Jonathan M. Zenilman

Bio: Jonathan M. Zenilman is an academic researcher from Johns Hopkins University School of Medicine. The author has contributed to research in topics: Sexually transmitted disease & Population. The author has an hindex of 61, co-authored 272 publications receiving 12253 citations. Previous affiliations of Jonathan M. Zenilman include Johns Hopkins Bayview Medical Center & Johns Hopkins University.

Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial.

Abstract: Context.—The efficacy of counseling to prevent infection with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) has not been definitively shown.Objective.—To compare the effects of 2 interactive HIV/STD counseling interventions with didactic prevention messages typical of current practice.Design.—Multicenter randomized controlled trial (Project RESPECT), with participants assigned to 1 of 3 individual face-to-face interventions.Setting.—Five public STD clinics (Baltimore, Md; Denver, Colo; Long Beach, Calif; Newark, NJ; and San Francisco, Calif) between July 1993 and September 1996.Participants.—A total of 5758 heterosexual, HIV-negative patients aged 14 years or older who came for STD examinations.Interventions.—Arm 1 received enhanced counseling, 4 interactive theory-based sessions. Arm 2 received brief counseling, 2 interactive risk-reduction sessions. Arms 3 and 4 each received 2 brief didactic messages typical of current care. Arms 1, 2, and 3 were actively followed up after enrollment with questionnaires at 3, 6, 9, and 12 months and STD tests at 6 and 12 months. An intent-to-treat analysis was used to compare interventions.Main Outcome Measures.—Self-reported condom use and new diagnoses of STDs (gonorrhea, chlamydia, syphilis, HIV) defined by laboratory tests.Results.—At the 3- and 6-month follow-up visits, self-reported 100% condom use was higher (P<.05) in both the enhanced counseling and brief counseling arms compared with participants in the didactic messages arm. Through the 6-month interval, 30% fewer participants had new STDs in both the enhanced counseling (7.2%; P = .002) and brief counseling (7.3%;P=.005) arms compared with those in the didactic messages arm (10.4%). Through the 12-month study, 20% fewer participants in each counseling intervention had new STDs compared with those in the didactic messages arm (P = .008). Consistently at each of the 5 study sites, STD incidence was lower in the counseling intervention arms than in the didactic messages intervention arm. Reduction of STD was similar for men and women and greater for adolescents and persons with an STD diagnosed at enrollment.Conclusions.—Short counseling interventions using personalized risk reduction plans can increase condom use and prevent new STDs. Effective counseling can be conducted even in busy public clinics.

Sexually Transmitted Infections Treatment Guidelines,2021

Abstract: These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.

Condom use to prevent incident STDs: the validity of self-reported condom use.

Abstract: Studies of sexual behavior and of interventions designed to reduce human immunodeficiency virus risk usually depend on self-report. Validation of self-reported condom use measures has not been previously reported in an urban population at high risk for sexually transmitted diseases (STDs) and human immunodeficiency virus. A prospective cohort study was performed in subjects recruited from STD clinics in Baltimore. At enrollment a questionnaire was administered that assessed human immunodeficiency virus risk factors and STD history and used a retrospective calendar to assess sexual events and condom use over the previous 30 days. Clinical evaluation was performed for STDs. A follow-up 3 months later the same procedures were repeated. Incident STDs at follow-up were defined as new culture or serologically documented diagnoses of gonorrhea chlamydia syphilis or trichomoniasis. In the 323 male and 275 female (total = 598) subjects who completed a follow-up visit 21% reported using condoms for every act of sexual intercourse over the previous 30 days 21% reported occasionally using condoms and 59% reported not using condoms. At follow-up 21% of subjects had new incident gonorrhea chlamydia syphilis or trichomoniasis. 15% of the men who were "always" condom users had incident STDs compared with 15.3% of "never users;" 23.5% of women who were "always" users had incident STDs compared with 26.8% of "never" users. In this high-risk population self-reported condom use is not associated with lower STD incidence. This finding suggests that self-reported condom use measures even in a research setting may be subject to substantial reporting bias. (authors)

