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Biomedical subjects

A B Moscicki

Publications and source records attributed to A B Moscicki.

46 records · Page 3Linked to original sources
PubMed1993

Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics.

This study was performed to identify specific high-risk behaviors, such as unprotected oral, anal, and vaginal intercourse and substance abuse, associated with human immunodeficiency virus infection among adolescents attending three diverse clinics located in a localized geographic area: a university-based clinic, a Planned Parenthood clinic, and an inner-city public health clinic (PHC). Six hundred seventy-one female and 207 male adolescents attending one of the three clinics completed a structured questionnaire. Similarities among patients at the clinic sites included high rates of anal intercourse (21%), unprotected vaginal sex (95%), oral sex (73%), and poor communication skills (42%). Some differences appeared as well, including higher rates of homosexual experiences, no birth control use, and having multiple partners among adolescents attending the PHC (p < 0.001). In contrast, adolescents attending either the university-based clinic or the Planned Parenthood Clinic had higher rates of substance abuse around sexual activity than those who attended the PHC (p < 0.001). We conclude that adolescents attending general medical clinics in the San Francisco Bay area engage in high-risk behaviors that place them at risk for transmission of human immunodeficiency virus even though many have had previous education about acquired immunodeficiency syndrome and sexually transmitted disease. Specific risk factors include unprotected receptive anal intercourse, unprotected vaginal intercourse with new and unknown partners, experience in homosexual behavior, high rates of oral sex, multiple partners, poor communication skills, and frequent use of illicit substances in conjunction with sex. The differences found among sites indicate the need for health care providers and prevention programs to provide emphasis on practices specific to the adolescents in their service area.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Comparison between methods for human papillomavirus DNA testing: a model for self-testing in young women.

This study examined the accuracy of samples obtained by women with Dacron swabs for testing for human papillomavirus (HPV). A total of 114 women obtained samples with the swabs and then had routine pelvic examinations done by nurse practitioners during which endocervical and exocervical samples were obtained by speculum-assisted technique. These samples were used for HPV DNA testing and cytology. The results of both sets of samples were compared. A total of 104 samples (91%) obtained by self-sampling were concordant with those obtained by speculum-assisted technique. Thus, self-sampling with a Dacron swab appears to be an accurate and noninvasive method for obtaining samples for HPV DNA testing.

DNA Probes, HPV↗
PubMed1993

Variability of human papillomavirus DNA testing in a longitudinal cohort of young women.

OBJECTIVE: To determine the variability in human papillomavirus (HPV) DNA testing of the cervix in young women found positive for HPV DNA by dot blot hybridization on routine examination. METHODS: Young women who were found to be HPV DNA-positive on routine screening using an RNA-DNA dot blot hybridization method were asked to return for repeat HPV DNA sampling, cytology, colposcopic examination, and biopsy if indicated. Those who had no histologic evidence of cervical dysplasia were asked to return every 4 months for cytology and HPV DNA testing using standardized RNA-DNA hybridization and polymerase chain reaction techniques. RESULTS: The women were followed for a mean of 27.6 months (range 13-40) with a mean of six visits (range four to ten). One-third of the women remained consistently or intermittently HPV DNA-positive by RNA-DNA dot blot hybridization, and almost 50% of the women remained consistently or intermittently positive using polymerase chain reaction techniques. Women were more likely to be positive by polymerase chain reaction than by RNA-DNA hybridization at both 1 year and after 2 years of follow-up (P < .05). However, rates for persistent positive tests by either method were similar at 1 and 2 years of follow-up. Forty percent of the subjects had new or different types than the original HPV type appear during follow-up. All five women who had evidence of spontaneous regression of cytologic abnormalities became HPV DNA-negative by both methods. CONCLUSIONS: Our data suggest that a portion of women infected with HPV appear to eliminate the infection over a relatively short period and are at low or no risk of developing disease. Persistent DNA negativity was also found in those women undergoing spontaneous regression. However, a substantial proportion of women remained intermittently positive by RNA-DNA hybridization and polymerase chain reaction. This finding suggests that the virus remains latent in some individuals and may undergo reactivation, defined by sufficient replication to allow detection by means less sensitive than polymerase chain reaction.

Adolescent↗
PubMed1992

Colposcopic and histologic findings and human papillomavirus (HPV) DNA test variability in young women positive for HPV DNA.

The purpose of this study was to determine the prevalence of human papillomavirus (HPV)-related disease in women positive for HPV DNA by using a commercially available DNA detection kit and to compare these results to HPV DNA variability observed in repeated sampling. Young women attending family planning clinics who were positive for HPV DNA on routine screening were asked to return for a repeat HPV DNA test, cytology, colposcopy, and biopsy if indicated. Of the 78 women examined, 35% had biopsy-verified low-grade dysplasia of the cervix, and 64% had evidence of HPV-related disease somewhere in the anogenital area. Fifty percent of the women had a negative test on repeat sampling, but there was no association between DNA persistence at the second visit and colposcopic/histologic findings. In conclusion, the minority of women positive for HPV DNA have latent infection. In addition, variability in detection is common and unrelated to the presence of HPV-related disease.

