Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers. Opportunity for early intervention

GOAL: To determine prevalence and incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection and assess risk factors predictive for such infections in a middle school-based clinic sample. STUDY DESIGN: 170 female students and 43 male students making 256 and 47 visits, respectively, > or = 30 days apart, in urban middle school clinics for primary care screening, reproductive health, or illness/injury were routinely asked to provide urine specimens for GC and CT ligase chain reaction testing if sexually active in the preceding 3-month period. Information regarding prior sexually transmitted diseases, reason for visit, and sexual risk behaviors was obtained. RESULTS: GC: 11.4% of female student and 2.1% of male student tests were positive. Incidence was 34.0 cases/1,000 person months (95% Confidence interval [CI]: 19.5-67.5). Median time to first positive and repeat positive test was 4.6 and 2.6 months, respectively. For CT: 16.4% of female student and 2.1% of male student tests were positive. Incidence was 57.5 cases/1,000 person months (95% CI: 35.2-93.8). Median time to first positive and repeat positive CT test was 6.0 and 4.8 months, respectively. Assessed risk factors failed to specify a candidate screening population. CONCLUSION: These data suggest that all sexually active adolescent girls in this high risk setting should be offered testing for GC and CT at least twice per year, regardless of age or other sexual risk behaviors and that STD control efforts in high risk middle schools should be encouraged.     

Determinants of reinfection with Chlamydia trachomatis

BACKGROUND AND OBJECTIVES: Epidemiologic studies of chlamydial infections may often miss factors associated with the acquisition of infection. GOAL: To evaluate factors associated with risk for initial and recurrent Chlamydia trachomatis infections. STUDY DESIGN: A retrospective study of patients attending a sexually transmitted disease clinic and, within this retrospective cohort, a nested case-control study. RESULTS: Among initial-negative subjects the crude incidence rate was 11.5 per 1,000 months of follow-up. Among initial-positive subjects, the crude incidence rate was 28 per 1,000 months of follow-up (RR = 1.8, 95% CI: 1.4-2.2). The increase in risk of infection associated with prior infection was independent of age. In the case-control study, a reduced risk of recurrent infection was associated with tubal ligation, hormonal contraception, and barrier contraception. CONCLUSIONS: As well as targeting sexually active adolescents, prevention programs should recommend repeat testing for all women with prior chlamydial infection, irrespective of age. Furthermore, issues related to personal control of health may modify risk for infection.     

Percutaneous transhepatic portal embolization using newly devised catheters: preliminary report

OBJECTIVES: The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections. METHODS: Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection. Predictor variables were derived from the index visit and any visits in the year prior to the index visit. Logistic regression was used to develop a model that was applied to all patients who attended in 1989. RESULTS: Of 24,439 patients attending in 1987, 18.5% returned within a year with a new infection. Return rates were highest for 15- to 19-year-old Black males (31.8%). The highest odds ratios for returning were a diagnosis or treatment for an infection in the previous year and a diagnosis or treatment for infection at the index visit. The patients predicted to be at highest risk had a 39% return rate. There were as many new infections among the 2893 patients at highest risk as there were among the 13,326 patients at lowest risk. CONCLUSIONS: We developed a model that identifies persons at very high risk for sexually transmitted infection. These persons should be targeted for intensive intervention to reduce their risk.     

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.     

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.     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes, beliefs, and practices of nursing students concerning HIV/AIDS: implications for prevention in women

Nursing students are a group of predominantly young women who may be sexually active but who are well educated and presumably health conscious. It might be expected, therefore, that they are not a population at risk for sexually acquired HIV infection. Recent studies indicate that heterosexual women constitute the fastest growing population of persons with AIDS in the United States and Canada (Health and Welfare Canada, 1993b; Wofsky, 1992) and that women and adolescents will constitute the next surge of the AIDS epidemic (Novello, 1993). First-year nursing students in a major Canadian city were surveyed regarding HIV-related knowledge, attitudes, beliefs, and behaviors. The women were highly knowledgeable about HIV transmission but 15% to 25% reported high risk sexual behavior. The results reinforce that knowledge is not enough to prevent HIV infection among young women and that interventions must be based on an understanding of the social context of women's lives.     

Sexual behavior among U.S. high school students, 1990-1995

CONTEXT: High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity. METHODS: Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12. RESULTS: The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students. CONCLUSIONS: Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection.     

