Akbar A. Zaidi

Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature.

Determining the magnitude of chlamydia and gonorrhea reinfection is critical to inform evidence-based clinical practice guidelines related to retesting after treatment. PubMed was used to identify peer-reviewed English language studies published in the past 30 years that estimated reinfection rates among females treated for chlamydia or gonorrhea. Included in this analysis were original studies conducted in the United States and other industrialized countries that reported data on chlamydia or gonorrhea reinfection in females. Studies were stratified into 3 tiers based on study design. Reinfection rates were examined in relation to the organism, study design, length of follow-up, and population characteristics. Of the 47 studies included, 16 were active cohort (Tier 1), 15 passive cohort (Tier 2), and 16 disease registry (Tier 3) studies. The overall median proportion of females reinfected with chlamydia was 13.9% (n = 38 studies). Modeled chlamydia reinfection within 12 months demonstrated peak rates of 19% to 20% at 8 to 10 months. The overall median proportion of females reinfected with gonorrhea was 11.7% (n = 17 studies). Younger age was associated with higher rates of both chlamydia and gonorrhea reinfection. High rates of reinfection with chlamydia and gonorrhea among females, along with practical considerations, warrant retesting 3 to 6 months after treatment of the initial infection. Further research should investigate effective interventions to reduce reinfection and to increase retesting.

Maternal hypertension and associated pregnancy complications among African-American and other women in the United States.

Objective To characterize maternal hypertension and related pregnancy complications among African-American and other women in the United States. Methods Using data from the National Hospital Discharge Survey, we analyzed the incidence and clinical spectrum of maternal hypertension among African- American women who delivered in hospital during 1998–1992. Maternal hypertension consisted of pregnancy-induced hypertension and chronic hypertension preceding pregnancy, including pregnancy-aggravated hypertension. Pregnancy-induced hypertension included preeclampsia, eclampsia, and transient hypertension. Incidence rates (per 1000 deliveries) and 95% confidence intervals (CI) were calculated by type of hypertension and demographic characteristics. Risk ratios and 95% CIs for adverse pregnancy outcomes among women with hypertension were also calculated. Results The overall incidence of all causes of maternal hypertension was 64.2, and of chronic hypertension preceding pregnancy it was 25.0 per 1000 deliveries among African-American women, an excess of 15.6 and 14.5 cases per 1000 deliveries, respectively, compared with rates for other women. The risks of preterm delivery and inadaquate fetal growth were similarly increased for all hypertensive women, regardless of race. However, hypertensive African- American women were at a threefold greater risk of pregnancies complicated by antepartum hemorrhage, an association that was not observed in other women. Development of preeclampsia and eclampsia irrespective of race was about four times higher among women with chronic hypertension preceding pregnancy than among those without chronic hypertension. Conclusion The excess incidence of maternal hypertension, particularly chronic hypertension, may contribute to adverse maternal and fetal pregnancy outcome and the disparity in outcomes observed between African-American and other women in the U.S. These findings provide a specific focus further clinical research and assessment of prenatal management in African-American Women.

Trends in Pelvic Inflammatory Disease Hospital Discharges and Ambulatory Visits, United States, 1985–2001

Objective: The objective of this study was to describe the estimated trends in incidence of pelvic inflammatory disease (PID) among reproductive-aged women in hospital and ambulatory settings. Study: Analyses of PID estimates were performed. Three nationally representative surveys conducted by the National Center for Health Statistics (NCHS): National Hospital Discharge Survey (NHDS), National Hospital Ambulatory Medical Care Survey (NHAMCS), and National Ambulatory Medical Care Survey (NAMCS), were used to obtain the estimates of PID (defined by International Classification of Diseases, 9th Revision codes). National Disease and Therapeutic Index (NDTI) estimates were reviewed for comparison. Results: Rates of hospitalized PID declined 68% overall from 1985 through 2001 (P <0.0001). Ambulatory data support a decrease in PID from 1985 to 2001. From 1995 to 2001, approximately 769,859 cases of acute and unspecified PID were diagnosed annually, 91% in ambulatory settings. Conclusions: PID has decreased in hospital and ambulatory settings. The expanded national surveys in outpatient and emergency departments provide more complete estimates for PID. Optimal management of PID should target ambulatory settings, where the majority of cases are diagnosed and treated.

Estimated incidence and prevalence of genital Chlamydia trachomatis infections in the United States, 1996.

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.

Sociodemographic factors and the variation in syphilis rates among US counties, 1984 through 1993: an ecological analysis.

OBJECTIVES Syphilis in the United States is focally distributed, with high incidence rates in the South and in metropolitan areas nationwide. In this study an ecological analysis, using the county as the unit of analysis, was performed to generate hypotheses about community-level determinants of syphilis rates. METHODS Bivariate rank correlations and multivariate, backward stepwise elimination linear regressions were performed. Mean annual incidence of primary- and secondary-stage syphilis in a county was the dependent variable, and county sociodemographic characteristics (from census data) were the independent variables. RESULTS In the multivariate regression model, sociodemographic characteristics accounted for 71% of the variation in syphilis rates among counties. With other factors accounted for, the most highly correlated characteristics were percentage non-Hispanic Black population, county location in the South, percentage of the population that was urban, percentage Hispanic population, and percentage of births to women younger than 20 years. CONCLUSIONS Most of the variation in syphilis rates among counties is accounted for by sociodemographic characteristics. Identification and remediation of modifiable health determinants for which these factors are markers are needed to improve the health status of these populations.

