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Ruiz Del Pino M, Rosales-Castillo A, Hidalgo-Tenorio C, Expósito-Ruiz M, Navarro-Marí JM, Gutiérrez-Fernández J. [Isolation of Haemophilus no ducreyi in samples from the genital tract of men: Its clinical relationship]. Rev Int Androl 2023; 21:100374. [PMID: 37413940 DOI: 10.1016/j.androl.2023.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION With the advancement of microbiological methods, the isolation of less typical pathogens in cases of urethral and rectal infection is more frequent, apart from the classic etiological agents. One of them is formed by species of Haemophilus no ducreyi (HND). The objective of this work is to describe frequency, susceptibility to antibiotics, and clinical features of HDN urethritis and proctitis in adult males. PATIENTS AND METHODS This is an observational retrospective descriptive study of the results obtained by the Microbiology laboratory of the Virgen de las Nieves University Hospital on the isolates of HND in genital and rectal samples from males between 2016 and 2019. RESULTS HND was isolated in 135 (7%) of the genital infection episodes diagnosed in men. H. parainfluenzae was the most commonly isolated (34/45; 75.6%). The most frequent symptoms in men with proctitis were rectal tenesmus (31.6%) and lymphadenopathy (10.5%); in those with urethritis, dysuria (71.6%), urethral suppuration (46.7%) and gland lesions (27%), so differentiating it from infections caused by other genitopathogens is difficult. 43% of patients were HIV positive. Antibiotic resistance rates for H. parainfluenzae were high to quinolons, ampicillin, tetracycline and macrolides. CONCLUSION HND species should be considered as possible etiologic agents in episodes of urethral and rectal infection in men, especially in cases with negative screening tests for agents that cause sexually transmitted infections (STIs). Its microbiological identification is essential for the establishment of an effective targeted treatment.
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Affiliation(s)
- Marta Ruiz Del Pino
- Departamento de Microbiología, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - Antonio Rosales-Castillo
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves-IBS, Granada, España; Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España.
| | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - Manuela Expósito-Ruiz
- Departamento de Bioestadística de FIBAO, Hospital Universitario Virgen de las Nieves-IBS, Granada, España
| | - José María Navarro-Marí
- Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España
| | - José Gutiérrez-Fernández
- Departamento de Microbiología, Hospital Universitario Virgen de las Nieves-IBS, Granada, España; Departamento de Microbiología, Facultad de Medicina, Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada-IBS, Granada, España
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Chambers LC, Morgan JL, Lowens MS, Robinson TS, Romano SS, Leipertz GL, Hughes JP, Golden MR, Khosropour CM, Fredricks DN, Manhart LE. Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients. Sex Transm Infect 2018; 95:212-218. [PMID: 30181326 DOI: 10.1136/sextrans-2018-053634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/22/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Although Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) are major causes of non-gonococcal urethritis (NGU), up to 50% of cases are of unknown aetiology. We sought to identify urethral exposures at last sexual episode associated with NGU and non-CT/non-MG NGU to identify anatomical sites from which aetiologically relevant micro-organisms may be acquired. METHODS We enrolled STD clinic patients with and without NGU assigned male sex at birth and age ≥16 into a cross-sectional study. NGU was urethral symptoms or visible discharge plus ≥5 polymorphonuclear leucocytes without Neisseria gonorrhoeae. Urine was tested for CT and MG (Aptima). We used logistic regression to estimate the association between urethral exposures at last sex and NGU separately among cisgender men and transgender women who have sex with men (MSM/TGWSM) and cisgender men who have sex with women (MSW). RESULTS Between 8 August 2014 and 1 November 2017, we enrolled 432 patients, including 183 MSM/TGWSM (118 NGU+, 65 NGU-) and 249 MSW (126 NGU+, 123 NGU-). The mean age was 34; 59% were white. CT and MG were detected in 72 (30%) and 49 (20%) NGU+ participants, respectively. Compared with MSM/TGWSM reporting only non-urethral exposures at last sex, those reporting insertive anal intercourse (IAI) only (adjusted OR (AOR)=4.46, 95% CI 1.09 to 18.19) and IAI with insertive oral sex (IOS) (AOR=7.88, 95% CI 2.67 to 23.26) had higher odds of NGU. MSM/TGWSM reporting IOS only had no significant increased odds (AOR=1.67, 95% CI 0.58 to 4.85). Compared with MSW whose only urethral exposure at last sex was vaginal sex (VS), MSW reporting IOS and VS had similar odds of NGU (OR=0.84, 95% CI 0.50 to 1.41). The results were similar for non-CT/non-MG NGU. CONCLUSIONS Among MSM/TGWSM, IAI may lead to transmission of yet-unidentified rectal micro-organisms that cause non-CT/non-MG NGU, in addition to transmission of known pathogens. Sites of urethral exposure appear less important for understanding NGU risk among MSW due to minimal variation in behaviour.
