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Biomedical subjects

K M Stone

Publications and source records attributed to K M Stone.

At least 19 recordsLinked to original sources
PubMed1999

Genital warts and their treatment.

Genital warts are manifestations of a common viral sexually transmitted disease (STD) that are often diagnosed and treated with a variety of clinical specialties. Unlike for other STDs, there is a general lack of a well-established treatment algorithm for the management of external genital warts. This, coupled with a wide variety of treatments and clinical settings, makes the development of a simple algorithm virtually impossible. In this review what is known and not known about current treatments and case management will be discussed.

Condylomata Acuminata↗
PubMed1999

Prevention agenda for genital herpes.

Few meeting participants envisioned a prevention and control program on the scale or scope of CDC's programs to prevent HIV infection, syphilis, gonorrhea, and chlamydial infection, but all agreed that the virtual absence of public health interventions to prevent genital herpes is no longer appropriate in light of evolving epidemiologic knowledge and other research advances. The ultimate scope of a national genital herpes prevention effort will depend in part on the results of the recommended research agenda, which probably will evolve over the better part of a decade. Numerous other STD prevention partners will also need to contribute to this effort and help to determine the makeup of future programs. Substantial new fiscal resources will be required both to implement the proposed research agenda and, depending on the results, to undertake the prevention efforts indicated by those studies. Competing STD prevention priorities and other national health needs will influence the availability of those resources. The consultants' meeting and the research and program activities summarized above are described in more detail in the full meeting report, which is posted on the Division's web site (www.cdc.gov/nchstp/dstd/dstdp.html) or may be requested directly from the Division. DSTDP is interested in receiving comments and suggestions about herpes prevention.

Antibodies, Viral↗
PubMed1997

A multi-disciplinary curriculum for 11- to 13-year-olds: immunization, plus!

A sixth grade curriculum entitled "Immunization, Plus!" Was developed to promote adolescent immunization. This targeted immunization curriculum utilized contemporary learning theory and innovative teaching approaches and styles to maximize acceptability among educators. Because instructional time in school was limited, a thematic curriculum was created to embed immunization and communicable disease content within mathematics, science/health, and language arts units. The curriculum, which reflected the theory of multiple intelligences among students, offered an array of different learning formats, including linguistic, logical-mathematical, spatial, and bodily-kinesthetic. The curriculum was made available free of charge to school districts in California, and its evaluation was planned to track distribution, utilization, and changes in students' knowledge, attitude, and behavior.

Adolescent↗
PubMed1995

Human papillomavirus infection and genital warts: update on epidemiology and treatment.

The treatment of genital warts remains frustrating since it is often painful, expensive, and unsuccessful. Moreover, little is known about the infectivity and natural history of exophytic genital warts or subclinical genital infection with human papillomavirus. The traditional goals of therapy for sexually transmitted diseases--eradication of infection, elimination of symptoms, prevention of long-term sequelae, and interruption of transmission--are currently not attainable for or applicable to genital warts. The medical literature from January 1988 to August 1993 was reviewed for recent studies on the treatment of exophytic warts. The following treatments were included in the reviewed studies: podofilox (which was recently approved by the Food and Drug Administration), podophyllin, cryotherapy, topical 5-fluorouracil, intralesional interferon, systemic interferon, and laser surgery. No single treatment modality was superior to another, and recurrence rates associated with all modalities were high. Treatment of genital warts should be guided by preferences of the patient, and a specific therapeutic regimen should be chosen with consideration of expense, efficacy, convenience, and potential for adverse effects.

Condylomata Acuminata↗
PubMed1995

Sexual behavior, sexually transmitted diseases, and risk of cervical cancer.

To explore sexually transmitted diseases and sexual behavior as risk factors for cervical cancer, we analyzed data from a population-based case-control study of breast and cervical cancer in Costa Rica. Data from 415 cases of cervical carcinoma in situ, 149 cases of invasive cervical cancer, and 764 controls were included in the analysis. Multivariate analysis showed that lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, herpes simplex virus type 2 seropositivity, and serologic evidence of previous chlamydial infection were predictors of carcinoma in situ. Serologic evidence of previous syphilis was not associated with carcinoma in situ. Predictors for invasive cervical cancer included lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, serologic evidence of previous syphilis, herpes simplex type 2 infection, and chlamydial infection. Cigarette smoking, socioeconomic status, self-reported history of sexually transmitted diseases, and douching were not associated with either carcinoma in situ or invasive cervical cancer.

