Relation of tubal infertility to history of sexually transmitted diseases

We studied the history of sexually transmitted diseases in 283 nulliparous women diagnosed with infertility due to tubal adhesions or occlusion and 3,833 women admitted for delivery at seven collaborating hospitals. The adjusted risks of tubal infertility associated with the history of each sexually transmitted disease were estimated by the odds ratios obtained by multiple logistic regression. Women who reported prior infection with gonorrhea were at a significantly increased risk of tubal infertility (relative odds = 2.4, 95% confidence interval 1.3-4.4). In addition, the risk of tubal infertility was almost twice as high in women who recalled previous trichomoniasis compared with women with no such infection (relative odds = 1.9, 95% confidence interval 1.3-2.8). Furthermore, there was a trend of increasing risk with an increasing number of episodes of gonorrhea or trichomoniasis.     

Association between cytomegalovirus seroconversion and upper genital tract infection among women attending a sexually transmitted disease clinic: a prospective study

To study relationships between acquisition of cytomegalovirus (CMV), sexual activity, and sexually transmitted diseases, 245 CMV-seronegative women were followed (median, 23 months) in a sexually transmitted disease clinic between 1980 and 1988. Thirty-six (15%) seroconverted (10%-12%/year). At entry, seroconverters were younger (P = .03), were younger at sexual debut (P = .004), and had more sex partners (P = .004) than non-seroconverters. During follow-up, seroconverters had more sex partners, had more new sex partners (P = .05 for each), and were more likely to have gonorrhea, chlamydia, or pelvic inflammatory disease. At seroconversion, Chlamydia trachomatis was isolated from cervix in 14%, versus 3% of non-seroconverters (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.3-14.9). Signs of upper genital tract infection were present in 8% of seroconverters versus 2% of non-seroconverters (OR, 4.7; 95% CI, 1.0-21.8). Acquisition of CMV in these women was associated with sexual activity, sexually transmitted diseases, and signs of upper genital tract infection.     

Sexually transmitted infections among sex workers in KwaZulu-Natal, South Africa

OBJECTIVE: The purpose of this study was to investigate the prevalence of sexually transmitted infections, including human immunodeficiency virus (HIV), among female sex workers operating at truckstops in the KwaZulu-Natal midlands of South Africa. METHODS: A total of 145 sex workers were recruited from August 1996 to March 1997. A gynecologic examination, including a speculum examination, was performed. Investigations were performed to identify gonorrhea, syphilis, chlamydia (infection), candidiasis, trichomoniasis, bacterial vaginosis, and HIV infection. RESULTS: A total of 50.3% of the sex workers were HIV positive. Infection with Trichomonas vaginalis was present in 41.3% of the women, Candida albicans in 40.6%, Neisseria gonorrheae in 14.3%, and Chlamydia trachomatis in 16.4%. Bacterial vaginosis was present in 71% and active syphilis in 42.1% of the women. CONCLUSION: The high prevalence of sexually transmitted infections, including HIV, clearly highlights the urgent need for interventions. In addition to empowering women with methods they can use and control to reduce their risk of infection, an effective approach to control of sexually transmitted infections also needs to recognize the role of the clients, such as truck drivers, so that they also are targeted for interventions.     

The core group revisited: the effect of partner mixing and migration on the spread of gonorrhea, Chlamydia, and HIV

A set of differential equations are used to model the spread of sexually transmitted diseases (STDs) in a one-sex population that includes a core group of highly sexually active subjects. The effects of partner mixing between groups and migration to and from the core on the equilibrium number of infected are shown for gonorrhea, chlamydia, and HIV. The STDs are described by the transmission probability per sexual contact and the duration of infectiousness. Partner change and intercourse frequencies are estimated from sexual survey data on heterosexual behavior. The core group is small (3% of the total population) with a partner change frequency 15 times and an intercourse frequency 2 times that of the remaining population. The degree of partner mixing and migration between the two groups can be varied. The number of sexual contacts in the three types of partnerships (core-core, "mixed," remaining population-remaining population) is also modeled. The mixed partnerships are assumed to be casual and to have a low frequency of intercourse. The model is fairly simple, and the emphasis is on qualitative rather that predictive results. The effects of partner mixing are found to be strikingly different for gonorrhea, chlamydia, and HIV. With increasing partner mixing between groups, gonorrhea shows a small increase and then a decrease in the total number of infected, whereas chlamydial infection shows a strong increase. For HIV infection the effect depends on the transmission probability; when it is 0.001 per sexual contact, the number of infected with HIV is almost unaffected by the partner mixing, and when the transmission probability is 0.002 per sexual contact, there is a strong increase in the number of HIV infected with increasing partner mixing. The effects of migration are also different for each disease. With increasing migration between groups, gonorrhea is almost unaffected in the total number of infected, whereas chlamydial infection shows a strong increase. For HIV the effect again depends on the transmission probability; when it is 0.001 per sexual contact, the number of infected with HIV shows a strong decrease, and when the transmission probability is 0.002 per sexual contact the number of HIV infected reaches its maximum for medium strong migration. A sensitivity analysis shows that for all three diseases the basic reproductive ratios (R0) and the total number of infected are sensitive to duration of infectiousness. In addition, for gonorrhea and chlamydia, RO is sensitive to the partner change rates in the core, whereas for HIV, RO is sensitive to the frequency of intercourse in the core.(ABSTRACT TRUNCATED AT 400 WORDS)     