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Affiliation(s)
- Laura C Chambers
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jennifer L Morgan
- HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA
| | - M Sylvan Lowens
- HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Tashina S Robinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sarah S Romano
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gina L Leipertz
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,HIV/STD Program, Public Health - Seattle & King County, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | | | - David N Fredricks
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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Kiss and Tell: Limited Empirical Data on Oropharyngeal Neisseria gonorrhoeae Among Men Who Have Sex With Men and Implications for Modeling. Sex Transm Dis 2018; 44:596-598. [PMID: 28910265 DOI: 10.1097/olq.0000000000000709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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4
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McMillan A, Young H. Rectal chlamydial infection among men who have sex with men: Partner notification as a means of nucleic acid amplification test validation. Int J STD AIDS 2016; 18:157-9. [PMID: 17362545 DOI: 10.1258/095646207780132389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nucleic acid amplification tests for the diagnosis of rectal chlamydial infection are not yet licenced. However, the detection of urethral Chlamydia trachomatis in sexual contacts of men who have sex with men (MSM) with rectal chlamydiae might support the validity of such tests. This was a retrospective study of the outcome of partner notification among MSM with rectal chlamydia who consecutively attended a sexually transmitted diseases clinic. During the study period, 5213 MSM attended the Department as new or ‘return new’ patients. There were 243 (5%) episodes of rectal chlamydial infection. In 87 men, at least one sexual partner was identified and attended the clinic. Overall, 34 (39%) of the 87 evaluable sexual contacts had urethral chlamydial infection. The finding of urethral C. trachomatis infection in a sizeable proportion of sexual contacts of men with rectal chlamydiae lends further support to the validation of the test system for the diagnosis of rectal chlamydia.
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Affiliation(s)
- Alexander McMillan
- Department of Genitourinary Medicine, Edinburgh Royal Infirmary, NHS Lothian, UK.
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Characteristics of acute nongonococcal urethritis in men differ by sexual preference. J Clin Microbiol 2014; 52:2971-6. [PMID: 24899041 DOI: 10.1128/jcm.00899-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nongonococcal urethritis (NGU) is a common clinical syndrome, but no etiological agent is identified in a significant proportion of cases. Whether the spectrum of pathogens differs between heterosexual men (MSW) and men who have sex with men (MSM) is largely unstudied but of considerable clinical relevance. A retrospective review was done using the electronic medical record database of Melbourne Sexual Health Centre, Australia. Cases were first presentations of symptomatic acute NGU with ≥ 5 polymorphonuclear leukocytes (PMNL)/high-powered field (HPF) on urethral Gram stain between January 2006 and December 2011. First-stream urine was tested for Chlamydia trachomatis and Mycoplasma genitalium by PCR. Demographic, laboratory, and behavioral characteristics of cases were examined by univariate and multivariable analyses. Of 1,295 first presentations of acute NGU, 401 (32%; 95% confidence interval [CI] of 29 to 34%) had C. trachomatis and 134 (11%; 95% CI of 9 to 13%) had M. genitalium detected. MSM with acute NGU were less likely to have C. trachomatis (adjusted odds ratio [AOR] = 0.4; 95% CI of 0.3 to 0.6) or M. genitalium (AOR = 0.5; 95% CI of 0.3 to 0.8) and more likely to have idiopathic NGU (AOR = 2.4; 95% CI of 1.8 to 3.3), to report 100% condom use for anal/vaginal sex (AOR = 3.6; 95% CI of 2.7 to 5.0), or to have engaged in sexual activities other than anal/vaginal sex (AOR = 8.0; 95% CI of 3.6 to 17.8). Even when C. trachomatis or M. genitalium was detected, MSM were more likely than MSW to report consistent condom use (OR = 4.7; 95% CI of 2.6 to 8.3). MSM with acute NGU are less likely to have the established bacterial sexually transmitted infections (STIs) and more likely to report protected anal sex or sexual activity other than anal sex prior to symptom onset than MSW. These data suggest that the etiologic spectrum of pathogens differs between MSM and MSW in acute NGU and that relatively low-risk practices are capable of inducing acute NGU.
