Cervical ectopy and the transformation zone measured by computerized planimetry in adolescents.

Objective: To determine whether cervical ectopy and the transformation (T) zone were larger in adolescents using oral contraceptives (OCs) compared to depot medroxyprogesterone acetate (DMPA).

Method: Cervical photographs were taken on 91 adolescents in Baltimore, Maryland. Ectopy and T zone size were measured using computerized planimetry.

Foundations for effective strategies to control sexually transmitted infections: voices from rural Kenya.

Achieving maximal benefit from clinic-based, sexually transmitted infection (STI) control strategies requires that persons seek treatment at public clinics. Community-based, ethnographic research methods were used to examine patterns of health-seeking behavior for sexually transmitted infections in western Kenya. Illness narratives of sexually transmitted infections provided the basis for an analysis of sequential steps in health-seeking behavior, namely recognition, classification, overcoming stigma, identification of treatment options and selection of a course of therapy.

Self-reported sexual activity and condom use among symptomatic clients attending STD clinics.

Background And Objectives: A cross-sectional survey of sexually transmitted disease (STD) patients assessed sexual activity and condom use during the time between STD symptom onset and clinic attendance.

Study Design: Patients were asked to report sexual activity and condom use while STD symptoms were present. Medical records were abstracted for diagnoses.

The geography of sexual partnerships in Baltimore: applications of core theory dynamics using a geographic information system.

Objective: Gonorrhea has a focused geographic distribution characterized by high incidence rates in defined "core" areas and decreased incidence as the radial distance from the central core increases. Dense cor group transmission has long been hypothesized.

Methods: We have previously mapped sexually transmitted disease (STD) rates in Baltimore census tracts using STD morbidity data interfaced with a geographic information system.

Nongonococcal urethritis--a new paradigm.

Urethritis in men has been categorized historically as gonococcal or nongonococcal (NGU). The major pathogens causing NGU are Chlamydia trachomatis and Ureaplasma urealyticum. Trichomonas vaginalis may be involved occasionally.

Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group.

Context: The efficacy of counseling to prevent infection with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) has not been definitively shown.

Objective: To compare the effects of 2 interactive HIV/STD counseling interventions with didactic prevention messages typical of current practice.

Design: Multicenter randomized controlled trial (Project RESPECT), with participants assigned to 1 of 3 individual face-to-face interventions.

Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers. Opportunity for early intervention.

Goal: To determine prevalence and incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection and assess risk factors predictive for such infections in a middle school-based clinic sample.

Study Design: 170 female students and 43 male students making 256 and 47 visits, respectively, > or = 30 days apart, in urban middle school clinics for primary care screening, reproductive health, or illness/injury were routinely asked to provide urine specimens for GC and CT ligase chain reaction testing if sexually active in the preceding 3-month period. Information regarding prior sexually transmitted diseases, reason for visit, and sexual risk behaviors was obtained.

Evaluation of vaginal infections in adolescent women: can it be done without a speculum?

Objective: Given that highly sensitive urine-based nucleic acid amplification tests may eliminate the need for speculum exam to diagnose gonorrhea and chlamydia cervicitis, we sought to determine if vaginal infections could be diagnosed without using a speculum.

Methods: Matched pairs of vaginal specimens were collected from participants before and during speculum exam for diagnosis of trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Females age 12 to 22 years presenting to the Johns Hopkins adolescent primary care clinics who required a pelvic examination were eligible to participate.

Susceptibility to vaccine-preventable diseases in a sexually transmitted disease clinic population.

Background And Objective: Sexually transmitted disease (STD) clinics often serve a population that has low medical care utilization. The objective of this study was to determine the susceptibility of an STD clinic population to vaccine-preventable diseases.

Study Design: A cross-sectional study of immunization practices and susceptibility to vaccine-preventable diseases was undertaken by enrolling consecutive patients attending an STD clinic.

Incident Chlamydia trachomatis infections among inner-city adolescent females.

Context: Adolescents are at highest risk for infection with Chlamydia trachomatis, an important preventable cause of pelvic inflammatory disease and subsequent tubal factor infertility in US women. Current guidelines for delivery of adolescent primary care services recommend yearly chlamydia screening for those adolescent females considered to be at risk.

Objectives: To describe the epidemiology of prevalent and incident chlamydia infection among adolescent females to assess the appropriate interval for chlamydia screening and to define risk factors that would identify adolescent females to target for screening.

Geographic epidemiology of gonorrhea in Baltimore, Maryland, using a geographic information system.

The epidemiology of gonorrhea is characterized by geographically defined hyperendemic areas, or "cores." Geographic information system (GIS) technology offers new opportunities to evaluate these patterns. The authors developed a GIS system linked to the disease surveillance database at the Baltimore Health Department and used this system to evaluate the geographic epidemiology of gonorrhea in Baltimore, Maryland, during 1994.