Risk factors for urethritis in heterosexual men. The role of fellatio and other sexual practices

BACKGROUND: Nonchlamydial nongonococcal urethritis (NGU) is a common sexually transmitted disease (STD) in heterosexual men. Prior studies have suggested that NGU may be acquired by insertive oral sex. GOAL: To assess the association of oral sex and other sexual practices with nonchlamydial NGU in heterosexual men in order to better understand this syndrome and to guide its prevention and treatment. Risk factors for urethral gonorrhea and chlamydial infection were explored to contrast with NGU. STUDY DESIGN: A retrospective case-control study was conducted among heterosexual men attending as STD clinic during 1993 and 1994. The study included 4,848 men who were sexually active within the prior 2 months and had urethral specimens obtained for Gram's stain, culture for Neisseria gonorrhoeae, and culture for Chlamydia trachomatis. RESULTS: Insertive oral sex was not shown to be an independent risk factor for NGU. Independent predictors of nonchlamydial NGU by multivariate analysis included African-American race (odds ratio [OR] 3.71, 95% confidence interval [95% CI] 3.06 to 4.50) and having > or = two sex partners in the prior 2 months (OR 1.45, 95% CI 1.20 to 1.75). History of using condoms "always" was negatively associated with NGU (OR 0.59, 95% CI 0.43 to 0.79), gonorrhea (OR 0.31, 95% CI 0.17 to 0.56), and chlamydial infection (OR 0.67, 95% CI 0.44 to 1.03). CONCLUSIONS: This study supports the sexually transmitted nature of nonchlamydial NGU but did not confirm an association with oral sex. However, the analysis was compromised by the rarity of insertive oral sex as patients' only sexual exposure. Consistent condom use protects against all causes of sexually acquired urethritis.     

What do Norwegians know about sexually transmitted diseases? Results from a survey on Norwegians' knowledge about sexually transmitted diseases

This paper reports on knowledge about sexually transmitted diseases in Norwegian adults. The sample (572 males and 601 females) was representative of Norwegians aged 15 and above. Data were collected by means of personal interviews and self-completed questionnaires. Out of ten respondents, seven did not know that sexually diseases are not transmitted via toilet seats; six that syphilis is not the most prevalent of the sexually transmitted diseases in Norway; five that both males and females can be infected by chlamydia; four that contraceptive pills do not protect against chlamydia infection; three that condoms protect against all sexually transmitted diseases; and two that condoms protect against gonorrhoea and that females infected by sexually transmitted diseases run higher risk of infertility. Knowledge about sexually transmitted diseases was lowest in the youngest and oldest age groups, and increased monotonously with increased education.     

Risk of human immunodeficiency virus infection among pregnant crack cocaine users in a rural community

OBJECTIVE: To investigate why women who use crack cocaine are at increased risk of human immunodeficiency virus (HIV) infection. METHODS: One thousand one hundred fifty-two (99.7%) of 1155 consecutive prenatal patients attending a rural public health clinic were interviewed about drug use and sexual practices and tested for HIV infection and other sexually transmitted diseases. RESULTS: Fifty-one (4.7%) of 1096 pregnant women reported ever using crack cocaine, but only five (10%) of the crack cocaine users had ever injected drugs. Eighteen (35%) of the crack users were HIV infected compared with 22 (2%) of the 1045 women who reported never using crack (odds ratio 25, 95% confidence interval 12-52; P < .001). Crack users were more likely to have had a known HIV-infected sex partner, exchanged sex for money or drugs, and tested positive for syphilis than were non-crack users (for each comparison, P < .001). Before using crack, 18% of crack users had exchanged sex for money or drugs and 8% had averaged three or more sex partners per month; in contrast, after beginning to use crack, 76% of crack users exchanged sex for money or drugs and 63% averaged three or more sex partners per month (for both comparisons, P < .001). Crack users who were not HIV infected were more likely to have almost always used condoms and/or had fewer than three sex partners per month than were HIV-infected crack users (P < .01). CONCLUSION: Women who reported using crack cocaine were at an increased risk of HIV infection because crack use was associated with a significant increase in unprotected sexual contact.     

