Epidemiologic differences between chlamydia and gonorrhea.

To assess the prevalence, demographics, and transmission patterns of genital chlamydia infection, we screened 3,078 patients, and compared identified cases (N = 511) to gonorrhea cases (N = 291) diagnosed in the same setting. Chlamydia cases were younger and more likely to be White than their gonorrhea counterparts. Chlamydia cases were distributed diffusely; geographic overlap between the two diseases was only about 40 percent. Gonococcal coinfection was noted in less than 10 percent of patients with chlamydia. Nearly half of men with chlamydia and four-fifths of women were asymptomatic and most cases were identified through screening or contact tracing. Populations at high risk for chlamydia are seemingly different from those for gonorrhea. Differences may be due to control interventions (active for gonorrhea, passive for chlamydia). Chlamydia case reporting and control initiatives are recommended.     

Incidence of four sexually transmitted diseases in a rural community: a prospective study

Despite the fact that incidence studies of sexually transmitted diseases have rarely been performed in rural areas, it is generally assumed that the frequency of such diseases in rural areas is lower than in cities. We studied the incidence of four sexually transmitted diseases in a rural community (population 150,000) located in southern Quebec. Between March and September 1986, a random sample of 41 of 123 general practitioners reported all cases of syphilis, gonorrhea, chlamydial genital infection, and genital herpes at the time of diagnosis. In addition, all the specialists of the area who regularly diagnose sexually transmitted diseases reported their cases. For each case contact tracing was attempted. The estimated incidence rate was 584 per 100,000 person-years for at least one of the studied diseases. For chlamydia, gonorrhea, and herpes, the rates per 100,000 person-years were 470, 149, and 36, respectively. Over 11% of the cases had more than one of these diseases. Of the 114 index cases diagnosed by physicians, 102 were symptomatic, whereas of the 62 contact cases, only 25 were symptomatic (p less than 0.001). In addition, for genital chlamydial infection 84% of female cases were primarily diagnosed by physicians, whereas 64% of male cases were found by contact tracing (p less than 0.001). This study shows that sexually transmitted diseases are a major public health problem in rural communities.     

Penicillinase-producing Neisseria gonorrhoeae infection in adolescent prostitutes in detention

In the first quarter of 1983, four (17%) of 24 cases of Neisseria gonorrhoeae infection diagnosed in female adolescent detainees in King County, Washington were caused by penicillinase-producing (PPNG) strains. Twelve (3%) of 397 reported cases of female gonorrhea in the rest of King County during this time were caused by PPNG strains (p less than 0.01). All the detainees with PPNG infection were prostitutes. Their case histories are presented here. Three had signs and symptoms suggestive of pelvic inflammatory disease. In areas with endemic PPNG, all isolates of N. gonorrhoeae from female adolescent detainees should be tested for pencillinase production, and all prostitutes with genitourinary symptoms suggestive of gonorrhea should be treated with an antimicrobial resistant to pencillinase.     

Activities of occupational health professionals in academic environments

We surveyed American and Canadian medical schools to assess the extent to which occupational health professionals provided services to their own institutions. Ninety-two of 155 schools (60 percent) responded to a mailed questionnaire. Forty-six (51 percent) of the respondents had an occupational health service distinct from an employee health service. Two thirds of the respondents provided occupational health services to business and industry. Such professionals based in nonclinical departments were more likely to provide educational and epidemiologic services for hospital employees than were professionals based in clinical departments. In those institutions with risk management, biohazards, or health and safety committees, less than one half of the occupational health professionals in those institutions were members of those committees. Five respondents felt that there were financial disincentives to providing occupational health services to their institution's employees. We conclude that academic-based occupational health professionals have inadequate input into the provision of such services at their own institutions.     

Perceived risk of chlamydial and gonococcal infection among sexually experienced young adults in the United States

CONTEXT: Understanding young adults' perceived risk of chlamydial and gonococcal infection can inform interventions to reduce the prevalence of these sexually transmitted diseases. METHODS: Bivariate and multivariate analyses, using data from Wave 3 of the National Longitudinal Study of Adolescent Health (2001-2002), were conducted to examine relationships between perceived risk and selected characteristics in two groups: a nationally representative sample of sexually experienced 18-26-year-olds and a subsample of those who tested positive for chlamydia or gonorrhea. The relationship between current infection and perceived risk was also evaluated. RESULTS: Only 14% of all respondents and 33% of infected participants reported some perceived risk of chlamydial or gonococcal infection. In the overall sample, the odds of perceiving risk were significantly elevated among blacks, Hispanics, unmarried respondents, inconsistent condom users and nonusers, respondents who reported multiple partners in the past year, those who had received a diagnosis of chlamydia or gonorrhea in the past year, and those reporting current symptoms (odds ratios, 1.5-3.3). Currently infected participants were significantly more likely than those who were not infected to perceive some risk of infection (2.4). Among infected respondents, the factors positively associated with perceived risk were being black or Hispanic, using condoms inconsistently or not using them, having exchanged money for sex, having been tested in the past year but with no diagnosis, having received a diagnosis, and reporting current symptoms (2.5-5.2). CONCLUSIONS: Interventions to increase the accuracy of young adults' risk perceptions may influence sexual and health care-seeking behaviors in a way that will reduce rates of chlamydia and gonorrhea.     

