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Biomedical subjects

S O Aral

Publications and source records attributed to S O Aral.

At least 19 recordsLinked to original sources
PubMed1997

Herpes simplex virus type 2 in the United States, 1976 to 1994.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) infection is usually transmitted sexually and can cause recurrent, painful genital ulcers. In neonates the infection is potentially lethal. We investigated the seroprevalence and correlates of HSV-2 infection in the United States and identified changes in HSV-2 seroprevalence since the late 1970s. METHODS: Serum samples and questionnaire data were collected during the National Health and Nutrition Examination Surveys (NHANES) II (1976 to 1980) and III (1988 to 1994). HSV-2 antibody was assessed with an immunodot assay specific for glycoprotein gG-2 of HSV-2. RESULTS: From 1988 to 1994, the seroprevalence of HSV-2 in persons 12 years of age or older in the United States was 21.9 percent (95 percent confidence interval, 20.2 to 23.6 percent), corresponding to 45 million infected people in the noninstitutionalized civilian population. The seroprevalence was higher among women (25.6 percent) than men (17.8 percent) and higher among blacks (45.9 percent) than whites (17.6 percent). Less than 10 percent of all those who were seropositive reported a history of genital herpes infection. In a multivariate model, the independent predictors of HSV-2 seropositivity were female sex, black race or Mexican-American ethnic background, older age, less education, poverty, cocaine use, and a greater lifetime number of sexual partners. As compared with the period from 1976 to 1980, the age-adjusted seroprevalence of HSV-2 rose 30 percent (95 percent confidence interval, 15.8 to 45.8 percent). The seroprevalence quintupled among white teenagers and doubled among whites in their twenties. Among blacks and older whites, the increases were smaller. CONCLUSIONS: Since the late 1970s, the prevalence of HSV-2 infection has increased by 30 percent, and HSV-2 is now detectable in roughly one of five persons 12 years of age or older nationwide. Improvements in the prevention of HSV-2 infection are needed, particularly since genital ulcers may facilitate the transmission of the human immunodeficiency virus.

Adolescent↗
PubMed1997

The natural history of syphilis. Implications for the transmission dynamics and control of infection.

BACKGROUND: Syphilis remains a significant cause of morbidity in many developing countries and in some areas within North America and Europe. Mathematical models of the transmission dynamics of sexually transmitted infections have provided insights of relevance both to the interpretation of observed epidemiological patterns and to the design of control programs. Their use for the study of syphilis has been limited to date. GOALS AND STUDY DESIGN: The authors investigated the transmission dynamics of syphilis against a template based on the natural history of infection in individual patients with the aim of (1) identifying gaps in our understanding of the biology of infection, and (2) providing insights of relevance to the design of control policies. RESULTS: Analyses reveal that Treponema pallidum has a moderate to high probability of transmission during contact between susceptible and infectious sexual partners. This, combined with questions over the existence of any immunity to reinfection, helps to ensure the long-term persistence of syphilis within "core" activity groups. Patterns of treatment in North America are shown to have significantly altered the relative frequency of individuals in the different stages of disease. CONCLUSIONS: The analyses emphasize the benefits to be gained from treating infected people early in the primary stage of infection to reduce the effective period during which infected people can transmit to others. This form of treatment is beneficial for both the individual and the community. Treatment has greatly altered the incidence of different disease stages, but the full implications of treatment depend on whether immunity is present.

Contact Tracing↗
PubMed1997

The promise of integrated representative surveys about sexually transmitted diseases and behavior.

BACKGROUND: It has been difficult to conduct representative surveys measuring both sexually transmitted disease prevalence and behavioral data. This article reviews the literature, describes a recent pretest of the feasibility of integrated surveys, and discusses the potential implications. METHODS: Several national surveys are reviewed, including the National Health and Nutrition Examination Surveys, National Health and Social Life Survey, and National Survey of Adolescent Males. The 1994 pretest of the National Survey of Adolescent Males collected urine specimens of male respondents, which were tested for Chlamydia trachomatis using ligase and polymerase chain reaction tests. RESULTS: There have not been any prior national surveys that collect clinical measures of STD infection and detailed behavioral data. In the pretest, 85% of the eligible interview respondents provided a urine specimen. Of those tested, 6% were positive for C. trachomatis. CONCLUSIONS: Combining behavioral surveys with collection of urine specimens for STD testing in representative samples is feasible. However, STD testing adds new operational and ethical challenges to the conduct of household surveys.

