Lars Forssman

Comparison of Development of Serum Antibodies to HPV16 and HPV33 and Acquisition of Cervical HPV DNA Among Sexually Experienced and Virginal Young Girls: A Longitudinal Cohort Study

Objectives: To study the importance of sexual activity and early coitus debut on the risk for acquiring infection with human papillomavirus (HPV) type 16 or 33. Study Design: Ninety‐eight healthy adolescent girls were followed up with consecutive interviews and donations of serum and cervical brush samples during 2 years. Results: Fourteen percent of sexually experienced girls had serum immunoglobulin G to HPV16 and/or HPV33 capsids, and 14% also had cervical HPV16 or HPV33 DNA. Seropositivity for HPV correlated with detection of cervical HPV DNA. None of the 36 girls without coital experience was seropositive or harbored cervical HPV DNA. Seropositivity for HPV was correlated strongly with the number of sexual partners: Odds ratio for >1 sexual partner was 16.3 (P < 0.001), and for early coitus debut (younger than 17 years of age), it was 14.3 (P < 0.002). Conclusions: Both HPV serology and HPV DNA testing indicated that the number of sexual partners and earliness of coitus debut determined the risk for acquiring HPV infection and that nonsexually transmitted infections are rare or nonexistent among adolescent girls.

Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls

Aim. To compare life‐style and reproductive health care factors in girls with a coitus debut < 15 years of age and girls with a later debut.

Conservative treatment of uterine arteriovenous fistula.

Abstract. A case of a uterine arteriovenous aneurysm in a 20‐year‐old woman is described. The patients main symptom was copious uterine bleeding. The diagnostic difficulties are described and the importance of arteriography is emphasized. The aneurysm was occluded at laparotomy by introducing gel‐foam into the uterine artery. The patient subsequently became pregnant and after an uneventful pregnancy was delivered of a healthy child. Thus, this type of conservative treatment seems to offer a possible means of avoiding hysterectomy in young patients with this rare condition who wish to retain their fertility.

Contact Tracing in the Control of Genital Chlamydia Trachomatis Infection

Four different types of contact tracing for partners of Chlamydia trachomatis infected patients were compared with respect to reinfections during two 15-month periods in 1979/80 and in 1983/84. Between the two study periods a gradual improvement in contact tracing occurred. No reduction in overall reinfections was observed in the second period, reinfections occurring within 12 weeks were similar in the two periods. Treatment of the regular partner (by giving the woman a prescription for her partner) without examination or further partner follow-up resulted in few reinfections. A system of partner referral without verification that partners actually appeared for examination resulted in significantly more reinfections by the regular partner than a system with non-mandatory verification: 60 of 997 women (6%) compared with 6 of 645 (1%). The addition of C. trachomatis infection to the existing STD legislation resulted in fewer identified partners refusing examination than previously, one of 254 men (0.4%) compared with 40 of 223 (18%) before legal inclusion.

Measurement of cardiac stroke volume by impedance cardiography in the last trimester of pregnancy

Abstract. Simultaneous determination of cardiac stroke volume by impedance cardiography and the dye dilution technique was compared in 10 women during the last trimester of pregnancy. Measurements were performed in different body positions to investigate the influence of body position on stroke volume.

Factors influencing aortocaval compression in late pregnancy

The circulatory effects of postural change in late pregnancy were investigated in 20 healthy pregnant women. Maximum stroke volume (93.2 +/- 11.9 ml) was recorded with the subject in the left lateral position and was significantly (p less than 0.001) reduced in the supine, right lateral, and lithotomy positions, but was largely unchanged in the standing motionless position (89.9 +/- 12.6 ml). Diastolic, systolic, and mean arterial blood pressures and total peripheral vascular resistance were significantly (p less than 0.001) increased in the supine, right lateral, lithotomy, and upright motionless positions when compared to the same variables in the left lateral position. The following factors were found to be significantly correlated to the hemodynamic response to the supine recumbent position: maternal age (p less than 0.05), the position of the fetus in the uterus (p less than 0.05), and systolic (p less than 0.001) and diastolic (p less than 0.001) blood pressures measured with the subject in the left lateral position. The implications of the present findings for modern obstetric delivery care and the etiology of the supine hypotensive syndrome are discussed.