Adolescent↗
PubMed1992

Human papillomavirus infections.

Though the existence of disease associated with HPV has been documented for centuries, it has been only within the past 2 decades that we have recognized the clinical diversity and significant morbidity and mortality associated with HPV infections. The original lack of interest and nonavailability of in vitro culture systems has hampered research. However, with the advent of molecular diagnostic techniques, strong evidence suggests that HPV plays a major role in the development of specific anogenital cancers, including cervical, vaginal, vulvar, penile, and anal. It is this association between anogenital cancers and HPV that may result in treatment guidelines that eventually will eliminate these cancers. Moreover, to the extent that this association has resulted in overdiagnosis and unnecessarily aggressive treatment, new and ongoing research may create more appropriate treatment options. The principles for diagnosis and treatment should be based on adequate evaluation, including colposcopic examination and histologic confirmation for suspected neoplastic lesions. The majority of HPV-induced disease should be treated conservatively (often best with observation). The role of HPV DNA testing in clinical outcome is yet to be defined, with the exception of high-grade neoplastic disease, which should be treated aggressively.

Adult↗
PubMed1991

The association between human papillomavirus deoxyribonucleic acid status and the results of cytologic rescreening tests in young, sexually active women.

We examined the utility of cytologic rescreening tests in women who had positive test results for human papillomavirus deoxyribonucleic acid but who were diagnosed as having benign conditions at cytologic testing. One hundred twenty-five Papanicolaou smears from women who were screened for human papillomavirus deoxyribonucleic acid were sent routinely to a private laboratory for diagnoses. These slides were then reviewed independently by two pathologists who were blinded to the human papillomavirus deoxyribonucleic acid results. The effects of cytologic rescreening in cases of both positive and negative human papillomavirus deoxyribonucleic acid were assessed by calculating z scores. Cervical intraepithelial neoplasia was diagnosed in 40% by pathologist A and in 20% by pathologist B of the human papillomavirus-positive subjects compared with none diagnosed by the private cytology laboratory (z = 3.09, p less than 0.005 and z = 1.98, p less than 0.05, respectively). No significant differences were found in the human papillomavirus-negative group. We conclude that cytologic rescreening in human papillomavirus deoxyribonucleic acid-positive women who were initially diagnosed as having benign cytologic results will yield a significant proportion of cases of cervical intraepithelial neoplasia.

Adolescent↗
PubMed1990

Human papillomavirus infection in sexually active adolescent females: prevalence and risk factors.

We examined the prevalence of human papillomavirus (HPV) infection, and associated risk factors for infection with HPV types 6, 11, 16, 18, 31, 33, and 35, in 661 sexually active adolescent females attending family planning clinics. Fifteen percent were positive for HPV DNA by RNA-DNA dot-blot hybridization. More than 60% of the HPV-positive subjects harbored at least one of the following cancer-related HPV types: 16, 18, 31, 33, or 35. Those with HPV had a mean range of four to 10 lifetime sexual partners compared with a mean range of one to three in those without HPV (p less than 0.001). After the analysis was adjusted for number of lifetime sexual partners, no other risk factor was associated with HPV infection. We conclude that oncogenic-related HPV types are common sexually transmitted organisms found in our population. The strong relationship with number of sexual partners suggests that acquisition of HPV infection is predominantly influenced by sexual behavior. However, in our population, confounders such as oral contraceptive use, past history of Chlamydia trachomatis infection, or substance abuse were not found to be significant independent risk factors.

Adolescent↗
PubMed1989

Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males.

We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males. Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+). Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%). The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively. Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected. The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.

Adolescent↗
PubMed1989

Differences in biologic maturation, sexual behavior, and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia.

Because several cofactors may influence the development of cervical intraepithelial neoplasia (CIN) in young women, we compared differences in behaviors (sexual activity, contraception, and cigarette use), sexually transmitted disease (STD) infection rates (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus), and cervical maturation (age of menarche and percentage of cervical ectopy) in groups of sexually active female adolescents with and without CIN. Those with CIN were compared with three non-CIN groups: (1) teenagers who were referred to a teen colposcopy clinic but had no evidence of CIN (high-risk group), (2) teenagers seen at a gynecology clinic without STD symptoms (asymptomatic group), and (3) teenagers seen at the gynecology clinic with STD symptoms (symptomatic group). The percentage of cervical ectopy was measured by colpophotography. Subjects with CIN had more lifetime sexual partners than the asymptomatic group (p less than 0.001) and were more likely to smoke cigarettes than either gynecology clinic group (p less than 0.01). No differences in behaviors existed between the CIN and high-risk groups. The mean age of menarche in those with CIN was 1 year older than all three non-CIN groups (p less than 0.05), and those with CIN had a greater area of ectopy than those without CIN (p less than 0.02). Those with CIN were more likely to have a past or present history of C. trachomatis infection than the two gynecology clinic groups; no difference was found between the CIN and high-risk groups. We conclude that cofactors such as smoking, sexual promiscuity, and C. trachomatis infection may influence cervical vulnerability. However, cervical biologic immaturity is an important risk factor for development of CIN in adolescent girls.

Adolescent↗