Adolescent↗
PubMed1996

The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies.

Each sexually transmitted disease (STD) epidemic evolves through predictable phases, shaped by a dynamic interplay among the pathogen, the behaviors of the subpopulations in which it emerges, and the prevention efforts that are developed to limit its impact. As STD epidemics move through these phases, the sexual and social networks that fuel them become located in subpopulations characterized by progressively higher rates of sex partner change and less contact with the health care system. As a result, phase-appropriate prevention strategies and research issues are essential to reducing STDs and their consequences.

Disease Outbreaks↗
PubMed1995

STD/HIV prevention in Turkey: planning a sequence of interventions.

This study was initiated to assess which mix of early STD/HIV prevention interventions would potentially be effective, cost-effective and sustainable in Turkey; and to program an intervention sequence to maximize synergy among the interventions. During rapid assessment we: 1) reviewed past issues of 3 leading newspapers; 2) collected information on TV coverage; 3) interviewed key informants including taxicab drivers, hotel employees, grocery store owners, academicians in public health and law, investigators of STD/HIV and reproductive tract infections, and officials in the ministry of health; 4) reviewed available evidence on STD/HIV morbidity, sexual behavior patterns, migration patterns and same/opposite gender sex trade. We found: 1) discrepancies between decision makers' perceptions and social realities with respect to the epidemiology of sexual behavior and STDs, and the state of public health programs; 2) discrepancies between sexual practices and public expression regarding sexual practices; 3) economic, demographic, and political pressures in Turkey and in surrounding countries for the expansion of prostitution; 4) a sexual double standard and gender specific migration patterns which sustain a high demand for commercial sex; 5) patterns of health care seeking behaviors and provision of STD clinical services which indicate other STDs may play a very important role in spread of HIV infection; 6) an important mass media role in opinion formation; 7) consensual denial of risk for the majority based on beliefs embedded in machismo, nationalism and religion, and a resulting marginalization and externalization of STD/HIV risk; 8) high prevalence of syphilis among both Turkish and immigrant female prostitutes in Istanbul (early latent 8 and 13%; late latent 0 and 4%; previous history 9 and 22%) 9) and high rates of syphilis among male prostitutes (early latent 11%, late latent 21% and previous history 58%). We concluded that interventions should initially include, in the following order; 1) awareness raising for decision makers and opinion leaders including members of parliament and mass media; 2) awareness raising for members of the general population; 3) needs assessment and intervention development for sex workers; 4) training in HIV and other STDs for medical personnel; and 5) quality assurance and control for laboratory procedures for STDs/HIV.

Female↗
PubMed1994

Predictors of high-risk behavior in unmarried American women: adolescent environment as risk factor.

BACKGROUND: Heterosexual intercourse with two or more partners in a short time period represents a high-risk behavior for acquisition and transmission of sexually transmitted pathogens (STDs). Identification of factors that may predict high-risk sexual behavior can help to focus primary prevention strategies on women at risk for future acquisition of infection. METHODS: We analyzed survey data obtained in 1988 from a nationally representative sample of 8,450 American women of reproductive age in order to identify such factors. RESULTS: Of all sexually experienced unmarried women, 6.6% reported having had two or more sexual partners in the preceding three months. Earlier age at first sexual intercourse was associated with multiple recent partners, and with lower reports of abstinence. Birth region in the West, lack of attendance at religious services as an adolescent, and having a mother who had her first child before she was 25 years of age were factors associated with multiple recent partners. Among unmarried white women having a mother who worked full time and not living with both parents during adolescence were associated with multiple recent partners; among unmarried black women, the inverse was true (p for racial difference < .05). Multivariate analysis showed western birth region and earlier age at first sexual intercourse to be significant predictors of having multiple recent sex partners. CONCLUSIONS: Early environment and race influence later sexual behavior. These factors should be considered in targeting and planning education for STD prevention.

Adolescent↗
PubMed1993

Fertility and use of cigarettes, alcohol, marijuana, and cocaine.