Demographics, sexual risk behaviours and uptake of screening for sexually transmitted infections among attendees of a weekly women-only community clinic program

OBJECTIVES: Vancouver's DTES represents a high-risk neighbourhood, in which there exist a number of community clinics and outreach programs. The purpose of this study was twofold: 1) to describe the population of women attending a weekly women's program with respect to demographics, risk behaviours and prevalence of STI, and 2) to assess the uptake of STI screening in this setting. METHODS: A cross-sectional survey was undertaken during a weekly community clinic-based women's program from October to December, 2004. Women were recruited at the start of the program each week and were invited to provide urine samples for chlamydia and gonorrhea screening. RESULTS: Among 126 respondents, the median age was 42 (36-49), more than half (52%) self-identified as White and 40% as Aboriginal ethnicity. Forty percent were currently involved in the sex trade. Two thirds reported a Pap smear in the past year, while 14% had not accessed sexual health care (Pap smear, STI or HIV testing). Among the 92/126 (74%) women providing a urine sample, the prevalence of chlamydia and gonorrhea was 2.2% and 0.0%, respectively. CONCLUSION: The majority of women accessing this program were over 35 years of age, and while nearly half were currently involved in the sex trade, cross-sectional screening did not reveal a substantial prevalence of STIs. Women who were not regular program attendees reported less sexual health care, and represented the only two cases of chlamydia found. Innovative programs that better serve the needs of populations that remain unable or unwilling to seek sexual health care in its current formats are needed.     

Mesothelioma in pet dogs associated with exposure of their owners to asbestos

Pet dogs with spontaneous mesothelioma were used to identify environmental exposures that might increase their owner's risk of asbestos-related disease. These animals share man's domicile environment, yet do not indulge in activities (e.g., smoking, working) which confound interpretation of epidemiologic studies. Eighteen histologically confirmed canine mesotheliomas were diagnosed at the Veterinary Hospital of the University of Pennsylvania, Philadelphia, from April 1977 to December 1981. Sixteen owners of cases and 32 owners of age, breed, and sex-matched controls were interviewed to determine their occupation and medical history and their dog's medical history, life style, diet, and exposure to asbestos. An asbestos-related occupation or hobby of a household member and use of flea repellents on the dog were significantly associated with mesothelioma. In addition, there was a trend indicating an increased risk of mesothelioma with an urban residence. Lung tissue from three dogs with mesothelioma and one dog with squamous cell carcinoma of the lung had higher levels of chrysotile asbestos fibers than lung tissue from control dogs. These findings indicate that well-designed epidemiological studies of spontaneous tumors in pet animals may provide insight into the role of environmental factors in human cancers and serve as a valuable sentinel model to identify environmental health hazards for humans.     

Where do people go for treatment of sexually transmitted diseases?

CONTEXT: Major public health resources are devoted to the prevention of sexually transmitted diseases (STDs) through public STD clinics. However, little is known about where people actually receive treatment for STDs. METHODS: As part of the National Health and Social Life Survey, household interviews were performed from February to September 1992 with 3,432 persons aged 18-59. Weighted population estimates and multinomial response methods were used to describe the prevalence of self-reported STDs and patterns of treatment utilization by persons who ever had a bacterial or viral STD. RESULTS: An estimated two million STDs were self-reported in the previous year, and 22 million 18-59-year-olds self-reported lifetime STDs. Bacterial STDs (gonorrhea, chlamydia, nongonococcal urethritis, pelvic inflammatory disease and syphilis) were more common than viral STDs (genital herpes, genital warts, hepatitis and HIV). Genital warts were the most commonly reported STD in the past year, while gonorrhea was the most common ever-reported STD. Almost half of all respondents who had ever had an STD had gone to a private practice for treatment (49%); in comparison, only 5% of respondents had sought treatment at an STD clinic. Respondents with a bacterial STD were seven times more likely to report going to an STD clinic than were respondents with a viral STD--except for chlamydia, which was more likely to be treated at family planning clinics. Men were significantly more likely than women to go to an STD clinic. Young, poor or black respondents were all more likely to use a family planning clinic for STD treatment than older, relatively wealthy or white respondents. Age, sexual history and geographic location did not predict particular types of treatment-seeking. CONCLUSIONS: The health care utilization patterns for STD treatment in the United States are complex. Specific disease diagnosis, gender, race and income status all affect where people will seek treatment. These factors need to be taken into account when STD prevention strategies are being developed.     