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Physical Barrier Methods. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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7
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Wetmore CM, Manhart LE, Golden MR. Idiopathic urethritis in young men in the United States: prevalence and comparison to infections with known sexually transmitted pathogens. J Adolesc Health 2009; 45:463-72. [PMID: 19837352 PMCID: PMC2764555 DOI: 10.1016/j.jadohealth.2009.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 06/18/2009] [Accepted: 06/30/2009] [Indexed: 01/07/2023]
Abstract
PURPOSE Urethritis is the most common male reproductive tract disease syndrome; yet 20-50% of diagnosed cases have no defined etiology, and few population-level data exist on the prevalence or etiology of the syndrome. We estimated the prevalence of urethritis among young men in the United States and compared correlates of idiopathic cases to correlates of detected infections with sexually transmitted pathogens. METHODS Questionnaire data and urine specimens from 5,447 men aged 18-27 years participating in Wave III of the National Longitudinal Study of Adolescent Health were analyzed. Symptomatic urethritis was defined as self-reported dysuria or urethral discharge in the past 24hours. Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium were identified using nucleic acid amplification tests. Idiopathic urethritis (IU) was defined as urethral symptoms in the absence of these four pathogens. Stratified weighted analyses generated population-based estimates. RESULTS Urethritis was reported by 1.2% (95% CI=.8-1.6%) of men, of whom 82.4% (61.1-93.3%) had IU. Men with previous STD diagnoses (aOR=9.3 [95% CI=3.0-28.7]), or fewer (1-4) or no lifetime vaginal sex partners (aOR=7.5 [2.9-19.3] and aOR=7.2 [1.9-27.4]), were more likely to have IU compared with men without urethral symptoms or identified pathogens, whereas men of Native American or Asian/Pacific Islander descent (aOR=.04 [.01-.2]) and heavy drinkers (aOR=.08 [.03-.2]) were less likely to have IU. Unlike infection with known pathogens, IU was not associated with black race, Hispanic ethnicity, or age at sexual debut. CONCLUSIONS Urethral symptoms were rarely associated with known pathogens. IU and known pathogens were associated with distinct characteristics.
