High prevalence and incidence of sexually transmitted diseases in urban adolescent females despite moderate risk behaviors

Developmental Changes in Sexual Risk and Substance Use Among African American Females: an Integrated Data Analysis Approach Using Time-varying Effect Models

The aim of this study was to describe age-related changes in sexual risk and substance use using existing data from three HIV/sexually transmitted infection (STI) prevention trials conducted in Atlanta, Georgia, that enrolled young African American women. We used two novel analysis methods: integrative data analysis (IDA) and time-varying effect models (TVEM). Each trial collected self-reported behavioral data and vaginal swab specimens assayed for chlamydia, gonorrhea, and trichomonas. Baseline data from all participants and follow-up data from participants not randomized to an active intervention arm were integrated in a pooled dataset using an IDA approach. The pooled dataset included observations for 1974 individuals, aged 14-25 years for behavioral outcomes and 16-25 years for STI outcomes. We used TVEM to model age-related changes in sexual risk and substance use behaviors and STI acquisition, adjusting for trial as a fixed effect. Coital frequency and condomless sex increased through the early 20s while multiple partnerships remained fairly steady. Alcohol use and cigarette smoking increased through about age 24 years before declining. Marijuana use peaked at age 16-17 years and thereafter generally declined. STI acquisition was highest at age 16 years. This study demonstrates the feasibility and utility of innovative methodological techniques to address novel questions related to adolescent development using existing data from multiple trials. The results suggest that mid-adolescence and the early 20s may be periods of particular risk. The findings may be useful for timing culturally and developmentally relevant prevention interventions for young African American women.

Immunocytochemistry Improving the Diagnosis of Trichomonas vaginalis Infections

The aim of this study was to evaluate the immunocytochemistry (ICC) to diagnose trichomoniasis, particularly asymptomatic infections. By culture serial dilutions, ICC was able to detect 1 trophozoite/mL, while the culture was positive up to 100 trophozoites/mL. The ICC in vivo detection capability was assessed in vaginal secretions of mice experimentally infected and in vaginal swabs from asymptomatic HIV-positive pregnant women compared with culture. All vaginal secretion samples from mice were positive according to both methods. Swabs from fifty-five asymptomatic women were positive in four (7.27%) of them by culture. Beyond these four, another ten (25.45%) women were positive by immunocytochemistry, proving their higher sensitivity (p = 0.002), noticing 3.5 times more positives. ICC had better performance in both successive dilutions as in asymptomatic women, showing higher sensitivity and specificity. In this way, its facility of execution and cost-effectiveness support its practicality, as a routine procedure to diagnose trichomoniasis not only when the parasite load is lower but probably in all clinical scenarios.

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood

Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana use to determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth.

Self-Esteem and Theoretical Mediators of Safer Sex Among African American Female Adolescents: Implications for Sexual Risk Reduction Interventions

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivariate analyses showed no relationship between self-esteem and STD or pregnancy; multivariate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.

High Rates of STIs in HIV-Infected Patients Attending an STI Clinic

OBJECTIVES

To evaluate the rates and types of sexually transmitted infections (STIs) in patients infected with the human immunodeficiency virus (HIV) attending a public STI clinic in Miami, Florida as compared with HIV-uninfected patients attending the same clinic.

METHODS

This was a retrospective review of medical records of individuals attending the Miami-Dade County Health Department STI clinic from March 2012 to May 2012. Demographic and clinical information was abstracted and transferred to an electronic database. Consecutive age-matched HIV-infected and HIV-uninfected patients were identified during the study period. Demographics, risk factors, and history and rates of STIs for HIV-infected and HIV-uninfected patients and for those with newly diagnosed and previously diagnosed HIV infection were compared.

RESULTS

A total of 175 medical records were reviewed (89 HIV-infected patients and 86 HIV-uninfected patients). The median age was 37 years. A history of STIs, including syphilis, was more common in HIV-infected than in HIV-uninfected patients. Individuals with a prior diagnosis of HIV were more likely to be older (older than 37 years of age, χ(2) = 15.3, P < 0.01), male (χ(2) = 4.74, P = 0.05), to have a new STI (χ(2) = 5.83, P = 0.01), to have a new diagnosis of syphilis (χ(2) = 5.15, P = 0.01), and to be under medical care (χ(2) = 31.19, P < 0.001) than those newly diagnosed as having HIV.

CONCLUSIONS

HIV-infected individuals who attended this urban STI clinic had high rates of new and past STIs, suggesting the persistence of high-risk sexual behaviors. STI clinics could be a premier site to identify individuals with HIV and high-risk sexual behaviors who could benefit from additional targeted interventions.

Associations between parental deployment, relocation, and risky sexual behaviors among a clinic-based sample of military-dependent youth

Although sexual behaviors have been extensively studied among youth in general, they have been relatively understudied among military-dependent youth (MDY). Furthermore, the impact of unique military stressors, such as parental deployment and multiple relocations, on the sexual behaviors of MDY has not been assessed. In this pilot study, we estimated the prevalence of sexual behaviors among MDY, and examined the association between these behaviors and parental deployment and multiple relocations. Between June and September 2011, we recruited youth (N = 208; aged 15-19 years) who attended a military treatment facility in the southern United States, to complete a short, paper-based survey. We computed prevalence estimates and conducted Chi-square analyses, as well as logistic regression analyses, while adjusting for age, gender, and race/ethnicity. More than half (53.7 %) of the youth reported being sexually experienced, and many of these youth reported engaging in risky sexual behaviors. Parental deployment and multiple relocations were significantly associated only with having had sex in the past 3 months. Although with most sexual behaviors there was no significant association between parental deployment and multiple relocations, many MDY are sexually experienced and engage in risky sexual behaviors. MDY should thus be exposed to evidence-based strategies for sexually transmitted infection and pregnancy prevention, as well as provided with teen-friendly health care services and comprehensive sexual/reproductive health counseling.

