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Biomedical subjects

Jonathan M Zenilman

Publications and source records attributed to Jonathan M Zenilman.

At least 19 recordsLinked to original sources
PubMed2006

The role of speculum and bimanual examinations when evaluating attendees at a sexually transmitted diseases clinic.

BACKGROUND: With the advent of molecular techniques, self-collected specimens without a clinician's examination are often adequate to detect common genital infections. OBJECTIVE: To evaluate the additional information that speculum and bimanual examinations provides clinicians in the routine evaluation of genital infections among attendees of a sexually transmitted disease (STD) clinic. METHODS: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified on the basis of reason for visit. Proportional and likelihood ratio estimates of the speculum examination in detecting clinically relevant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral for further management) and bimanual examination in detecting abnormalities (leading to a diagnosis of pelvic inflammatory disease or referral) are presented. RESULTS: 15 918 of 21 703 records were included: 12 073 were symptomatic (SYM; discharge, rash, abdominal pain, dysuria, genital irritation or odour), 1676 were asymptomatic contacts of an infected partner (CON) and 2169 were asymptomatic and presented for checkup (ASYM). The median age was 26 years; 94% were black. 11.8% of SYM, 4.6% of CON and 3.9% of ASYM patients had clinically meaningful lesions detected on speculum examination. The bimanual examination detected clinically relevant abnormalities in 6.5% of SYM, 0.8% of CON and 0.6% of ASYM patients. CONCLUSION: Symptomatic women are most likely to benefit from speculum and bimanual examinations. However, their yield in evaluating asymptomatic women is low. Prospective studies are needed to determine whether eliminating speculum and bimanual examinations in a subset of women would offer an operational advantage without compromising patient safety.

Adolescent↗
PubMed2006

Modeling a syphilis outbreak through space and time using the Bayesian maximum entropy approach.

PURPOSE: The aim of the study is to describe changes in the spatial distribution of syphilis before, during, and after an outbreak in Baltimore, MD, by using Bayesian maximum entropy (BME), a modern geostatistical technique for space-time analysis and mapping. METHODS: BME was used to conduct simple and composite space-time analyses of the density of syphilis infection based on primary, secondary and early latent syphilis cases reported to the Baltimore City Health Department between January 1, 1994, and December 31, 2002. RESULTS: Spatiotemporal covariance plots indicated that the distribution of the density of syphilis cases showed both spatial and temporal dependence. Temporally dependent disease maps suggested that syphilis increased within two geographic core areas of infection and spread outward. A new core area of infection was established to the northwest. As the outbreak waned, density diminished and receded in all core areas. Morbidity remained elevated in the two original central and new northwestern core areas after the outbreak. CONCLUSIONS: Density of syphilis infection was a simple informative measure easily compared across years. The BME approach was useful for quantitatively and qualitatively describing the spatial development and spread of syphilis. Our results are specific to Baltimore; however, the BME approach is generalizable to other settings and diseases.

Baltimore↗
PubMed2006

Sexually transmitted infections and prostatic inflammation/cell damage as measured by serum prostate specific antigen concentration.

PURPOSE: Although inflammation and cell damage due to STIs are hypothesized to contribute to the later development of prostate disease, few clinical studies have been done to investigate the extent to which sexually transmitted agents infect and induce an inflammatory immune response in the prostate. We indirectly investigated this question by measuring serum PSA, a possible marker of prostatic inflammation and cell damage, in men with documented STIs. MATERIALS AND METHODS: Archived serum specimens from young men with laboratory confirmed exudative STIs, including gonorrhea, chlamydia and trichomonosis, and young men with no STI diagnoses were identified in 2 prospective studies of patients at Baltimore City STI clinics, that is 84 in the STI Transmission and Acquisition Study, and 61 in the Mucosal Immunity Study. Serum specimens from visits before, during and after STI diagnoses in men with at least 1 exudative STI diagnosis and from all visits in men with no STI diagnoses were tested for total PSA concentration. RESULTS: After combining the studies patients with STIs were more likely to have a 40% or greater increase in PSA than patients with no STI diagnoses (32% vs 2%, p <0.01). CONCLUSIONS: These findings suggest that STIs may contribute to prostatic inflammation and cell damage in a subset of infected men. Further studies are warranted to replicate study findings and determine host and infection characteristics associated with large PSA increases.