The association of herpes simplex virus type 2 (HSV-2), Haemophilus ducreyi, and syphilis with HIV infection in young men in northern Thailand.

To evaluate the association between sexually transmitted diseases that commonly may cause genital ulceration and prevalent and incident HIV infections, we conducted three case control studies in a cohort of 21-year-old male military conscripts in northern Thailand. The men were evaluated at baseline in 1991 and semiannually until their discharge 2 years later. Serologic evidence of infection with herpes simplex virus type 2 (HSV-2), Haemophilus ducreyi, and HIV were more frequent at baseline in 83 men with a history of genital ulcer than in 97 men without such a history.

Definitions of genital ulcer disease and variation in risk for prevalent human immunodeficiency virus infection.

Objectives: Although genital ulcer disease (GUD) has been associated with human immunodeficiency virus (HIV) infection in a number of studies, definitions of genital ulceration have varied. The authors hypothesized that the association of GUD with prevalent HIV infection may vary according to the definition of GUD that is used.

Methods: As part of a prospective cohort study, 863 patients were interviewed and examined who presented to a sexually transmitted disease (STD) clinic for new symptom evaluation and who agreed to HIV testing to determine demographic and behavioral risk associated with prevalent HIV infection.

Reasons for not using condoms of clients at urban sexually transmitted diseases clinics.

Background And Goal: Greater understanding of the factors related to inconsistent condom use is essential in the development of strategies to promote condom use among clients who access public, inner-city sexually transmitted diseases (STD) clinics. Therefore, this study aimed to explore reasons for not using condoms among 260 predominantly African American heterosexual male and female clients presenting for care at two inner-city STD clinics.

Study Design: Clients selected for this descriptive analysis reported having had at least one unprotected episode of sexual intercourse in the last 10 episodes.

Self-treatment patterns among clients attending sexually transmitted disease clinics and the effects of self-treatment on STD symptom duration. The Study Group.

Objective: To assess patterns of self-treatment and its effects on the duration of sexually transmitted disease (STD) symptoms before medical care.

Methods: A cross-sectional interview survey in public STD clinics (7 U.S.

Sex, drugs, and infections among youth. Parenterally and sexually transmitted diseases in a high-risk neighborhood.

Background And Objectives: To determine the extent to which youth who reside in households in a neighborhood with large numbers of drug injectors 1) are infected with parenterally or sexually transmitted agents, and 2) engage in high-risk behaviors.

Study Design: A multistage probability household sample survey was conducted in Bushwick, Brooklyn from 1994 to 1995. All households in 12 randomly selected primary sampling units were screened for age-eligible youth.

Sexually transmitted disease control in the era of managed care: "magic bullet" or "shadow on the land"?

Sexually transmitted diseases (STDs) are a major public health problem. In the United States, nearly 12 million STD infections occur annually, generating estimated direct annual health care costs exceeding $12 billion. Lifetime costs may total $88 billion.

Sexually transmitted diseases in patients attending a Baltimore tuberculosis clinic. Assessment of use of multiple categoric services.

Background: Recent increases in the incidence of tuberculosis and syphilis have occurred disproportionately in young heterosexuals of low socioeconomic status. The authors hypothesized that an overlap of tuberculosis and sexually transmitted disease clinic populations potentially could result in inefficient use of limited public health resources.

Methods: The authors conducted a retrospective study to determine the coinfection rate of syphilis and other sexually transmitted diseases in patients seen for evaluation at the Baltimore City Tuberculosis Clinic, Baltimore, Maryland.

Reliability of partner reports of sexual history in a heterosexual population at a sexually transmitted diseases clinic.

Background: In epidemiologic research, information about sexual frequency and condom use is by necessity based on self-reports. This study investigated the reliability of self-reported sexual behavior in 162 heterosexual partnerships.

Methods: Subjects were part of a larger study of condom use and sexually transmitted diseases (STD) conducted in two Baltimore STD clinics from 1990 to 1992.

Early intervention for human immunodeficiency virus in Baltimore Sexually Transmitted Diseases Clinics. Impact on gonorrhea incidence in patients infected with HIV.

Background: High incidences of sexually transmitted diseases (STD) after posttest counseling have been documented in patients diagnosed with human immunodeficiency virus (HIV) in Baltimore STD clinics. In July 1991, the authors instituted an HIV early intervention program providing long-term medical care and social work services. This study compares the incidence of gonorrhea after post-HIV+ test counseling in patients diagnosed with HIV before and after the institution of the early intervention program.

Diagnosis by AMPLICOR PCR of Chlamydia trachomatis infection in urine samples from women and men attending sexually transmitted disease clinics.

Screening of urine specimens from men for Chlamydia trachomatis infection by a commercial PCR assay (AMPLICOR C. trachomatis Test; Roche Diagnostic Systems, Inc., Branchburg, N.