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Biomedical subjects

Anne Rompalo

Publications and source records attributed to Anne Rompalo.

14 recordsLinked to original sources
PubMed2005

Managing patients with genital herpes and their sexual partners.

There is increasing recognition of the growing size and significance of the genital herpes epidemic. Recent developments in the wide-scale availability of type-specific herpes simplex virus (HSV) sero-logic assays have meant that many previously undiagnosed mild,atypical, and subclinical infections may now be diagnosed with some degree of confidence without the use of Western blots. The value of such diagnostics is controversial. However, the importance of HSV with its facilitation of HIV transmission and acquisition, the availability of various preventative strategies for limiting vertical HSV transmission, and the growing evidence that condoms, some educational and counseling interventions, and antiviral therapies may limit sexual transmission, have challenged many of the arguments against wider testing of the population.

Antiviral Agents↗
PubMed2004

Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis.

BACKGROUND: No safe and convenient regimen has proved to be effective for the management of recurrent vulvovaginal candidiasis. METHODS: After inducing clinical remission with open-label fluconazole given in three 150-mg doses at 72-hour intervals, we randomly assigned 387 women with recurrent vulvovaginal candidiasis to receive treatment with fluconazole (150 mg) or placebo weekly for six months, followed by six months of observation without therapy. The primary outcome measure was the proportion of women in clinical remission at the end of the first six-month period. Secondary efficacy measures were the clinical outcome at 12 months, vaginal mycologic status, and time to recurrence on the basis of Kaplan-Meier analysis. RESULTS: Weekly treatment with fluconazole was effective in preventing symptomatic vulvovaginal candidiasis. The proportions of women who remained disease-free at 6, 9, and 12 months in the fluconazole group were 90.8 percent, 73.2 percent, and 42.9 percent, as compared with 35.9 percent, 27.8 percent, and 21.9 percent, respectively, in the placebo group (P< 0.001). The median time to clinical recurrence in the fluconazole group was 10.2 months, as compared with 4.0 months in the placebo group (P<0.001). There was no evidence of fluconazole resistance in isolates of Candida albicans or of superinfection with C. glabrata. Fluconazole was discontinued in one patient because of headache. CONCLUSIONS: Long-term weekly treatment with fluconazole can reduce the rate of recurrence of symptomatic vulvovaginal candidiasis. However, a long-term cure remains difficult to achieve.

Administration, Oral↗
PubMed2004

Changing Epidemiology of Syphilis and Its Persistent Relationship with HIV.

Syphilis rates are increasing, particularly among men who have sex with men, many of whom are HIV coinfected. Screening based on risk behaviors, in addition to early recognition of primary and secondary syphilis and prompt reporting of cases to local and state health departments to assist in partner notification and treatment services, may curtail further spread of both infections.

Journal Article↗
PubMed2004

Phase-specific network differences associated with the syphilis epidemic in Baltimore city, 1996-2000.

OBJECTIVES: The objective of this study was to determine whether the syphilis epidemic in Baltimore City during the mid-1990s was associated with changes in sexual networks. METHODS: Data on index cases of syphilis and their partners were collected from 1996 to 2000 and entered into CDC STD*MIS software. Unique pairs of dyads were used to create networks using SAS Interactive Matrix Language. PAJEK and UCINET were used to analyze the largest component from all years (1996-2000), during the epidemic (1997-1998), and after the epidemic (1999-2000). RESULTS: Between 1996 and 2000, there were 3343 components containing 18,709 nodes. The 2 largest components were comprised of 1103 nodes and 125 nodes, respectively. From the period during the epidemic to after the epidemic, the average distance among reachable pairs, network centralization, number of n-cliques (n = 2, size = 3), and number of k-plexes (k = 2, n = 3) declined, whereas the block densities increased. CONCLUSIONS: Important differences exist between the sexual networks during and after the syphilis epidemic.

Baltimore↗
PubMed2003

Longitudinal study of mucosal Candida species colonization and candidiasis among human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women.