2008 - 2016年阆中市梅毒及淋病流行病学分析

目的 分析阆中市2008 - 2016年梅毒及淋病的流行特征和趋势,为阆中市制定防控梅毒和淋病相关措施提供依据。方法 从中国疾病预防控制信息系统子系统传染病报告信息管理系统下载2008 - 2016年梅毒及淋病相关信息,并对该信息进行描述性流行病学分析。结果 阆中市2008 - 2016年累计报告梅毒1 692例、淋病109例。梅毒累计发病率21.55/10万,各年发病率呈逐年上升的趋势（χ2 = 860.006,P＜0.001）。淋病累计发病率1.39/10万,淋病各年发病率差异有统计学意义（χ2 = 21.638,P = 0.002）;2008 - 2016年地区分布中,梅毒以保宁镇（30.20%）、江南镇（5.97%）位居前2位,淋病以保宁镇（20.18%）、七里镇（11.93%）位于前2位;女性梅毒病例多于男性梅毒病例,男女梅毒病例性别比为0.91∶1,男性淋病病例多于女性淋病病例,男女淋病病例性别比为1.60∶1;梅毒以20～79岁年龄段人群为主,占发病总数的87.41%,淋病以20～49岁年龄段人群为主,占总发病数的71.56%;职业分布中,两病均以农民为主,梅毒病例中农民占49.17%,淋病病例中农民占44.04%。结论 阆中市梅毒和淋病疫情仍然相当严峻,应该及时采取措施防控,以减少梅毒和淋病的发生。     

Tuberculosis transmission attributable to close contacts and HIV status, Malawi

We conducted the first molecular study of tuberculosis (TB) to estimate the role of household contact and transmission from HIV-positive putative source contacts (PSCs) in a high HIV-prevalence area. TB patients in a long-term population-based study in Malawi were asked about past contact with TB. DNA fingerprinting was used to define clusters of cases with identical strains. Among 143 epidemiologically defined PSC-case pairs, fingerprinting confirmed transmission for 44% of household and family contacts and 18% of other contacts. Transmission was less likely to be confirmed if the PSC were HIV positive than if he or she was HIV negative (odds ratio 0.32, 95% confidence interval [CI] 0.14-0.74). Overall, epidemiologic links were found for 11% of 754 fingerprint-clustered cases. We estimate that 9%-13% of TB cases were attributable to recent transmission from identifiable close contacts and that nearly half of the TB cases arising from recent infection had acquired the infection from HIV-positive patients.     

Clinical spectrum of pharyngeal gonorrhea in children and adolescents: a report of sixteen patients

Pharyngeal gonorrhea in children and adolescents is probably increasing. During a 1-year period, 16 patients were diagnosed and treated for pharyngeal gonorrhea. This was the result of a search among a high-risk group, consisting of victims of sex abuse, patients suspected of homosexual practices, and adolescents with symptoms or signs suggestive of sexually transmitted diseases. Of the 16 positive throat cultures, 75% represented pharyngeal colonization while only 25% had clinical symptoms. Pharyngeal gonorrhea was found to be a marker in screening for psychosocial pathology, leading in two-thirds of the cases to the discovery of instances of incest, sexual abuse, chaotic family situations, or severe depression, all of which had been previously denied, ignored, or neglected. The purpose of this article is to alert health care providers to the clinical spectrum of pharyngeal gonorrhea in children and adolescents.     

Screening for gonorrhoea in family planning acceptors in a developing community

This study attempted to determine the prevalence of gonorrhea in new asymptomatic family planning acceptors attending a clinic in Soweto, Johannesburg, and to assess a new method of gonorrhea detection with the Microcult GC. Results showed: a) that 20% of the women unknowingly had clinical signs of severe genital tract infection; b) that the prevalence of culture-positive gonorrhea was 10.2% in the entire group and 17.5% in the group with clinical signs; c) that Microcult-GC is a quick and reliable method of detecting gonorrhea which would be useful in largescale screening programs; and d) less than 1.2 of the patients returned for treatment. The importance of explaining and treating complications of contraception in a developing community is discussed. Particular emphasis is placed on pelvic inflammatory disease which may complicate IUD insertion in the presence of gonorrhea. The need for further health education rather than largescale screening programs when planning healthcare for a developing community is emphasized.     