Adult↗
PubMed1993

Use of multiple molecular subtyping techniques to investigate a Legionnaires' disease outbreak due to identical strains at two tourist lodges.

A multistate outbreak of Legionnaires' disease occurred among nine tour groups of senior citizens returning from stays at one of two lodges in a Vermont resort in October 1987. Interviews and serologic studies of 383 (85%) of the tour members revealed 17 individuals (attack rate, 4.4%) with radiologically documented pneumonia and laboratory evidence of legionellosis. A survey of tour groups staying at four nearby lodges and of Vermont-area medical facilities revealed no additional cases. Environmental investigation of common tour stops revealed no likely aerosol source of Legionella infection outside the lodges. Legionella pneumophila serogroup 1 was isolated from water sources at both implicated lodges, and the monoclonal antibody subtype matched those of the isolates from six patients from whom clinical isolates were obtained. The cultures reacted with monoclonal antibodies MAB1, MAB2, 33G2, and 144C2 to yield a 1,2,5,7 or a Benidorm 030E pattern. The strains were also identical by alloenzyme electrophoresis and DNA ribotyping techniques. The epidemiologic and laboratory data suggest that concurrent outbreaks occurred following exposures to the same L. pneumophila serogroup 1 strain at two separate lodges. Multiple molecular subtyping techniques can provide essential information for epidemiologic investigations of Legionnaires' disease.

Adult↗
PubMed1991

Epidemiology of human papillomavirus infections.

Human papillomavirus infection represents the most common mucocutaneous viral infection, and 3% to 5% of all patients have clinically evident warts. Human papillomavirus infections of the genital tract are one of the most common sexually transmitted viral infections in the United States. Data from STD clinics and private physicians' offices reveal that genital warts, one manifestation of genital HPV infection, have been diagnosed more frequently in recent years. With the use of a variety of diagnostic techniques, asymptomatic HPV infection has been identified in men and women and is probably much more common than is clinically apparent infection.

Adolescent↗
PubMed1990

Treatment of external genital warts: a randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation.

Four hundred and fifty patients were enrolled into a randomised clinical trial in a public sexually transmitted diseases clinic to evaluate the efficacy of podophyllin, cryotherapy, and electrodesiccation for treatment of external genital warts. Complete clearance of warts was observed in 41%, 79%, and 94% of patients who received up to six weekly treatments of podophyllin, cryotherapy, and electrodesiccation, respectively. Relapses occurred in 25% of all patients, yielding 3 month clearance rates of 17%, 55%, and 71% for podophyllin, cryotherapy, and electrodesiccation, respectively. Wart volume and duration did not influence treatment outcome. Response to therapy was greater in women than in men, and did not differ by treatment modality. Electrodesiccation and cryotherapy were more effective than podophyllin for the treatment of external genital warts, but none of these three treatments were highly successful.

Adult↗
PubMed1990

Increase in condom sales following AIDS education and publicity, United States.

Data from a national probability sample of drug stores show that condom sales rose from 240 million annually in 1986 to 299 million in 1988. The greatest increase occurred in 1987 after the Surgeon General's report on AIDS was released. Sales of latex condoms with spermicide rose 116 percent. Sales of other types of condoms increased less. These data suggest that Americans are using more condoms and probably more effective condoms in response to AIDS education.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Avoiding sexually transmitted diseases.

As the spectrum of sexually transmitted diseases (STDs) has broadened to include many infections that are not readily cured, prevention of STDs has become more important than ever. Primary prevention methods include abstinence, careful selection of sexual partners, condoms, vaginal spermicides, and a vaccine for hepatitis B. Condoms will protect against STDs only if they are used consistently and correctly; vaginal spermicides may also reduce risk of certain STDs. Health care providers should routinely counsel women on methods to reduce risk of STDs.

Female↗
PubMed1987

Genital human papillomavirus infection. A growing concern.

HPV infections of the genital tract are one of the most common sexually transmitted viral infections in the United States. Data from STD clinics and private physicians' offices reveal that genital warts, one manifestation of genital HPV infection, have been diagnosed more frequently in recent years. Using a variety of diagnostic techniques, asymptomatic HPV infection has been identified in men and women and is probably much more common than clinically apparent infection.

Epidemiologic Methods↗
PubMed1986

Primary prevention of sexually transmitted diseases. A primer for clinicians.