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Affiliation(s)
- Catherine M. Wetmore
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Center for AIDS and STD, University of Washington, Seattle, WA
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Center for AIDS and STD, University of Washington, Seattle, WA
| | - Matthew R. Golden
- Department of Medicine, University of Washington, Seattle, WA
- Department of Center for AIDS and STD, University of Washington, Seattle, WA
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Mindel A, Sawleshwarkar S. Condoms for sexually transmissible infection prevention: politics versus science. Sex Health 2008; 5:1-8. [DOI: 10.1071/sh07054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 11/09/2007] [Indexed: 11/23/2022]
Abstract
The present review assesses the protection that condoms offer against sexually transmissible infections (STI) and the impact that social, political and religious opinion in the USA has had in the past 8 years on promoting condoms for safer sex. Condoms offer protection against most STI. However, the degree of protection depends on correct and consistent use, the type of sexual activity and the biological characteristics of different infections. Cross-sectional and case-control studies and other observational data provide the majority of evidence for STI prevention. Condoms provide a high level of protection against those infections that are transmitted mainly via infected secretions, including HIV, gonorrhoea, chlamydia and trichomoniasis. Protection against those infections transmitted via skin and mucous membrane contact, including Herpes simplex virus infection and human papilloma virus, appears to be less. The Bush administration, driven by conservative political, social and religious elements in the USA, has mounted a concerted campaign to undermine the role of the condom in health-promotion activities in the USA and overseas by undervaluing and misrepresenting scientific data, and through a sustained and well-funded promotion of abstinence-only education. However, this has lead to considerable controversy and disillusionment with abstinence-only education, both at home and abroad, and there is now incontrovertible evidence that abstinence-only programs are ineffectual.
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Lyttle PH, Thompson SC. Maintaining sexual health in commercial sex workers in Australia: condom effectiveness, screening, and management after acquiring sexually transmissible infections. Aust N Z J Public Health 2007; 28:351-9. [PMID: 15704700 DOI: 10.1111/j.1467-842x.2004.tb00443.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To provide practical advice to health care providers and public health practitioners regarding screening and management of sexually transmitted infections (STIs) in sex workers, and to examine the effectiveness of condoms in reducing transmission of STIs. METHODS Medline search using the key words sex workers, prostitutes, condoms and these terms in conjunction with pregnancy, sexually transmitted infections (including the names of individual STIs), infectivity, exclusion periods. Additional articles were identified from cited references. Articles were selected on the basis of information provided on efficacy of condoms in STI prevention, prevalence of STIs in sex workers and changes following condom promotion, and advice about management of STIs in infected workers. RESULTS Condoms offer some protection (30-90%) against STIs passed in semen, urethral, vaginal or cervical secretions (such as HIV, gonorrhoea, chlamydia). They give little to no protection (0-30%) against diseases due to skin-to-skin contact such as genital herpes and genital warts. Transmissibility of STIs varies according to the sex of the exposed person and the sexual practice. Condom effectiveness against STIs also varies with gender, and experience and consistency of condom use. CONCLUSIONS Sex workers require regular screening for STIs as condom use is not fully protective. Management of sex workers identified with infection requires understanding of the issues faced by sex workers, biological characteristics of the infective organism, treatment efficacy, and test sensitivity and specificity. Advice on frequency of STI testing, supply of medical certificates, management of condom breakage, and management of infected sex workers is proposed.
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Affiliation(s)
- P Heather Lyttle
- Northern Territory AIDS/STD Program, Territory Health Services, Northern Territory.
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Abstract
OBJECTIVE To investigate the association of condom use with chlamydia infection in men attending a large sexually transmitted infection (STI) clinic in Australia. STUDY Computerized records for all attendances between July 2002 and June 2003 were included and separate analyses were performed for men reporting male-to-male sexual contact (MSM) and for men reporting heterosexual contact only (non-MSM). Associations among age, condom use, and number of partners with chlamydia infection were assessed. RESULTS Chlamydia was diagnosed at a rate of 8.6 cases per 100 consultations (95%CI: 7.1, 10.3) among MSM and at a rate of 6.8 cases per 100 consultations (95%CI: 5.9, 7.8) among non-MSM. Condom use was associated with a lower odds of rectal chlamydia but not urethral infection in MSM. Condom use was associated with lower odds of urethral chlamydia among non-MSM. CONCLUSIONS The findings suggest that condoms do provide some protection against rectal chlamydia infection in MSM and chlamydial urethritis in non-MSM, but other factors may play an important role in the transmission of chlamydial urethritis in MSM.
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Affiliation(s)
- Jane Hocking
- School of Population Health, University of Melbourne and Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.
