Showing papers in "Sexually Transmitted Diseases in 1999"
TL;DR: African Americans' higher infection rate for bacterial diseases can be explained by the patterns of sexual networks within and between different racial/ethnic groups.
Abstract: Background:Many studies have observed that African Americans have comparatively high rates of selected STDs, often 10 to 20 times higher than whites and other racial/ethnic groups, but without convincing explanation.Goal:This study attempts to solve this puzzle using data from a nationally represent
619 citations
TL;DR: The most widely quoted number of new sexually transmitted disease (STD) cases each year is 12 million as discussed by the authors, however, this figure has not changed in more than a half century.
Abstract: Background:Accurate, updated estimates of the incidence and prevalence of sexually transmitted infections in the United States remain elusive. The most widely quoted number of new sexually transmitted disease (STD) cases each year is 12 million. However, this figure has not changed in more than a de
563 citations
TL;DR: A significant percentage of adolescents have concurrent partners during a main relationship, and having concurrent partners increases STD risk.
Abstract: Background/Objectives. A large percentage of sexually active adolescents have multiple sex partners and are at high risk of acquiring sexually transmitted diseases (STDs). Little is known about adolescents' patterns of sexual partnerships (e.g., concurrent versus serial) and how these patterns influence STD risk. Goal of the Study: To determine the frequency with which adolescents have concurrent partners during a main relationship and the association between having concurrent partners and STD risk. Study Design: Adolescents seeking care at a public STD clinic were recruited from March, 1996, to May, 1998. Demographic and behavioral data were obtained during an interviewer-administered questionnaire. Sexually transmitted disease testing and physical exams were performed by clinicians. Results: Of those adolescents who reported having at least one main partner during the previous 6 months (n = 245), 110 (44.9%) had multiple partners, and 76 (31%) had at least one concurrent partner during a main relationship. Greater number of concurrent partners was associated with STD diagnosis/ exposure after controlling for number of sex partners (OR = 1.6; 95% Cl, 1.1-2.4). Conclusions: A significant percentage of adolescents have concurrent partners during a main relationship, and having concurrent partners increases STD risk.
177 citations
TL;DR: Subsequent STI frequently follow an initial STI, but there is substantial variation in the causal organism, suggesting the importance of comprehensive STI prevention programs for adolescents rather than organism-specific interventions.
Abstract: Objective:To identify factors associated with subsequent sexually transmitted infection (STI) (within 1 year of initial infection) due toChlamydia trachomatis, Neisseria gonorrhoeaeorTrichomonas vaginalis.Design:Prospective cohort study.Setting:A sexually transmitted diseases clinic and four communi
174 citations
TL;DR: In settings where patient return for treatment is a problem, point-of-care tests contribute significantly to the detection and treatment of chlamydial infections among women.
Abstract: Background and Objectives: Screening tests for detection of Chlamydia trachomatis include those processed in laboratories and those designed to be processed at the point of care. The latter tests can yield results at the time of the initial patient visit, but most available lab-processed tests have greater sensitivity. In settings where a proportion of patients do not return for treatment after positive test results, the less sensitive rapid tests could lead to the treatment of more patients and be more cost-effective. Goal of this Study: To determine the situations, if any, in which a rapid test might be more cost-effective and treat more infections than lab-based tests. Study Design: A decision analysis framework was used to compare one point-of-care test (the BioStar Chlamydia OIA) with two lab-based tests (cell culture and the polymerase chain reaction [PCR] assay). It was assumed that all women in the model would be screened. Variables included in the analysis were the prevalence, test sensitivity and specificity, the probability of developing pelvic inflammatory disease after treated and untreated chlamydial infections, and the likelihood that patients would wait for rapid test results or return to the facility for treatment. Results: The rapid test treated more cases of infection than the PCR alone if the return rate was less than 65%. A two-test algorithm of the rapid test followed by a PCR test on those initially testing negative identified and treated the greatest number of chlamydial infections and was the most cost-effective at all prevalences above 9%, but this finding was sensitive to the cost estimate for pelvic inflammatory disease. Conclusion: In settings where patient return for treatment is a problem, point-of-care tests contribute significantly to the detection and treatment of chlamydial infections among women.