Telethermographic studies on the effect of immunoglobulins (Beriglobin) on heat radiation behavior in radiodermatitis

OBJECTIVES: To determine the criterion-related validity of alternative approaches to the measurement of sexual intercourse using sexually transmitted diseases (STD) as a biomarker (the criterion). STUDY DESIGN: Analyses are based on an urban sample of 255 adolescent women, 15 to 19 years of age, treated for genitourinary infections with Neisseria gonorrhoeae, Chlamydia trachomatis or Trichomonas vaginalis who returned 3 months later for reexamination. Subjects completed self-administered questionnaires at enrollment and at 3 months. Genitourinary cultures were obtained at enrollment, 2 to 4 weeks later at a test-of-treatment visit (TOT), and at 3 months. RESULTS: Two hundred fourteen of the 255 adolescents also returned for a TOT culture; 186 of these 214 (73%) were free of infection 2 to 4 weeks after enrollment and 30% (56/186) acquired a subsequent STD by 3 months. The validity of questions about sexual behavior differed. No adolescent who denied interim intercourse by reporting "0" sexual partners or "0" coitions acquired an interval STD. Adolescents who denied regular intercourse (vaginal sex) or failed to indicate the number of interim coitions were at high risk for new STD-23% and 21%, respectively. A new measure of sexual intercourse using both the number of sexual partners and the number of coitions contained no missing data; adolescents classified as not having had interim sexual intercourse were free of infection at 3 months, whereas 32% of those who reported intercourse acquired an interim infection. CONCLUSIONS: These data suggest that high-risk urban adolescent women can accurately report whether they have engaged in vaginal intercourse. The validity of the report appears sensitive to the wording and content of the questions.     

An assessment of care provided by a public sector STD clinic in Cape Town

A study was undertaken in a Cape Town public sector STD clinic to evaluate the content and quality of care provided since it has been recognized that appropriate improvements in the management of conventional sexually transmitted diseases (STDs), including provision of correct therapy, health education, condom promotion and partner notification, could result in a reduced incidence of HIV infection. Our objectives were to assess patients' needs for health education and to assess the quality of STD management in terms of health education, condom promotion, partner notification, the validity of the clinical diagnoses and the adequacy of the treatments prescribed. The study subjects were sampled systematically, according to their gender. Patients included in the study were given a standardized interview and their clinical records reviewed. Specimens were collected for laboratory investigations. For each STD detected, the treatment was defined as adequate if drugs currently known to be active against that infection were prescribed. One hundred and seventy men and 161 women were included in the study (median age: females 22 years, males 26 years). While almost all patients believed their STD may have been caused by unprotected sexual intercourse, many also believed it may have been caused by other factors, such as bewitchment with traditional medicine. Only 21% of male and 37% of female patients received any education about STD transmission during the clinic visit, and only 25% of male and 36% of female patients received education about condom use. As a result of the low sensitivity of the clinicians' diagnoses, 16% of men and 61% of women left the clinic with at least one infection inadequately treated. The majority of patients were not receiving education for the prevention of STDs including HIV. Many were not receiving adequate treatment for their infections. The introduction of a syndromic management protocol in this setting would substantially reduce the proportion of inadequately-treated patients. However, syndromic protocols, and the means by which they are implemented, need to take into account problems with the clinical detection of genital ulcerative disease and candidiasis in women.     

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.     

Substance use and sexual risk taking among Black adolescents and White adolescents.

Analyses of data from a random sample of 1,259 sexually active adolescents revealed that substance use was associated with increased sexual risk taking on 2 occasions of intercourse (1st intercourse ever and 1st intercourse with most recent partner), even after controlling for demographic, experiential, and dispositional confounders. Within-persons analyses yielded similar results, indicating that adolescents who used substances, on 1 of the 2 occasions, reported higher levels of risk taking on the occasion when substances were used than on the no-substance-use occasion. However, substance use was both more common and more strongly linked to risk taking among White than Black adolescents, suggesting that White adolescents are at greater risk of negative consequences related to substance use proximal to intercourse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Colonization with vancomycin-resistant enterococci in chronic hemodialysis patients

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.     

Inadequate weight gain among pregnant adolescents: risk factors and relationship to infant birth weight

OBJECTIVE: Our purpose was to identify behavioral markers for inadequate weight gain (< 20 pounds) during pregnancy among adolescents < 18 years old. STUDY DESIGN: A total of 337 adolescents who were delivered of a term infant at our institution between March 10, 1992, and November 28, 1994 participated in this study. A comprehensive structured interview conducted at the first prenatal visit elicited demographic information and behavioral risk factors. Maternal weights, reproductive history, evidence of sexually transmitted disease, and infant birth weight were extracted from medical records. Logistic regression and chi 2 analyses compared characteristics and infant birth weights between those who gained < 20 pounds with those who gained > or = 20 pounds. RESULTS: A total of 11.6% (39/337) of the total sample gained < 20 pounds during the pregnancy. Adolescents who gained < 20 pounds compared with > or = 20 pounds were delivered of significantly lighter (2942 gm vs 3392 gm) infants and were more likely to be delivered of infants weighing < 2500 gm (13% vs < 1%). Stepwise logistic regression revealed that adolescents who were battered (odds ratio 5.3) or had a sexually transmitted disease (odds ratio 2.3) or an unplanned pregnancy (odds ratio 8.1) were at increased risk for insufficient weight gain during pregnancy. CONCLUSION: Our data suggest that behavioral risk factors are important in the identification of adolescents at greatest risk for inadequate weight gain. Early identification during pregnancy is essential to modify nutritional practices and thus minimize poor obstetric outcomes.     