Distribution of Blood Flow in Myomatous Uteri as Measured by Locally Injected 133XENON

Abstract. Regional blood flow in the myometrium and myomata has been measured during laparotomy in 11 patients using locally injected 133Xenon. Blood flow was calculated from the wash‐out curves using both initial slope technique and compartment analysis. Assuming equal partition coefficients in myometrium and myomata the following values in ml ± min−1 ± 100 g−1 are seen: initial slope technique–myometrium 15.6±2.29, myomata 5.1±0.95, compartment analysis–myometrium 20.01±3.21, myomata 5.5±1.16. The blood flow was always lower in myomata than in myometrium of the same uterus. The main reason for the reduction of blood flow per unit weight of uterus in patients with myomata previously reported thus seems to be low blood flow in the myomata. A slight reduction of blood flow in the surrounding myometrium, however, also seems probable.

Treatment of Bacterial Vaginosis with an Acid Cream: A Comparison between the Effect of Lactate-Gel and Metronidazole

Bacteriological isolation of anaerobes, Gardnerella and lactobacilli was carried out in a group of 62 women with the diagnosis bacterial vaginosis and 42 control women. Lactobacilli were the predominant organisms in the control group whereas anaerobes dominated the flora in bacterial vaginosis patients. Lactate-gel (pH 3.5, 5 ml) inserted into the vagina daily for 7 days is as effective as oral metronidazole, 500 mg twice daily for 7 days. The women in both groups became symptom-free and objectively improved. Anaerobes were significantly reduced (p less than 0.0001) in both groups after 1-week treatment but Gardnerella was not significantly reduced. As bacterial vaginosis is generally looked upon as a mild noninflammatory condition lactate-gel seems to be an ideal treatment for this disease.

Prevalence of Antibodies to Herpes Simplex Virus Types 1 and 2, Epstein-Barr Virus and Cytomegalovirus in Teenage Girls

Seropositivity to herpes virus type 1 (HSV-1), herpes virus type 2 (HSV-2), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) was estimated in a group of 98 16-year-old Swedish girls. Antibodies to HSV-1 were seen in 41% of the girls and to HSV-2 in 1%, and antibodies to CMV in 45 and to EBV in 82%. In girls with coitus experience, there was significantly higher prevalence of HSV-1 and EBV antibodies, compared with girls with no sexual contact. The age of coitarche or number of coitus partners did not affect the rate of seropositivity. During 2 years of follow-up, 13 girls seroconverted. All but one EBV-seroconverting girl, were sexually active, and no girl converted for more than one type of virus. We concluded that transmission of herpes viruses is common in adolescence, and sexuality, even with regard to its close association with kissing, is one important determinant.

Risk factors for Chlamydia trachomatis infection in 6810 young women attending family planning clinics.

Screening programmes are important for the control of Chlamydia trachomatis (Ct) infection, a disease spread mainly by asymptomatic carriers. Risk factors for Ct infection were assessed in 6810 consecutive asymptomatic young women seeking contraceptive advice. All women filled in a questionnaire and were offered Ct testing. Of the 5785 who consented to testing, 425 (7.3%) were Ct culture positive. Four variables were significantly related to increased risk of being infected: age 18–23 years, duration of present relationship < 1 year, non-use of condoms, and a history of not having had a previous genital infection. It is not possible to devise screening criteria that would effectively identify women at high risk. Therefore a screening programme should be targeted at all sexually active young people. However, if after some years the programme succeeds in lowering general Ct prevalence, these factors may be important when selecting patients for Ct testing.