Acquisition and loss rates and estimates of duration of oral and vaginal Candida species colonization and candidiasis were examined among 868 human immunodeficiency virus (HIV)-seropositive and 437 at-risk HIV-seronegative women monitored prospectively during 1993-1999. Colonization and candidiasis acquisition rates, both oral and vaginal, were significantly higher among HIV-seropositive women; the magnitude of increase in candidiasis outcomes for HIV-seropositive women was greater for oral candidiasis than for vaginal candidiasis. Loss rates and estimates of duration of incident outcomes indicated that persistent mucosal colonization was more likely among HIV-seropositive women. However, results did not suggest persistent mucosal candidiasis. Higher HIV loads were significantly associated with increased odds of incident or persistent oral and vaginal colonization and candidiasis, an effect significantly reduced by highly active antiretroviral therapy for the incident outcomes of oral candidiasis and vaginal colonization. Cell-mediated immunodeficiency (CD4(+) lymphocyte count <500 cells/mm(3)) was significantly associated with increased odds of oral colonization or candidiasis, but not with vaginal colonization or candidiasis. In HIV-seropositive women, mucosal candidiasis is the consequence of multiple interacting factors.

AIDS-Related Opportunistic Infections↗
PubMed2003

Incident and persistent vulvovaginal candidiasis among human immunodeficiency virus-infected women: Risk factors and severity.

OBJECTIVE: To examine risk factors for vulvovaginal candidiasis among women with or at risk for human immunodeficiency virus (HIV) infection. METHODS: Data were from 856 HIV-infected women and 421 at-risk uninfected women observed semiannually at four study sites from April 1993 through February 1999. At enrollment women were 15-55 years old and had no acquired immunodeficiency syndrome-defining conditions. Three definitions for vulvovaginal candidiasis of differing severity were constructed using data from vaginal Candida culture and Gram stains scored for yeast and three signs on pelvic examination (vulvovaginal edema, erythema, or discharge): 1) culture or Gram stain positivity plus at least one clinical sign, 2) culture or Gram stain positivity plus at least two clinical signs, and 3) visible yeast on Gram stain plus at least one clinical sign. RESULTS: The prevalence and cumulative incidence of each definition of vulvovaginal candidiasis were greater among HIV-infected women than among women not infected with HIV (P <.01 for all comparisons). Stratified by status at the preceding visit, vulvovaginal candidiasis was most likely among women with prior vulvovaginal candidiasis, least likely among women without earlier Candida colonization, and intermediately likely among women with preceding subclinical Candida colonization. Among HIV-infected women, lower CD4 count and higher HIV viral load were associated with vulvovaginal candidiasis. Several other factors were independently associated with vulvovaginal candidiasis, with strong associations for diabetes mellitus and pregnancy in particular. Vulvovaginal candidiasis was not more severe among HIV-infected women. CONCLUSION: Vulvovaginal candidiasis occurred with higher incidence and greater persistence, but not greater severity, among HIV-infected women.

Adolescent↗
PubMed2003

Overweight and human immunodeficiency virus (HIV) progression in women: associations HIV disease progression and changes in body mass index in women in the HIV epidemiology research study cohort.

An association of increased weight with a slower progression of human immunodeficiency virus (HIV) disease has been reported in studies that have not included large numbers of women. We evaluated the association of HIV disease progression with body mass index (BMI) in 871 women and present cross-sectional, survival, and longitudinal analyses. A higher baseline BMI was associated with a lower rate of occurrence of the first CD4 cell count <200 cells/mm(3). In analyses that incorporated time-varying BMI, underweight and normal women had an increased risk of clinical acquired immune deficiency syndrome, and underweight women had increased risk of HIV-related death, compared with obese women. The association between change in BMI and CD4 cell count was estimated; increases in BMI were associated with slight increases in CD4 cell counts, even after controlling for prior values of CD4 cell count, viral load, and treatment. Higher BMI and increases in BMI are associated with a decreased risk of HIV progression.