Adolescent↗
PubMed2006

High HIV sexual risk behaviors and sexually transmitted disease prevalence among injection drug users in Northern Vietnam: implications for a generalized HIV epidemic.

BACKGROUND: HIV prevalence in Vietnam is currently concentrated among injection drug users (IDUs). The extent to which this core risk group represents a potential for broader HIV transmission to the general population is currently unknown. METHODS: A community-based cross-sectional study among IDUs in Vietnam assessed sexually transmitted disease (STD) prevalence and behavioral risk factors. Qualitative interview data enhanced quantitative findings. RESULTS: The prevalence of any STDs among 272 IDUs was 30% (chlamydia, 9%; herpes simplex virus type 2 [HSV-2], 22%; gonorrhea, 0%; and syphilis, 1%). Part-time work or unemployment (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 1.1 to 6.9), sex with > or =2 sex workers in the past year (OR = 4.9, 95% CI: 1.91 to 12.6), having ever smoked heroin (OR = 4.5, 95% CI: 1.1 to 18.3), and injecting less frequently than daily (OR = 3.9, 95% CI: 1.43 to 10.6) were independently associated with chlamydial infection. Urban residency (OR = 4.0, 95% CI: 1.4 to 11.0) and daily injecting (OR = 2.2, 95% CI: 1.1 to 4.4) were independently associated with HSV-2. Odds of HSV-2 among older (> or =28 years of age) IDUs who had sex with <2 sex workers in the past year was higher than among younger IDUs who had sex with more sex workers (OR = 6.4, 95% CI: 2.1 to 18.4). CONCLUSIONS: High STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.

Chlamydia Infections↗
PubMed2006

Burden of Clostridium difficile-associated diarrhea in a long-term care facility.

OBJECTIVES: To describe the incidence and prevalence of Clostridium difficile-associated diarrhea (CDAD) in a long-term care facility (LTCF). DESIGN: Retrospective review of CDAD cases between July 2001 and December 2003. SETTING: Two hundred two-bed LTCF affiliated with an academic medical center in Baltimore, Maryland. PARTICIPANTS: All residents of the facility during July 2001 to December 2003. MEASUREMENTS: Clinical and laboratory-confirmed cases of CDAD. RESULTS: Incidence of CDAD ranged from 0 to 2.62 cases per 1,000 resident days. The highest rates were observed in residents of subacute units, whereas incidence was much lower on traditional nursing home units. Prevalence of CDAD at admission was greater on units (subacute and rehabilitative) where the majority of patients were admitted from hospital settings than on those where the majority of patients were admitted from the community (nursing home units). Recurrent disease occurred in 21.7% of patients with CDAD. CONCLUSION: CDAD remains a problem in the long-term care setting, and importation from the acute care setting accounts for a large proportion of the C. difficile seen LTCFs. As the population continues to age, issues of disease and infection in long-term care are expected to increase. New prevention and control strategies are needed to control the spread of CDAD in LTCFs.

Aged↗
PubMed2006

Plasma antibodies against Trichomonas vaginalis and subsequent risk of prostate cancer.

BACKGROUND: Although several previous case-control studies have investigated associations between sexually transmitted infections (STI) and prostate cancer, most have focused on gonorrhea and syphilis, two well-recognized, symptomatic STIs. Another STI of interest for prostate carcinogenesis is trichomonosis, a less well recognized and frequently asymptomatic STI with known prostate involvement. We investigated this infection in relation to incident prostate cancer in a nested case-control study within the Health Professionals Follow-up Study. METHODS: Prostate cancer cases were men diagnosed with prostate cancer between the date of blood draw (1993-1995) and 2000 (n = 691). Controls were men who had had at least one prostate-specific antigen test and who were free of prostate cancer and alive at the time of case diagnosis. One control was individually matched to each case by age (n = 691). Serologic evidence of a history of trichomonosis was assessed by a recombinant Trichomonas vaginalis alpha-actinin IgG ELISA. RESULTS: Thirteen percent of cases and 9% of controls were seropositive for trichomonosis (adjusted odds ratio, 1.43; 95% confidence interval, 1.00-2.03). This association persisted after additional adjustment for such factors as a history of other STIs, and was strongest among men who used aspirin infrequently over the course of their lives (odds ratio, 2.05; 95% confidence interval, 1.05-4.02, P(interaction) = 0.11). CONCLUSIONS: Serologic evidence of a history of trichomonosis was positively associated with incident prostate cancer in this large, nested case-control study of male health professionals. As this study is the first, to our knowledge, to investigate associations between T. vaginalis serology and prostate cancer, additional studies are necessary before conclusions can be made.