Sexually transmitted disease acquisition among women infected with human immunodeficiency virus type 1

Recent evidence suggests that sexually transmitted diseases (STDs) enhance the transmission of human immunodeficiency virus (HIV) type 1. In 143 HIV-infected women enrolled in a university-based longitudinal HIV clinic over 16 months (mean), the STD point prevalence was examined at enrollment and the cumulative prevalence was calculated at follow-up. At enrollment, 35 women (25%) had > or = 1 STD. These included trichomoniasis in 16 women (11%); syphilis, 9 (6%); genital herpes, 8 (6%); gonorrhea, 5 (4%); chlamydia, 5 (4%); genital warts, 2 (1%); and pelvic inflammatory disease (PID), 1 (1%). STDs were found in 55 (42%) of the 125 patients who returned for at least one follow-up visit: trichomoniasis in 23 (18%); genital herpes, 20 (12%); gonorrhea, 9 (7%); syphilis, 7 (6%); genital warts, 7 (6%); chlamydia, 5 (4%); and PID, 4 (3%). Despite counseling at both enrollment and follow-up, these women had a very high cumulative prevalence of STDs, indicating persistent high-risk sexual behavior.     

Risk factors for HIV infection in a rural cohort in Zimbabwe: a pilot study

OBJECTIVE: To identify demographic, sexual behavioural and cultural risk factors for human immunodeficiency virus (HIV) infection in a rural community in Zimbabwe. DESIGN: Prospective study. SETTING: Rural area in Zimbabwe. SUBJECTS: 207 subjects (81 males, 126 females) mean age 31.6 years (SD 15.3), range 12 to 76 years living in the area. MAIN OUTCOME MEASURES: HIV seropositivity and seroconversion, exposure or no exposure to risk factor. RESULTS: Prevalence of HIV was 7.7% and was associated with being divorced or widowed [Odds ratio (OR) 4.26, 95% confidence interval (CI) 1.17 to 14.97] and past history of sexually transmitted diseases (STDs) [(OR 3.54, 95% CI 1.31 to 9.89)]. Seroconversion rate was 3.6% per year and was associated with history of STD [Relative Risk (RR) 13.22, 95% CI 1.15 to 156.1)] during the follow up period. Individuals over 20 years of age, those reporting one or more sexual partners, those reporting irregular use of condoms and those scarified were at greater risk than their counterparts. Individuals who reported being circumcised were at slightly lesser risk than those who did not report circumcision. CONCLUSION: STDs were major determinants of HIV transmission in the study area. In addition being divorced or widowed was a risk factor for HIV infection. Scarification, tattooing and circumcision require further investigations.     

Incidence and sexual risk factors of cytomegalovirus seroconversion in HIV-infected subjects. The SEROCO Study Group

BACKGROUND: Data on incidence of cytomegalovirus (CMV) seroconversion in HIV-infected (HIV(+)) subjects was sparse. GOAL: To determine the incidence of CMV seroconversion in sexually active HIV(+) subjects and sexual factors associated with CMV seroconversion. STUDY DESIGN: One hundred eighty four persons not infected by CMV at enrollment in a cohort of HIV(+) persons were studied. A case-control study within the cohort was conducted to determine the effect of sexual behavior in the 6 months prior to CMV seroconversion. Thirty seven cases of CMV seroconversion were compared with 136 controls. RESULTS: The overall incidence of CMV seroconversion was 9.18 per 100 person-years (95% confidence interval (CI), 6.67-12.28) and was particularly high among homosexual men. After adjustment for age, socio-professional category, sexual orientation, and casual sex, the risk of CMV seroconversion was higher in subjects who never used condoms than in those who used them systematically (adjusted odds ratio (OR) 3.37;95% CI, 1.05-11.00). CONCLUSIONS: In addition to the need to protect their sexual partners from HIV infection, HIV(+) subjects free of CMV infection should use condoms to avoid CMV infection and its complications.     

