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J M Zenilman

Publications and source records attributed to J M Zenilman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Ethnicity and sexually transmitted infections.

Public health workers have long recognized that sexually transmitted diseases are differentially distributed within the population, with the highest rates observed in ethnic minorities. Incidence rates for bacterial diseases, such as gonorrhea and chlamydia, may be five to 10 times higher than in the general population, and two to three times higher for prevalent viral infections such as genital herpes. Unless ethnic group-specific analyses are performed, however, the elevated rates may not be discernible. These groups are also often at highest risk for heterosexual HIV transmission. Understanding the differential risks faced by ethnic groups is a critical component of developing appropriate behavioral and healthcare access interventions.

Journal Article↗
PubMed1998

Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers. Opportunity for early intervention.

GOAL: To determine prevalence and incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection and assess risk factors predictive for such infections in a middle school-based clinic sample. STUDY DESIGN: 170 female students and 43 male students making 256 and 47 visits, respectively, > or = 30 days apart, in urban middle school clinics for primary care screening, reproductive health, or illness/injury were routinely asked to provide urine specimens for GC and CT ligase chain reaction testing if sexually active in the preceding 3-month period. Information regarding prior sexually transmitted diseases, reason for visit, and sexual risk behaviors was obtained. RESULTS: GC: 11.4% of female student and 2.1% of male student tests were positive. Incidence was 34.0 cases/1,000 person months (95% Confidence interval [CI]: 19.5-67.5). Median time to first positive and repeat positive test was 4.6 and 2.6 months, respectively. For CT: 16.4% of female student and 2.1% of male student tests were positive. Incidence was 57.5 cases/1,000 person months (95% CI: 35.2-93.8). Median time to first positive and repeat positive CT test was 6.0 and 4.8 months, respectively. Assessed risk factors failed to specify a candidate screening population. CONCLUSION: These data suggest that all sexually active adolescent girls in this high risk setting should be offered testing for GC and CT at least twice per year, regardless of age or other sexual risk behaviors and that STD control efforts in high risk middle schools should be encouraged.

Adolescent↗
PubMed1997

The association of herpes simplex virus type 2 (HSV-2), Haemophilus ducreyi, and syphilis with HIV infection in young men in northern Thailand.

To evaluate the association between sexually transmitted diseases that commonly may cause genital ulceration and prevalent and incident HIV infections, we conducted three case control studies in a cohort of 21-year-old male military conscripts in northern Thailand. The men were evaluated at baseline in 1991 and semiannually until their discharge 2 years later. Serologic evidence of infection with herpes simplex virus type 2 (HSV-2), Haemophilus ducreyi, and HIV were more frequent at baseline in 83 men with a history of genital ulcer than in 97 men without such a history. Seropositivity to H. ducreyi (odds ratio [OR] = 3.46), HSV-2 (OR = 3.83), and syphilis (OR = 1.53) were more common in HIV-positive than HIV-negative men. Men (N = 45) who seroconverted to HIV while in the military were more often seropositive for H. ducreyi and HSV-2 before HIV seroconversion and also were more likely to seroconvert to HSV-2 and H. ducreyi during the same interval as their HIV seroconversion compared with men who remained HIV-negative. These data suggest that HSV-2 and H. ducreyi may be both markers for high-risk sexual behavior and risk factors for HIV infection among young men in Thailand.

AIDS-Related Opportunistic Infections↗
PubMed1997

Typhoid fever.

Explore the source record for details and available documents.

Adult↗
PubMed1997

Sexually transmitted diseases in patients attending a Baltimore tuberculosis clinic. Assessment of use of multiple categoric services.