STD screening,testing, case reporting,and clinical and partner notification practices: a national survey of US physicians

OBJECTIVES: This study presents results from a national survey of US physicians that assessed screening, case reporting, partner management, and clinical practices for syphilis, gonorrhea, chlamydia, and HIV infection. METHODS: Surveys were mailed to a random sample of 7300 physicians to assess screening, testing, reporting, and partner notification for syphilis, gonorrhea, chlamydia, and HIV. RESULTS: Fewer than one third of physicians routinely screened men or women (pregnant or nonpregnant) for STDs. Case reporting was lowest for chlamydia (37 percent), intermediate for gonorrhea (44 percent), and higher for syphilis, HIV, and AIDS (53 percent-57 percent). Physicians instructed patients to notify their partners (82 percent-89 percent) or the health department (25 percent-34 percent) rather than doing so themselves. CONCLUSIONS: STD screening levels are well below practice guidelines for women and virtually nonexistent for men. Case reporting levels are below those legally mandated; physicians rely instead on patients for partner notification. Health departments must increase collaboration with private physicians to improve the quality of STD care.     

A study of 'routine' gonorrhea cultures in a family practice

A varying, but significant, incidence of "asymptomatic" gonorrhea in women has been reported by numerous investigators and is one rationale for collecting specimens during pelvic examinations for screening gonorrhea cultures. There is a lack of research evidence, however, to document the value of such cultures in all settings. In this retrospective study of gonorrhea cultures in a family practice, all of the cultures performed in one year were reviewed. Of the 219 clinically asymptomatic women who had screening cultures ordered, only two (0.9 percent) had culture-positive results, and both were known to be recent contacts of men with confirmed gonorrhea and hence would have had a screening culture ordered anyway. This finding opens to serious question the value of routinely screening women for gonorrhea by culturing vaginal specimens in all circumstances and suggests that thorough history and examination alone, supplemented by cultures only when clinically indicated, would suffice in certain settings.     

Gonorrhea and chlamydia infection among women visiting family planning clinics: racial variation in prevalence and predictors

CONTEXT: Black women are disproportionately infected with gonorrhea and chlamydia. Because of the potential impact of these infections on women's reproductive health, it is important to determine whether different factors are predictive of infection in women of different races. METHODS: Data from 31,762 women aged 15-24 who were tested for gonorrhea and chlamydia at Missouri family planning clinics in 2001 were used to calculate the prevalence of each infection by selected variables. Logistic regression analysis was used to assess factors associated with the risk of infection. RESULTS:Overall, 0.7% of women had gonorrhea, and 4% had chlamydia. The gonorrhea rate was 4% for blacks and 0.4% for whites; the chlamydia rate, 9% and 4%, respectively. Independent predictors of gonorrhea in both races were symptoms, recent sexual contact with a partner who had STD symptoms, and chlamydia infection. Predictors specific to whites were visiting the clinic for STD care and having a new partner or multiple partners in the past year. Being aged 15-21 was associated with an elevated risk of gonorrhea for blacks only. In both racial groups, chlamydia infection was associated with younger age, contact with a symptomatic partner, cervicitis, cervical friability and gonorrhea positivity. Additional predictors among whites were having a new partner, having multiple partners and having pelvic inflammatory disease; no other factors were significant for blacks. CONCLUSIONS: The prevalence and predictors of gonorrhea and chlamydia infection differ significantly between blacks and whites. Until these disparities are better understood, it will be difficult to establish screening criteria for gonorrhea.     

HIV infection in Ukraine (1987-96)

In Ukraine, the number of reported HIV infections increased extremely rapidly during the second half of the 1990s, from less than 50 per year until 1994 to more than 12,000 in 1996. The increase was initially observed and was particularly striking in the regions along the Black Sea. The majority of reported HIV infections were diagnosed in injecting drug users. The extend of HIV spread through sexual transmission is more difficult to assess because of the strong social stigma attached to homosexuality and the lack of information on sexual behaviour in general. The reported number of syphilis cases have also dramatically increased, from 3,000 cases in 1990 to nearly 80,000 cases in 1996. In this paper, we describe the surveillance systems for, and epidemiologic data on HIV infections, AIDS, and other STD in Ukraine from 1987 to 1996. We review the contributions of different vulnerable groups and we also discuss the factors influencing the past spread and the potential for future spread of HIV infection and make recommendations for surveillance, research and prevention.     

