Mary E. Guinan

National Case-Control Study of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia in Homosexual Men: Part 1, Epidemiologic Results

To identify risk factors for the occurrence of Kaposis sarcoma and Pneumocystis carinii pneumonia in homosexual men, we conducted a case-control study in New York City, San Francisco, Los Angeles, and Atlanta. Fifty patients (cases) (39 with Kaposis sarcoma, 8 with pneumocystis pneumonia, and 3 with both) and 120 matched homosexual male controls (from sexually transmitted disease clinics and private medical practices) participated in the study. The variable most strongly associated with illness was a larger number of male sex partners per year (median, 61 for patients; 27 and 25 for clinic and private practice controls, respectively). Compared with controls, cases were also more likely to have been exposed to feces during sex, have had syphilis and non-B hepatitis, have been treated for enteric parasites, and have used various illicit substances. Certain aspects of a lifestyle shared by a subgroup of the male homosexual population are associated with an increased risk of Kaposis sarcoma and pneumocystis pneumonia.

Frequency of Acquisition of First-Episode Genital Infection With Herpes Simplex Virus From Symptomatic and Asymptomatic Source Contacts

Sixty-six source contacts of index patients with first-episode genital infection caused by herpes simplex virus (HSV) were evaluated for evidence of current or past HSV infections. Forty-three source contacts (65%) reported a history consistent with previous recurrent HSV infection or were experiencing a first episode of genital herpes when initially examined. However, 60% of these 43 contacts were not aware that they had transmissible HSV infection. Twenty-nine (67%) of the 43 individuals had had recent sexual contact with an index patient when lesions were present. All of the remaining 23 source contacts, who were without a history of symptoms consistent with HSV infection, had detectable neutralizing antibody to HSV; HSV type 2 was isolated from the cervix of two of these asymptomatic source contacts. Efforts to identify individuals with undiagnosed genital herpes and to instruct these individuals concerning the risk of disease transmission in the presence of lesions are needed if the rate of transmission is to be decreased; however, methods designed to deerease the rate of transmission by asymptomatic individuals must also be evaluated.

Black communities' belief in “AIDS as genocide”☆A barrier to overcome for HIV prevention

The belief that acquired immunodeficiency syndrome (AIDS) is a form of genocide targeted at the black population is prevalent in black communities in the United States. Public health authorities are distrusted, in part because of the legacy of the Tuskegee Study of untreated syphilis, a perceived racist experiment. For effective interventions to prevent the transmission of human immunodeficiency virus in black communities, genocidal fears and beliefs must be addressed and black community leaders should be involved in planning and implementation.

Screening to Reduce Transmission of Sexually Transmitted Diseases in Semen Used for Artificial Insemination

The practice of artificial insemination by donor semen is increasing in the United States. Many sexually transmitted organisms are found in semen, but screening procedures for the detection of these agents in donor semen have not been standardized. Sexually transmitted organisms have been transmitted during artificial insemination by donor, and such transmission can cause local, disseminated, or fatal disease in the recipient woman and may harm the fetus or newborn. Therefore, screening of both the donor and the donated semen is necessary to avoid infectious complications. Because semen samples cannot be evaluated completely on the day of donation, the use of fresh semen for artificial insemination should be discouraged. Until accurate, rapid diagnostic tests are available, only frozen semen that has been appropriately screened should be used.

Vaginal Colonization with Staphylococcus aureus in Healthy Women: A Review of Four Studies

Four studies assessed the frequency of vaginal Staphylococcus aureus colonization in healthy women and associated risk factors. An association was found between S. aureus vaginal colonization and colonization at the labia minora and the anterior nares. Significant risk factors associated with an increased risk of vaginal S. aureus in at least one study were a history of genital herpes simplex infection, insertion of tampons without an applicator, and the use of Rely (Procter & Gamble) tampons. The use of systemic antibiotics within 2 weeks of the vaginal culture decreased the risk of recovery of S. aureus. The overall frequency of vaginal S. aureus in the 808 women in the four studies was 9.2%.

Sexual Behavior, Sexually Transmitted Diseases, and Risk of Cervical Cancer

To explore sexually transmitted diseases and sexual behavior as risk factors for cervical cancer, we analyzed data from a population-based case-control study of breast and cervical cancer in Costa Rica. Data from 415 cases of cervical carcinoma in situ, 149 cases of invasive cervical cancer, and 764 controls were included in the analysis. Multivariate analysis showed that lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, herpes simplex virus type 2 sero-positivity, and serologic evidence of previous chlamydial infection were predictors of carcinoma in situ. Serologic evidence of previous syphilis was not associated with carcinoma in situ. Predictors for invasive cervical cancer included lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, serologic evidence of previous syphilis, herpes simplex type 2 infection, and chlamydial infection. Cigarette smoking, socioeconomic status, self-reported history of sexually transmitted diseases, and douching were not associated with either carcinoma in situ or invasive cervical cancer.

