Disease prevalence among women attending a sexually transmitted disease clinic varies with reason for visit.

Prevalence of sexually transmitted diseases (STD) and selected behavioral and demographic variables were evaluated in 279 women attending a Baltimore STD clinic, using a standardized questionnaire and cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Stratified by reason for clinic visit, 102 (37%) of 279 women attending the clinic stated that they were recent contacts to men with STDs with the majority (59 out of 102, or 58%) reporting gonorrhea contact as their reason for visit. Another 124 women (44%) came to the clinic for symptom evaluation, and 53 (19%) for other reasons. Prevalence of STDs was higher among those attending as contacts than among noncontacts: 35% versus 15% for N. gonorrhoeae; 26% versus 16% for C. trachomatis; and 27% versus 15% for T. vaginalis (P less than 0.05 for each). Furthermore, multiple infections were found in 23% of those attending as contacts but only in 10% of noncontacts (P less than 0.001). In general, patients reporting contact with an infected person were also less likely to report symptoms (43% versus 34%, P less than 0.001), despite increased disease prevalence. These data suggest that multiple STDs are often present in women attending STD clinics, irrespective of reason for visit. Merely treating women for reported exposure without further evaluation will fail to identify a substantial number of women coinfected with other organisms.     

Measured versus self-reported compliance with doxycycline therapy for chlamydia-associated syndromes: high therapeutic success rates despite poor compliance.

OBJECTIVE: To compare self-reported doxycycline compliance in men and women attending an STD clinic with indications for Chlamydia trachomatis treatment to compliance measured using microprocessor-containing medication vials to count each time and date medication vials were opened. A secondary objective was to correlate outcomes of therapy, as measured by symptom resolution and persistence of chlamydial nucleic acids, with measured doxycycline compliance. METHODS: Between September 1995 and July 1997, Medication Event Monitoring System (MEMS) caps were used to measure compliance with recommended doxycycline therapy (14 doses over 7 days) in patients treated for presumed C. trachomatis infections. Polymerase chain reaction (PCR) assays for C. trachomatis were performed on urine specimens collected at the time of follow-up evaluation. RESULTS: Of 221 evaluable participants, although 90% reported taking their medication as directed, only 33 (16%) managed this level of compliance according to data obtained from the MEMS cap. Although 144 (65%) patients took more than 11 of 14 doses over 8 days, 147 (67%) participants had at least one interval of 24 hours or longer between doses in an 8-day period. Of 81 participants with positive C. trachomatis cultures at enrollment, follow-up urine PCR for C. trachomatis was positive in 5 (6%). Medication Event Monitoring System data for four of the five patients with positive PCR tests as follow-up showed each had two or more 24-hour intervals when their medication vials were not opened and three of four had opened their vials less than 11 times. CONCLUSIONS: This study suggests that few patients take medications as prescribed and that self-report substantially underestimates medication noncompliance. Despite poor compliance, there were few treatment failures.     

Epidemiology of gonorrhea: distribution and temporal changes in auxotype/serovar classes of Neisseria gonorrhoeae

The auxotype/serovar (A/S) class of 489 isolates of Neisseria gonorrhoeae were determined and 425 isolates from 390 consecutive patients with gonorrhea who attended the Sexually Transmitted Diseases Clinic at Harborview Medical Center in Seattle during the first three months of 1985 were analyzed. Patients included 123 women, 187 heterosexual men, and 80 homosexual men. A total of 57 A/S classes of N. gonorrhoeae were identified during this study. For the first eight weeks, between three and seven new A/S classes were identified each week. The number of new A/S classes encountered in this community declined subsequently, and leveled off at about zero to two new A/S classes introduced per week. Two A/S classes were limited almost solely to homosexual men, one group of related classes was limited to heterosexual patients, and one class was initially limited largely to heterosexual men, possibly because of spread from a prostitute. The results show that the A/S classification system can be used in combination with epidemiologic data for tracing the introduction and spread of gonoccocal strains and their eventual elimination from a community. A/S classification can be used to study the clinical epidemiology of gonorrhea and may facilitate evaluation of strategies for control of gonorrhea.     

Sexual risk behaviors associated with having older sex partners: a study of black adolescent females.