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Warner L, Stone KM, Macaluso M, Buehler JW, Austin HD. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33:36-51. [PMID: 16385221 DOI: 10.1097/01.olq.0000187908.42622.fd] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically. OBJECTIVES The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates. DESIGN We reviewed studies published 1966-2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use. RESULTS Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04). CONCLUSIONS Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness.
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Affiliation(s)
- Lee Warner
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
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Adam MB, Reyna VF. Coherence and correspondence criteria for rationality: experts' estimation of risks of sexually transmitted infections. JOURNAL OF BEHAVIORAL DECISION MAKING 2005. [DOI: 10.1002/bdm.493] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Celentano DD. Editorial response: it's all in the measurement: consistent condom use is effective in preventing sexually transmitted infections. Sex Transm Dis 2004; 31:161-2. [PMID: 15076928 DOI: 10.1097/01.olq.0000117589.12564.1b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shlay JC, McClung MW, Patnaik JL, Douglas JM. Comparison of Sexually Transmitted Disease Prevalence by Reported Level of Condom Use Among Patients Attending an Urban Sexually Transmitted Disease Clinic. Sex Transm Dis 2004; 31:154-60. [PMID: 15076927 DOI: 10.1097/01.olq.0000114338.60980.12] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is controversy as to the protective effect of condoms in preventing various sexually transmitted diseases (STDs). GOAL The goal of this study was to assess the association of various levels of condom use with a variety of STD. STUDY DESIGN We conducted a cross-sectional study of female and heterosexual male visits to an urban STD clinic between 1990 and 2001. METHODS Prevalence rates were calculated for gonorrhea, chlamydia, trichomonas, recent-onset genital warts, first-episode herpes, and molluscum contagiosum by reported level of condom use over the past 4 months, with adjusted odds ratios (AOR) calculated by logistic regression. RESULTS Among 126,220 patient visits (39% women and 61% men), condom use over the past 4 months was reported by 54%, with 38% reporting inconsistent use and 16% consistent use. Condom users reported greater sexual risk in the past 4 months than nonusers (ie, new sex partners: 63% vs. 41%, P <0.001; multiple sex partners: 60% vs. 36%, P <0.001). When all condom users were compared with nonusers, there was limited evidence of protection against specific STD. However, when the analysis was restricted to condom users, infection rates were significantly lower in consistent than inconsistent users for both men and women for gonorrhea (AOR, 0.87 and 0.71, respectfully) and chlamydia (AOR, 0.66 and 0.74, respectfully), for trichomonas in women (AOR, 0.87), and for genital herpes in men (AOR, 0.73). CONCLUSIONS Comparisons of STD between condom users and nonusers are confounded by greater sexual risk in users. Comparing consistent with inconsistent users reduces this confounding, revealing protection for both men and women for nonviral STD and for genital herpes for men.
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Affiliation(s)
- Judith C Shlay
- Department of Public Health, Denver Health and Hospital Authority, Denver, Colorado 80204-4507, USA.
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Riemersma WA, van der Schee CJC, van der Meijden WI, Verbrugh HA, van Belkum A. Microbial population diversity in the urethras of healthy males and males suffering from nonchlamydial, nongonococcal urethritis. J Clin Microbiol 2003; 41:1977-86. [PMID: 12734237 PMCID: PMC154717 DOI: 10.1128/jcm.41.5.1977-1986.2003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2002] [Revised: 01/17/2003] [Accepted: 02/11/2003] [Indexed: 11/20/2022] Open
Abstract
Nonchlamydial, nongonococcal urethritis (NCNGU) is suggested to be a sexually transmitted disease in men. NCNGU patients were compared to control subjects with regard to the presence of potentially infectious bacteria in the first void urine. Patients' pre- and post-antibiotic-treatment urine samples and two samples obtained 2 weeks apart from healthy volunteers, who did not receive antibiotic therapy, were analyzed with broad-spectrum PCR tests aiming at eubacterial small subunit rRNA genes. Restriction fragment length polymorphism analysis of the amplicons cloned from the mixtures of PCR products revealed that many different species of microorganisms were found to be colonizing the male urethra. We document here clear differences in the composition of the resident urethral flora between samples obtained from various individuals and between samples obtained at various points in time for a single individual. No major changes in population complexity were found upon antimicrobial treatment. In two of five patients a previously suggested pathogen (Mycoplasma genitalium or Haemophilus parainfluenzae) was accurately identified on the basis of DNA sequencing. No ubiquitous, azithromycin-sensitive organism was identified as a common pathogen in all patients, but up to 40% of all clones represented as-yet-unclassified bacterial species. Relatively often Pseudomonas spp. or Pseudomonas-like organisms were identified in the bacterial flora of patients. Interestingly, an as-yet-uncharacterized microbial species was identified as a negative predictor of NCNGU. This species was identified in all control subjects and was absent from all of the patient' samples (5 of 5 versus 0 of 5, P = 0.0079). This suggests that NCNGU might also be diagnosed by assessing the absence rather than the presence of certain bacterial species.
