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  • 1
    In: Sex Transm Dis, 2001, Vol.28(5), pp.247-251
    Description: BACKGROUND: The temporal pattern of partners and sexual encounters may be key factors in the acquisition and transmission of sexually transmitted diseases (STDs). Behavior among adolescent women is of particular interest because they frequently have the highest prevalence and incidence of infection. GOAL: To examine coital diary data collected during a 7-month longitudinal study of young women at high risk of STDs and to describe their sexual behaviors, with particular attention to issues of partner sequence and overlap. STUDY DESIGN: A 7-month longitudinal study of young women infected with or having a sexual contact infected with Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis attending the STD clinic or one of four neighborhood adolescent health clinics. Data were collected at enrollment and at 1, 3, 5, and 7-month follow-up visits. Coital diaries were kept between visits. RESULTS: The average frequency of coital events was 0.94 per week. The median number of sexual partners during the follow-up period was one, and overlapping of partnerships was an uncommon occurrence. The number of days between the last coital event of a current relationship and the first encounter of a new relationship differed for those choosing a new partner (mean, 20.6 days) and those who returned to a previous partner (mean, 7.9 days;P 〈 0.001). CONCLUSION: Although at high risk for STDs, high-risk behavior was not common among the study population. Partner choice and the behavior of these partners may be more important elements than personal high-risk behavior in accounting for the high prevalence of sexually transmitted infections among inner-city adolescent women.
    Keywords: Teenage Girls -- Sexual Behavior ; Sexually Transmitted Diseases -- Research;
    ISSN: 0148-5717
    E-ISSN: 15374521
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  • 2
    Language: English
    In: PLoS ONE, 2012, Vol.7(5), p.e36298
    Description: Lactobacillus- dominated vaginal microbiotas are associated with reproductive health and STI resistance in women, whereas altered microbiotas are associated with bacterial vaginosis (BV), STI risk and poor reproductive outcomes. Putative vaginal taxa have been observed in male first-catch urine, urethral swab and coronal sulcus (CS) specimens but the significance of these observations is unclear. We used 16 S rRNA sequencing to characterize the microbiota of the CS and urine collected from 18 adolescent men over three consecutive months. CS microbiotas of most participants were more stable than their urine microbiotas and the composition of CS microbiotas were strongly influenced by circumcision. BV-associated taxa, including Atopobium , Megasphaera , Mobiluncus , Prevotella and Gemella , were detected in CS specimens from sexually experienced and inexperienced participants. In contrast, urine primarily contained taxa that were not abundant in CS specimens. Lactobacilllus and Streptococcus were major urine taxa but their abundance was inversely correlated. In contrast, Sneathia , Mycoplasma and Ureaplasma were only found in urine from sexually active participants. Thus, the CS and urine support stable and distinct bacterial communities. Finally, our results suggest that the penis and the urethra can be colonized by a variety of BV-associated taxa and that some of these colonizations result from partnered sexual activity.
    Keywords: Research Article ; Biology ; Medicine ; Public Health And Epidemiology ; Infectious Diseases ; Microbiology ; Urology
    E-ISSN: 1932-6203
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  • 3
    Language: English
    In: Pediatrics, February 2011, Vol.127(2), pp.e336-44
    Description: We assessed differences in chlamydia screening rates according to race/ethnicity, insurance status, age, and previous sexually transmitted infection (STI) or pregnancy. A retrospective cohort study was performed using electronic medical record and billing data for women 14 to 25 years of age in 2002-2007, assessing differences in the odds of a chlamydia test being performed at that visit. Adjusted odds of a chlamydia test being performed were lower among women 14 to 15 years of age (odds ratio: 0.83 [95% confidence interval: 0.70-1.00]) and 20 to 25 years of age (20-21 years, odds ratio: 0.78 [95% confidence interval: 0.70-0.89]; 22-23 years, odds ratio: 0.76 [95% confidence interval: 0.67-0.87]; 24-25 years, odds ratio: 0.64 [95% confidence interval: 0.57-0.73]), compared with women 18 to 19 years of age. Black women had 3 times increased odds (odds ratio: 2.96 [95% confidence interval: 2.66-3.28]) and Hispanic women nearly 13 times increased odds (odds ratio: 12.89 [95% confidence interval: 10.85-15.30]) of testing, compared with white women. Women with public (odds ratio: 1.74 [95% confidence interval: 1.58-1.91]) and public pending (odds ratio: 6.85 [95% confidence interval: 5.13-9.15]) insurance had increased odds of testing, compared with women with private insurance. After first STI diagnosis, differences according to race/ethnicity persisted but were smaller; after first pregnancy, differences persisted. Despite recommendations to screen all sexually active young women for chlamydia, providers screened women differently according to age, race/ethnicity, and insurance status, although differences were reduced after first STI or pregnancy.