Facilitating condom use with clients during commercial sex in Nevada's legal brothels

OBJECTIVES: This study examined condom use in legal Nevada brothels. METHODS: Forty female prostitutes in two brothels were interviewed about client resistance to condoms and techniques for facilitating condom use. RESULTS: Of 3290 clients in the previous month, 2.7% (95% confidence interval [CI] = 2.2%,3.4%) were reluctant to use condoms. Of these individuals, 72% ultimately used condoms, while 12% chose nonpenetrative sex without condoms. The remaining 16% left the brothels without services. Condom use rates were markedly lower with nonpaying sex partners (lowers) than with clients. CONCLUSIONS: Brothel prostitutes may be at greater risk for acquiring HIV and other sexually transmitted diseases from lovers than from clients.     

Human immunodeficiency virus seropositivity in adolescents with syphilis

OBJECTIVE: The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection among inner-city, minority group adolescents. METHODS: From August 1989 through June 1990, serum from all positive serologic tests for syphilis, obtained from patients attending a comprehensive adolescent health center in an acquired immunodeficiency syndrome epicenter and its two school-based clinics, were frozen without patient identifiers and were subsequently screened for HIV by enzyme-linked immunosorbent assay with confirmatory Western blot for positives. In addition, a retrospective chart review was performed for all patients with a positive serologic test for syphilis during the study period. RESULTS: Of the 59 specimens with a positive syphilis serologic test, 9 (15.3%) were HIV seropositive. Of the patients with syphilis, 57.4% were black and 42.6% were Hispanic; 16.4% were male (mean age 18.1) and 83.6% were female (mean age 17.8). Only 1 subject (female) was an injection drug user; 4 of the male subjects self-identified as having had sex with other males. Of the subjects, 27.8% had primary, 19.7% had secondary, and 52.5% had latent syphilis at the time of diagnosis. A prior or concurrent sexually transmitted disease was present in 90% of the males and 80% of the females; gonorrhea was the most prevalent sexually transmitted disease in the males (89%) and chlamydia was most prevalent in the females (35%). A history of chancroid and/or herpes was present in 16.4% of the subjects. CONCLUSIONS: It is concluded that the diagnosis of syphilis in an adolescent is a risk factor for HIV infection. All sexually active adolescents should be routinely screened for syphilis, regardless of sexual practices. Those with syphilis should be specifically counseled about their increased risk for HIV infection and the importance of consistent condom use, and they should be referred for formal HIV pretest counseling.     

Antiretroviral treatment of men infected with human immunodeficiency virus type 1 reduces the incidence of heterosexual transmission. Italian Study Group on HIV Heterosexual Transmission

OBJECTIVE: To determine the incidence of heterosexual human immunodeficiency virus type 1 disease transmission and the effect of zidovudine therapy on this risk of transmission. DESIGN: A cohort of 436 monogamous seronegative female sexual partners of human immunodeficiency virus type 1-infected males was followed up for 740 person-years with regular structured interviews and laboratory tests. PATIENTS: At enrollment of the women, 50% of their infected partners had one or more signs of disease progression (symptoms of acquired immunodeficiency syndrome, p24 antigen positivity, or CD4+ cell counts lower than 0.4 x 10(9)/L) and 15% were treated with zidovudine. MAIN OUTCOME MEASURE: Incidence rates of seroconversion were calculated and relative risks were estimated as incidence rate ratios. RESULTS: Twenty-seven women seroconverted during follow-up, and the incidence of seroconversion was 3.7 per 100 person-years. Seroconversion was about six times more frequent (relative risk, 5.8; 95% confidence interval, 2.2 to 15.3) in couples not using condoms. Men with signs of disease progression transmitted infection to their partners more frequently and were more frequently treated with zidovudine. When the risk of transmission was estimated accounting for disease progression, the rate of transmission in zidovudine-treated men was lower than in untreated men (relative risk, 0.5; 95% confidence interval, 0.1 to 0.9). CONCLUSION: Treatment of human immunodeficiency virus type-1 infected men with zidovudine reduces, but does not eliminate, heterosexual transmission of infection. Behavioral counseling that encourages sexual practices with a lower risk of transmission remains the most important method of prevention.     