Correlates of inconsistent condom use among youth aged 18-24 years in South Africa

This paper examines the correlates of inconsistent condom use with most recent sexual partner among sexually experienced youth (N = 2 138) in South Africa. A cross-sectional population based survey with youth aged 18 to 24 years was conducted in 4 provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). More women than men (57.7% vs. 25.8%) reported inconsistent condom use with their most recent partner. Multivariate analysis indicated that for males, not having talked with a partner about condoms in the past 12 months, having 2 or more sexual partners in the past 12 months, having ever had a transactional sex partner and alcohol use before sex in the past 3 months were associated with inconsistent condom use with their most recent sexual partner. In females multivariate analysis showed that lack of self-efficacy, not having talked with a partner about condoms in the past 12 months, having ever had or been subjected to forced sex and hazardous or harmful alcohol use were found to be associated with inconsistent condom use with their most recent sexual partner in multivariate analysis.

Partner meeting place is significantly associated with gonorrhea and chlamydia in adolescents participating in a large high school sexually transmitted disease screening program

BACKGROUND

From 2003 to 2012, the Philadelphia High School STD Screening Program screened 126,053 students, identifying 8089 Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) infections. We examined sociodemographic and behavioral factors associated with CT/GC diagnoses among a sample of this high-risk population.

METHODS

Standardized interviews were given to infected students receiving in-school CT/GC treatment (2009-2012) and to uninfected students calling for results (2011-2012). Sex-stratified multivariable logistic models were created to examine factors independently associated with a CT/GC diagnosis. A simple risk index was developed using variables significant on multivariable analysis.

RESULTS

A total of 1489 positive and 318 negative students were interviewed. Independent factors associated with a GC/CT diagnosis among females were black race (adjusted odds ratio [AOR], 2.27; confidence interval, 1.12-4.58), history of arrest (AOR, 2.26; 1.22-4.21), higher partner number (AOR, 1.75; 1.05-2.91), meeting partners in own neighborhood (AOR, 1.92; 1.29-2.86), and meeting partners in venues other than own school, neighborhood, or through friends ("all other"; AOR, 9.44; 3.70-24.09). For males, factors included early sexual debut (AOR, 1.99; 1.21-3.26) and meeting partners at "all other" venues (AOR, 2.76; 1.2-6.4); meeting through friends was protective (AOR, 0.63; 0.41-0.96). Meeting partners at own school was protective for both sexes (males: AOR, 0.33; 0.20-0.55; females: AOR, 0.65; 0.44-0.96).

CONCLUSIONS

Although factors associated with a GC/CT infection differed between males and females in our sample, partner meeting place was associated with infection for both sexes. School-based screening programs could use this information to target high-risk students for effective interventions.

Individual, partner, and partnership level correlates of anal sex among youth in Baltimore City

Anal sex is an efficient mode of STI transmission and studies indicate that anal sex is common among heterosexuals, including adolescents. We examined the association between individual, partner, and sexual partnership-level characteristics with anal sex among a household survey of 263 individuals aged 15-24 years in Baltimore City, Maryland. We used weighted multiple logistic regression to examine correlates of anal sex in a heterosexual partnership by gender. Twenty-nine percent of males and 15% of females reported anal sex in a partnership in the past 6 months. For males, anal sex was associated with having two or more partners in the past 3 months (AOR = 13.93, 95% CI 3.87-50.12), having been tested for HIV (AOR = 0.30, 95% CI 0.12-0.72), and oral sex with a partner (AOR = 8.79, 95% CI 1.94-39.78). For females, anal sex was associated with reporting having a main partner (AOR = 6.74, 95% CI 1.74-23.65), partner meeting place (AOR = 3.03, 95% CI 1.04-8.82), partner history of STI (AOR = 0.20, 95% CI 0.05-0.85), and oral sex with a partner (AOR = 8.47, 95% CI 1.08-66.25). Anal sex was associated with inconsistent condom use for both males (OR = 5.77, 95% CI 1.68-19.79) and females (OR = 5.16, 95% CI 1.46-18.30). We conclude that anal sex is a prevalent risk behavior among heterosexual youth and is associated with a range of factors at the individual and partnership levels. These findings provide support for comprehensive sex education that includes information about anal sex; findings from this study can inform public health campaigns targeting youth at risk for STIs.

Trajectories of multiple adolescent health risk behaviors in a low-income African American population

This study examined interdependent trajectories of sexual risk, substance use, and conduct problems among 12- to 18-year-old African American youths who were followed annually as part of the Mobile Youth Study. We used growth mixture modeling to model the development of these three outcomes in the 1,406 participants who met the inclusion criteria. Results indicate that there were four distinct classes: normative, low risk (74.3% of sample); increasing high-risk takers (11.9%); adolescent-limited conduct problems and drug risk with high risky sex (8.0%); and early experimenters (5.8%) The higher risk classes had higher rates of pregnancy and sexually transmitted infections diagnoses than the normative sample at each of the ages we examined. Differing somewhat from our hypothesis, all of the nonnormative classes exhibited high sexual risk behavior. Although prevention efforts should be focused on addressing all three risk behaviors, the high rate of risky sexual behavior in the 25% of the sample that fall into the three nonnormative classes underscores an urgent need for improved sex education, including teen pregnancy and HIV/sexually transmitted infections prevention, in this community.

