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Objectives. This study was conducted to define factors associated with the epidemic spread, elimination, and reintroduction of primary and secondary syphilis in King County, Washington, from 1987 through 1998. Methods. Reports of primary and secondary syphilis in King County from 1987 through 1998 were reviewed retrospectively. Results. During the epidemic spread of syphilis, only 15.8% of cases were imported. A total of 24.0% of patients reported cocaine use, and 18.3% of female patients reported having commercial sex. During the elimination of syphilis, significantly higher percentages of cases were imported and lower percentages of patients reported cocaine use or female commercial sex. During the reintroduction of syphilis in 1997-1998, 68% of patients were men who reported sex with men; of this 68%, 66% were seropositive for HIV. Most men reporting sex with men were 30 years or older and recruited many anonymous partners. Conclusions. As syphilis wanes, local control must focus on outbreaks following its reintroduction. Resurgence of syphilis among men reporting sex with men recapitulates the epidemiology of syphilis before the historical advent of AIDS, warranting immediate attention to this problem. (Am J Public Health. 1999:89:1093-1097)

Objectives: To determine how patterns of non-monogamy influence prevalences of sexually transmitted infections (STIs) in individuals and their cohabitating sex partners. METHODS A 2002 survey in 24 Peruvian cities enrolled men and women aged 18-29 years from random household samples. The cohabiting sex partner of each enrolee was also enrolled until approximately 100 couples per city were recruited. Men provided urine and women vaginal swabs or urine for molecular testing for Chlamydia trachomatis and Trichomonas vaginalis; both genders provided blood for serological testing.Results: Among 2099 females and 2052 males providing specimens and behavioural data, 18.2% of males and 2.5% of females reported non-monogamy during the past year. C trachomatis was detected in 121 females (5.8%) and 80 males (4.1%) and T vaginalis in 87 females (4.2%) and 26 males (1.3%). Multivariate analyses showed that C trachomatis infection in females was significantly associated with her male partner's non-monogamy (OR 2.02, CI 1.32 to 3.08) but not significantly with her own non-monogamy; T vaginalis was associated with her own non-monogamy (OR 3.11, CI 1.25 to 7.73) and with her partner's non-monogamy (OR 2.07, CI 1.26 to 3.42). For males, both C trachomatis (OR 2.17, CI 1.29 to 3.69) and T vaginalis (OR 2.49, CI 1.06 to 5.87) were significantly associated only with his own non-monogamy.Conclusions: Among cohabiting couples, male non-monogamy was common and was associated with C trachomatis and T vaginalis infection in himself and in his female partner, whereas female non-monogamy was reported infrequently and was significantly associated only with her own T vaginalis infection. Patterns of non-monogamy may guide public health interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Understanding the time course of sexual partnerships is important for understanding sexual behaviour, transmission risks for sexually transmitted infections (STI) and development of mathematical models of disease transmission.Study Design: The authors describe issues and biases relating to censoring, truncation and sampling that arise when estimating partnership duration. Recommendations for study design and analysis methods are presented and illustrated using data from a sexual-behaviour survey that enrolled individuals from an adolescent-health clinic and two STD clinics. Survey participants were queried, for each of (up to) four partnerships in the last 3 months, about the month and year of first sex, the number of days since last sex and whether partnerships were limited to single encounters. Participants were followed every 4 months for up to 1 year.Results: After adjustment for censoring and truncation, the estimated median duration of sexual partnerships declined from 9 months (unadjusted) to 1.6 months (adjusted). Similarly, adjustment for censoring and truncation reduced the bias in relative risks for the effect of age in a Cox model. Other approaches, such as weighted estimation, also reduced bias in the estimated duration distribution.Conclusion: Methods are available for estimating partnership duration from censored and truncated samples. Ignoring censoring, truncation and other sampling issues results in biased estimates. [ABSTRACT FROM AUTHOR]

Background: Over the past 60 years, Neisseria gonorrhoeae has acquired clinically significant resistance to sulfonamides, tetracyclines, penicillins, and ciprofloxacin. Objective: To determine U.S. trends in the prevalence of antimicrobial resistance of N. gonorrhoeae from 1988 to 2003. Design: 16-year, multisite, sentinel surveillance for gonococcal isolate susceptibility through the Gonococcal Isolate Surveillance Project (GISP). Setting: Sexually transmitted disease clinics in 37 cities. Patients: Male patients with a total of 82 064 episodes of urethral gonorrhea. Measurements: Primary outcome measures included percentage of gonococcal isolates resistant to antimicrobials used to treat gonorrhea, percentage of patients treated with specific antimicrobials for gonorrhea, and trends of these measures over time. Results: The median age of patients was 26 years, and 74.1% of patients were African American. The proportion of men treated with penicillins for gonorrhea declined from 39.5% in 1988 to 0% in 1994, while the proportion of those receiving fluoroquinolone treatment increased from 0% in 1988 to 42.0% in 2003. Penicillin resistance peaked at 19.6% in 1991, then declined to 6.5% in 2003. Tetracycline resistance peaked at 25.8% in 1997 and declined to 14.4% in 2003. The first fluoroquinolone-resistant isolate was found in 1991. Nationally, 0.4% of isolates were fluoroquinolone-resistant in 1999 and were identified in 39% of GISP cities. By 2003, 4.1% of isolates were fluoroquinolone-resistant and were identified in 70% of GISP cities. Isolates with decreased susceptibility to ceftriaxone, cefixime, azithromycin, and spectinomycin remained rare. In 2001, 3 multidrug-resistant isolates with decreased susceptibility to cefixime were identified. Limitation: Sentinel surveillance may not fully reflect trends for all patients with gonorrhea in the United States. Conclusions: Prevalence of penicillin resistance has declined in the years since gonorrhea treatment with penicillin was discontinued. Fluoroquinolone-resistant N. gonorrhoeae infections continue to increase at a time when fluoroquinolone use has increased. Ongoing nationwide and local antimicrobial susceptibility monitoring is crucial to ensure appropriate treatment of gonorrhea. [ABSTRACT FROM AUTHOR]

The article discusses a study that assesses and compares sexual behaviors using partner-specific data between HIV-negative men who have sex with men recruited for an HIV vaccine efficacy trial and a control group. Vaccine trial participants were more likely to report an HIV-positive partner and more often reported receptive unprotected anal intercourse during last sexual encounter with HIV-positive partner. Most believed their HIV-positive partners were receiving antiretroviral treatment.

The article discusses trends in susceptibility of cephalosporin among Neisseria gonorrhoeae isolates in the U.S. from 2000 to 2010. It cites the data from the Gonococcal Isolate Surveillance Project (GISP) which monitors antimicrobial susceptibilities in gonorrhoeae. It notes the similarity in the epidemiologic pattern of cephalosporin susceptibility and the fluoroquinolone-resistant Neisseria gonorrhoeae. It explains some concerns over the potential emergence of gonococcal cephalosporin resistance in the U.S.