Biomedical subjects

G Bolan

Publications and source records attributed to G Bolan.

61 records · Page 4Linked to original sources

PubMedDate not supplied

Factors associated with condom use in a high-risk heterosexual population.

The use of condoms has been advocated as a means of preventing the transmission of the human immunodeficiency virus and other sexually transmitted agents. To better understand factors that may influence condom use, 300 heterosexuals were enrolled in a cross-sectional study of patients attending San Francisco's only public sexually transmitted disease clinic. Interviewer-administered questionnaires were conducted. Condom use at last sexual intercourse was examined by logistic regression analysis. Men who used drugs or alcohol at last intercourse and whose partners did not want to use condoms were less likely to have used them; women who were black or Hispanic, who reported difficulty getting their partners to use condoms, or who reported that condoms decrease sexual pleasure also were less likely to have used them. Efforts to increase condom use in this population should target minorities, assist women to negotiate their use, emphasize the dangers of using alcohol and other drugs with sex, and address the perception that condoms interfere with sexual pleasure.

Adolescent↗

PubMedDate not supplied

Detection of Chlamydia trachomatis in first catch urine samples from symptomatic and asymptomatic males.

BACKGROUND AND OBJECTIVES: Non-invasive tests are needed to detect Chlamydia trachomatis in the genital tract. For men, urine appears to be a useful specimen for chlamydial antigen or nucleic acid detection. GOAL OF THIS STUDY: To evaluate enzyme immunoassays (EIA) for chlamydial antigens in first catch urine (FCU) from symptomatic and asymptomatic men. STUDY DESIGN: We conducted five different studies; FCUs and urethral swabs were collected from 1,341 symptomatic and 816 asymptomatic males. Four EIAs (SureCell, Chlamydiazyme, MicroTrak and IDEIA) were tested on the FCU sediments. RESULTS: Prevalence of chlamydia by tissue culture isolation was 6% for asymptomatic and 14% for symptomatic men. With symptomatic males, the EIA sensitivities and specificities were: SureCell 85% and 97%, IDEIA 82% and 98%, MicroTrak 86% and 99%, and Chlamydiazyme 91% and 95%. For asymptomatic men, Chlamydiazyme sensitivity was 35% with frozen urine vs 77% with fresh urine. Overall, tissue culture sensitivity was about 90%. CONCLUSION: EIA results on FCU sediments are comparable to that of tissue culture isolation on urethral swabs. In many settings, FCU may be the specimen of choice for diagnosing chlamydial infections in men.

Chlamydia Infections↗

PubMedDate not supplied

Reliability of sexual histories in heterosexual couples.

BACKGROUND AND OBJECTIVES: Reliability of responses between partners was used as a surrogate to examine the validity of self-reported sexual histories in two samples with different risk and demographic profiles and different intensities of contact with study staff. STUDY DESIGN: Retrospective self-report data were compared between partners and between samples. RESULTS: Despite differences between the two groups, reliability of the sexual history data was comparable. CONCLUSIONS: Further study is needed to examine other methodologies for collecting sensitive data. Intensive contact and rapport building may not be necessary.

Adult↗

PubMedDate not supplied

Commonly used diagnostic criteria for pelvic inflammatory disease have poor sensitivity for plasma cell endometritis.

BACKGROUND: The majority of women with tubal damage do not have a history of acute pelvic inflammatory disease. The prevalence of upper genital tract inflammation was evaluated in women deemed not to have pelvic inflammatory disease by common diagnostic criteria. GOAL OF THIS STUDY: To compare clinical signs and laboratory tests used to diagnose pelvic inflammatory disease with endometrial biopsy histopathology. STUDY DESIGN: Endometrial biopsy and commonly used physical and laboratory tests were performed on 52 women with pelvic tenderness, 51 with vaginosis or cervicitis, and 22 control subjects who had no evidence of infection with Neisseria gonorrhoeae or Chlamydia trachomatis and who tested negative for bacterial vaginosis using vaginal swab Gram's stain. RESULTS: Thirty-six of 52 patients (69%) with pelvic tenderness, compared with 22 of 51 patients (43%) with vaginosis or cervicitis and two of 22 control subjects (9%), had plasma cell endometritis. The Centers for Disease Control and Prevention minimal diagnostic criteria for pelvic inflammatory disease had a sensitivity of 33% for plasma cell endometritis. CONCLUSIONS: The clinical diagnosis of pelvic inflammatory disease using published criteria correlates poorly with plasma cell endometritis.