166 citations
TL;DR: In men with symptomatic urethritis, the median HIV RNA concentration in seminal plasma from men with T. vaginalis was significantly higher that in seminal Plasma from HIV-positive men without trichomonas, and there was no difference in the rate of HIV seropositivity in men with and without T. vaginais.
Abstract: This study was conducted to determine the prevalence of trichomoniasis in Malawian men to evaluate a polymerase chain reaction (PCR) detection assay for T. vaginalis in urethral swab samples and to examine the effect of T. vaginalis infection on HIV excretion in the semen. There were 206 men with symptomatic urethritis in STD clinic and 127 asymptomatic men in the Dermatology Clinic who were enrolled from January to March 1996. Results according to a wet-mount microscopy and urethral swabs culture combination showed that of 293 men only 38 (13%) men were positive for T. vaginalis. The estimated prevalence among symptomatic and asymptomatic cases was 15.7% and 8.7% respectively. The PCR yielded a sensitivity of 0.82 (95% CI: 0.66-0.92) and specificity of 0.95 (95% CI: 0.91-0.97); these were compared to the wet-mount microscopy and culture combination. Overall HIV seroprevalence of men was 51% because gonococcal urethritis was shown to significantly increase seminal HIV RNA levels. The median HIV RNA concentration in seminal plasma from men with symptomatic urethritis plus T. vaginalis infection was significantly higher than in seminal plasma from HIV-positive men with symptomatic urethritis only. Since this study has several important limitations a randomized clinical trial would be useful for determining whether urethritis cure rates can be significantly improved.
148 citations
137 citations
TL;DR: Gonorrhea has a focused geographic distribution characterized by high incidence rates in defined "core" areas and decreased incidence as the radial distance from the central core increases, and partner selection patterns in general indicate nonrandom distribution.
Abstract: Objective: Gonorrhea has a focused geographic distribution characterized by high incidence rates in defined "core" areas and decreased incidence as the radial distance from the central core increases. Dense core group transmission has long been hypothesized. Methods: We have previously mapped sexually transmitted disease (STD) rates in Baltimore census tracts using STD morbidity data interfaced with a geographic information system. Core areas were defined using a standard definition based on gonorrhea distribution. We studied spatial distance patterns between sexual partners, using the residential addresses of 572 individuals, representing 286 dyad partnerships recruited as part of an epidemiology and behavioral study. To determine if partners lived closer together than would be expected, a modified bootstrap algorithm using Monte Carlo models was developed to compare the distances between partners' residences and all other possible residences. Results: Two distinct (east and west) core areas were previously identified. Compared with randomly selected Baltimore addresses, partners tended to reside closer to one another than would be expected by chance (z = −1.8), with a median distance of 1.7 kilometers. Within the core areas, women resided a median of 547 meters from their partner, and men resided a median of 339 meters from their reported partners. Results: When all partnerships were considered, the median distance was 1,699 meters. Of the 500 simulation models, the minimum median distance was 4,889 meters. Conclusions: Partners of patients in core areas in Baltimore live remarkably close to one another, and the partner selection patterns in general indicate nonrandom distribution. Geographic information system-determined patterns of STD patients residing in hyperendemic census tracts support the core theory of disease transmission. In these areas, targeted geographically based interventions may be warranted.
133 citations
TL;DR: An underground economy for the exchange of sex for drugs or money is suggestive, the existence of which facilitates the spread of STDs in high-risk communities.
Abstract: Background and Objectives: Persons who participate in behaviors such as drug use and buying or selling sex are at elevated risk for sexually transmitted diseases (STD)/human immunodeficiency virus (HIV) infection Goals: To describe the economic structure supporting drug use and the buying and selling of sex services in two urban Houston communities Study Design: Residents of two Houston communities participated in street-intercept interviews to obtain information on sex and drug use behaviors Results: Many members of the population reported having bought or sold sex A history of crack use significantly predicted the trading of sex for money and drugs, and sellers of sex were more likely to have engaged in recent high-risk sexual behavior than those who had never sold sex Conclusion: The data are suggestive of an underground economy for the exchange of sex for drugs or money, the existence of which facilitates the spread of STDs in high-risk communities
122 citations
TL;DR: The etiology of genital ulcer disease among patients attending sexually transmitted disease clinics in Pune, India, and to examine the relationship to HIV infection and compare the clinical diagnosis of GUD with the results of a multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum, herpes simplex virus (HSV), and Hemophilus ducreyi infection are determined.