A case-control Study of syphilis among men who have sex with men in New York City: Association with HIV infection

Objective: The objective of this study was to determine factors associated with syphilis among men who report sex with other men in New York City. Design, Setting and Study Subjects: We conducted a case–control study among 88 men who reported sex with men in the previous year, 18 to 55 years old and diagnosed with primary or secondary syphilis during 2001; and 176 control subjects frequently matched by age and type of health provider. Results: HIV prevalence among syphilis cases was 48% compared with 15% among control subjects (P <0.001). Variables associated with syphilis in a multivariate model were HIV infection (odds ratio [OR], 7.3; 95% confidence interval [CI], 3.5–15.4), income >

Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project.

30,000 per year (OR, 2.7; CI, 1.4–5.2), and barebacking (OR, 2.6; CI, 1.4–4.8). The median time since HIV diagnosis for HIV-positive was 6 years for cases and 7 years for control subjects (P = 0.70). Among HIV-infected participants, syphilis cases were more likely than control subjects to report being on antiretroviral therapy (69% vs. 44%, P = 0.05) and to report having undetectable viral load (58% vs. 24%, P = 0.02). Conclusion: HIV infection was strongly associated with syphilis in this study. High-risk behavior reported by both cases and control subjects indicates the potential for increased HIV transmission.

Group Counseling to Prevent Sexually Transmitted Disease and HIV: A Randomized Controlled Trial

Objective:To implement an HIV prevention intervention among female commercial sex workers (CSW), and to monitor key outcomes using routinely collected clinical and laboratory data. Design:Cross-sectional and longitudinal analysis of data from an open-enrollment cohort. Setting:One public sexually transmitted disease (STD) clinic and about 25 brothels in La Paz, Bolivia. Participants:A total of 508 female CSW who work at brothels and attend a public STD clinic. Intervention:Improved STD clinical care, supported by periodic laboratory testing, and behavioral interventions performed by a local non-governmental organization. Main outcome measures:Prevalence of gonorrhea, syphilis (reactive plasma reagin titer ≥ 1 : 16), genital ulcer disease, chlamydial infection, and trichomoniasis; self-reported condom use in the previous month; and HIV seroprevalence. Results:From 1992 through 1995, prevalence of gonorrhea among CSW declined from 25.8 to 9.9% (P < 0.001), syphilis from 14.9 to 8.7% (P = 0.02), and genital ulcer disease from 5.7 to 1.3% (P = 0.006); trends in prevalence of chlamydial infection and trichomoniasis were not significant. Self-reported condom use during vaginal sex in the past month increased from 36.3 to 72.5% (P < 0.001). In a multivariate analysis, condom use was inversely associated with gonorrhea [odds ratio (OR), 0.63; 95% confidence interval (CI), 0.41–0.97], syphilis (OR, 0.39; 95% CI, 0.23–0.64), and trichomoniasis (OR, 0.44; 95% CI, 0.32–0.71). In 1995, HIV seroprevalence among CSW was 0.1%. Conclusion:Effective prevention interventions for female CSW can be implemented through public services and non-governmental organizations while HIV rates are still low, and key outcomes can be monitored using data obtained from periodic screening examinations.

Gonorrhea in the United States, 1981-1996. Demographic and geographic trends.

Objective: To compare prevention effectiveness of multisession group counseling with standard HIV prevention counseling for reducing risk behaviors and new sexually transmitted diseases (STDs). Methods: Small groups of consenting STD clinic patients were randomized to four 1‐hour small group counseling interventions based on the information‐motivation‐behavioral skills (IMB) model with a booster session at 2 months or to the standard two 20‐minute individual counseling sessions. Follow‐up interviews and examinations were 2, 6, 9, and 12 months after enrollment. Results: From March 1992 through June 1993, 996 (59%) of 1,681 eligible persons were enrolled; 32 (3%) tested HIV‐positive and were excluded. Intervention attendance was 98% for one session, and 47% attended four or five counseling sessions. Follow‐up was similar for both groups: 72% attended at least once; 47% returned at 12 months. Both groups had similar increases in condom use and decreases in number of partners, and similar number of new infections with gonorrhea (14%), chlamydia (10%), or syphilis (2%). Conclusions: Two 20‐minute counseling sessions were as effective as four 1‐hour group sessions for reducing risk behavior and STD incidence in an STD clinic patient population.

The general transition metal (Tro) and Zn2+ (Znu) transporters in Treponema pallidum: analysis of metal specificities and expression profiles

Objective: To describe demographic and geographic trends in gonorrhea incidence in the United States from 1981 through 1996. Study Design: We analyzed aggregate gonorrhea cases reported to the Centers for Disease Control and Prevention by the 50 states, District of Columbia, and 63 large cities. Annual incidence rates (cases/100,000 persons) were calculated. Results: Between 1981 and 1996, the incidence of reported gonorrhea decreased 71.3%, from 431.5 to 124.0 cases/100,000. However, rates among blacks were 35 times higher than rates among whites in 1996 (684.6 versus 19.4) compared with 11 times higher in 1981 (1,894.3 versus 164.3). Among women of all races, 15 to 19 year olds had the highest rates (716.6 in 1996), whereas among men, 20 to 24 year olds had the highest rates (512.9 in 1996). Southern states had higher rates than other regions. Conclusions: Large segments of the population, including adolescents, young adults, and blacks, continue to have high rates of gonococcal infection; prevention programs and health care providers should address the needs of these groups.