Adult↗
PubMed2006

Prevalence and risk factors for reproductive tract infections among women in rural Vietnam.

The objective of this study was to estimate prevalence and risk factors of reproductive tract infections (RTIs) among women in Haiphong, Vietnam. In October 1998, 197 women aged 18-49 were recruited into a community-based, cross-sectional study. Of the 197 women, 95 (49.5%) were diagnosed with > or = 1 endogenous reproductive tract infections (RTI) and 7 (3.6%) with > or = 1 sexually transmitted disease (STD). In three separate multivariate analyses, age <30 years (OR = 2.5; 95% CI = 1.1, 5.8), residential mobility (OR = 2.3; 95% CI = 1.1, 4.9), self reported genital itch/discharge (OR = 2.1; 95% CI = 1.1, 4.1), and reported belief that RTI symptoms were shameful (OR = 2.5; 95% CI = 1.2, 5.0) were associated with bacterial vaginosis (BV); low education was associated with candida (OR = 2.6; 95% CI = 1.0, 6.7); > or = 1 abortion was associated with > or = 1 STD (OR = 9.2; 95% CI = 1.1, 427). The prevalence of STDs was low but the prevalence of endogenous infections was high. Abortion is a proxy for other factors, such as high risk sexual behavior in either the woman or her partner. Given the low prevalence STD in this area of Vietnam, clinical case management of women presenting with RTI symptoms should focus on treatment of the more common endogenous infections, candida and BV.

Adolescent↗
PubMed2006

"Getting AIDS: not in my back yard." Results from a national knowledge, attitudes and practices survey.

BACKGROUND: Israel, as a country of immigration, has a heterogeneous distribution of risk for human immunodeficiency virus. Therefore, general population-based surveys of sexual behaviors among young adults may be useful for guiding prevention policy. To the best of our knowledge, the present survey is the first one among Israeli adults ever published. OBJECTIVES: To survey knowledge, attitudes and practices regarding sexually transmitted infections in Israeli adults in order to target the future AIDS public campaigns for the general population. METHODS: A national sample of 800 individuals, aged 18-45, was interviewed telephonically in September 2000. RESULTS: The average number of sexual partners reported in the previous 3 months was 1.3. Accurate knowledge on HIV transmission modes was expressed by 99% of respondents for unprotected sexual intercourse, 97% for re-use of needles and syringes, and 85% for mother-to-child infection. However, incorrect notions on transmission were also prevalent (34% for insect bites, 29% for kissing and 21% for public toilets). Prevention of STIs and prevention of pregnancy were the most common reasons for using condoms (72-73%); HIV prevention was the motivation for 39%. Fifty percent of single individuals without steady partners always/usually used condoms. It was decided that women need empowerment to negotiate condom use. CONCLUSIONS: Gaps were found between knowledge (at high level), attitudes (perceiving greater risk for others than themselves) and behavioral practices (combining low level of partner exchange with widespread disregard for safe sex). Promptly implemented, these findings will serve as a baseline for further surveys.

Acquired Immunodeficiency Syndrome↗
PubMed2005

A community-based study of hepatitis B infection and immunization among young adults in a high-drug-use neighborhood in New York City.