Abstract: The etiology of genital ulcer disease (GUD) and the relationship between GUD and HIV infection were investigated in 302 patients presenting to a sexually transmitted disease clinic in Pune India in a 3-month period in 1994. Swabs of each genital ulcer were tested for herpes simplex virus (HSV) antigen by enzyme immunoassay and processed in a multiplex polymerase chain reaction (M-PCR) assay for simultaneous detection of HSV Treponema pallidum and Haemophilus ducreyi. The seroprevalence of HIV in this series was 22.2%. Clinical diagnosis of GUD was undermined when HIV infection was present. The etiology of GUD according to M-PCR was HSV in 26% chancroid in 23% primary syphilis in 10% and multiple infections in 7%; no etiology could be identified in the remaining 34% of cases. Attempts to differentiate the etiology of GUD based solely on clinical grounds resulted in many inaccurate diagnoses. Chancroid was the most common clinical diagnosis (40%) followed by HSV (24%) syphilis (20%) and multiple infections (3%). HIV seroprevalence was significantly higher in patients with HSV compared with other etiologies (odds ratio 2.1; 95% confidence interval 1.2-3.7) presumably as a result of HIV-induced immunosuppression and consequent HSV reactivation. Until rapid inexpensive and sensitive assays become available syndromic treatment with antibiotics should be provided to patients with GUD in order to reduce the risk of acquiring HIV infection.
117 citations
TL;DR: Examining associations between genital cleaning practices, bacterial vaginosis, and ethnic group found ethnic differences in genital hygiene behaviors can explain a twofold increase in the risk of bacterialvaginosis in black Caribbean compared with white women.
Abstract: Background and Objectives:Bacterial vaginosis and vaginal douching are both reported to be more common in African-American and Caribbean than white women. It is also thought that douching alters the vaginal milieu. This study was conducted to examine associations between genital cleaning practices,
TL;DR: Vaginal pH and flora differed significantly by race/ethnicity; blacks were more likely to have pH > or = 4.5, no lactobacilli, small gram-variable and -negative rods, and Mobiluncus compared with whites; quantity of morphotypes also differed, especially for Mobil uncus.
Abstract: Objectives:To investigate the relationship between bacterial vaginosis during pregnancy and black race/ethnicity.Study Design:Gram staining was used to evaluate vaginal flora in 842 women at 24 to 29 weeks' gestation.Results:Overall, 22.3% of blacks and 8.5% of whites had bacterial vaginosis. Vagina
TL;DR: The study confirms the widespread practice of douching in African pregnant women and confirms the harmful effects of antiseptics need to be substantiated.
Abstract: Background and Objectives:Douching, a common practice, could further increase the risk of genital infections.Goal of this Study:To describe douching practices in pregnant women and to evaluate associations with lower genital tract infections.Study Design:Cross-sectional study in Abidjan, Cote d'Ivoi
TL;DR: Critical data needed for more precise estimates include: sensitivity of current diagnostics, better data on infections in males, the current extent of underdetection and underreporting, and betterData on duration of infection in men and women.
Abstract: BACKGROUND AND OBJECTIVE: Because genital Chlamydia trachomatis infections and their sequelae have a major impact on individuals and the health care system, it is important to periodically update estimates of chlamydia incidence and prevalence in the United States. STUDY DESIGN: Chlamydia incidence and prevalence were estimated using: (1) a method based on estimates of population-specific chlamydia prevalence, and (2) a method based on the chlamydia-to-gonorrhea case rate ratio. RESULTS: Using the prevalence-based method, point prevalence among persons 15 to 44 years of age was estimated to be 1.6 million chlamydial infections, and annual incidence, 2.4 million cases per year. Using a method based on the ratio of reported gonorrhea to chlamydia, incidence was estimated to be 2.8 million infections per year, and prevalence, 1.9 million. Adjustment for sensitivity of diagnostic tests yielded annual incidence estimates of 2.5 to 3.3 million infections. CONCLUSIONS: Using two methods, we estimated the annual incidence of chlamydial infections in the United States among persons 15 to 44 years of age to be approximately 3 million infections. Critical data needed for more precise estimates include: sensitivity of current diagnostics, better data on infections in males, the current extent of underdetection and underreporting, and better data on duration of infection in men and women.