Compliance in a screening program for neuroblastoma

OBJECTIVES: Whether or not spermicides can reduce the risk of human immunodeficiency virus (HIV) transmission remains an important question for the control of heterosexual HIV transmission. The authors provide estimates from a reanalysis of one of the few observational studies on the efficacy of condoms and spermicides, used separately and together, per vaginal contact. METHODS: In this reanalysis, three different models were used to assess the efficacy of spermicides and condoms: linear (Pearl index), exponential (maximum likelihood), and monotonic (marginal likelihood). RESULTS: Reported use of barrier methods among 27,432 contacts was as follows: condoms plus nonoxynol-9, 39%; condoms alone, 25%; nonoxynol-9 alone, 24%; and unprotected, 11%. Under all three models, the results indicate a strong protective effect for spermicidal suppositories. The Pearl index indicated that spermicide alone is apparently efficacious, but the efficacy per contact cannot be quantified with this approach. Maximum likelihood estimates for the efficacy of nonoxynol-9 alone and condoms (with or without nonoxynol-9) were 100% (95% confidence interval [CI95] = 43%, 100%) and 92% (95% CI95 = 79%, 100%), respectively. CONCLUSIONS: The data from this observational study suggest that spermicides may be efficacious in reducing the risk of HIV transmission.     

Neuropathology in the neurosciences. A system in transition

BACKGROUND: Despite the use of warfarin, major systemic embolism remains an important complication in patients with heart-valve replacement. Although the addition of antiplatelet agents has the potential to reduce this complication, their efficacy and safety when given in combination with warfarin are uncertain. METHODS: In a randomized, double-blind, placebo-controlled trial, we assessed the efficacy and safety of adding aspirin (100 mg per day) to warfarin treatment (target international normalized ratio, 3.0 to 4.5) in 370 patients with mechanical heart valves or with tissue valves plus atrial fibrillation or a history of thromboembolism. RESULTS: A total of 186 patients were randomly assigned to aspirin and 184 to placebo, and they were followed for up to 4 years (average, 2.5). Major systemic embolism or death from vascular causes occurred in 6 aspirin-treated patients (1.9 percent per year) and 24 placebo-treated patients (8.5 percent per year) (risk reduction with aspirin, 77 percent; 95 percent confidence interval, 44 to 91 percent; P < 0.001). Major systemic embolism, nonfatal intracranial hemorrhage, or death from hemorrhage or vascular causes occurred in 12 patients assigned to aspirin (3.9 percent per year) and 28 patients assigned to placebo (9.9 percent per year) (risk reduction, 61 per cent; 95 percent confidence interval, 24 to 80 percent; P = 0.005); major systemic embolism or death from any cause occurred in 13 patients (4.2 percent) and 33 patients (11.7 percent), respectively (risk reduction, 65 percent; 95 percent confidence interval, 33 to 82 percent; P < 0.001); and death from all causes occurred in 9 patients (2.8 percent) and 22 patients (7.4 percent), respectively (risk reduction, 63 percent; 95 percent confidence interval, 19 to 83 percent; P = 0.01). Bleeding occurred in 71 patients in the aspirin group (35.0 percent), as compared with 49 patients in the placebo group (22.0 percent) (increase in risk, 55 percent; 95 percent confidence interval, 8 to 124 percent; P = 0.02); major bleeding occurred in 24 and 19 patients, respectively (increase in risk, 27 percent; 95 percent confidence interval, -30 to 132 percent; P = 0.43). CONCLUSIONS: In patients with mechanical heart valves and high-risk patients with prosthetic tissue valves, the addition of aspirin to warfarin therapy reduced mortality, particularly mortality from vascular causes, together with major systemic embolism. Although there was some increase in bleeding, the risk of the combined treatment was more than offset by the considerable benefit.     

Changes in attitude, sexual behaviour and the risk of HIV/AIDS transmission in southwest Nigeria

This pilot study was carried out in southwest Nigeria to determine the current trends in sexual behaviours known to be associated with HIV transmission in Nigeria. Knowledge of AIDS in general and as an incurable disease was high (91.4% and 79.4% respectively). Knowledge of the means of AIDS transmission was also very high among both men and women. Overall, condom use was consistent at 25%, inconsistent at 55% and non-existent at 20% for all sexually active respondents. Over 60 per cent of sexually active respondents had two or more sexual partners, with significantly more males than females having this number of sexual partners (p < 0.01). Eighteen per cent of sexually active respondents had a history of sex with commercial sex workers while 25% had a history of at least one sexually transmitted disease. Using multiple logistic regression, the significant determinants of condom use among the sexually active group were: being in a stable sexual relationship, history of sex with commercial sex workers, self-perception of testing positive for HIV and self-perception of HIV/AIDS risk in Nigeria. Prevalence of condom use in this study was much higher than those reported in previous studies, suggesting a probable decline in high risk sexual behaviours among inhabitants of urban Southwest Nigeria since the advent of AIDS. Most sexually active respondents aged 19 years or below (adolescents) who perceived themselves at a high risk of testing positive for HIV had never used condoms. The non usage of condoms among this group of adolescents is disturbing, since they are at greatest risk of spreading the disease. Health education and promotion of safe sex practices need to be extensively targeted at adolescents.     