Exploration of gender differences of Chlamydia trachomatis infection amongst young people reveals limitations of using sexual histories to assess risk in high-prevalence areas

Summary

In England, chlamydia positivity in young men occurs at a slightly older age group (20–24 years) than positivity among young women (16–20 years) but total rates of infection among the population aged under 25 years are similar. Where there is variation, explanations often focus on individual sexual risk behaviours. We aimed to explore the extent to which variations in chlamydia positivity could be explained by reasons for attendance and sexual behaviour at a sexual health clinic in a high-prevalence area of England. Data routinely collected during clinic appointments were extracted retrospectively from the medical records of 952 clinic users (634 women) aged 16 to 24. We tested for associations with chlamydia positivity using the Chi square statistic and multiple logistic regression for men and women separately; 19.5% of men tested positive (95% CI: 15.1–23.8) compared to 11.5% of women (95% CI: 9.0–14.0). Reporting a partner with symptoms or a sexually transmitted infection diagnosis was significantly associated with a positive diagnosis (Men OR: 3.14, 95% CI: 1.5–6.25; Women OR: 3.78, 95% CI: 1.83–7.83). All other reasons for attendance and all sexual behaviour variables were not significantly associated with a positive diagnosis. Differences in chlamydia positivity between men and women attending this service cannot be explained by individual sexual behaviours found to be associated with higher risk of infection in national studies. Our findings question the utility of individual behavioural data routinely collected during clinic appointments for predicting risk of sexually transmitted infections in high-prevalence areas.

It takes 2: partner attributes associated with sexually transmitted infections among adolescents

OBJECTIVES

The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention.

DESIGN

The design of this study was systematic review.

METHODS

We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded.

RESULTS

Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI.

CONCLUSIONS

Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.

Behavioral and sociodemographic risk factors for serological and DNA evidence of HPV6, 11, 16, 18 infections

INTRODUCTION

Risk for HPV6/11/16/18 infections in young sexually active, behaviorally low-risk females is not well described and may inform public policy.

METHODS

To assess exposure risk for HPV/6/11/16/18 among 16-23 year old low-risk females, data for 2409 female clinical trial participants were evaluated. Baseline visit self-reported sexual, behavioral and demographic characteristics; and results from HPV genotyping and serology, and other clinical laboratory assays were analyzed. All subjects reported <5 lifetime male sexual partners and no prior abnormal cytology at baseline.

RESULTS

While 98% (2211/2255) were naïve to HPV16 or 18 and 99.6% (2246/2255) were naïve for 1-3 index HPVs, 27% (616/2255) showed antibody, DNA or both for ≥1 index HPV. While 18% (409/2255) tested HPV16- or -18-antibody- or -DNA-positive, only 2% (44/2255) tested positive for both types. Against this high background, other sexually transmitted infections (STIs) were uncommonly detected, suggesting low sexual risk-taking behavior. The adjusted analyses showed race, age, alcohol consumption, current Chlamydia trachomatis (chlamydia) and Trichamonas vaginalis (trichomoniasis), bacterial vaginosis (BV), number of lifetime male sex partners predicted positive index-HPV antibody test results. However, only the number of male sex partners predicted positivity for HPV6/11- and 16/18-DNA, and chlamydia infection predicted positivity for HPV6/11-DNA alone.

CONCLUSIONS

Taken together, type-specific HPV-DNA and -antibody evidence of HPV6/11/16/18 infections among behaviorally low-risk 16-23 year old females is high. Since almost all participants would have benefited by either currently available bivalent or quadrivalent vaccine strategies, delaying vaccination beyond menarche may be a missed opportunity to fully protect young females against HPV6/11/16/18 infections and related dysplasias. Early diagnosis and treatment of chlamydia and trichomonas may be important in HPV pathogenesis.

HIV prevention among African American youth: how well have evidence-based interventions addressed key theoretical constructs?

Certain constructs are demonstrated in the research literature to be related to HIV risk behaviors among African American adolescents. This study examines how well these constructs are addressed in evidence-based interventions (EBIs) developed for this population. A literature review on variables for sexual risk behaviors among African American adolescents was undertaken. Simultaneously, a review was conducted of the contents of HIV-prevention EBIs. To facilitate comparison, findings from both were organized into constructs from prominent behavior change theories. Analysis showed that environmental conditions and perceived norms were frequently associated with sexual risk behaviors in the literature, while EBIs devoted considerable time to knowledge, skills, and self-efficacy. Findings imply that (a) EBIs might be complemented with activities that focus on important constructs identified in the literature and (b) researchers should better assess the relationship between skill development and HIV risk behaviors. Implications for practice and research are discussed.

Chlamydia trachomatis Infection in minority adolescent women: a public health challenge

Chlamydia trachomatis is the most common bacterial sexually transmitted infection in the United States. This disease disproportionately affects adolescent minority women, and untreated infection can lead to lasting reproductive tract morbidity. Recommendations for primary prevention include patient counseling to decrease risky behavior and increase barrier protection use; secondary prevention recommendations include screening and treatment of affected individuals and their sexual partners, barrier contraception use, as well as counseling to decrease behaviors that lead to reinfection. Despite these strategies, both incidence and prevalence of Chlamydia have continued to escalate in this population. Interventions to decrease chlamydial infection should encompass all facets of primary and secondary prevention as well as address the fundamental barrier to prevention-lack of perception of risk in this young age group.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this educational activity, the obstetrician/gynecologist should be better able to identify current screening guidelines to test for chlamydial infection in sexually active adolescents; obtain more thorough sexual histories, and understand dynamics of disproportionate disease burden in minority teens; recognize and act to decrease the high risk of reinfection in this patient population; and employ novel methods to increase STI screening.

Neighborhood environment, sexual risk behaviors and acquisition of sexually transmitted infections among adolescents diagnosed with psychological disorders

The association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.

Especially for daughters: parent education to address alcohol and sex-related risk taking among urban young adolescent girls

This study evaluates the Especially for Daughters intervention, which aims to provide urban Black and Latino parents with information and skills to support their daughters in delaying sexual initiation and alcohol use. In a randomized field trial, 268 families with sixth-graders were recruited from New York City public schools and assigned either to the intervention, a set of audio CDs mailed home; an attention-controlled condition (print materials); or controls. Girls completed classroom baseline and three follow-up surveys, and telephone surveys were conducted with parents. At follow-up, girls in the intervention reported fewer sexual risks (adjusted odds ratio [AOR] = 0.39, confidence interval [CI] = 0.17-0.88) and less drinking (AOR = 0.38, CI = 0.15-0.97, p < .05). Their parents reported greater self-efficacy to address alcohol and sex and more communication on these topics. This gender-specific parent education program was for communities with high rates of HIV, where early sexual onset is common and often fueled by alcohol.