Adult↗
PubMed2003

Generalizability of STD screening in urban emergency departments: comparison of results from inner city and urban sites in Baltimore, Maryland.

BACKGROUND: A previous study in an inner city emergency department (ED) in Baltimore, Maryland, showed a high prevalence of gonorrhea and chlamydia infection among ED patients. GOAL: The goal was to compare results from an inner city ED to results from an urban ED in Baltimore, in terms of study population and setting, risks for infection, and factors associated with nonparticipation in the study. METHODS: This was a cross-sectional study of patients aged 14 to 44 years at two EDs. Outcomes for multivariate logistic regression analyses were (1). positive for gonorrhea or chlamydia by urine ligase chain reaction assay and (2). nonparticipation in the study. Comparative analyses were limited to patients aged 18 to 31 years. RESULTS: Patients differed significantly between EDs by participation rate, distribution of race/ethnicity, healthcare access, and behavioral risks, although the prevalence of infection did not differ. Risks for infection at the inner city ED were younger age, history of STD, and recent number of sex partners. Risks for infection at the urban ED were female gender and recent number of sex partners. At both EDs, being African American was associated with increased chance of participating, whereas lack of any genitourinary complaint was associated with nonparticipation. At the urban ED, women and patients approached for study enrollment during the day were also less likely to participate. CONCLUSION: ED-based screening for STDs can be an effective intervention for unrecognized infections. However, assessing population characteristics is necessary to develop targeted screening methods and clinical algorithms and to improve participation of patients and program sustainability.

Adolescent↗
PubMed2003

Responding to a community outbreak of syphilis by targeting sex partner meeting location: an example of a risk-space intervention.

BACKGROUND: Effective syphilis control and elimination require community effort and innovative case-finding techniques, especially to identify infected persons from core transmission groups. GOAL: To summarize the implementation and outcomes of a community-oriented response to a localized outbreak of syphilis directed at sex partner meeting places. STUDY DESIGN: Syphilis surveillance and rapid response data from a 7-month period were analyzed for risk behaviors, sex partner meeting locations, field investigation outcomes, and social and sexual network connections. RESULTS: Four (6%) of the sixty-nine persons tested were confirmed syphilis reactors, of whom three were new cases. A sexual and needle-sharing network of 15 persons was identified that included two of the new syphilis cases. These two had not been found through standard field investigation. CONCLUSIONS: Targeting interventions to sex partner meeting places may effectively complement traditional syphilis control tools and find previously unidentified syphilis cases in high-morbidity areas.

Adult↗
PubMed2002

Scabies and pediculosis pubis: an update of treatment regimens and general review.

The ectoparasites scabies and pediculosis pubis are common causes of skin rash and pruritus worldwide. They are transmitted primarily by person-to-person spread and are generally associated with low morbidity. The preferred treatment for scabies has generally been topical agents such as lindane and permethrin. Recently, ivermectin has demonstrated good efficacy in the treatment of scabies, and it may be of particular use in institutional outbreaks and in communities in which scabies is endemic. Combination treatment with topical agents and oral ivermectin may be necessary for crusted scabies. Treatment of pediculosis pubis is best accomplished with topical permethrin, lindane, or pyrethrins with piperonyl butoxide. Although resistance to these topical agents has been reported in head lice, decreased efficacy in the treatment of pediculosis pubis has not been reported.

Anthelmintics↗
PubMed2002

Use of highly active antiretroviral therapy in HIV-infected women: impact of HIV specialist care.