Adolescent↗

PubMedDate not supplied

Management of pelvic inflammatory disease by primary care physicians. A comparison with Centers for Disease Control and Prevention guidelines.

BACKGROUND: The Centers for Disease Control and Prevention published recommendations for clinicians on the management of pelvic inflammatory disease, but it is unknown if providers are aware of the guidelines or follow them. GOAL: To compare pelvic inflammatory disease screening, diagnosis, treatment, and reporting practices among primary care physicians with the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease. STUDY DESIGN: A weighted random sample of California primary care physicians surveyed in November 1992 and January 1993. RESULTS: Of the 1,165 physicians surveyed, 553 (48%) returned completed questionnaires. Among respondents, 302 (55%) reported having treated a case of pelvic inflammatory disease during the last 12 months, and of these, 52% answered that they were unsure of or do not follow the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease. Pediatricians and those with more years since residency were less likely to deviate from the Centers for Disease Control and Prevention guidelines for pelvic inflammatory disease, and family practitioners were more likely to deviate from the guidelines. CONCLUSIONS: Pelvic inflammatory disease is commonly encountered by primary care physicians in California. Training and experience were important predictors of compliance with the Centers for Disease Control and Prevention recommendations; however, substantial divergence from the guidelines occurs.

Adolescent↗

PubMedDate not supplied

Failure to disclose HIV risk among gay and bisexual men attending sexually transmitted disease clinics.

We analyzed data from a multisite study of 1,063 gay or bisexual men attending sexually transmitted disease clinics to evaluate factors predicting failure to disclose human immunodeficiency virus (HIV) risk behaviors to clinic staff and the extent of such failure. We compared data from a brief screening assessment on unprotected anal and oral sex with data on the same behaviors from a subsequent detailed interview. We also compared behavioral data from screening and the interview with data on diagnoses of rectal gonorrhea abstracted from medical charts. Of 523 men reporting unprotected anal sex at interview, 29% failed to report this behavior at screening. Men failing to disclose unprotected anal sex were also less likely to disclose engaging in unprotected oral sex. Among men reporting no unprotected anal sex, either at screening or interview, 1.6% were diagnosed with rectal gonorrhea. Logistic regression analyses comparing men who did and did not disclose at screening having engaged in unprotected anal sex showed that men who failed to disclose reported greater involvement in gay organizations, greater perceived peer support for condoms, fewer episodes of unprotected anal sex in the last four months, and lower rates of substance abuse treatment. Our data suggest that men who failed to disclose may have lower risk levels, and may be more integrated into the gay community. Brief interviews, as opposed to detailed ones, also may underestimate incidence of unsafe sex. Where feasible, HIV risk assessment and counseling and laboratory screening should be routinely provided to all clinic attendees, regardless of self-reports.

Adolescent↗

PubMedDate not supplied

The impact of health care market changes on local decision making and STD care: experience in three counties.

INTRODUCTION: In 1993 health care reform including universal coverage appeared imminent. Some county health departments elected to discontinue provision of direct services including sexually transmitted disease (STD) care. County A moved in this direction with final clinic closure in 1996. Coincidentally, two other counties elected to continue their STD treatment services. These events have created a "natural experiment" in which to evaluate the contrasting strategies among three counties. METHODS: This report describes the changes in local delivery over a three-year period (1993-1995). Measurements were carried out in three counties in two states. STD program capacity, service delivery, and morbidity rates for STDs (chlamydia and gonorrhea) were monitored in each study county. Quantitative data were complemented by a qualitative patient survey at each site. RESULTS: Capacity changed dramatically in County A as compared with the other two over the three-year period. Major declines in STD clinic visits (-43%) and laboratory testing (-46%) occurred. A major drop in reported STD incidence (-23% for chlamydia and -49% for gonorrhea) also occurred, including a drop in public provider reporting. CONCLUSIONS: In County A, a decision to end delivery of personal health services led to a divestiture in STD service delivery and a decline in all measured parameters. Etiology of concurrent declined in reported STDs is unclear. Possibly decreased public services led to a spurious decline in reporting. Alternatively, an overall strategy of shifting care to private providers has succeeded in reducing disease. Public health surveillance may be less accurate in such settings.

Adult↗