TL;DR: It is suggested that few patients take medications as prescribed and that self-report substantially underestimates medication noncompliance, and despite poor compliance, there were few treatment failures.
Abstract: Objective:To compare self-reported doxycycline compliance in men and women attending an STD clinic with indications for Chlamydia trachomatis treatment to compliance measured using microprocessor-containing medication vials to count each time and date medication vials were opened. A secondary object
TL;DR: User characteristics and experience are determinants of breakage and slippage, which are often regarded only as the effect of product design flaws, and attention to modifiable determinant of failure may improve user counseling and product labeling.
Abstract: Background and Objectives:Mechanical failure may reduce the efficacy of condoms. Little is known about frequency and determinants of condom failure in groups at high risk of sexually transmitted diseases (STD).Goal:To measure condom breakage and slippage rates and evaluate potential determinants of
TL;DR: It is suggested that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.
Abstract: Background and Objectives: Failure to disclose human immunodeficiency virus (HIV) infection to sexual partners interferes with risk reduction. Goal of this Study: The purpose of this study was to identify factors associated with disclosure and failure to disclose HIV infection to sexual partners and to describe condom use with nondisclosure. Study Design: A longitudinal survey study of HIV seropositive persons recruited at a public STD clinic. Results: Approximately 76% of the study population (n = 147) reported disclosing their HIV status to their last sex partner at baseline. Predictors of disclosure included consistent condom use and being in a monogamous relationship. Twenty-two percent of those who disclosed at baseline reported nondisclosure during follow-up. Approximately 23% reported not using a condom with a person to whom their status was not disclosed. Conclusions: These results suggest that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.
TL;DR: The use of coital diaries for the collection of sexual behavior data may be limited to cross-sectional community surveys and a recall questionnaire may provide more reliable and a better quality of data for longitudinal studies and for human immunodeficiency virus/sexually transmitted disease evaluation programs.
Abstract: This study aimed to compare data obtained from coital diaries (CD) with those collected using weekly recall (WR) and daily recall (DR) questionnaires. 79 female sex workers aged 18-44 coming from KwaZulu-Natal South Africa were studied. They were followed up every month with clinical examination and treatment of STDs provision of condoms and CD collection. There were 52 WR 27 DR and 79 CD records collected from the participants. Results showed that CD records showed a significantly greater mean number of clients compared to the questionnaires (23.3 vs. 13.6 P < 0.001) number of condoms used (2.7 vs. 0.5 P < 0.001) vaginal acts (6.8 vs. 2.9 P < 0.001) and anal acts (1.9 vs. 0.7 P = 0.044). Daily accounts of weekly sexual activity showed significant differences in 1) the number of days worked (6.2 vs. 5.2 P = 0.009) 2) the number of clients (21.7 vs. 17.4 P = 0.027) and 3) the number of anal acts with clients (3.9 vs. 0.8 P = 0.004) with higher means reported in the CD records for all cases. The CD records are an important instrument for gathering preliminary sexual behavioral information; however their use is limited to long-term data collection. Therefore a comprehensive recall questionnaire is recommended for future trials.
TL;DR: This study provides a comprehensive assessment of forgetting as a cause of incomplete reporting of sexual and injection partners and suggests that reinterviewing is the best method available for identifying partners as completely as possible.
Abstract: Background and Objectives:Partner notification and social network studies of infectious disease often involve interviewing people to elicit their sexual and/or drug injection partners. Incomplete reporting of partners in these contexts would significantly hamper efforts to understand and control the
TL;DR: Based on the studies conducted on STD/HIV transmission, a frequently listed cause of condom failure was the type of condom being used during sexual intercourse and the user's failure to properly use the condom.