BACKGROUND: Recent increases in the incidence of tuberculosis and syphilis have occurred disproportionately in young heterosexuals of low socioeconomic status. The authors hypothesized that an overlap of tuberculosis and sexually transmitted disease clinic populations potentially could result in inefficient use of limited public health resources. METHODS: The authors conducted a retrospective study to determine the coinfection rate of syphilis and other sexually transmitted diseases in patients seen for evaluation at the Baltimore City Tuberculosis Clinic, Baltimore, Maryland. The authors determined the sexually transmitted disease clinic utilization patterns of this patient population. RESULTS: For patients referred to the tuberculosis clinic, 9.0% had a history of syphilis and 13.6% had at least one documented visit at a Baltimore City sexually transmitted disease clinic. Blacks presenting to the tuberculosis clinic were more likely to have previously diagnosed syphilis (13.6%) and to have had visited the sexually transmitted disease clinics (16.5%). CONCLUSIONS: In Baltimore, the patient population of tuberculosis clinics overlaps with those at the public sexually transmitted disease clinics. Thus, cross screening for syphilis and tuberculosis at urban clinics would be an important mechanism for identifying new cases of disease and increasing the efficiency of the public health system.

Adult↗
PubMed1997

Self-treatment patterns among clients attending sexually transmitted disease clinics and the effects of self-treatment on STD symptom duration. The Study Group.

OBJECTIVE: To assess patterns of self-treatment and its effects on the duration of sexually transmitted disease (STD) symptoms before medical care. METHODS: A cross-sectional interview survey in public STD clinics (7 U.S. cities). Patients, seeking treatment for STD symptoms or having a known infected sexual contact, reported self-treatment behaviors and symptom duration. Additional data were abstracted from medical charts. RESULTS: Self-treatment, primarily over-the-counter topical medications (54.8%), was reported by 21.8% of 2,508 symptomatic patients. Self-treaters were significantly more likely to be African-American (odds ratio [OR] = 1.8), female (OR = 1.7), over age 30 (OR = 1.3), report > 1 symptom (OR = 1.4), and report a genital lesion (OR = 2.1). Symptom duration was 2 days longer among self-treaters (p < 0.01). African-Americans (OR = 1.5), men (OR = 1.2), and self-treaters of symptoms other than genital lesions (OR = 1.4) had a significantly longer time from symptom onset to receiving medical care. CONCLUSIONS: Self-treatment is common among patients with STDs. Self-treatment of a genital lesion, unlike certain demographic factors and self-treatment of other STD symptoms, did not prolong the time to medical treatment.

Adolescent↗
PubMed1995

Bacterial vaginosis in lesbians: a sexually transmitted disease.

Sexual transmission of bacterial vaginosis (BV), a common syndrome in sexually active women, has not been previously established. Because no male counterpart for BV has been found, a population of lesbians is an ideal one in which to test the hypothesis that BV is sexually transmitted. We studied 103 homosexual women (lesbians) who sought gynecologic care at a community clinic and in a private gynecology practice in New York City. Participants were asked to refer their sexual partners for evaluation. In this cross-sectional prevalence study, all participants were evaluated for the presence of BV, and pairs of monogamous sexual partners were analyzed for concordance of their vaginal secretions. Twenty-nine (28.7%) of the 101 participants from whom satisfactory vaginal wash samples were available had BV. There were 21 pairs of monogamous partners. Of 11 index women who had BV, eight (72.7%) had partners who also had BV. Of 10 index women who did not have BV, only one (10%) had a partner with BV. The likelihood of a partner's having BV was 19.7 times greater if the index case had BV (P < .008; 95% CI, 2.1-588.0). We conclude that with respect to BV, lesbians in monogamous relationships usually have concordant vaginal secretions. This concordance probably reflects the sexual transmission of BV between lesbians.

Female↗
PubMed1995

Sexual transmission of hepatitis C virus among patients attending sexually transmitted diseases clinics in Baltimore--an analysis of 309 sex partnerships.