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Affiliation(s)
- W A Riemersma
- Department of Dermatology and Venereology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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Andersen B, van Valkengoed I, Olesen F, Møller JK, Østergaard L. Value of self-reportable screening criteria to identify asymptomatic individuals in the general population for urogential Chlamydia trachomatis infection screening. Clin Infect Dis 2003; 36:837-44. [PMID: 12652383 DOI: 10.1086/368188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2002] [Accepted: 12/09/2002] [Indexed: 11/03/2022] Open
Abstract
Submission of samples from the home allows screening for Chlamydia trachomatis without preceding professional assessment of clinical risk factors. Therefore, a validation of self-reportable information for use as selective screening criteria is needed. We asked a total of 1175 women and 1033 men who participated in an in-home sampling screening study to provide information on behavior and sociodemographic characteristics. In a multivariate model, selective screening criteria were developed on the basis of information from a random part of the tested population (development group), and the validity was assessed for the remaining part of the tested population (validation group). To find all infections, 95% of the subjects had to be screened, and screening 63% of them would have detected 86% of infections. Low predictive values were found when selective screening criteria from other studies were assessed. Selective screening by means of in-home sampling strategies among men and women aged 21-23 years cannot be recommended in the area studied.
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Affiliation(s)
- Berit Andersen
- Research Unit and Department of General Practice, Aarhus University, Denmark .
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Reyna VF, Adam MB. Fuzzy-trace theory, risk communication, and product labeling in sexually transmitted diseases. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2003; 23:325-342. [PMID: 12731817 DOI: 10.1111/1539-6924.00332] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Health care professionals are a major source of risk communications, but their estimation of risks may be compromised by systematic biases. We examined fuzzy-trace theory's predictions of professionals' biases in risk estimation for sexually transmitted infections (STIs) linked to: knowledge deficits (producing underestimation of STI risk, re-infection, and gender differences), gist-based mental representation of risk categories (producing overestimation of condom effectiveness for psychologically atypical but prevalent infections), retrieval failure for risk knowledge (producing greater risk underestimation when STIs are not specified), and processing interference involving combining risk estimates (producing biases in post-test estimation of infection, regardless of knowledge). One-hundred-seventy-four subjects (experts attending a national workshop, physicians, other health care professionals, and students) estimated the risk of teenagers contracting STIs, re-infection rates for males and females, and condom effectiveness in reducing infection risk. Retrieval was manipulated by asking estimation questions in two formats, a specific format that "unpacked" the STI category (infection types) and a global format that did not provide specific cues. Requesting estimates of infection risk after relevant knowledge was directly provided, isolating processing effects, assessed processing biases. As predicted, all groups of professionals underestimated the risk of STI transmission, re-infection, and gender differences, and overestimated the effectiveness of condoms, relative to published estimates. However, when questions provided better retrieval supports (specified format), estimation bias decreased. All groups of professionals also suffered from predicted processing biases. Although knowledge deficits contribute to estimation biases, the research showed that biases are also linked to fuzzy representations, retrieval failures, and processing errors Hence, interventions that are designed to improve risk perception among professionals must incorporate more than knowledge dissemination. They should also provide support for information representation, effective retrieval, and accurate processing.