We conducted a community-based study of the prevalence and correlates of hepatitis B virus (HBV) infection and immunization among young adults in a "drug supermarket" neighborhood in New York City. Four hundred eighty-nine young adults ages 18-24 years were recruited from Bushwick, Brooklyn through multistage household probability sampling (n = 332) and targeted sampling (n = 157), interviewed, and tested for three hepatitis B markers (HBsAg, anti-HBc, and anti-HBs). Serological evidence of HBV infection was found in 8.0% (6.0% in the household sample and 12.1% in the targeted sample) and of hepatitis B immunization in 19.6% (22.6% in the household sample and 13.4% in the targeted sample). HBV infection was higher among young adults who either used crack or injected drugs and among those who traded sex for money or drugs. Having Medicaid was significantly associated with lower odds of infection in the household sample and higher odds of immunization in the targeted sample. Although adolescent hepatitis B immunization has been a public health priority in the United States since 1995, nearly three-quarters of young adults in this community did not have serological evidence of being either exposed or immunized. Whereas subsequent younger generations benefited from universal childhood hepatitis B immunization, this particular cohort of young adults who live in communities like Bushwick presents a unique group for prevention intervention.

Adolescent↗
PubMed2005

Fluoroquinolone-resistant Neisseria gonorrhoeae: the inevitable epidemic.

The worldwide incidence of fluoroquinolone-resistant Neisseria gonorrhoeae has increased dramatically in the last few years. Single doses of fluoroquinolones can no longer be used to treat N gonorrhoeae infections acquired in the Far East, parts of the Middle East, the Pacific Islands, and parts of Western Europe and the United States. Although California and Hawaii account for most of the current United States cases, the increased incidence of FQR in some high-risk groups independent of geography heralds an imminent spread of drug-resistant strains throughout the rest of the population. The use of molecular tests has revolutionized the diagnostic field in STIs. The main limitation of their application in N gonorrhoeae testing has been the loss of culture specimens that allow antimicrobial sensitivity testing. New molecular methods have made it possible to detect antimicrobial resistance without the use of live organisms. These tests hold the promise of improving epidemiologic tracking of N gonorrhoeae drug resistance, leading to better patient management at the local level. The loss of fluoroquinolones limits available oral regimens to a single CDC-recommended antibiotic, cefixime. Oral, inexpensive, single-dose alternatives are needed to ensure continued therapeutic success.

Anti-Bacterial Agents↗
PubMed2005

Epidemiology of chlamydial infection, gonorrhea, and trichomoniasis in the United States--2005.

The prevalence and incidence of chlamydial infection, gonorrhea, and trichomoniasis are unacceptably high in the United States. The prevalence of gonorrhea is substantially lower than chlamydial infection and trichomoniasis; in part, this is presumably due to the greater frequency of symptomatic disease. The disparity between racial/ethnic groups is considerable for each of these infections. Greater effort must be devoted to reducing this disparity and to understanding the underlying mechanisms of disease persistence in the United States.

Adolescent↗
PubMed2005

Behavioral interventions--rationale, measurement, and effectiveness.

Effective STD and HIV prevention requires synergism of individual-based prevention behaviors and societal/structural supports that will promote and maintain these behaviors. We should also expect the unexpected. STD rates in gay men have risen after effective prevention of HIV/STD in gay men and effective antiretroviral therapy. New drugs of abuse, such as methamphetamine ("crystal meth"), have induced risky sexual behaviors in gay and heterosexual communities. Economic dislocation in Eastern Europe has resulted in trafficking of commercial sex workers to Europe, the Mideast, and Asia, all with the potential for STD and HIV spread. James Curran, formerly director of the HIV epidemiology and prevention effort at the CDC, has written: It is ironic that the two clearest examples of large-scale success in HIV prevention-reduction in HIV transmission in gay men in the United States and national declines in HIV incidence in Thailand-arise in societies/communities known in their own way for sexual openness....the openness in both communities provided the environment to make the powerful revolutionary changes needed. In Africa, the powerful voice of President Museveni of Uganda has also encouraged candor about sexual risk-taking and facilitated that nation's encouraging early success in reducing HIV prevalence...Unfortunately, most of the world remains unable or unwilling to deal frankly and consistently with sexuality despite the considerable risks of HIV infection in many communities. There is a worldwide sexual hangup hampering HIV prevention efforts.

Adult↗
PubMed2005

Polymerase chain reaction detection of Y chromosome sequences in vaginal fluid: preliminary studies of a potential biomarker for sexual behavior.