The prevalence of antibodies to hepatitis C virus (anti-HCV), the behavioral and laboratory-derived risk factors for anti-HCV, and the quantity and homology of HCV RNA were assessed among 1039 non-injection drug-using sexually transmitted disease (STD) patients representing 309 sex partnerships. Thirty-seven (7%) of 555 males and 19 (4%) of 484 females had anti-HCV. In logistic regression analyses, factors associated with anti-HCV included age (P < .001), greater numbers of lifetime sex partners (P = .023), human immunodeficiency virus infection (P < .001), Trichomonas infection (P < .001), cigarette smoking (P < .001), and male homosexual exposure (P = .012). Among couples, females whose sex partners were anti-HCV positive were 3.7 times more likely to have anti-HCV than females whose sex partners were anti-HCV negative (P = .039). The proportion of RNA homology between anti-HCV positive females and their male partners (94%) was higher than among randomly selected patients (82%). Sexual transmission of HCV may contribute to the high prevalence of anti-HCV reported in urban settings.

Adolescent↗
PubMed1994

Seroconversion in patients attending sexually transmitted disease clinics.

OBJECTIVES: To characterize recent HIV seroconverters in a sexually transmitted disease (STD) clinic population, and examine changing transmission patterns. METHODS: We conducted a case-control study nested within a retrospectively defined cohort of individuals attending Baltimore STD clinics between January 1988 and July 1990. Seroconverters, who tested HIV-positive after having a negative test, were compared to both HIV-negative controls, who were also tested twice, and a second, prevalent HIV-positive control group. Controls were matched 2:1 by sex, clinic, and month of HIV test. RESULTS: Forty-nine out of 6175 (0.79%) patients tested at least twice had documented HIV-1 seroconversion. On multivariate analysis, seroconversion was significantly associated with self-reported injecting drug use [odds ratio (OR), 7.3; 95% confidence interval (CI), 2.3-23)], with being a man who has had sex with other men (OR, 3.5%; 95% CI, 1.2-10), or with having sex with a known HIV-infected person (OR, 11; 95% CI, 1.3-96). Thirty-five per cent of seroconverters did not report a risk for HIV infection, and a higher proportion of recent seroconverters also reported no risk. Compared to the prevalent positive control group, more seroconverters reported no risk and a lower proportion reported recognized risks. A diagnosis of gonorrhea was also significantly associated with seroconversion (OR, 2.5; 95% CI, 1.1-5.7). CONCLUSIONS: These data suggest increasing heterosexual transmission of HIV in this inner-city STD clinic population. Incident STD, in particular gonorrhea, may increase a patient's risk for HIV infection, suggesting that patients with STD should be targeted aggressively for HIV prevention activities.

Adult↗
PubMed1993

Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae.

OPC-17116 is a new fluoroquinolone with potent activity against aerobic and anaerobic organisms. We evaluated the susceptibilities of 200 clinical gonococcal isolates including organisms with plasmid and chromosomally mediated resistance to beta-lactams and tetracycline. The antibiotics studied included OPC-17116, ofloxacin, ciprofloxacin, penicillin, tetracycline, erythromycin, azithromycin, and ceftriaxone. All isolates tested were susceptible to the quinolone class of antibiotics. The MICs of ciprofloxacin, ofloxacin, and OPC-17116 for 90% of isolates tested were 0.004, 0.03, and 0.004 micrograms/ml, respectively. For organisms with chromosomally mediated resistance to penicillin and tetracycline, geometric mean MICs of all antibiotics including the quinolones were increased.

Anti-Infective Agents↗
PubMed1992

Effect of HIV posttest counseling on STD incidence.