BACKGROUND: Volunteer black adolescent females from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted disease were studied to determine the frequency of condom use and unprotected vaginal sex with steady, older partners during various time periods over the previous 6 months. GOAL: To examine associations between having male sex partners who were typically older (by at least 2 years) and adolescent females' sexually transmitted disease (STD)/HIV-associated sexual risk behaviors. STUDY DESIGN: In this cross-sectional study, 522 sexually active black adolescent females completed a questionnaire and a structured interview, of which a portion assessed the age difference between the adolescents and their typical sex partners. The adolescents' ages, length of relationship and their use of hormonal contraception were identified as covariates. Adjusted odds ratios (AOR), their 95% confidence intervals, and respective P values were calculated to detect significant associations. RESULTS: Sixty-two percent of the adolescents reported their typical sex partners were at least 2 years older. These adolescents were more likely to report never using condoms during the most recent sexual encounter (AOR = 2.0), during the last five sexual encounters (AOR = 2.0), and during the past month (AOR = 2.2). Similarly, having older partners was associated with greater odds of reporting any unprotected vaginal sex in the past 30 days (AOR = 1.7) or the past 6 months (AOR = 1.5). CONCLUSION: Our findings suggest that many adolescent females have sex partners who are at least 2 years older and that their relationship dynamics do not favor the adoption and maintenance of behavior protective against STD or HIV infection. Prevention programs could include training designed to help adolescent females overcome barriers to safer sex with older male partners.     

Implementing Adolescent Screening,Brief Intervention,and Referral to Treatment (SBIRT) Education in a Pediatric Residency Curriculum

Background: Screening, brief intervention, and referral to treatment (SBIRT) is recommended as part of routine health care for adolescents as well as adults. In an effort to promote universal SBIRT, the Substance Abuse and Mental Health Services Administration awarded funding to residency programs to develop and implement SBIRT education and training. Our project focused on creating scientifically based, developmentally appropriate strategies and teaching materials for the adolescent age range. This paper describes curriculum development and implementation and presents evaluation data. Methods: Pediatric and child psychiatry residents were trained. The training consisted of 4 activities: (1) case-based teaching modules, (2) role-play of motivational interviewing and brief interventions, (3) mock interviews with trained adolescents, and (4) supervised “hands-on” screening and brief interventions. Main outcome measures included trainee satisfaction, and SBIRT knowledge, perceived self-efficacy, and self- and observer report of use of the SBIRT algorithm. Results: Among 150 total participants completing the SBIRT training modules, nearly all (92.3%) were satisfied/very satisfied with the training modules. Knowledge accuracy immediately post training was high, but declined significantly by the end of the first residency year, with little change across subsequent years of residency. Confidence ratings also declined over time. Use of the SBIRT algorithm during the Adolescent Medicine rotation was high according to trainee self- and faculty observer report. Conclusions: We found evidence of training satisfaction, increased confidence in talking to adolescents about substance use, and widespread use of recommended practices immediately following training. Use of a highly structured algorithm to guide practice, and simple, highly structured brief interventions was a successful training approach, as residents self-reported accurate use of the SBIRT algorithm immediately after training. Knowledge and self-confidence declined over time. It is possible that “booster” sessions and ongoing opportunities to review materials could help residents retain knowledge and skills.     

Quantitation of silica-induced type II cell hyperplasia by using alkaline phosphatase histochemistry in glycol methacrylate embedded lung

A light microscopic technique based on alkaline phosphatase histochemistry was developed to specifically quantitate Type II cells in the intact rat lung. Lungs were fixed in 4% neutral-buffered formalin containing 0.25 M sucrose and embedded in glycol methacrylate. Two micron thick sections were mounted on glass microscope slides. Alkaline phosphatase activity was localized by using naphthol AS-BI phosphate as substrate in 0.125 M 2-amino-2-methyl-1-propanol buffer containing 0.625 mM MgCl2 (pH 8.9). Sections were counterstained with Harris hematoxylin. Type II cells were the only cell type in the alveolar region containing alkaline phosphatase activity, an observation that was confirmed by using electron microscopic histochemistry. By combining the alkaline phosphatase staining technique with standard morphometric procedures, the proliferative response to a single intratracheal dose of 10 mg silica was followed as a function of time. Type II cells were significantly increased at all time points examined. Twenty eight days following silica, Type II cells had increased to (252 +/- 16) X 10(6) cells per set of lungs compared to a control value of (141 +/- 32) X 16(6) cells. The method presented is a simple and rapid technique for examining Type II cell population kinetics.     

Surgical management of recurrent squamoid eccrine ductal carcinoma of the scalp

Squamoid eccrine ductal carcinoma (SEDC) is an exceedingly rare tumor that shows both squamous differentiation and adnexal ductal differentiation. As our review of the literature revealed, only a total of 7 cases were reported to date. We report an additional case of SEDC occurring on the scalp of a 53-year-old man. Despite complete excision by conventional technique with clear margin, the lesion recurred within a 3-month period, with regional lymph node metastasis. The tumor was completely removed, and the large scalp defect was reconstructed by using scalp rotation flap. We present a case of recurrent SEDC on the scalp, and we surgically resected this tumor. In addition, the large scalp defect was reconstructed successfully with scalp flap, and no recurrence has been observed in the patient's postoperative follow-ups.