OBJECTIVES: To evaluate factors associated with use of HIV specialist care by women, and to determine whether medical indications for therapy validate lower rates of antiretroviral use in women not using HIV specialty care. DESIGN: Cross-sectional analysis of the 1998 interview from the HIV Epidemiology Research Study (HERS) cohort. METHODS: Data from 273 HIV-infected women in the HERS were analyzed by multiple logistic regression to calculate predictors of the use of HIV specialist care providers. Variables included study site, age, education, insurance status, income, substance abuse, depression, AIDS diagnosis, CD4 + lymphocyte count, and HIV-1 viral load. In addition, medical indications for therapy and medical advice to begin antiretroviral therapy were assessed. RESULTS: Of 273 women, 222 (81%) used HIV specialists and 51 (19%) did not. Having health insurance, not being an injection drug user, and being depressed were predictive of using HIV specialist care (all p < or = .05). Although medical indications for therapy in the two groups were comparable, the rate of highly active antiretroviral therapy (HAART) use was significantly higher in women using HIV specialist care (27%) compared with those not using HIV specialists (7.8%). Women using HIV specialists received significantly more advice to begin antiretroviral therapy (ART) in the 6 months prior to the interview compared with those not using specialists (relative risk, 2.4; 95% CI = 1.3-4.6). CONCLUSIONS: Having insurance, not being an injection drug user, and being depressed all increased the likelihood of women receiving HIV specialty care, which, in turn, increased the likelihood of receiving recommended therapies. The level of HAART use (23%) and any ART use (47%) in these HIV-infected women was disturbingly low. Despite comparable medical indications, fewer women obtaining care from other than HIV specialists received HAART. These data indicate substantial gaps in access to HIV specialist care and thereby to currently recommended antiretroviral treatment.

Adolescent↗
PubMed2002

Urinary tract infections in women with or at risk for human immunodeficiency virus infection.

OBJECTIVE: The purpose of this study was to determine the risk for urinary tract infection in women with or at risk for human immunodeficiency virus infection. STUDY DESIGN: A prospective study of 871 women who were human immunodeficiency virus seropositive and 439 women who were human immunodeficiency virus seronegative was conducted, with additional semiannual interviews, human immunodeficiency virus serologic evaluation, human immunodeficiency viral load determination, T-cell subset test, urinalysis, pregnancy test, and selected quantitative urine culture examination. RESULTS: At baseline, 26 women (3.0%) who were human immunodeficiency virus seropositive and 14 women (3.2%) who were human immunodeficiency virus seronegative women had urinary tract infections(P =.97). During 4280 person-years of follow-up, incident urinary tract infections was associated significantly with <12 years education (adjusted risk ratio, 1.43; 95% CI, 1.01-2.00), public assistance (adjusted risk ratio, 1.70; 95% CI, 1.11-2.60), pregnancy (adjusted risk ratio, 3.04; 95% CI, 2.04-4.53), and recent previous urinary tract infection (adjusted risk ratio, 1.82; 95% CI, 1.16-2.86), but not with human immunodeficiency virus infection. Among women who were human immunodeficiency virus seropositive, risk was associated with viral load (adjusted risk ratio, per log(10) increase 1.30; 95% CI, 1.03-1.63), but not with CD(4+) lymphocyte count. CONCLUSION: Risk for urinary tract infection is not associated with human immunodeficiency virus infection but is associated with viral load among women who are infected with human immunodeficiency virus.

Adolescent↗
PubMedDate not supplied

Vaginal flora morphotypic profiles and assessment of bacterial vaginosis in women at risk for HIV infection.

Specific morphotypic profiles of normal and abnormal vaginal flora, including bacterial vaginosis (BV), were characterized. A prospective study of 350 women yielded concurrent Gram-stain data and clinical assessment (n = 3455 visits). Microbiological profiles were constructed by Gram stain. Eight profile definitions were based on dichotomizing the levels of Lactobacillus, Gardnerella, and curved, Gram-negative bacillus (Mobiluncus) morphotypes. Of these, two were rare, and the other six demonstrated a graded association with the clinical components of BV. The proposed profiles from the Gram stain reflect the morphotypic categories describing vaginal flora that may enable clearer elucidation of gynecologic and obstetric outcomes in various populations.

Adolescent↗