC). We calculated the proportion of cases identified in corrections facilities in the 30 counties with the largest number of cases in 2002 and determined the male-to-female syphilis rate ratios. RESULTS: From 1999 to 2002, there were 63,293 cases of early syphilis reported to the CDC, of which 61,691 (97.5%) had a known source of report. Of these, 7725 (12.5%) noted corrections facilities as the source of information. Among men, 4747 (13.0%) cases were from corrections and in women 2974 (11.8%) of cases were. We found that counties with a higher proportion of cases from corrections facilities were likely to have lower male-to-female rate ratios (r = -0.66, P <0.001). CONCLUSIONS: A substantial proportion of early syphilis cases is identified from corrections facilities. Among counties with the largest number of cases, a higher proportion of syphilis cases was identified from corrections facilities in counties with higher rates of heterosexually transmitted syphilis.     

Incidence and survival of desmoplastic melanoma in the United States, 1992-2007

Background: Desmoplastic melanoma (DM) represents a relatively rare malignancy. The aim of this study was to describe the incidence and survival of DM in the United States. Methods: Incidence and survival data were obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, 1992–2007. Kaplan–Meier and Cox proportional hazards regression methods were used to calculate the survival rates and hazard ratios for DM‐specific death. Results: We identified 1129 DM patients from SEER 13 registries, with 64% in men, 37% in women and most (96.8%) occurring in White populations. The incidence rates per 1,000,000 were 1.3 (female), 3.0 (male) and 2.0 (both). The annual percentage change for incidence was 4.6 (95% confidence interval: 2.9–6.5) from 1992 to 2007. The 5‐year and 10‐year DM‐specific survival rates from SEER 17 registries were 84.8 and 79.2%. The 5‐year DM‐specific survival rates by stage ranged from 90.9% (local) to 51.5% (distant). Independent predictors of mortality from DM included age, anatomic site, thickness, ulceration, lymph node and surgery. Conclusions: The incidence of DM has been increasing steadily over the past 15 years. Older age, anatomic site of the head and neck, tumor thickness >2 mm, ulceration, lymph node involvement and non‐receipt of surgery are associated with lower survival. Feng Z, Wu X, Chen V, Velie E, Zhang Z. Incidence and survival of desmoplastic melanoma in the United States, 1992–2007.     

Influence of sexual activity on cytomegalovirus seroprevalence in the United States, 1988-1994

BACKGROUND: Sexual and nonsexual transmission of cytomegalovirus (CMV) occurs, but the frequency of sexual transmission in the general population of the United States is unknown. METHODS: Using data from 15- to 44-year-old (n = 7883) participants of the Third National Health and Nutrition Examination Survey (1988-1994), we examined the association between CMV seroprevalence and sexual activity markers. Using logistic regression, we calculated standardized prevalence differences (PDs)-the weighted average CMV prevalence among higher sexual risk groups minus CMV prevalence among the lowest sexual risk group-for each of several sexual activity markers (ever had sex, number of sex partners [lifetime and past year], age at first intercourse, potential years of sexual activity, ever use oral contraceptives, herpes simplex virus type 2 antibody, and a calculated composite marker). RESULTS: Even after controlling for covariates, we found associations between CMV seroprevalence and sexual activity among non-Hispanic black [all PDs for sexual activity markers were positive and composite PD = 8.5%, 95% confidence interval (CI) = 4.0%-13.1%] and non-Hispanic white women (15 of 18 PDs for sexual activity markers were positive and composite PD = 10.8%, 95% CI = 3.1%-18.5%). We found a borderline significant association among Mexican American women (13 of 18 PDs for sexual activity markers were positive and composite PD = 3.5%, 95% CI = -0.7% to 7.6%). We found little or no association within each racial/ethnic group of men. CONCLUSIONS: Sexual activity measurably influences CMV seroprevalence among women of childbearing age, indicating that congenital CMV prevention messages should include strategies to reduce sexual transmission of CMV among pregnant women.     

Syphilis in the United States

Syphilis gained notoriety in the 1500s, when it became widespread throughout Europe. While the origins of syphilis are not certain, recent data have shown that it may have originated in the Americas from a close relative that causes Yaws (Treponema pallidum pertenue). ¹ For the past 500 years, the disease has shown its various faces all over the world. The 19th century saw an entire medical subspecialty—syphilology (sometimes known as syphilography)—devoted to the study of the great disease, then known as “the great imitator.” Syphilis has an entire textbook of presentations and can mimic many other infections and immune-mediated processes. At the beginning of the 20th century, the many faces of the disease led to Sir William Osler’s well-known aphorism, “The physician who knows syphilis knows medicine." ²