Prevalence and correlates of Trichomonas vaginalis among incarcerated persons assessed using a highly sensitive molecular assay

We describe the epidemiology of Trichomonas vaginalis (TV) among San Francisco County Jail inmates using APTIMA TV analyte-specific reagents on remnant urine. We detected TV in 15/713 (2.1%) men and 95/297 (32.0%) women. Among women, increased age was significantly associated with TV. The benefits of TV screening should be determined.

Character as a predictor of reproductive health outcomes for youth: a systematic review

To review research examining the influence of character on adolescent sexual and reproductive health (ASRH). We defined character as comprising two positive youth development constructs: prosocial norms and spirituality. We conducted a systematic review of behavioral research published from 1985 through 2007 that examined the association between two character constructs (prosocial norms and spirituality) and ASRH outcomes. We coded results as showing a protective association, risk association, or no association, and as longitudinal, or cross-sectional. We considered consistent associations from at least two longitudinal studies for a given outcome to be sufficient evidence for a protective or risk association. There is sufficient evidence to indicate that prosocial norms and spirituality can be protective factors for some ASRH outcomes including intention to have sex, early sex or ever having sex, contraceptive and condom use, frequency of sex, and pregnancy. The generalizability of findings by age, race/ethnicity, and gender was unclear. Findings suggest that some character sub-constructs are associated with a reduced likelihood of several adverse ASRH outcomes and with an increased likelihood of using contraceptives and intending to use condoms. Further research is needed to better understand mixed results and results showing some character sub-constructs, such as religious affiliation, to be associated with adverse ASRH outcomes.

Condoms and AIDS: Is the Pope Right or Just “Horrifically Ignorant”?

Pope Benedict XVI's assertion that the distribution of condoms cannot overcome the AIDS epidemic in sub-Saharan Africa and that condoms may even worsen the problem was met with widespread ridicule and condemnation. Yet, experts in HIV/AIDS and sexually transmitted diseases (STDs) have published scores of articles documenting condom ineffectiveness in preventing STD transmission. Even with perfect use, condoms fail. The standard of correct and consistent use has always proven to be beyond the capacity of condom users. Numerous studies have shown the tendency of individuals to take greater risks (more partners, less careful partner selection, etc.) when they think they are protected, for example, by condoms or antiretroviral drugs. Repeated exposures to STDs over time produce a cumulative risk that virtually guarantees transmission. Most HIV/AIDS experts today concur that behavioral changes (principally abstinence and monogamy), not condoms, are key to reducing incidence.

Association between provision of initial family planning services and unintended pregnancy among women attending an STD clinic

BACKGROUND

Most sexually transmitted disease (STD) clinics focus solely on STD treatment and prevention. However, women seeking care are also at high risk for unintended pregnancy. We sought to examine the relationship between baseline demographic and clinical characteristics and incident pregnancy among women provided initial contraceptive services in an STD clinic.

METHODS

Computerized record review of women attending an STD clinic who initiated contraception, were seen at least twice within a 4-year period (repeat attendees), and indicated no intention of pregnancy were included in these analyses. Associations between baseline demographic, behavioral, and clinical characteristics and incident pregnancy were assessed using multivariate logistic regression.

RESULTS

Among 4617 women seen from 2003 to 2006, 710 (15%) were repeat attendees and 3907 (85%) were single attendees (seen only during a single year). Among the repeat attendees, 642 (90%) indicated no interest in pregnancy, of whom 124 (19%) had a subsequent pregnancy. Using multivariate analysis and controlling for age and race/ethnicity, incident pregnancy was associated with previous pregnancy (OR 2.57, 95% CI 1.63-4.04), <or=150% federal poverty level (OR 2.22, 95% CI 1.05-4.71), and no contraceptive use at last sex (OR 1.67, 95% CI: 1.11-2.52). Incident pregnancy was not associated with educational level, sexual frequency, age of first pregnancy, number of partners, prior therapeutic abortion, or provision of effective contraception at the initial STD clinic visit.

CONCLUSIONS

Certain baseline characteristics identified a subset of women seen in an STD clinic that were associated with future unintended pregnancy. Targeted interventions addressing these factors are needed.

Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States

OBJECTIVE

Most young women initiate sexual activity during adolescence; risk for sexually transmitted infections (STIs) accompanies this initiation. In this study we estimated the prevalence of the most common STIs among a representative sample of female adolescents in the United States.

METHODS

Data were analyzed from 838 females who were aged 14 to 19 and participating in the nationally representative National Health and Nutrition Examination Survey 2003-2004. After interview and examination, survey participants provided biological specimens for laboratory testing. The main outcome was weighted prevalence of at least 1 of 5 STIs: Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and human papillomavirus (HPV) (any of 23 high-risk types or type 6 or 11).

RESULTS

Prevalence of any of the 5 STIs was 24.1% among all and 37.7% among sexually experienced female adolescents. HPV (23 high-risk types or type 6 or 11) was the most common STI among all female adolescents (prevalence: 18.3%), followed by C trachomatis infection (prevalence: 3.9%). Prevalence of any of the STIs was 25.6% among those whose age was the same or 1 year greater than their age at sexual initiation and 19.7% among those who reported only 1 lifetime sex partner.

CONCLUSIONS

The prevalence of STIs among female adolescents is substantial, and STIs begin to be acquired soon after sexual initiation and with few sex partners. These findings support early and comprehensive sex education, routine HPV vaccination at the age of 11 to 12 years, and C trachomatis screening of sexually active female adolescents.

Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature

Determining the magnitude of chlamydia and gonorrhea reinfection is critical to inform evidence-based clinical practice guidelines related to retesting after treatment. PubMed was used to identify peer-reviewed English language studies published in the past 30 years that estimated reinfection rates among females treated for chlamydia or gonorrhea. Included in this analysis were original studies conducted in the United States and other industrialized countries that reported data on chlamydia or gonorrhea reinfection in females. Studies were stratified into 3 tiers based on study design. Reinfection rates were examined in relation to the organism, study design, length of follow-up, and population characteristics. Of the 47 studies included, 16 were active cohort (Tier 1), 15 passive cohort (Tier 2), and 16 disease registry (Tier 3) studies. The overall median proportion of females reinfected with chlamydia was 13.9% (n = 38 studies). Modeled chlamydia reinfection within 12 months demonstrated peak rates of 19% to 20% at 8 to 10 months. The overall median proportion of females reinfected with gonorrhea was 11.7% (n = 17 studies). Younger age was associated with higher rates of both chlamydia and gonorrhea reinfection. High rates of reinfection with chlamydia and gonorrhea among females, along with practical considerations, warrant retesting 3 to 6 months after treatment of the initial infection. Further research should investigate effective interventions to reduce reinfection and to increase retesting.

Current issues and considerations regarding trichomoniasis and human immunodeficiency virus in African-Americans

Trichomonas vaginalis has long been recognized as one of the most prevalent sexually transmitted infections. However, it is only in recent years that it has been appreciated that Trichomonas may play a critical role in amplifying human immunodeficiency virus (HIV) transmission. Given the evidence that T. vaginalis likely promotes HIV infection, the apparent high level of Trichomonas infection in the African-American community is cause for concern. Even if T. vaginalis increases the risk of HIV transmission by a small or modest amount, it translates into a sizable population effect since Trichomonas is so common in this community. Therefore, control of trichomoniasis may represent an important avenue of control for the prevention of HIV transmission, particularly among African-Americans.

Efficacy of partner notification for Chlamydia trachomatis among young adults in youth health centres in Uppsala County, Sweden

BACKGROUND

The study was conducted to define the contact-tracing success rate of the partner notification services routinely provided by the community-based youth health centres and the county medical officer for communicable disease control (CMO) in Uppsala County, Sweden.

OBJECTIVE

The study had three goals, (i) to register the number of sexual partners routinely reported by each diagnosed index case with CT and the success rate in tracing and testing these partners for CT infection. (ii) To analyse the current notification practices in reporting the number of cases of unsuccessful contact tracing to the CMO. (iii) To determine the contact tracing success rate of the partner notification services provided by the CMO.

METHODS

Each diagnosed case of CT is obliged by law to participate in the contact-tracing procedure performed by the physician managing the patient or by a specialised sexually transmitted infection (STI) adviser. Successful contact-tracing is defined as the confirmed attendance of a sexual contact within 12 months of the contact with the index case.

RESULTS

The number of CT cases diagnosed by the youth health centres during the study period was 463 (299 females and 164 males). The females reported 660 male sexual contacts and the males reported 386 female contacts. Successful partner notification was achieved for 73% of all sexual contacts. 284 (190 females and 94 males) unsuccessful partner notifications were reported to the CMO of whom 98 (52%) of the female contacts and 20 (21%) of the male contacts were successfully notified by the CMO. However, for 134 (71 females and 63 males) partners, personal details given by the index case were insufficient for identification of the partner.

CONCLUSIONS

When asymptomatic, genital CT infection spreads among sexually active young adults with multiple, unidentified sexual partners, appropriate methods of partner notification are not sufficient to achieve its aims at the population level.

Risk factors for incident herpes simplex type 2 virus infection among women attending a sexually transmitted disease clinic

OBJECTIVES

To estimate the incidence of herpes simplex type 2 virus (HSV-2) infection, to identify risk factors for its acquisition, and to assess the protective effect of condoms.

STUDY DESIGN

Prospective study of 293 HSV-2 seronegative women, aged 18 to 35 years, attending a sexually transmitted disease clinic in Alabama from 1992 to 1995.

RESULTS

Incidence of HSV-2 infection was 20.5 per 100 woman-years [95% confidence interval (CI), 13.1-30.5]. Young women (18-20 years) had a significantly higher risk of incident HSV-2 infection [adjusted hazard ratio (HR), 2.8; 95% CI, 1.3-6.4] than older women. Women diagnosed with prevalent or incident bacterial vaginosis had a higher incidence of HSV-2 infection than those who were not so diagnosed (adjusted HR, 2.4; 95% CI, 1.1-5.6). No significant protective effect was observed for consistent (100%) condom use without breakage and slippage against HSV-2 acquisition (adjusted HR, 0.8; 95% CI, 0.2-2.3).

CONCLUSION

Acquisition of HSV-2 infection among study participants was higher than previous estimates for adult female sexually transmitted disease clinic attendees, and no protective effect for condoms was demonstrated. The high incidence of HSV-2 infection with its potential for adverse health consequences emphasizes the need for better prevention strategies.

Temporal associations with declining Trichomonas vaginalis diagnosis rates among women in the state of Victoria, Australia, 1947 to 2005

BACKGROUND

To investigate the temporal associations between Trichomonas vaginalis (TV) diagnoses in women at a large urban sexual health clinic and a major Papanicolaou (Pap) smear screening laboratory in Victoria, Australia with Pap smear screening rates and the introduction of nitroimidazole treatments.

METHODS

An ecological analysis of TV diagnosis rates at the Melbourne Sexual Health Centre and the Victorian Cytology Service, Pap smear screening rates and nitroimidazole prescription data.