    Keywords: Chlamydia Infections -- Diagnosis ; Health Personnel -- Standards ; Mass Screening -- Methods
    ISSN: 00314005
    E-ISSN: 1098-4275
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  • 4
    Language: English
    In: BMC medicine, 06 November 2014, Vol.12, pp.204
    Description: Nearly 1 in 5 people living with HIV in the United States are unaware they are infected. Therefore, it is important to develop and evaluate health communication messages that clinicians can use to encourage HIV testing. The objective was to evaluate health communication messages designed to increase HIV testing rates among women and evaluate possible moderators of message effect. We used a randomized four-arm clinical trial conducted at urban community outpatient health clinics involving 1,919 female patients, 18 to 64 years old. The four health message intervention groups were: i) information-only control; ii) one-sided message describing the advantages of HIV testing; iii) two-sided message acknowledging a superficial objection to testing (i.e., a 20 minute wait for results) followed by a description of the advantages of testing; and iv) two-sided message acknowledging a serious objection (i.e., fear of testing positive for HIV) followed by a description of the advantages of testing. The main outcome was acceptance of an oral rapid HIV test. Participants were randomized to receive the control message (n = 483), one-sided message (n = 480), two-sided message with a superficial objection (n = 481), or two-sided message with a serious objection (n = 475). The overall rate of HIV test acceptance was 83%. The two-sided message groups were not significantly different from the controls. The one-sided message group, however, had a lower rate of testing (80%) than the controls (86%) (OR, 0.66; 95% CI, 0.47-0.93; P = 0.018). "Perceived obstacles to HIV testing" moderated this effect, indicating that the decrease in HIV test acceptance for the one-sided message group was only statistically significant for those who had reported high levels of obstacles to HIV testing (OR, 0.36; 95% CI, 0.19-0.67; P = 0.001). None of the messages increased test acceptance. The one-sided message decreased acceptance and this effect was particularly true for women with greater perceived obstacles to testing, the very group one would most want to persuade. This finding suggests that efforts to persuade those who are reluctant to get tested, in some circumstances, may have unanticipated negative effects. Other approaches to messaging around HIV testing should be investigated, particularly with diverse, behaviorally high-risk populations. Clinicaltrials.gov Identifier: NCT00771537. Registration date: October 10. 2008.
    Keywords: HIV Infections -- Diagnosis ; Mass Screening -- Statistics & Numerical Data ; Patient Acceptance of Health Care -- Statistics & Numerical Data ; Patient Education As Topic -- Methods
    E-ISSN: 1741-7015
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  • 5
    Language: English
    In: The Journal of infectious diseases, 01 January 2010, Vol.201(1), pp.42-51
    Description: Repeated Chlamydia trachomatis infections are common among young sexually active women. The relative frequency of reinfection and antibiotic treatment failure is undefined. Adolescent women enrolled in a longitudinal cohort had behavioral and sexually transmitted infection assessments performed every 3 months, including amplification tests for C. trachomatis, ompA genotyping, and interviews and diary entries to document sex partner-specific coitus and event-specific condom use. Repeated infections were classified as reinfection or treatment failure by use of an algorithm. All infections for which treatment outcomes were known were used to estimate the effectiveness of antibiotic use. We observed 478 episodes of infection among 210 study participants; 176 women remained uninfected. The incidence rate was 34 episodes/100 woman-years. Of the women who were infected, 121 experienced 1 repeated infections, forming 268 episode pairs; 183 pairs had complete data available and were classified using the algorithm. Of the repeated infections, 84.2% were definite, probable, or possible reinfections; 13.7% were probable or possible treatment failures; and 2.2% persisted without documented treatment. For 318 evaluable infections, we estimated 92.2% effectiveness of antibiotic use. Most repeated chlamydial infections in this high-incidence cohort were reinfections, but repeated infections resulting from treatment failures occurred as well. Our results have implications for male screening and partner notification programs and suggest the need for improved antibiotic therapies.