This study demonstrated that cigarette smoking was associated with an increase in both time to conception (among 2817 fertile women) and risk of primary infertility (among 1818 infertile women and their primiparous control subjects). The average time to conception was 4.3 months for women who never smoked, 4.6 months for those who smoked in the past, and 5.1 months for those who currently smoked. The delay in conception for current smokers remained significant after adjusting for confounders (risk ratio of 0.9 (0.8 to 1.0)). Additionally, current smokers were at increased risk of primary infertility (odd ratios of 1.9 (1.5 to 2.3)). For alcohol use, the average time to conception and risk of primary infertility did not vary by level of consumption. The average time to conception was significantly shorter for women who had used marijuana regularly and for women who had ever used cocaine than for women who had never used these drugs. Because of the increased use of marijuana and cocaine among young adults, further investigations of these associations are needed.

Canada↗
PubMed1993

Defining behavioral methods to prevent sexually transmitted diseases through intervention research.

This article focuses on efforts to use behavioral interventions to prevent STDs. Presented is a history of attempts to prevent and control STDs through behavior change and a summary of the main theoretic approaches to human behavior that have provided the scientific base for behavioral public health interventions. The authors also review the important behavior intervention studies, most of which have addressed chronic disease prevention. They specify the differences between behaviors that are associated with chronic disease and those that increase risk for STDs, as well as the implications of these differences for behavioral prevention of STDs. Finally, a review of the accumulating empiric evidence in the area of behavioral prevention of STDs is presented and a strategy for the development of methods to help change risk behaviors for STDS (including AIDS) is proposed.

Counseling↗
PubMed1992

Women with multiple sexual partners: united states, 1988.

Women who have multiple sexual partners in a short time period are appropriate targets for sexually transmitted disease (STD) prevention. We analyzed survey data collected in 1988 from a nationally representative sample of 8450 American women aged 15 to 44 to identify markers of such behavior. Among sexually active persons, 0.4% of married women and 8.4% of unmarried women had two or more sexual partners in the 3 months preceding the interview; unmarried marital status, early age at first sexual intercourse, lack of religious affiliation, and young age were associated with this behavior. All except young age were predictive after multivariate analysis. Such factors may help define women at elevated STD risk and allow better targeting of STD prevention.

Adolescent↗
PubMed1992

Vaginal douching among women of reproductive age in the United States: 1988.

BACKGROUND: Vaginal douching has been associated with pelvic inflammatory disease (PID) in several epidemiologic studies. METHODS: To determine the extent to which douching is practiced and to describe the population subgroups in which it is most prevalent, we analyzed data from the 1988 National Survey of Family Growth, which is based on a nationally representative sample of 8450 United States women between the ages of 15 and 44 years. RESULTS: Thirty-seven percent of the sample reported douching; 18% douched at least once a week. The variable most strongly and consistently associated with douching was race: two thirds of Black women, but only one third of White women, reported douching. The practice was least frequent among 15- to 19-year-olds (31%) and most frequent among 20- to 24-year-olds (41%). Douching was more common among women who lived in poverty (50%) than among those who did not (28%). Seventy percent of Black women living in poverty reported douching. Women with less than a high school education were almost four times more likely to report douching as those with 16 or more years of schooling (56% vs 16%). Women with only 1 partner and those with 10 or more partners were less likely to douche than others. Sixteen percent of women who reported douching, compared with 10% of those who did not, also reported a history of PID. CONCLUSIONS: Douching may be a modifiable risk factor for PID, it should be a high priority for future etiologic research.

Adolescent↗
PubMed1991

Self-reported pelvic inflammatory disease in the United States, 1988.

OBJECTIVE: --To assess any changes in the characteristics of women with self-reported pelvic inflammatory disease (PID) between 1982 and 1988 and to evaluate the role of additional behavioral factors. In 1982, PID was a frequent problem among American women of reproductive age, occurring in one in seven. It was also more common among older (greater than or equal to 30 years) than younger women, more common among blacks than among whites, and more common among formerly married women than among those currently married. DESIGN: --We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. SAMPLE: --The survey was conducted with a multistage probability sample of 8450 women. RESULTS: --The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. CONCLUSION: --PID is still a widely prevalent condition among American women, PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae.

Adolescent↗