BACKGROUND: Self-reported measures of sexual behavior are subject to nontrivial reporting biases. OBJECTIVE: The objective of this study was to develop a behavioral biomarker of recent sexual activity among females that is inexpensive, easily administered, and can be used in low sexually transmitted disease prevalence populations. METHODS: We developed a polymerase chain reaction (PCR) assay to detect Y chromosome (Yc) fragments. The Yc primers were developed against a 200-basepair (bp) microsatellite repeat sequence, which is unique to the male genome. A standard PCR technique was used. Assay sensitivity was determined quantitatively using donated semen samples. To assess longevity of detectability, we recruited female subjects in monogamous relationships. Seventeen subjects had unprotected intercourse followed by 3 weeks of abstinence from vaginal intercourse. Self-administered vaginal swabs (SAVS) were collected every other day. In addition to the swabs, subjects kept daily sexual diaries. Swabs were processed by semiquantitative PCR, and Yc decay curves were determined for each subject. The half-life of Yc in vaginal fluid was calculated on the collection of individual decay curves by a random-effects regression model approach. RESULTS: The sensitivity of our Yc-PCR assay was determined to be 5 copies of Yc. In the longevity studies, Yc was detectable in SAVS up to 15 postcoital days (PCD). Mean Yc DNA concentration in SAVS eluate followed an exponential decay pattern for each subject. Mean concentrations were 66.7 ng/mL at PCD-1, 20.6 ng/mL at PCD-7, and 4.5 ng/mL at PCD-15. The estimated half-life for Yc clearance was 3.83 days. CONCLUSION: The swab-based Yc-DNA PCR assay can detect coitus in women for a 2-week retrospective period. This can be used to validate sexual behavior-reporting and condom use in women and promises to be a useful tool in sexual behavior research.

Adult↗
PubMed2005

Reassessing a large-scale syphilis epidemic using an estimated infection date.

OBJECTIVES: Timely ascertainment of syphilis cases is critical to initiating disease-control measures. Epidemic curves typically use the report date and may introduce lag-time bias into assessment. GOAL: To reassess a large syphilis epidemic using an imputed infection date. STUDY: We compared 2 types of epidemic curves-1 based on report date and 1 on estimated infection date-using the large 1993-2003 Baltimore epidemic as our model. RESULTS: In general, the shape of the report curves did not accurately reflect the shape of the corresponding infection curves during the growth period (period of largest increase in incidence); during the hyperendemic period (period of highest incidence), peaks in report curves did not follow peaks in the infection curve by the appropriate lag time. There was a tendency for reporting data to underestimate infections during the growth period and overestimate infections during the hyperendemic period. A sensitivity analysis showed similar trends regardless of the length of stage-specific incubation period used. CONCLUSIONS: Lag-time bias may be present when using epidemic curves based on report dates. Health departments should consider using an estimated infection date.

Bias↗
PubMed2005

Genetic typing of the porin protein of Neisseria gonorrhoeae from clinical noncultured samples for strain characterization and identification of mixed gonococcal infections.

Molecular methods that characterize the Neisseria gonorrhoeae porin protein Por are needed to study gonococcal pathogenesis in the natural host and to classify strains from direct clinical samples used with nucleic acid amplification-based tests. We have defined the capabilities of por variable region (VR) typing and determined suitable conditions to apply the method to direct clinical specimens. Nested PCR from spiked urine samples detected 1 to 10 copies of template DNA; freezing spiked whole urine greatly reduced the ability to amplify porB. In a laboratory model of mixed gonococcal infections, the por type of one strain could be determined in the presence of a 100-fold excess of another. por VR typing was used to examine clinical samples from women enrolled in studies conducted in Baltimore, Md., and Madagascar. por type was determined from 100% of paired cervical swab and wick samples from 20 culture-positive women from Baltimore; results for eight individuals (40%) suggested infection with more than one strain. In frozen urine samples from Madagascar, porB was amplified and typed from 60 of 126 samples from ligase chain reaction (LCR)-positive women and 3 samples from LCR-negative women. The por VR types of 13 samples (21%) suggested the presence of more than one gonococcal strain. Five por types, identified in >45% of women with typed samples, were common to both geographic areas. Molecular typing is an important adjunct to nucleic acid amplification-based diagnostics. Methods that utilize direct clinical samples and can identify mixed infections may contribute significantly to studies of host immunity, gonococcal epidemiology, and pathogenesis.

Bacterial Typing Techniques↗