    Keywords: Anti-Bacterial Agents -- Therapeutic Use ; Azithromycin -- Therapeutic Use ; Chlamydia Infections -- Drug Therapy
    ISSN: 00221899
    E-ISSN: 1537-6613
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  • 6
    In: Perspectives on Sexual and Reproductive Health, March 2010, Vol.42(1), pp.43-48
    Description: CONTEXT: Adolescent pregnancy prevention is difficult because adolescent sex is intermittent. Understanding why sexually experienced adolescents have sex after a period of abstinence will help clinicians to tailor counseling. METHODS: For up to 4.5 years between 1999 and 2006, a sample of 354 adolescent women recruited at urban primary care clinics were interviewed and tested for STDs every three months, and were asked to complete three months of daily diaries twice a year. Survival analyses were used to estimate associations between intrapersonal, relationship and STD‐related characteristics and the risk of ending an abstinence period with sex. RESULTS: Participants reported 9,236 abstinence periods, which averaged 31 days. The risk that an abstinence period ended with sex increased steeply for periods of fewer than 17 days (short), rose less steeply for 17–39‐day (intermediate) periods and was fairly steady for longer periods. For short periods, the risk increased with age, sexual interest, positive mood, partner support, relationship quality and history of STD diagnosis more than three months ago (hazard ratios, 1.02–1.2); it decreased as negative mood increased (0.98) and was reduced among adolescents with a recent STD diagnosis (0.9). For intermediate periods, the association with a recent STD diagnosis became positive (1.4). For long periods, sex was associated only with age, sexual interest and relationship quality. CONCLUSIONS: To provide targeted and timely sexual health counseling, clinicians may want to ask adolescents not only whether they are sexually active but also when they last had sex.
    Keywords: Sexual Abstinence -- Research ; Teenage Sexual Behavior -- Research ; Sexual Intercourse -- Research;
    ISSN: 1538-6341
    E-ISSN: 1931-2393
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  • 7
    Language: English
    In: The Journal of infectious diseases, 01 June 2009, Vol.199(11), pp.1671-9
    Description: Haemophilus ducreyi causes chancroid, which facilitates transmission of human immunodeficiency virus type 1. To better understand the biology of H. ducreyi, we developed a human inoculation model. In the present article, we describe clinical outcomes for 267 volunteers who were infected with H. ducreyi. There was a relationship between papule formation and estimated delivered dose. The outcome (either pustule formation or resolution) of infected sites for a given subject was not independent; the most important determinants of pustule formation were sex and host effects. When 41 subjects were infected a second time, their outcomes segregated toward their initial outcome, confirming the host effect. Subjects with pustules developed local symptoms that required withdrawal from the study after a mean of 8.6 days. There were 191 volunteers who had tissue biopsy performed, 173 of whom were available for follow-up analysis; 28 (16.2%) of these developed hypertrophic scars, but the model was otherwise safe. Mutant-parent trials confirmed key features in H. ducreyi pathogenesis, and the model has provided an opportunity to study differential human susceptibility to a bacterial infection.
    Keywords: Chancroid -- Microbiology ; Haemophilus Ducreyi -- Pathogenicity
    ISSN: 0022-1899
    E-ISSN: 15376613
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  • 8
    Language: English
    In: American journal of public health, February 2002, Vol.92(2), pp.211-3
    Description: This study sought to describe condom use over time in new and established adolescent relationships. The outcome variable was time (in days) until first unprotected coital event. Analyses involved comparisons of Kaplan-Meier survival curves and Cox proportional hazards models. Survival functions for the 2 relationship groups were significantly different. However, by 21 days the curves had converged: 43% of new and 41% of established relationships involved no unprotected coital events. Time to first unprotected coital event was significantly longer in new than in established relationships. Prolongation of condom use in ongoing relationships may be a useful intervention to prevent sexually transmitted diseases.