Podiatric medical resources on the Internet

PURPOSE: To determine utility of polymerase chain reaction (PCR)-based urine screening for Chlamydia trachomatis in the care of adolescent females in an urban clinic. METHODS: Females > or = 15 years of age attending an adolescent clinic were approached consecutively. Each enrollee was interviewed to determine the primary reason(s) for the clinic visit and was queried about genitourinary symptoms. Nonsterile voided urine specimens were tested for C. trachomatis using PCR-based analysis. Endocervical C. trachomatis cultures were obtained from the subjects who had a pelvic examination. Main outcome measures were chlamydia infection rates in clinic attendees whether a pelvic examination was performed or not. RESULTS: A total of 315 (99.4%) of 317 patients approached agreed to participate. Overall, 47 (14.9%) patients had positive urine PCR tests. The chlamydia infection rate detected by urine PCR was 22.1% (19 of 86) among those who had pelvic examinations performed and 12.2% (28 of 229) among those who did not (p = .03; odds ratio 2.04; 95% confidence interval 1.02, 4.06). Sixty percent (28 of 47) of chlamydia infections identified during the study period were identified by the urine screening test. CONCLUSION: Urine screening was accepted by vast majority of female adolescents attending the clinic irrespective of reason for the clinic visit, and was highly effective in identifying unsuspected C. trachomatis infections, particularly among girls attending the clinic for reasons unrelated to reproductive health care and as an interim screening tool for adolescent family-planning clients.     

Young adolescents' comfort with discussion about sexual problems with their physician

OBJECTIVE: To identify factors associated with young adolescents' sense of comfort about discussing sexual problems with their physician. DESIGN: Confidential, assisted self-report questionnaires on physician-adolescent communication developed by the investigators and completed by participants at visits for general health examinations. SETTING: Five primary care pediatric practices at health maintenance organizations in Washington, DC. PATIENTS: A consecutive sample of all adolescents 12 to 15 years old who received a general health examination. Of 412 eligible patients, 221 received parental consent and participated. MAIN OUTCOME MEASURE: Adolescents' sense of comfort about talking to their physician about a sexually transmitted disease or some other sexual problem. This outcome was chosen for a substudy of a larger longitudinal prevention trial. RESULTS: Most adolescents valued their physicians' opinions about sex (89%) and said it was easy to talk to the physician during their visit (99%), but about half said they would be uncomfortable talking to the physician if they had a sexually transmitted disease or some other sexual problem (43%) [corrected]. Adolescents' sense of comfort was greater when physicians discussed sexual issues in the general health examination, adolescents perceived their personal risk of sexually transmitted disease to be high, adolescents had high self-esteem, and physicians were adolescents' usual physicians. CONCLUSIONS: This study emphasizes the need for physicians to discuss sexual risks with young adolescents and suggests ways physicians can help young adolescents feel more comfortable talking with them about sexual concerns.     

Sexually transmitted disease prevention: adolescents' perceptions of possible side effects

Forty-eight sexually active adolescents participated in an open-ended interview about the possible secondary consequences (side effects) of implementing measures to reduce the risk of contracting a sexually transmitted disease (STD). These adolescents noted 134 different consequences, which were grouped into 15 substantive categories. When four prevention measures (using condoms, being selective about sex partner(s), being monogamous, and abstaining from sexual activity) were analyzed, different patterns of consequences that were salient to these adolescents emerged. The results are discussed in terms of their implications for understanding and improving adolescent decision making about STD prevention.     

In vitro kinetics of drug release and pulmonary retention of microencapsulated antibiotic in liposomal formulations in relation to the lipid composition

Today's society seems enthralled with serial killers in the news and the media. Forensic psychiatrists often interview serial killers after they have been caught. There are retrospective studies and case reports of individuals who have committed sexually sadistic serial murders. However, there exists a dearth of case reports on adolescents who have expressed serious fantasies about becoming serial killer prior to actualizing their fantasy. This article presents nine clinical cases of 14- to 18-year-olds who have clinically significant fantasies of becoming a serial killer. Similarities exist in these adolescent cases when compared with retrospective studies and case reports of serial killers on the role of sexually sadistic fantasies and actual killings. Since it has been established that sexual paraphilias may develop at a young age, one can surmise that sadistic paraphilias may also develop in some adolescents. The question is posed, can we predict which of these adolescents may go on to actually become serial killers? This article focuses on how the sexually sadistic fantasy can eventually be acted out and possible motives for the act to be repeated multiple times. Finally, recommendations are made about assessing and treating a youngster who expresses violent sexually sadistic killing fantasies so that attempts can be made to interrupt the progression to actual killing.