Abstract: Male latex condoms are considered to be the most effective method in reducing the risk of sexually transmitted disease (STD) and HIV transmission if properly used during sexual intercourse. Several studies were documented citing the effectiveness of latex condoms. Although one study reported condom failure due to breakage and slippage this does not put the user at risk of STD/HIV transmission because such mechanical failure occurs before intercourse or during removal (nonclinical breakage and slippage). Most importantly condom users who report more frequent condom breakage and slippage can be counseled to develop skills to avoid behaviors that may place them at increased risk. Aside from condom breakage and slippage a possible explanation for the observed failure of condoms to protect against STD/HIV transmission is the respondents behavior of not providing valid information about their consistency in use. Based on the studies conducted on STD/HIV transmission a frequently listed cause of condom failure was the type of condom being used during sexual intercourse and the users failure to properly use the condom.
TL;DR: It is suggested that interventions with providers to standardize sexual history elicitation can help to reduce barriers to prevention, diagnosis, and treatment of STD.
Abstract: Background:The frequently asymptomatic nature and high incidence of severe complications of sexually transmitted diseases (STD) calls for targeted efforts to identify those at greatest risk. Earlier studies have shown inconsistencies regarding STD evaluation by primary care clinicians and physicians
TL;DR: HIV+ women were more likely than HIV- women to report previous genital tract infections and symptoms, however, the HIV+ women reported less recent sexual activity and few gonococcal or chlamydial infections.
Abstract: Background and Objectives:Few comparisons of factors associated with sexually transmitted diseases (STDs) and HIV are available for representative samples of American women.Goal of the Study:To compare factors associated with STDs in a large sample of women infected with HIV and women not infected w
TL;DR: Of the patients with positive chlamydial screening tests, the proportion not treated was similar to that found in studies performed in STD clinics.
Abstract: A chart review of patients with positive laboratory tests for C. trachomatis at the University of Alabama at Birmingham Hospital and affiliated clinics during 1996 was performed to determine whether the problem of failure to notify patients of positive sexually transmitted disease (STD) test results is generalizable beyond STD clinics. Furthermore it would review chlamydia testing practices in nonreproductive health setting. Findings revealed that of the 326 patients with positive tests 95% were females aged 22 years and 5% were males aged 25 years. Most positive C. trachomatis test results were 51% from the emergency room (ER) and 31% from obstetric/gynecologic (OB/GYN). 57% of ER patients and 36% of OB/GYN patients received antibiotics on their initial visits. Among patients with positive screening tests 32% of ER patients and 14% of OB/GYN patient had no documented treatment. 4% of women with positive tests who did not receive therapy at the time of their initial evaluation developed pelvic inflammatory disease in the interval between testing and returning to the medical center. From the findings a substantial proportion of patients with positive screening tests for C. trachomatis may not receive timely treatment of their infections which suggests that the problem occurs in settings other than STD and family clinics.
TL;DR: During gonococcal infection of human fallopian tube mucosa in organ culture, the mucosal tissue concentration of TNF-alpha can be used to predict the PPCA, and therefore, the extent of mucosal damage, and this finding should facilitate studies of the molecular pathogenesis of infectious diseases involving human genital mucosa.