    Keywords: Adolescent Behavior ; Contraception Behavior ; Safe Sex ; Condoms -- Statistics & Numerical Data ; Sexually Transmitted Diseases -- Prevention & Control
    ISSN: 0090-0036
    E-ISSN: 15410048
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  • 9
    Language: English
    In: Sexual Health, 2012, Vol.9(4), p.299-303
    Description: This study examined young women’s actual timing of use of a microbicide surrogate gel (vaginal moisturiser (VM)) compared with assigned timing conditions. Participants used a VM with coitus during 4-week cycles over a 3-year period in random timing sequences: 1 h before coitus, 10 min before coitus and 10 min after coitus. Daily diaries collected information related to coital behaviours, VM use and timing, and participants’ and partners’ VM assessments. Descriptive and mixed-effects model analyses were conducted. At least three VM timing conditions were completed by 109 women aged 18–22 years old. Of 17 772 diary days collected, coitus was reported on 2128 (1252 with VM use; 59%). Median times between VM application and coitus were: 60 min before coitus (mean = 68.2; s.d. = 76.9) for the 1-h pre-coital group, 13.5 min before coitus (mean = 44.9; s.d. = 117.1) for the 10-min pre-coital group and 5 min before coitus (mean = 24.5; s.d. = 205.1) for the 10-min post-coital group. Women reported that the VM was very easy to use (68%), it was somewhat messy (61%), they were very wet during sex (81%), sex was very good (80%) and their partners liked using the VM (38%). Overall, the VM was rated positively. There was substantial deviation in application time across timing conditions, with significantly greater variability in the post-coital group. These findings contribute to understanding of how VMs are accepted and used, with implications for HIV prevention with microbicides requiring specific application timing.
    Keywords: acceptability; application; HIV prevention; STI prevention; vaginal microbicide.
    ISSN: 1448-5028
    E-ISSN: 1449-8987
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  • 10
    Language: English
    In: Sports medicine (Auckland, N.Z.), July 2017, Vol.47(7), pp.1437-1451
    Description: The natural history of mild traumatic brain injury (TBI) or concussion remains poorly defined and no objective biomarker of physiological recovery exists for clinical use. The National Collegiate Athletic Association (NCAA) and the US Department of Defense (DoD) established the Concussion Assessment, Research and Education (CARE) Consortium to study the natural history of clinical and neurobiological recovery after concussion in the service of improved injury prevention, safety and medical care for student-athletes and military personnel. The objectives of this paper were to (i) describe the background and driving rationale for the CARE Consortium; (ii) outline the infrastructure of the Consortium policies, procedures, and governance; (iii) describe the longitudinal 6-month clinical and neurobiological study methodology; and (iv) characterize special considerations in the design and implementation of a multicenter trial. Beginning Fall 2014, CARE Consortium institutions have recruited and enrolled 23,533 student-athletes and military service academy students (approximately 90% of eligible student-athletes and cadets; 64.6% male, 35.4% female). A total of 1174 concussions have been diagnosed in participating subjects, with both concussion and baseline cases deposited in the Federal Interagency Traumatic Brain Injury Research (FITBIR) database. Challenges have included coordinating regulatory issues across civilian and military institutions, operationalizing study procedures, neuroimaging protocol harmonization across sites and platforms, construction and maintenance of a relational database, and data quality and integrity monitoring. The NCAA-DoD CARE Consortium represents a comprehensive investigation of concussion in student-athletes and military service academy students. The richly characterized study sample and multidimensional approach provide an opportunity to advance the field of concussion science, not only among student athletes but in all populations at risk for mild TBI.
    Keywords: Athletes ; Athletic Injuries ; Military Personnel ; Students ; Brain Concussion -- Diagnosis ; Universities -- Organization & Administration
    ISSN: 01121642
    E-ISSN: 1179-2035
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