With the advent of sexually transmitted infections for which curative therapy is not available, primary prevention has assumed greater importance. The spectrum of sexually transmitted diseases (STDs) has broadened, and clinicians need to understand the mechanisms of their transmission and prevention. Modifying selection of sexual partners and avoiding certain sexual practices should theoretically reduce the risk of infection. Clinical and laboratory studies indicate that the use of condoms, diaphragms, and spermicides reduces the risk of acquiring certain infections. At present, hepatitis B is the only STD for which a safe, effective vaccine is available. Use of oral antibiotics cannot be recommended. Postcoital washing or urination have not been shown to have a protective effect against infection. Because of the potential benefits, persons at risk for STDs should be encouraged to modify their sexual behavior and use barrier methods and spermicides to protect themselves against sexually transmitted infections.

Administration, Oral↗
PubMed1986

Personal protection against sexually transmitted diseases.

Primary prevention of sexually transmitted diseases has received little emphasis in control programs. To evaluate the effectiveness of prevention strategies, we reviewed the world's literature on this topic. Use of condoms and spermicides greatly reduces the risk of gonorrhea, and barrier methods are practical and acceptable. Certain systemic antibiotics are effective, but for practical reasons, their use cannot be recommended. Washing or urinating after sexual exposure does not appear to protect against infection. Although the effectiveness of modifying sexual behavior to reduce the risk of sexually transmitted diseases has not been evaluated, many people have changed or are willing to change their behavior. Even if preventive measures are used consistently by only a minority of persons at risk, rates of sexually transmitted diseases would decline rapidly. In this era of sexually transmitted diseases that are not readily cured by antibiotics, use of effective preventive measures should be strongly encouraged.

Anti-Bacterial Agents↗
PubMed1986

Epidemiology of genital herpes infections in the United States. The current situation.

To investigate national trends in genital herpes infections, we analyzed data collected by the National Disease and Therapeutic Index survey from 1966 to 1984. The number of private physician-patient consultations for symptomatic genital herpes increased 15-fold during this period. The number of patient visits for newly diagnosed infections increased 8.8-fold. Women aged 20-24 years and men aged 25-29 years were more likely to consult a private physician for genital herpes than were patients in other age brackets. Our analysis suggests that the incidence of genital herpes infections among patients visiting private practitioners is increasing nationally. Additionally, to establish the magnitude and distribution of neonatal herpes infections, we initiated a nationwide pilot reporting system. The analysis, in progress, should provide clues to prevention of this devastating disease.

Acyclovir↗
PubMedDate not supplied

Treatment of genital herpes.

Oral acyclovir has been used successfully to treat and prevent symptomatic episodes of genital herpes simplex virus infection. Daily suppressive therapy has proven to be safe and effective when used continuously for periods as long as 4 years. Several new regimens have been shown to be effective and are likely to be more convenient for patients than previous schedules. In vitro resistance to acyclovir does not appear to be associated with clinical failure of treatment in immunocompetent hosts, but available data are limited and concerns remain. Failure of treatment in cases due to acyclovir-resistant strains has been reported in immunocompromised patients infected with the human immunodeficiency virus. The safety of acyclovir use by pregnant women has not been established. The value of acyclovir for the prevention of mucocutaneous ulcerations in asymptomatic persons or for the prevention of primary infections is unknown. Judicious use of acyclovir only by persons with clinically apparent infections is warranted at the present time.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Management of genital infection caused by human papillomavirus.

Recent studies of genital wart therapy have evaluated laser surgery, interferon, and 5-fluorouracil. On the basis of considerations of efficacy, cost, adverse effects, and recurrence rates, cryotherapy with liquid nitrogen remains the recommended therapy for most sexually transmitted warts. None of the treatment methods eradicates the papillomavirus, and genital wart recurrences are seen with each method. The influence of treatment of genital warts on the natural course and sequelae of genital papillomavirus infection is unknown.

Condylomata Acuminata↗
PubMedDate not supplied

National surveillance for neonatal herpes simplex virus infections.

To explore the magnitude and descriptive epidemiology of neonatal herpes simplex virus (HSV) infection, the Centers for Disease Control (CDC) conducted an 18-month hospital-based surveillance study in which 184 cases were reported. Only 22% of mothers had a history of genital HSV infection and only 9% had genital lesions at the time of delivery. Cesarean delivery initiated prior to membrane rupture failed to prevent infection in 15 cases. These data confirm previous observations that most mothers of infected neonates have no history of genital HSV and are asymptomatic at delivery. Furthermore this study suggests that intrauterine infection may be an important route of transmission and underscores the limitations of current prevention strategy.

Adolescent↗