Abstract: BACKGROUND AND OBJECTIVES An experimental model consisting of gonococcal infection of human fallopian tube mucosa in organ culture has proven useful in studying the molecular pathogenesis of acute gonococcal salpingitis and postsalpingitis sequelae. Gonococcal infection of human fallopian tube mucosa in organ culture results in the sloughing of ciliated epithelial cells from the mucosa. This damage to the mucosa can be quantified on fallopian tube pieces by an assay of the percent of the periphery that has ciliary activity (PPCA) remaining at specific time points after infection. Although assay of the PPCA has been quite valuable, it is labor-intensive, somewhat subjective, and requires that the observers have training and experience. A more practical assay for genital mucosal damage is desirable for further investigations that employ the fallopian tube experimental model. Gonococcal infection of fallopian tube mucosa in organ culture also results in the production of easily quantified tumor necrosis factor-alpha (TNF-alpha) by the mucosa. Furthermore, treatment of the organ cultures with recombinant human TNF-alpha (rHuTNFalpha) alone also causes sloughing of ciliated cells from the mucosa. These findings strongly suggest that TNF-alpha is a mediator of the mucosal damage that attends gonococcal infection. GOALS OF THE STUDY To determine: (1) whether the PPCA values and the TNF-alpha concentrations in fallopian tube mucosal tissues correlate closely enough to allow prediction of the PPCA from a measurement of the mucosal tissue TNF-alpha concentration; and (2) whether the correlation of the TNF-alpha mucosal tissue concentration with the sloughing of ciliated cells (measured by the PPCA) supports the hypothesis that induction of TNF-alpha by gonococcal infection, with resultant sloughing of ciliated cells, is likely to be a major pathogenic mechanism of gonococcal salpingitis and might mediate postsalpingitis infertility and ectopic pregnancy. STUDY DESIGN A metaanalysis was performed on studies from three research groups (two laboratories in the United States and one in the United Kingdom, using identical techniques for quantifying the PPCA, TNF-alpha, or both. RESULTS There was a close and statistically significant correlation between the TNF-alpha mucosal tissue concentration and the proportion of ciliated cells lost from the mucosa as measured by the PPCA (r = 0.95, p < 0.001). Therefore, as the mucosal tissue concentration of endogenous TNF-alpha increased, the loss of ciliated cells from the epithelium increased proportionately. CONCLUSIONS During gonococcal infection of human fallopian tube mucosa in organ culture, the mucosal tissue concentration of TNF-alpha can be used to predict the PPCA, and therefore, the extent of mucosal damage. This finding should facilitate studies of the molecular pathogenesis of infectious diseases involving human genital mucosa. Further, the close correlation of mucosal TNF-alpha concentration with genital mucosal damage, evaluated by the PPCA, supports the hypothesis that induction of the proinflammatory cytokine, TNF-alpha, by gonococcal infection, with resultant inflammation and sloughing of ciliated cells, is an important pathogenic mechanism of gonococcal salpingitis and may mediate postsalpingitis infertility and ectopic pregnancy as well.
TL;DR: Low-dose N- 9 gel was not associated with macroscopic rectal and penile epithelial disruption or inflammation, but histologic abnormalities were commonly observed during N-9 gel as well as during placebo gel use.
Abstract: Background and objectives Methods of HIV and STD prevention, which can be controlled by the receptive partner, are a high priority for research and development. Studies on the safety of Nonoxynol-9 (N-9) on the vaginal mucosa have yielded conflicting results. No Phase I study has evaluated the effect of N-9 on the rectal mucosa. Goals To assess the safety of 52.5 mg of N-9 in a 1.5-g gel when applied one to four applicators per day to the rectum and penis. Study design The study included 25 HIV-negative and 10 HIV-positive, monogamous gay male couples in which each partner was exclusively insertive or receptive while using N-9 gel. Each participant served as his own control during placebo gel use compared to during N-9 gel use. Receptive partners underwent anoscopic examination after 1 week of placebo use and after 2, 5, and 6 weeks of N-9 gel use, with rectal biopsies obtained after 1 week of placebo use and after 5 and 6 weeks of N-9 gel use. Insertive partners had safety monitoring after 1 week of placebo use and after 2, 5, and 6 weeks of N-9. Results No rectal ulcers were detected; superficial rectal erosions were noted in two HIV-negative participants. Abnormal or slightly abnormal histologic abnormalities of rectal biopsies were detected in 31 (89%) receptive participants after N-9 gel use compared to 24 (69%) participants after 1 week of placebo gel use. Meatal ulceration, not caused by herpes simplex virus, was detected in one HIV-negative participant. Conclusion Low-dose N-9 gel was not associated with macroscopic rectal and penile epithelial disruption or inflammation, but histologic abnormalities were commonly observed during N-9 gel as well as during placebo gel use.
TL;DR: Screening by age provided a cost-savings to the Army over a 1-year period and prevented 222 cases of pelvic inflammatory disease, and universal treatment provided the highest cost-Savings and prevented the most disease over a 2- year period.