Preventing Halloween Arson in an Urban Setting: A Model for Multisectoral Planning and Community Participation

Arson is a violent crime and a public health problem that causes injuries and deaths, destroys homes, and destabilizes neighborhoods. During the late 1970s, pre-Halloween pranks in Detroit, Michigan, turned destructive when hundreds of fires were set deliberately throughout the city; in 1984, a record of 810 fires were set during the Halloween period. In 1985, a citywide anti-arson campaign that involved the mobilization and training of thousands of community volunteers was begun in Detroit. This report describes the multiple components of the anti-arson intervention from 1985 through 1996 and changes in the incidence of Halloween fires. Both the decrease in annual Halloween arson fires after the intervention began and the inverse relationship between the number of volunteers and the number of fires suggest a causal effect. This study illustrates the capacity of an urban community to mobilize its residents and stakeholders, the importance of community participation and multisectoral partnerships in program planning and implementation, and the challenges faced in retrospectively evaluating an apparently successful, complex, community-based intervention.

The National Gonorrhea Therapy Monitoring Study: II. Trends and Seasonality of Antibiotic Resistance of Neisseria Gonorrhoeae

The Gonorrhea Therapy Monitoring Study was designed to monitor the efficacy of gonorrhea treatment and the antibiotic susceptibility of isolates of Neisseria gonorrhoeae in vitro and to correlate characteristics of patients and gonococcal isolates with rates of therapeutic failure. Since November 1972 isolates of N. gonorrhoeae were collected from study patients before treatment and tested in vitro for susceptibilities to penicillin ampicillin tetracycline and spectinomycin. Since 1974 some isolates have also been tested in vitro for susceptibility to amoxicillin since 1975 to erythromycin and trimethoprimsulfamethoxazole (TMP-SMZ); since 1976 to cefoxitin. This report describes recent trends of resistance and examines the seasonality of resistance of N. gonorrhoeae to antibiotics. Cultures of N. gonorrhoeae were obtained for all patients before and after treatment. Trends and seasonality were analyzed by use of a harmonic regression technique. 3 components of the data in Jaffes earlier analysis (1975) were considered: the differences in resistance among years; the differences in resistance among months within the year; and the changes in year to year seasonality. The proportion of isolates relatively resistant to all 4 antibiotics--penicillin ampicillin tetracycline and spectinomycin--decreased over the November 1972 to October 1977 period and the proportion of isolates relatively sensitive to all 4 antibiotics increased. More than 50% of the isolates collected between May 1977 and October 1977 had MICs of penicillin of less than 0.03 mcg/ml. Between November 1972 and April 1974 31-35% had MICs of penicillin of less than 0.03 mcg/ml. For ampicillin there was a similar increase in the proportion of isolates that were relatively susceptible strains. The increase in the percentage of strains susceptible to tetracycline was even more dramatic; the smallest increase was that for spectinomycin. Although the percentages of strains very resistant and very susceptible to penicillin ampicillin tetracycline spectinomycin and amoxicillin vary somewhat from 1 6-month period to the next the general overall trend for each geographic area was toward increasing susceptibility. The data are in accord with those of Jaffe et al. who showed that in the US the resistances of gonococcal strains to antibiotics started to decrease after 1972. The proportions of therapeutic failures for disease due to N. gonorrhoeae with different levels of MICs of penicillin ampicillin tetracycline spectinomycin and amoxicillin have remained stable during the period studied. The findings indicate no need to increase dosages of antibiotics in the treatment schedules because of increasing resistance.

Cefoxitin vs. Penicillin in the Treatment of Uncomplicated Gonorrhea

Four hundred six men and women with gonorrhea were randomly assigned to receive either 2 g of cefoxitin or 4.8 X 10(6) units of aqueous procaine penicillin G intramuscularly. All patients also received 1 g of probenecid orally. There was no statistically significant difference in the failure rate between patients treated with penicillin (4.3%) and those treated with cefoxitin (5.1%). Twelve (92%) of 13 homosexual men with gonococcal proctitis who received penicillin and 19 (95%) of 20 who received cefoxitin were cured. Adverse reactions were infrequent and mild in the cefoxitin-treated group. Three patients who received penicillin developed reactions consistent with procaine toxicity. It is concluded that cefoxitin is a safe and effective alternative to penicillin for treating uncomplicated anogenital gonorrhea in men and women.

Epidemiology of AIDS in Women in the United States: 1981 Through 1986

As of November 7, 1986, a total of 27,140 cases if acquired immunodeficiency syndrome (AIDS) in adults had been reported, 1819 (6.7%) of whom were women. Between 1982 and 1986, the proportion of adult women with AIDS has not changed significantly. Women with AIDS are significantly younger than non-homosexual/bisexual men with AIDS. A larger proportion of women compared to men with AIDS are in the 20-29 year age group, (32% vs. 20%, P.001), and a lower proportion are in the 40-49 year age group (11% vs. 18%, P.01). The vast majority of women with AIDS are of reproductive age, with 79% between ages 13-39 years. Over 1/2 of the women with AIDS are black. New York has the highest number of men (7727) as well as women (855) with AIDS. The major transmission category for women with AIDS is intravenous drug use (52%), and the 2nd largest category is heterosexual contact with a person at risk for AIDS (21%). The proportion of women with AIDS in the intravenous drug use group decreased between 1983 and 1986. The proportion of women with AIDS in the heterosexual contact category increased from 12% to 26% between 1982 and 1986, (P.0001). Between 1982 and 1986, there was an increase in pediatric patients with AIDS whose mothers were in the above risk groups. Since the majority of childhood AIDS cases are a result of perinatal transmission from the mother, trends in AIDS cases in women may also predict future trends for AIDS in children.