A tale of two sexually transmitted diseases. Prevalences and predictors of chlamydia and gonorrhea in women attending Colorado family planning clinics

BACKGROUND: The comparative prevalences and predictors of chlamydia and gonorrhea have not been studied in the family planning clinic population. GOALS: To determine the comparative prevalences and predictors of chlamydia and gonorrhea among Colorado family planning clinic patients. STUDY DESIGN: Cross-sectional study of public and private family planning clinic patients in Colorado tested for both chlamydia and gonorrhea (n = 12,926). RESULTS: Among women tested for both infections, the chlamydia prevalence rate was 4.5% and the gonorrhea prevalence rate was 0.5%. Multivariate analysis showed that independent predictors of chlamydia were age younger than 25 years, black or Hispanic race-ethnicity, cervical friability, mucopus, exposure to a sex partner with chlamydia, or multiple recent sex partners. Independent predictors of gonorrhea were age younger than 20 years, black or Hispanic race-ethnicity, or exposure to a sex partner with gonorrhea; adjusted odds ratios for exposure to gonorrhea and black race were the highest for either infection. CONCLUSIONS: The gonorrhea prevalence rate was very low compared to that of chlamydia in patients at Colorado family planning clinics. Cost-effective gonorrhea testing strategies are needed for this population.     

A meta-analysis of condom effectiveness in reducing sexually transmitted HIV

Before condoms can be considered as a prophylaxis for sexually transmitted human immunodeficiency virus (HIV), their efficacy must be considered. This paper reviews evidence on condom effectiveness in reducing the risk of heterosexually transmitted human HIV. A meta-analysis conducted on data from in vivo studies of HIV discordant sexual partners is used to estimate the protective effect of condoms. Although contraceptive research indicates that condoms are 87% effective in preventing pregnancy, results of HIV transmission studies indicate that condoms may reduce risk of HIV infection by approximately 69%. Thus, efficacy may be much lower than commonly assumed, although results should be viewed tentatively due to design limitations in the original studies.     

The association between Chlamydia trachomatis serology and pelvic damage in women with tubal ectopic gestations

OBJECTIVE: To determine whether pelvic damage is associated with positive Chlamydia trachomatis serology in women with tubal ectopic pregnancy. DESIGN: Cross-sectional retrospective study. SETTING: A prepaid health maintenance organization. PATIENTS: Two-hundred eighty-one women admitted with confirmed tubal ectopic pregnancy were interviewed for history of sexually transmitted diseases. Chlamydia serology was obtained for 135 subjects, and operative findings were available for 121 of these. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Pelvic damage, as determined by review of operative findings of the pelvis at the time of ectopic surgery. RESULTS: Pelvic damage was associated with positive chlamydia serology with an adjusted odds ratio of 4.2 (95% confidence interval: 1.8 to 9.7). Moderate and severe pelvic damage were more strongly associated with positive serology than mild damage. CONCLUSIONS: Women with ectopic pregnancies and antibodies to C. trachomatis are more likely to have damaged pelves than women with ectopic pregnancies without such antibodies. Prevention or early treatment of C. trachomatis infection may reduce pelvic damage and, therefore, reduce incidence of ectopic pregnancy.     

A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group

BACKGROUND: The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 percent, but the factors that influence this risk are not well understood. METHODS: We conducted a case-control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert. RESULTS: Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio= 15; 95 percent confidence interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio= 6.2; 95 percent confidence interval, 2.2 to 21), a procedure involving a needle placed in the source patient's artery or vein (odds ratio=4.3; 95 percent confidence interval, 1.7 to 12), and exposure to a source patient who died of the acquired immunodeficiency syndrome within two months afterward (odds ratio=5.6; 95 percent confidence interval, 2.0 to 16). The case patients were significantly less likely than the controls to have taken zidovudine after the exposure (odds ratio=0.19; 95 percent confidence interval, 0.06 to 0.52). CONCLUSIONS: The risk of HIV infection after percutaneous exposure increases with a larger volume of blood and, probably, a higher titer of HIV in the source patient's blood. Postexposure prophylaxis with zidovudine appears to be protective.