Abstract: Context: Chlamydia trachomatis genitourinary infections in females can lead to serious and costly sequelae. Programs such as basic (initial entry) military training with controlled points of entry offer an opportunity to screen large cohorts of women at risk for infection. Objective: To assess the cost-effectiveness of three interventions for C. trachomatis infections in women beginning Army training: 1) screening using urine ligase chain reaction (LCR) by age, 2) unrestricted testing using urine LCR, and 3) universal antibiotic treatment with azithromycin. Design: Cost-effectiveness analysis from a military perspective. Setting and Patients: A hypothetical cohort of 10,000 women who intended to complete at least 2 years of military service was studied. Analysis was based on data from 13,204 female trainees screened for chlamydial infection at Fort Jackson, SC. Outcomes: Program and training costs, cost of illness averted, and pelvic inflammatory disease (PID) prevented were determined for a 1-year follow-up period. Using sensitivity analysis, outcomes over 2 years were studied. Results: At a 9.2% prevalence, no screening resulted in $220,900 in training and sequelae costs and 276 cases of PID. Screening by age produced the lowest cost $217,600, over a 1-year period and prevented 222 cases of PID for a cost-savings of $15 per case of PID prevented. Universal testing prevented an additional 11 cases of PID at a cost of $226,400, or costing $800 per additional case of PID prevented over age-targeted screening. Universal treatment prevented an additional 32 cases of PID and cost $221,100, saving $167 per additional cases of PID prevented over universal screening. Over a 2-year period, universal treatment provided the highest cost-savings and prevented the most disease. Conclusion: Screening by age provided a cost-savings to the Army over a 1-year period. Other organizations accessing large cohorts of young women could also benefit, even in the short term, from implementation of an age-based chlamydial screening program. Universal testing or universal treatment may be warranted in which long-term societal goals, such as maximum reduction of PID, are relevant.
TL;DR: The National Committee for Quality Assurance's recent adoption of the measure for chlamydia screening among young women into the formal HEDIS measurement set is justifiable from a health benefit standpoint and from a cost-effectiveness standpoint.
Abstract: Background:The Health Plan Employer Data and Information Set (HEDIS) is a set of performance measures used to assess the quality of care delivered in managed care plans. New measures that address unevaluated areas of care are continuously being developed. Chlamydia screening among young women is one
TL;DR: Most facilities had a policy for STD screening based only on symptoms or by arrestee request, but facilities having a policy of routine STD testing are not testing most of the arrestees.
Abstract: Background and Objectives:Studies have shown that sexually transmitted disease (STD) rates are high in the incarcerated population. However, little is known about STD testing policies or practices in jails.Goal:To assess STD testing policies and practices in jails.Study Design:The Division of STD Pr
TL;DR: It is concluded that data on sexual behavior can be collected reliably among sexually transmitted disease clinic attendees, although reporting bias does occur and the frequency of sexual intercourse was not sufficiently reliable.
Abstract: Background and Objectives: The objective was to assess reliability of self-reported sexual histories among sexually transmitted disease clinic attendees who enrolled in a study in 1994. Goal of this Study: Knowledge about the reliability of sexual data is important to decide whether these measures of sexual behavior can be used in epidemiologic studies of sexually transmitted diseases. Study Design: In 288 attendees, degree of agreement was assessed in responses to an identical set of sexual questions asked independently by a medical doctor and a public health nurse and in responses made by members of the same couple (n = 50) to a public health nurse. Results: In the test-retest comparison, high agreement was found for most questions: kappa-values and exact agreement ranged from 0.73 to 0.96 and 54% to 99%, respectively. Participants interviewed by the medical doctor reported significantly lower numbers of partners and a higher age at first intercourse. Stratified analyses showed variability in agreement across subgroups. Most consistent, women provided more reliable reports than men. In the comparison of couples, substantial agreement was found for the municipality where they met (88% agreement; kappa = 0.72) and contraceptive method (87% agreement; kappa = 0.60), but only moderate agreement was found for frequency of sexual intercourse (26% agreement; kappa = 0.50). Conclusion: The authors conclude that data on sexual behavior can be collected reliably among sexually transmitted disease clinic attendees, although reporting bias does occur. The frequency of sexual intercourse was not sufficiently reliable and should be interpreted as an estimate only.