RESULTS

Diagnoses of TV at the Melbourne Sexual Health Centre peaked in the 1950s at 20% to 30% and then rapidly declined through the 1960s and 1970s to below 1% in 1990. A similar pattern was observed at the Victorian Cytology Service. Metronidazole prescribing and opportunistic Pap smear screening began in Victoria in the 1960s coinciding with declining TV. The availability of tinidazole in 1976 led to further declines in TV in the late 1970s. A national cervical screening program introduced in 1991 was temporally associated with further declines in TV.

CONCLUSIONS

Our analyses suggest that the introduction of metronidazole was associated with a large reduction in TV among Victorian women in the 1960s. The subsequent availability of tinidazole and increased Pap smear screening may have contributed to the current low TV prevalence in Victoria.

Partner age difference and prevalence of chlamydial infection among young adult women

OBJECTIVES

Sexual partner mixing by age is common among adolescents and adults. Although adolescent girls with older male partners are at increased risk of sexually transmitted infection, the importance of this association in young adults is unclear.

GOAL

To assess the association between partner age difference and prevalence of chlamydial infection among young women.

STUDY DESIGN

Using Wave III of the National Longitudinal Study of Adolescent Health (April 2, 2001-May 9, 2002), the authors examined the relation between the prevalence of chlamydial infection and the partner age among women aged 18 to 26 years.

RESULTS

Among women with most recent partners 2 to 8 years younger, the odds of chlamydial infection were approximately 2 times greater [adjusted odds ratio (OR), 1.8; 95% confidence interval (CI), 0.9, 3.5] than among women with partners within 1-year age difference, adjusting for number of partners in the past year. Prevalence of chlamydial infection was only slightly greater for women with partners 2 to 5 years older (adjusted OR, 1.4; 95% CI, 0.9, 2.3) and partners 6 or more years older (adjusted OR, 1.6; 95% CI, 0.9, 2.8), when compared with women with partners within 1-year age difference. The relation between most discordant partner age difference and chlamydial infection seems to vary by women's race/ethnicity, although these stratified estimates are imprecise.

CONCLUSIONS

These findings suggest that among young adult women, in contrast to adolescents, older male partners are only moderately associated with the prevalence of chlamydial infection. Young adult women have the lowest odds of infection with partners within 1 year of age difference.

Mapping the core: chlamydia and gonorrhea infections in Calgary, Alberta

OBJECTIVES

To examine the spatial patterning of the individuals with gonorrhea or chlamydia infection in the Calgary Health Region (CHR) to target prevention and control activities.

METHODS

A Geographic Information System was used to map the prevalence rates of gonorrhea and chlamydia infection in the CHR to 2001 Census Tracts in the CHR. Data from the 2001 Canadian Census were used to describe the socioeconomic status (SES) of these areas.

RESULTS

Low SES indicators correlated with each other (low median household income, lower education, single mothers) as did high SES indicators (married, owning a dwelling, high median income, university education). A correlation was detected between areas of low SES and areas of high prevalence rates for gonorrhea and for chlamydia. These areas clustered primarily downtown and in the northeast part of the city.

CONCLUSIONS

Nodes and corridors of activity in Calgary were detected in correlation studies of the 2001 Census variables used. The core (high prevalence) areas should be the areas targeted for sexually transmitted infection prevention and control. This can be done at the community level through measures such as more sexually transmitted infection clinics operating with longer hours in areas identified from this mapping.

Marijuana use and sexually transmitted infections in young women who were teenage mothers

PURPOSE

Teenage pregnancy and marijuana use are associated with higher risk of contracting sexually transmitted infections (STIs). In this study, we examined the role of early and current marijuana use as it related to STI risk in a sample of young women who were pregnant teenagers, using a variety of statistical models.

METHODS

We recruited 279 pregnant adolescents, ages 12-18, from an urban prenatal clinic as part of a study that was developed to evaluate the long-term effects of prenatal substance exposure. Six years later, they were asked about their substance use and sexual history. The association of early and late marijuana use to lifetime sexual partners and STIs was examined, and then structural equation modeling (SEM) was used to illustrate the associations among marijuana use, number of sexual partners, and STIs.

RESULTS

Bivariate analyses revealed a dose-response effect of early and current marijuana use on STIs in young adulthood. Early and current marijuana use also predicted a higher number of lifetime sexual partners. However, the effect of early marijuana use on STIs was mediated by lifetime number of sexual partners in the SEM, whereas African-American race, more externalizing problems, and a greater number of sexual partners were directly related to more STIs.

CONCLUSIONS

Adolescent pregnancy, early marijuana use, mental health problems, and African-American race were significant risk factors for STIs in young adult women who had become mothers during adolescence. Pregnant teenage girls should be screened for early drug use and mental health problems, because they may benefit the most from the implementation of STI screening and skill-based prevention programs.

Molecular epidemiology of genital chlamydial infection among male patients attending an STD clinic in Taipei, Taiwan

OBJECTIVE

To assess the epidemiology of genital Chlamydia trachomatis infection among men attending an STD clinic in Taipei, Taiwan.

STUDY

Between July 2004 and June 2005, a total of 426 first-void urine specimens from male patients were tested for C. trachomatis by using a urine-based PCR DNA amplification assay.

RESULTS

The overall prevalence of genital C. trachomatis infection was 16.4%. Youth, current symptoms, the presence of N. gonorrhoeae infection, and inconsistent use of condoms were positively associated with C. trachomatis infection. The most common chlamydia strain present was genotype E, followed by D and Da, F, K, J, G, and H.

CONCLUSIONS

C. trachomatis genital infection was prevalent among male patients attending a STD clinic in Taipei. Young Taiwanese men attending STD clinics should be counselled on condom use.

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 <or= 30 years; adjusted odds ratio (AOR)=2.37, 95% confidence interval (CI)=1.31-4.34), inconsistent use of condoms (AOR=2.10, 95% CI=1.21-3.54), and being symptomatic at the time of testing (dysuria, urethral discharge, painful urination, urethral irritation/itching; AOR=2.05, 95% CI=1.16-3.40) were shown to be risk factors for C. trachomatis infection.

