David J. Breland

Concordance and Transmission of Human Papillomavirus Within Heterosexual Couples Observed Over Short Intervals

BACKGROUND Because many human papillomavirus (HPV) infections are transient, rates of transmission may be miscalculated if the interval between testing spans several months. We examined rates of concordance and transmission in heterosexual couples over short intervals. METHODS  Twenty-five adult couples were enrolled and sampled for HPV DNA from the genitals, hand, and mouth 5 times over a 6-week period, including 24 hours after sexual intercourse and after 48 hours of abstinence. Concordance and transmission patterns were described. RESULTS Concordance between the couples genital sites ranged from 64% to 95% for at least 1 HPV type. The highest rates of concordance were observed 24 hours after sexual intercourse. A similar peak in concordance was not seen between genital and nongenital anatomic sites. Transmission rates for female genital to male genital ranged from 26.8 to 187.5 per 100 person-months and for male genital to female genital from 14.5 to 100 per 100 person-months. CONCLUSIONS High rates of concordance shortly after intercourse suggest that some DNA detections in the genital area are contaminants from a partner and not established HPV infections. Female-to-male transmission appeared more common than male-to-female transmission.

Human Papillomavirus Concordance in Heterosexual Couples

PURPOSE Few studies have examined the relationships between sexual or hygienic behaviors and human papillomavirus (HPV) transmission. Our objectives were to (1) describe HPV concordance between the anogenital, oral, and palmar areas of monogamous heterosexual couples; and (2) determine sexual behaviors, hygienic practices, sexual histories, and subject characteristics associated with HPV anogenital concordance. METHODS Couples were recruited from women who developed an incident HPV infection while being enrolled in a longitudinal HPV natural history study that recruited from two family-planning clinics. Men were their monogamous partners of at least 3 months. Samples were tested for HPV-DNA of 37 high- and low-risk genotypes. Questionnaires completed privately assessed health, sexual, hygienic history, and behaviors. RESULTS A total of 25 couples enrolled between February 2006 and July 2007; none had received HPV vaccine. The average age was 25 years (SD, 6) for men and 23 years (SD, 3) for women. HPV-84 was the most commonly shared HPV type in the anogenital and palmar areas. HPV-16 was the only shared oral-HPV type. Sixty-eight percent of couples had type-specific anogenital concordance. Receiving finger-anal sex (p = .05), sharing towels (p = .04), longer time since last intercourse (women: p = .03, men: p = .02 men), and men washing their genitals after sex (p = .03) were associated with decreased likelihood of concordance. Persistence of incident HPV types in women was associated with HPV in men (p = .002). CONCLUSIONS Our findings show that certain hygienic and sexual behaviors are associated with anogenital concordance between healthy, monogamous, heterosexual couples. Future studies are needed to see whether these detections reflect contamination, transient, or established infections.

Adolescent and Young Adult Male Health: A Review

Adolescent and young adult male health receives little attention, despite the potential for positive effects on adult quality and length of life and reduction of health disparities and social inequalities. Pediatric providers, as the medical home for adolescents, are well positioned to address young men’s health needs. This review has 2 primary objectives. The first is to review the literature on young men’s health, focusing on morbidity and mortality in key areas of health and well-being. The second is to provide a clinically relevant review of the best practices in young men’s health. This review covers male health issues related to health care access and the Centers for Disease Control and Prevention’s Healthy 2020 objectives for adolescents and young adults, focusing on the objectives for chronic illness, mortality, unintentional injury and violence, mental health and substance use, and reproductive and sexual health. We focus, in particular, on gender-specific issues, particularly in reproductive and sexual health. The review provides recommendations for the overall care of adolescent and young adult males.