桐乡市宫颈癌筛查成本效益分析

目的:探讨宫颈癌筛查项目有效性。方法:对2009～2011年桐乡市宫颈癌筛查项目进行成本效益分析。结果:50 000例中,细胞学阳性754例,阳性检出率1.51%。731例行阴道镜检查,活体组织检查(活检)病理诊断386例,最后诊断CIN 218例(CINⅠ38例,CINⅡ101例,CINⅢ79例),微小浸润癌7例,浸润癌2例。据估算挽救1个寿命年平均需花费22 911.60元,小于桐乡市2010年人均GDP60 830元,效益成本比2.65∶1。结论:桐乡市现行宫颈癌筛查模式具有良好的经济效益,值得作为常规性公共卫生项目进一步推广。     

Acute poststreptococcal glomerulo-nephritis in general practice: the contribution of infection to its onset and course.

Twenty-one patients considered to have acute poststreptococcal glumerulo-nephritis were encountered during 35 years of general practice. In ten of them good evidence of active streptococcal infection at the time of discovery of nephritis was recorded. The more complete the data the more convincing was the evidence of active infection. In over half of those whose urine were routinely cultured pathogens were isolated and over a third were treated for infection of the urinary tract. Such infections were associated with adverse effects and prolonged illness. As compared with children, adults in general had a longer history of ill-health, were less likely to present with acute infections and more likely to have urinary tract infections and prolonged illness. Vigorous antistreptococcal treatment was followed by rapid recovery in those patients so treated whose illnesses were not complicated by urinary tract infections. Concurrent streptococcal infection and secondary infection of the urinary tract may contribute more to the onset of acute poststreptococcal glomerulo-nephritis and to its course than is currently believed.     

2004—2010年广西横县梅毒、淋病、AIDS/HIV疫情分析

目的了解横县近7年法定传染病中的梅毒、淋病、艾滋病和HIV阳性病例情况,分析其流行特征和规律,为制定防治策略和措施提供科学依据。方法收集该县2004—2010年的法定传染病梅毒、淋病、AIDS/HIV阳性病例疫情资料,采用EXCEL软件进行统计分析。结果全县近7年报告梅毒、淋病、艾滋病和HIV阳性病例共6682例,人群发病率为83.35/10万,男性高于女性,其中淋病2126例(26.52/10万),梅毒2930例(36.55/10万),艾滋病371例,死亡70例,HIV阳性1255例,死亡151例,艾滋病及HIV阳性病例人群发病率为20.28/10万。以上4种疾病高发年龄在15～44岁。农民发病人数占70.22%。4种疾病病例数近几年呈逐年上升趋势,特别是梅毒和AIDS/HIV阳性病例呈现平行上升较明显。结论该县淋病、梅毒、AIDS/HIV阳性总病例不断增多,其防治任务仍然非常严峻。     

Current care of hepatitis C-positive patients by primary care physicians in an integrated delivery system

BACKGROUND: Infection with the hepatitis C virus (HCV) is an emerging health problem in the United States. Management of this condition in asymptomatic patients remains controversial. METHODS: A questionnaire was mailed in November 1997 to all primary care physicians caring for adults (internists and family physicians) in an integrated health delivery system regarding the current approach to screening, diagnosis, and management of HCV infection. Charts of patients whose tests were positive for HCV were audited in selected practice sites to document care received by those patients. RESULTS: Most physicians (70%) reported ordering alanine aminotransferase (ALT) measurements to screen for HCV infection as part of a complete checkup. Each physician diagnosed an average of 3.1 new cases of HCV infection per year. Patients received widely divergent advice regarding prognosis, precautions to prevent transmission, and treatment. More than one half of the physicians advised their patients that the condition was serious (68%) and to abstain from alcohol (56%) and use condoms in monogamous relationships (62%). In caring for HCV-positive patients, more than three quarters of physicians reported recommending a liver biopsy to patients who had elevated ALT levels, and observing clinically, without liver biopsy, those patients who had normal ALT levels. A chart audit, however, showed less-aggressive intervention. Approximately one third of HCV-positive patients with elevated ALT levels had been seen by a gastroenterologist and had had a liver biopsy. Physicians in practice longer were less likely to recommend treatment with interferon-alpha. Of those patients whose physicians reported they would recommend biopsy and treatment with interferon-alpha, only 36% had a documented liver biopsy in their charts, and 29% had documented interferon-alpha treatment. Only 1.6% and 3.0% of patients, respectively, had received the recommended hepatitis A and hepatitis B vaccines. CONCLUSIONS: Approaches to screening, diagnosis, and management of HCV infection by primary care physicians vary greatly. There appears to be a considerable population of patients in primary care settings who continue to receive conservative management of asymptomatic HCV infection.