CONCLUSIONS

The prevalence of untreated asymptomatic chlamydial infection is high in young adults in Taipei. Young Taiwanese men attending STD clinics should be screened routinely for chlamydial infection.

Social capital and rates of gonorrhea and syphilis in the United States: Spatial regression analyses of state-level associations

We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15-34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs.

School-Based Screening for Chlamydia Trachomatis and Neisseria Gonorrhoeae Among Philadelphia Public High School Students

CONTEXT

The prevalence of sexually transmitted diseases among adolescents is high. Innovative screening and treatment programs need evaluation.

OBJECTIVES

The objectives of this study were to identify, treat, and describe the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections among Philadelphia public high school students.

DESIGN

We analyzed cross-sectional data from the first year of an annual program offering education, screening, and treatment for CT and GC. For the school year analyzed, screening took place between January 2003 and June 2003.

RESULTS

In the first year, 19,394 students aged 12-20 years were voluntarily tested; 1,052 students were identified with GC, CT, or both; 1,051 received treatment. Prevalence of CT among females (95% confidence interval [CI] = 8.1) was 3.3 times higher than among males (95% CI = 2.5%). Attending disciplinary schools and residing in high reported morbidity areas were also related to higher prevalence of CT and GC.

CONCLUSIONS

A high prevalence of CT infections was identified among Philadelphia public high school students. This program demonstrated the effectiveness of a school-based screening program to identify and treat these infections.

Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary

The sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and reinforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.

Incidence and Prevalence of Herpes Simplex Virus Infections in Adolescent Women

OBJECTIVES

We conducted this study to examine the incidence, prevalence, and risk factors for herpes simplex virus (HSV) 1 and HSV 2 infection in a cohort of young women who were closely followed for acquisition of sexually transmitted infections.

STUDY DESIGN

Women between the ages of 14 and 18 years had blood and genital specimens obtained quarterly to test for incident sexually transmitted infections. Subjects also had 2 12-week periods each year when they kept a detailed behavioral diary and performed weekly vaginal swabs. Serum specimens were tested for HSV 1 and HSV 2 antibody, and genital specimens were tested for HSV DNA by PCR.

RESULTS

A total of 100 subjects enrolled and had at least 2 sera that could be analyzed for seroconversion. The mean age of the subjects was 15.8 years at entry. The HSV 1 and HSV 2 seroprevalence at entry was 59.6% and 13.5%, respectively. During the study, 4 subjects acquired HSV 1 antibody and 7 acquired HSV 2 antibody, but there were no cases of symptomatic HSV infection identified. The annualized incidence among susceptible individuals was 8.9% for HSV 1 and 7.4% for HSV 2. Three of the 7 HSV 2 sero-converters had HSV 2 DNA detected in vaginal swabs. Age, duration of sexual activity, and the presence of other sexually transmitted infections were predictors of HSV 2 antibody positivity.

CONCLUSIONS

Acquisition of HSV 1 and HSV 2 is relatively common in adolescent women, although symptomatic infection is uncommon. HSV 2 is shed in the genital tract despite the lack of symptoms.

New sexual partners and readiness to seek screening for chlamydia and gonorrhoea: predictors among minority young women

OBJECTIVES

To determine (1) level of readiness and (2) demographic and behavioural predictors of readiness to seek chlamydia (CT) and gonorrhoea (NGC) screening in the absence of symptoms after sex with a "new" partner.

METHODS

Baseline data, obtained as part of a larger randomised controlled clinical trial in young women, were analysed. Readiness to seek screening for CT and NGC after sex with a "new" partner was assessed using the stages of change framework from the transtheoretical model of change-precontemplation, contemplation, preparation, and action. Ordinal logistic regression, using the proportional odds model, was used to determine predictors of being in action for or having already been screened for CT and NGC after sex with a "new" partner.

RESULTS

The sample consisted of 376 predominantly African American (67%) young women (mean age 18.5 (SD 1.4) years). The distribution of readiness to seek CT and NGC screening was 4% precontemplation, 11% contemplation, 28% preparation, and 57% action. The best fitting logistic model that predicted being in action for seeking screening after sex with a "new" partner included high perceived seriousness of acquiring a sexually transmitted infection (OR = 2.02, 95% CI 1.05 to 3.89), and having "other" (not steady) partners in the last 6 months (OR = 0.50, 95% C.I. 0.32 to 0.78)

CONCLUSIONS

Many young women report that they were not getting screened for CT and NGC after sex with a "new" partner and therefore may be at increased risk of an untreated STI. Enhancing level of perceived seriousness of acquiring an STI from a "new" partner may increase a young woman's readiness to seek screening after initiating a new sexual relationship.

The Prevalence of Trichomoniasis in Young Adults in the United States

BACKGROUND AND OBJECTIVES

The prevalence of trichomoniasis in the general population of the United States is unknown. This study provides the first population-based prevalence estimates of trichomoniasis among young adults in the United States.

METHODS

The National Longitudinal Study of Adolescent Health (Add Health) is an ongoing prospective cohort study. In a cross-sectional analysis of Wave III of Add Health (N = 12,449), we determined the prevalence of trichomoniasis using a polymerase chain reaction assay.

RESULTS

The estimated overall prevalence of trichomoniasis in U.S. young adults was 2.3% (95% confidence interval [CI], 1.8-2.7%). The prevalence was slightly higher among women (2.8%; 95% CI, 2.2-3.6%) than men (1.7%; 95% CI, 1.3-2.2%). The prevalence increased with age and varied by region, with the south having the highest prevalence (2.8%; 95% CI, 2.2-3.5%). The prevalence was highest among black women (10.5%; 95% CI, 8.3-13.3%) and lowest among white women (1.1%; 95% CI, 0.8-1.6%). Among men, the prevalence was highest among Native Americans (4.1%; 95% CI, 0.4-29.3%) and blacks (3.3%; 95% CI, 2.2-4.9%), and lowest among white men (1.3%; 95% CI, 0.9-1.8%).