OBJECTIVE: To evaluate the effectiveness of human immunodeficiency virus (HIV) testing and posttest counseling in reducing subsequent high-risk behavior. METHODS: The incidence of sexually transmitted diseases (STDs) in the Baltimore, Md, public STD clinic population after HIV testing and counseling was determined by chart review and was compared in two groups, 868 HIV-seropositive patients and 1104 HIV-seronegative patients, matched by age, sex, and month in which HIV test was conducted. Patients were observed for incident STDs at intervals of 6 through 23 months. Patients with incident STDs were classified hierarchically after being notified of the HIV test result and receiving posttest counseling. RESULTS: Of HIV-seropositive patients, 615 (71%) returned for their test results and received posttest counseling; 694 HIV-seronegative patients (63%) returned. Of all those who returned for results and posttest counseling, 60 (9.7%) of 615 HIV-seropositive patients and 61 (8.8%) of 694 HIV-seronegative patients were diagnosed at least once with definite STD (syphilis, gonorrhea, or trichomoniasis) (P, not significant). Twenty-four HIV-seropositive patients (3.9%) and 71 HIV-seronegative patients (10.2%) returned with probable STD (nongonococcal urethritis or pelvic inflammatory disease) (P less than .001). Nine HIV-seropositive patients (1.5%) and 23 HIV-seronegative patients (3.3%) returned having had an STD-infected sexual partner (P less than .03). Age, sexual orientation, and drug use behavior did not predict return with STD. CONCLUSIONS: Both HIV-seropositive and HIV-seronegative patients showed high rates of repeat STDs after posttest counseling, an important public health challenge in creating effective high-risk behavior prevention strategies.

Counseling↗
PubMed1992

Urinary leukocyte esterase test: a screening method for the detection of asymptomatic chlamydial and gonococcal infections in men.

The ability of a urinary dipstick leukocyte esterase test (LET) to predict culture-verified asymptomatic urethral infections of Chlamydia trachomatis and Neisseria gonorrhoeae was determined in 1095 men (aged 18-39) who presented to an urban hospital for acute general medical care. Prevalence of chlamydial and gonococcal infections were 4% and 2.5% respectively; LET sensitivity was 41% and specificity was 91%. In the youngest one-third, the prevalence of infection and LET sensitivity and specificity increased to 9%, 58%, and 93%, respectively. Higher inclusion count in chlamydia culture was also significantly correlated with younger age. This is the first study to assess LET performance as a screening test for asymptomatic disease in adult men and suggests that LET has promising accuracy in young men but is less likely to be a useful screening test in men greater than 25 years old.

Adult↗
PubMed1992

Update on bacterial sexually transmitted disease.

Sexually transmitted diseases (STDs) are the most frequently reported bacterial infections. In 1990, slightly more than 700,000 cases of gonococcal disease were reported to the Centers for Disease Control, and the estimated incidence of chlamydial infections is 3 million to 4 million annually. Bacterial genital ulcer diseases such as syphilis and chancroid are increasing in epidemic proportions. The author reviews bacterial STDs in two categories: exudative mucosal infections and genital ulcer diseases.

Female↗
PubMed1991

CD4 lymphocyte concentrations in patients with newly identified HIV infection attending STD clinics. Potential impact on publicly funded health care resources.

Since January 1990, human immunodeficiency virus (HIV)-infected patients attending two sexually transmitted disease clinics in Baltimore, Md, have been offered T-lymphocyte subset evaluations. From January through September, CD4+ lymphocyte concentrations were measured in 223 newly diagnosed HIV-infected patients; 50% had fewer than 500 CD4+ T cells and 12% had fewer than 200 CD4+ T cells per cubic millimeter. Most patients were asymptomatic, and, even among patients with fewer than 200 CD4+ T cells, 54% had no symptoms or signs suggestive of advanced HIV infection. Homosexually active men had significantly lower mean CD4+ lymphocyte concentrations than intravenous drug users. Given the substantial numbers of patients with CD4+ concentrations that qualified them for zidovudine therapy, we also assessed their mechanisms of paying for health care. Only 24% of HIV-infected patients had private insurance. Seventy-two percent of patients with fewer than 200 CD4+ T cells either had no insurance or relied on public assistance for health care. Thus, although 50% of asymptomatic individuals identified by routine voluntary HIV screening in an inner-city sexually transmitted disease clinic may benefit from therapy for their disease, 75% of those qualifying for presently recommended therapy either depend on publicly funded health care or have no means of payment for care.

Adolescent↗