Depression: Focus on the Adolescent Male

of depression have a significant impact on male morbidity and mortality. Depressive symptoms and suicidal thoughts or attempts in adolescent males are present and impact daily functioning. The Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBSS) administers a national survey that includes a broad measure of depressive symptomatology in adolescents. The 2005 YRBSS assessed the following to gauge depressive symptoms: “During the past 12 months, did you feel so sad or hopeless almost every day for ≥ 2 weeks in a row that you stopped doing some usual activities?” One in five males (20.4%) reported this level of sadness. The 2005 YRBSS reports on suicidal thoughts and behavior. Among high school males within the past 12 months, 12% had seriously considered attempting suicide, 9.9% had made a plan about how they would attempt suicide, 6% had attempted suicide one or more times, and 1.8% had a suicide attempt that resulted in injury, poisoning, or overdose that was treated by a doctor or nurse (Youth Risk Behavior Surveillance System, 2005). Using the Center for Epidemiological Studies–Depression Scale to examine degrees of depressive symptomatology, Rushton et al. reported that 5.9% of males met criteria for moderate or severe depression within the past week (Rushton, Forcier, & Schectman, 2002).

Alcohol and cigarette use among adolescent and young adult males

males’ use of substances, and consider strategies for reducing alcohol use and cigarette smoking. The past decade has witnessed advances in research and policy in these areas—advances that have led to two comprehensive reports from the Institute of Medicine (IOM) (Bonnie & O’Connell, 2004; Bonnie, Stratton, & Wallace, 2007). This column focuses disproportionately on adolescents, reflecting the relative lack of research on young adult substance use.

Starting on a Healthy Path: Promotion of Young Men's Sexual Health

Sexuality is an integral part of human life. Mens needs in sexual and reproductive health and health care are receiving increased attention. Adolescence offers the opportunity to improve mens sexual health, as males begin exploring their sexual identity and developing romantic relationships. Despite encouraging trends in risky behavior and health status, rates of sexually transmitted infections (STIs) remain high and disparities persist. Young African American men have higher incidence of risky behavior, STIs, and HIV/AIDS. Promoting sexual health and well-being for young men requires multifaceted strategies, including clinical care, education, and improved access to services. Strategies should address the needs of all youth, including homosexual youth. Although reducing specific risky behaviors and health problems remains a priority, more holistic efforts to understand the context and meaning of sexual activity for young males are needed.

Investing in adolescence: building a strong foundation for male health.

Clark, 2002). Males typically will have peak weight and height velocity occurring about the same time (age 14), averaging around 9 kg/year and 10.3 cm/year, respectively (Rogol et al., 2002). Normal physical growth and development begins with a dynamic hormonal change that influences somatic growth and pubertal development. The sexual maturity ratings (Tanner) were developed to help determine normality of pubertal maturation and divided into five classes based on pubic hair and genitalia development in males (Healy, Lockhart, Mackenzie, Tanner, & Whitehouse, 1956). Typical pubertal sequence in males is adrenarche, followed by beginning of growth spurt, testicular development, beginning of pubic hair, and, finally, peak height velocity. On average, puberty begins in males around age 13 (range 9-14 years) and takes 3 years for completion (range 2-5 years). The average male enters puberty 2 years later than his female counterpart and has a greater peak height velocity, resulting in an average of 13 cm height difference (Rogol et al., 2002). Physical growth in adolescence is accompanied by major cognitive and psychosocial development. Cognitive changes include an increasing ability to consider hypothetical situations, think abstractly, and view the world in multiple dimensions—changes that lead to greater sophistication in areas such as planning, reasoning and understanding, human behavior, and relationships (Halpern-Felsher, Millstein, & Irwin, 2002; Keating, 1990). Recent advances in brain research suggest that neurological changes may play a role in this cognitive growth. For example, substantial changes occur in the prefrontal cortex, which is responsible for executive functions such as planning and priority setting. While gray matter is reduced and white matter is increased, neural connections become more complex and efficient—mechanisms that are hypothesized to enhance adolescents’ cognitive capacity. This process continues into the early 20s (Weinberger, Elvevag, & Giedd, 2005). Looking at psychosocial development, Steinberg identifies five Why Adolescence?