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Case Report: Persistent Discharge and Pelvic Pain in a 19 YO Female A 19-year-old female patient with PID presented with persistent discharge and pelvic pain despite multiple rounds of treatment [...]

Background: Neisseria gonorrhoeae and Chlamydia trachomatis are characterized by different risk factors, thus control strategies for each also differ. In contrast, risk factors for Mycoplasma genitalium have not been well characterized. Methods: Between 2000 and 2006, 1090 women ages 14 to 45 attending the Public Health-Seattle & King County Sexually Transmitted Diseases Clinic in Seattle, WA, underwent clinical examination and computer-assisted survey interview. M. genitalium was detected by transcription mediated amplification from self-obtained vaginal swab specimens. C. trachomatis and N. gonorrhoeae were detected by culture from cervical swab specimens. Results: Prevalent M. genitalium infection was detected in 84 women (7.7%), C. trachomatis in 63 (5.8%), and N. gonorrhoeae in 26 (2.4%). Age Conclusions: The limited number of risk factors for prevalent infection common to all 3 pathogens suggests that M. genitalium may circulate in different sexual networks than N. gonorrhoeae or C. trachomatis. The predominance of sociodemographic risk factors for M. genitalium, rather than high-risk sexual behaviors, suggests broad-based testing may be the most effective control strategy. DOI: 10.1097/OLQ.0b013e3181e8087e

Objective: To examine factors associated with heterosexual anal intercourse (AI). Methods: Between 2001 and 2004, 1084 heterosexual adults aged 18 to 26 attending public sexually transmitted disease clinics in Seattle, New Orleans, and St Louis were interviewed using computer-assisted self interview and tested for STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, and genital herpes (HSV-2). Characteristics associated with AI were identified using logistic regression. Results: Overall 400 (37%) reported ever having had AI, 266 (28.9%) reported AI with at least 1 of their last 3 partners, and 19% reported AI with their last partner. Fewer women than men reported condom use at last AI (26% vs. 45%, P 3 lifetime sex partners [AOR 2.8 (1.56-5.07)] among women, and sex on the same day as meeting a partner [AOR 2.0 (1.33-3.06]) among men. AI with the last partner was associated with sex toy use [AOR 5.6 (2.63-12.0)] and having concurrent partners [AOR 2.2 (1.21-4.11)] among men, and with sex within a week of meeting [AOR 2.4 (1.28-4.37)], believing the partner was concurrent (AOR 1.9 [1.12-3.22]), and sex toy use [AOR 5.7 (2.31-14.0)] among women. Prevalent vaginal and urethral sexually transmitted infections were not associated with AI. Conclusions: Many young heterosexuals attending sexually transmitted disease clinics reported M, which was associated with other sexual risk behaviors, suggesting a confluence of risks for HIV infection.

Background: Sex partner concurrency is an important determinant of STI transmission dynamics, yet its measurement is not standardized. Goal: We assessed the agreement, compared correlates, and investigated data quality and completeness between 2 common concurrency measures. Study Design: Young adults (ages 18-26) attending public STD clinics between 2001 and 2004 in Seattle, St. Louis, and New Orleans, provided data on 2 or more sex partners in a computer-administered survey interview (N = 680). Concurrency with last partner was measured in 2 ways: (a) a direct question about other sexual contacts during the most recent sexual relationship and (b) overlapping start and end dates of the 2 most recent relationships. Results: Although 56% reported concurrency by direct questioning and 54% by overlapping dates, the [kappa] statistic for agreement between measures was only fair (0.395). Indeed, 29% of those reporting concurrent partners by the direct question did not do so by overlapping dates and 26% of participants concurrent by overlapping dates were not concurrent by the direct question. Each of the measures had dissimilar correlates, and concurrency data were missing or uninterpretable more often for the overlapping dates measure (21.3%) than the direct question (1.8%). Conclusions: Concurrency was common by both measures but the measures were not interchangeable. Although the overlapping dates measure provided information about partnership duration, it is subject to missing or uninterpretable data. The direct question substantially minimized the amount of missing data and may be more appropriate for use with computer-administered survey interview.

Objectives: Population-level data on prevalence and distribution of human papillomavirus (HPV) types in the United States are necessary to guide optimal vaccination strategies. Study: Urine specimens from 3262 women ages 18 to 25 in the National Longitudinal Study of Adolescent Health (Wave HI) were tested and typed for HPV. Poststratification sampling weights generated nationally representative estimates. Results: Overall HPV prevalence was 26.9% and as high as 14.3% among women with 1 lifetime partner but did not vary by geographic region. High-risk types were detected in 20%; ~10% were infected with types in current candidate vaccines. HPV infection was independently associated with mixing sex with alcohol, a black partner, >3 lifetime sex partners, being single, and illegal drug use. Having a current sex partner and receptive oral sex were inversely associated with HPV. Conclusion: HPV prevalence was high throughout the country, even among women with only 1 lifetime partner, suggesting early and widespread rather than targeted immunization of young women.

Background: Although condoms most likely prevent HIV infection, evidence of their effectiveness against other sexually transmitted diseases is mixed. Goal: The goal of the study was to determine whether condom use prevents genital human papillomavirus (HPV) infection and HPV-related conditions. Study Design: We conducted a literature review and meta-analysis of the effect of condom use on the prevention of genital warts, subclinical HPV infection, cervical intraepithelial neoplasia (CIN), and invasive cervical cancer (ICC). Results: Among 27 estimates from 20 studies, there was no consistent evidence that condom use reduces the risk of becoming HPV DNA-positive. However, risk for genital warts, CIN of grade II or III (CIN II or III), and ICC was somewhat reduced. Conclusions: Available data are too inconsistent to provide precise estimates. However, they suggest that while condoms may not prevent HPV infection, they may protect against genital warts, CIN II or III, and ICC.

Background: Sex partner concurrency probably accelerates the spread of sexually transmitted disease (STD) and HIV, yet few data exist on population prevalence or correlates. Goal: The goal of the study was to compare definitions and estimate the frequency of concurrent partnerships and to identify individual and partnership correlates of concurrency. Study Design: A random-digit-dialing survey (n = 637) was performed to collect demographic information, sexual history and history of STD, and partnership characteristics. Results: Men reported concurrency more frequently than women. For men, lifetime partners (odds ratio [OR], 1.15 per partner; 95% CI, 1.07-1.23), a night in jail (OR, 1.99; 95% CI, 1.03-3.82), and same sex partners (OR, 1.88; 95% CI, 0.92-3.84) were associated with concurrency. Important factors for women were first coitus before age 16 (OR, 2.90; 95% CI, 1.38-6.10), lifetime partners (OR, 1.09 per partner; 95% CI, 1.01-1.16), and STD diagnoses during relationship (OR, 3.53; 95% CI, 1.55-8.05). Partnership characteristics associated with concurrency included lifetime partners (OR, 1.09; 95% CI, 1.05-1.14), race discordance (OR, 1.72; 95% CI, 1.14-2.59), married/living together (OR, 0.60; 95% CI, 0.36-0.98), night in jail (OR, 2.04; 95% CI, 1.32-3.17), partnership duration of > 6 months (OR, 2.43; 95% CI, 1.41-4.19), and STD diagnoses during relationship (OR, 2.68; 95% CI, 1.42-5.07). Conclusions: Concurrency was independently associated with individual STD risk. Sex differences may reflect true behavioral differences or differential reporting.