Incident Chlamydia trachomatis Infections Among Inner-city Adolescent Females

Abstract: Context Adolescents are at highest risk for infection with Chlamydia trachomatis, an important preventable cause of pelvic inflammatory disease and subsequent tubal factor infertility in US women Current guidelines for delivery of adolescent primary care services recommend yearly chlamydia screening for those adolescent females considered to be at risk Objectives To describe the epidemiology of prevalent and incident chlamydia infection among adolescent females to assess the appropriate interval for chlamydia screening and to define risk factors that would identify adolescent females to target for screening Design Prospective longitudinal study Patients A consecutive sample of 3202 sexually active females 12 through 19 years old making 5360 patient visits over a 33-month period, January 1994 through September 1996 Setting Baltimore, Md, family planning, sexually transmitted disease, and school-based clinics Intervention Testing for C trachomatis by polymerase chain reaction Main outcome measures Prevalence and incidence of C trachomatis infections; predictors of positive test result for C trachomatis Results Chlamydia infection was found in 771 first visits (241%) and 299 repeat visits (139%); 933 adolescent females (291%) had at least 1 positive test result Females who were 14 years old had the highest age-specific chlamydia prevalence rate (63 [275%] of 229 cases; P=01) The chlamydia incidence rate was 280 cases per 1000 person-months (95% confidence interval, 249-315 cases) The median time was 72 months to a first positive chlamydia test result and 63 months to a repeat positive test result among those with repeat visits Independent predictors of chlamydia infection--reason for clinic visit, clinic type, prior sexually transmitted diseases, multiple or new partners, or inconsistent condom use-failed to identify a subset of adolescent females with the majority of infections Conclusions A high prevalence and incidence of C trachomatis infection were found among adolescent females We, therefore, recommend screening all sexually active adolescent females for chlamydia infection every 6 months, regardless of symptoms, prior infections, condom use, or multiple partner risks

Sexual Transmission of Hepatitis C Virus among Patients Attending Sexually Transmitted Diseases Clinics in Baltimore—An Analysis of 309 Sex Partnerships

Abstract: The prevalence of antibodies to hepatitis C virus (anti-HCV), the behavioral and laboratory-derived risk factors for anti-HCV, and the quantity and homology of HCV RNA were assessed among 1039 non-injection drug-using sexually transmitted disease (STD) patients representing 309 sex partnerships. Thirty-seven (7%) of 555 males and 19 (4%) of 484 females had anti-HCV. In logistic regression analyses, factors associated with anti-HCV included age (P < .001), greater numbers of lifetime sex partners (P = .023), human immunodeficiency virus infection (P < .001), Trichomonas infection (P < .001), cigarette smoking (P < .001), and male homosexual exposure (P = .012). Among couples, females whose sex partners were anti-HCV positive were 3.7 times more likely to have anti-HCV than females whose sex partners were anti-HCV negative (P = .039). The proportion of RNA homology between anti-HCV positive females and their male partners (94%) was higher than among randomly selected patients (82%). Sexual transmission of HCV may contribute to the high prevalence of anti-HCV reported in urban settings.

How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability

Abstract: Guidelines for determining nonprobabilistic sample sizes are virtually nonexistent. Purposive samples are the most commonly used form of nonprobabilistic sampling, and their size typically relies on the concept of “saturation,” or the point at which no new information or themes are observed in the data. Although the idea of saturation is helpful at the conceptual level, it provides little practical guidance for estimating sample sizes, prior to data collection, necessary for conducting quality research. Using data from a study involving sixty in-depth interviews with women in two West African countries, the authors systematically document the degree of data saturation and variability over the course of thematic analysis. They operationalize saturation and make evidence-based recommendations regarding nonprobabilistic sample sizes for interviews. Based on the data set, they found that saturation occurred within the first twelve interviews, although basic elements for metathemes were present as early as six...

Sexually transmitted diseases treatment guidelines.

Abstract: The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

Multiple Imputation for Nonresponse in Surveys

Abstract: 25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.