CONCLUSIONS

Trichomoniasis is moderately prevalent among the general U.S. population of young adults and disturbingly high among certain racial/ethnic groups.

A programmatic and methodologic review and synthesis of clinic-based risk-reduction interventions for sexually transmitted infections: research and practice implications

The over-arching goal of this article is to systematically review and synthesize empirical findings for sexually transmitted disease risk-reduction programs that were developed and implemented specifically for adolescents seeking health care services at clinical venues. The objective is to examine the reported efficacy of these programs in reducing adolescents' sexually transmitted infection (STI)-associated behavior, in enhancing theoretically and empirically important psychosocial mediators associated with the adoption of STI-preventive behaviors, and, most important, in reducing adolescents' risk of acquiring an STI. In addition, our review assesses program and methodologic characteristics of the studies, determines compliance with standardized reporting guidelines, identifies a subset of program characteristics that are related to efficacy in terms of modifying adolescents' sexual risk behaviors, and examines the research and practice implications of these findings for implementing evidence-based STI risk-reduction programs in clinics.

The epidemiology of sexually transmitted infections in adolescents

This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.

Sexual Behavior and Herpes Simplex Virus 2 Infection in College Students

BACKGROUND

Given the relevance of HSV-2 infection in youth, the aim of this study was to determine the seroprevalence of HSV-2 in college students in Cuernavaca, Mexico, as well as the sociodemographic and sexual behavioral characteristics associated with this infection.

METHODS

A cross-sectional study was carried out using convenience sampling with consenting students of both genders. Students answered a questionnaire and provided a blood sample to detect antibodies to HSV-2 by Western blot. To establish the magnitude of the association between the prevalence of HSV-2 infection and the selected risk factors, we estimated prevalence odds ratios by performing logistic analyses of these results

RESULTS

Overall seroprevalence of HSV-2 was 5.9% (20/340; CI(95%) 3.7-8.9), 7.0% (14/200; CI(95%) 3.9-11.5) for women and 4.3% (6/140; CI(95%) 1.6-9.1) for men. HSV-2 infection was independently associated with female sex (POR=5.3, CI(95%) 1.4-19.7), age (26 years and over, POR=4.7, CI(95%) 1.0-22.2), number of sexual partners over the last year (two or more partners POR=4.1, CI(95%) 1.2-14.2), a history of genital ulcers (POR=6.1, CI(95%) 1.9-19.8), and having been paid for sex (POR=21.4, CI(95%) 1.0-447.5).

CONCLUSIONS

The frequency of HSV-2 infection among these students was lower than in other Mexican populations who have high-risk sexual behavior. However, there was a subgroup of participants identified as having high-risk sexual behavior. These individuals could, therefore, be prone to acquiring and transmitting HSV-2 infection and represent the target group for whom preventive interventions against HSV-2 and other STIs might be developed.

Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics

OBJECTIVE

To assess maturity indices, menstrual patterns, hormonal factors, and risk of adolescent genital tract infections.

METHODS

Cross sectional study in three genitourinary medicine clinics. Females 17 years or less, within 5 years of menarche, or reporting oligo-amenorrhoea were screened for genital tract infections and menstrual cycle characteristics determined. The outcome measures were risk factors associated with chlamydia, human papillomavirus (HPV DNA) and bacterial vaginosis (BV), separately and pooled. Correlations between estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) hormone concentrations and chlamydia, HPV, and BV.

RESULTS

Among 127 adolescents, HPV was present in 64.4% (95% CI: 54.5 to 74.3), BV in 33.9% (19.1 to 34.5), and chlamydia in 26.8% (19.1 to 34.5). Breast maturity, oligomenorrhoea, and older gynaecological age were associated with lower risk of all infections. After adjustment for calendar age, race, and behavioural factors, gynaecological age remained significant (OR = 0.7, 0.6-0.9; p = 0.008). Behavioural risk factors differed by infection. Smoking was protective for HPV (OR = 0.1, 0.0 to 0.9; p = 0.007), and a recent new partner for chlamydia (OR = 0.3, 0.1 to 0.9; p = 0.024). Sex during menses was associated with increased BV risk (OR = 3.3, 1.5 to 7.2; p = 0.003). Chlamydia was higher among adolescents who used emergency contraception (2.5; 1.1 to 5.9, p = 0.029) and lower among those using condoms at last sex (OR = 0.3, 0.1 to 0.9; p = 0.015). Among 25 adolescents not using hormonal contraceptives, 15 had disturbed or anovulatory cycles. Chlamydia risk was inversely associated with P3G concentrations (Mann-Whitney; p = 0.05).

CONCLUSIONS

Adolescents engaging in high risk behaviour at a young gynaecological age are susceptible to multiple infections. Adolescent clinical assessment should include gynaecological age.

Is There an Association Between Alcohol Consumption and Sexually Transmitted Diseases? A Systematic Review

OBJECTIVE/GOAL

The objective of this study was to conduct a systematic review of published literature on the association between problematic alcohol consumption and sexually transmitted diseases (STDs).

DESIGN

Using a MEDLINE search (1995-2003) and article references, we identified articles that described measures of alcohol consumption and STDs and presented data on their association. For each eligible study, we classified the alcohol consumption measure as specific (problem drinking) or general, and examined study designs, study populations, STD measures, and results.

RESULTS

Of 42 eligible studies, 11 included specific measures of problem drinking, of which 8 found a significant association between alcohol consumption and at least 1 STD. The relationship did not appear to vary according to gender or pattern of alcohol consumption assessed.

CONCLUSIONS

The literature supports an overall association between problematic alcohol consumption and STDs, although their causal relationship cannot be determined with certainty from these observational studies. The findings have implications for prevention planners, clinicians, and individual patients at risk of STDs.