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Affiliation(s)
- Valerie F Reyna
- Informatics and Decision-Making Laboratory, Department of Surgery, University of Arizona, PO Box 245031, Tucson, AZ 85724-5031, USA. ,
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Abstract
OBJECTIVE To ascertain the urological complications of coitus, as the proximity of the lower urinary tract to the organs of coitus exposes the tract to coital trauma. MATERIALS AND METHODS Medline was searched from 1966 to 2000 to identify reports on coital injuries. Publications and relevant references were retrieved. Those reporting urological complications were selected for analysis. RESULTS In all, 1454 cases of reported coital injuries were reviewed; 790 occurred in men while 664 occurred in women, mainly in the genital area. Physical urological complications were more common in men than in women. The injuries were often sustained during voluntary coitus, but one penile fracture was sustained during an attempted rape. The presentations included penile swellings and deviations, haemorrhage, erectile dysfunction and urinary incontinence. Complications included vesicovaginal fistulae, bladder and cavernosal ruptures, and urinary tract infections. Rare complications included isolated rupture of the penile vasculature. Major risk factors included penovaginal disproportion, excessive force at coitus, urethral coitus, fellatio and anal intercourse. Urethral injuries were the commonest complications; in men these were associated with 10-38% of penile fractures. The treatments included cold compress and anti-inflammatory agents in contusions, repairs of lacerations, closure of fistulae and urethral and vaginal reconstruction. The results of treatment were essentially good. Recurrent penile fractures were reported. CONCLUSION Coitus, although pleasurable, may be risky. The complications have been termed 'faux pas' implying that they are preventable. While the ultimate prevention is abstinence, this is an unrealistic prescription. Therefore, efforts are necessary to identify risk factors to enable preventive strategies.
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Affiliation(s)
- N Eke
- Urology Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
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Page-Shafer K, Graves A, Kent C, Balls JE, Zapitz VM, Klausner JD. Increased sensitivity of DNA amplification testing for the detection of pharyngeal gonorrhea in men who have sex with men. Clin Infect Dis 2002; 34:173-6. [PMID: 11740704 DOI: 10.1086/338236] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2001] [Revised: 08/23/2001] [Indexed: 11/03/2022] Open
Abstract
We compared ligase chain reaction (LCR) assay with standard culture for the detection of pharyngeal Neisseria gonorrhoeae infection in men who have sex with men (MSM) presenting at a sexually transmitted diseases clinic in San Francisco. Pharyngeal specimens were obtained from 200 MSM who reported performing fellatio during the previous 2 weeks. Confirmatory testing of discrepant specimens was conducted using N. gonorrhoeae pilin proteins. Prevalence of pharyngeal N. gonorrhoeae was 6% by culture or 11% by LCR. The sensitivity and specificity of LCR were 94.7% and 97.8%, respectively, compared with values of 47.4% and 100% for culture. Prevalence of pharyngeal N. gonorrhoeae infection, as determined by DNA amplification testing, was higher than that suggested by traditional culture. Results support the use of DNA amplification testing in the oropharynx. The high prevalence of pharyngeal N. gonorrhoeae infection among MSM suggests that routine screening should be considered in efforts to reduce the burden of gonorrhea in this population.
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Affiliation(s)
- Kimberly Page-Shafer
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA 94105, USA.
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Abstract
The majority of cases of acute nongonococcal urethritis (NGU) are due to causes other than infection with Chlamydia trachomatis. Pathogens implicated as causes of nonchlamydial nongonococcal urethritis (NCNGU) include Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, and primary infection with herpes simplex virus. In a majority of cases of acute NCNGU, no pathogen can be isolated. The etiology of chronic NCNGU is unknown.
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Affiliation(s)
- M A Schwartz
- Department of Medicine, University of Washington School of Medicine, Seattle, USA.
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