Biomedical subjects
Publications and source records attributed to W Cates.
During the past 10 years, the field of sexually transmitted diseases has evolved from one emphasizing the traditional venereal diseases of gonorrhea and syphilis, to one concerned with the syndromes associated with Chlamydia trachomatis, herpes simplex virus, and human papillomavirus, and then to one preoccupied with the fatal systemic infections caused by human immunodeficiency virus.
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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.
The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples. The study was conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world. Over 5800 couples completed the investigation. African centres had a pattern of infertility different from those in other developing regions or the developed countries. African couples were more likely than those from elsewhere to have secondary infertility or longer duration, a history of sexually transmitted diseases or pregnancy complications, and infertility diagnoses (such as bilateral tubal occlusion or pelvic adhesions) suggestive of previous genital infections.
Despite decades of experience with congenital syphilis, problems still arise in case definition, diagnostic evaluation, treatment, and follow-up. We reviewed all 50 cases of early congenital syphilis reported to the State of Texas in 1982. A large proportion of the infants were premature (39%), of low birth weight (38%), and symptomatic at birth (62%). Because of these findings, we believe that possible cases of asymptomatic congenital syphilis in Texas may be under-reported. Laboratory and/or roentgenographic findings were important to confirm the diagnosis of congenital syphilis. Over half of the asymptomatic infants had positive results of cerebrospinal fluid VDRLs. After diagnosis, the treatment of infants with penicillin varied considerably. While all 47 living infants were treated with penicillin, 21 different regimens were used. We urge all physicians to perform complete diagnostic evaluations on suspected infants consisting of a quantitative serum test for syphilis, serum IgM levels, a cerebrospinal fluid VDRL, roentgenographs of the long bones, and dark-field microscopy where indicated. Additionally, infants and their families need appropriate follow-up after treatment.
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We analyzed data from a national telephone survey to determine whether awareness of the herpes epidemic led to changes in sexual behavior. Of those surveyed, 67 per cent heard about herpes only within the last two years. More importantly, 45 per cent of individuals perceiving themselves to be at risk stated they had changed their behavior as a result of this perception. Among those never married, 60 per cent stated they were willing to modify their lives to avoid genital herpes.
Based on a nationally representative sample of American women of reproductive age, in 1982, one in seven reported having had pelvic inflammatory disease (PID). One in ten had received ambulatory care, and one in 25 were hospitalized for PID. A two-fold race differential was observed in self-reported history of PID. One in four Blacks compared to one in eight Whites reported having received treatment for this condition sometime in the past. The previous history of PID, especially in the older age groups, reflects the combined effect of secular trends in PID incidence and temporal changes in diagnostic and treatment practices.
Opinion is divided as to the advisability of routine use of prophylactic antibiotics for curettage abortion. Six studies, including three randomized clinical trials, suggest that prophylaxis reduces infectious morbidity associated with curettage abortions by about one half. Three other studies, two involving prophylaxis for instillation abortions and one involving a vaginal antiseptic for curettage abortion, support the hypothesis that antimicrobial prophylaxis reduces morbidity. Tetracyclines are commonly used for this purpose. The cost of routine prophylaxis even with an expensive tetracycline would appear to be offset by the savings in direct and indirect costs. Prophylaxis may help prevent both short-term morbidity and potential late sequelae, such as ectopic pregnancy and infertility.
A total of 159 cases of early congenital syphilis were reported in the United States during 1982, with Texas reporting 50 cases. We reviewed these Texas cases to identify the most important characteristics on which to focus control efforts. Thirty-eight mothers were 25 years of age or younger; 33 were unmarried. All were from minority groups. No congenital syphilis occurred in whites. Blacks were twice as likely as Hispanics to have an infected infant. Foreign-born Hispanic women were three times more likely to be delivered of an infected child than Hispanics born in the United States. Attendance at prenatal care facilities significantly affected the risk of being delivered of an infected child in both black and Hispanic women; 31 women received no prenatal care. Based on these findings, congenital syphilis in Texas can be reduced primarily through improving prenatal care for high-risk populations and by refining casefinding efforts to control infectious syphilis in the community.
To reduce the occurrence of neonatal herpes, laboratory screening with viral cultures during the last four to eight weeks of pregnancy has been recommended as a way to recognize women with subclinical herpes infection at delivery. Screening efforts have focused on a group of high-risk women, especially those with recurrent genital herpes infection. Using the technique of decision analysis, we examined the benefits, risks, and costs of viral culture screening for women with recurrent genital herpes. In a cohort of 3.6 million women, we estimate that screening would avert 11.3 neonatal deaths and 3.7 cases of severe retardation, but 3.3 women would die as a result of cesarean deliveries necessitated by culture results. Weekly viral cultures would diagnose one fourth of women with subclinical recurrent infection at delivery. The cost per case averted would be approximately $1.8 million. Future screening recommendations should consider not only the number of cases averted but also the effectiveness of screening and the costs in both maternal lives and medical care dollars.
To assess trends in hospitalizations for pelvic inflammatory disease (PID) in the United States for 1975 through 1981, we analyzed data from the Hospital Discharge Survey conducted by the National Center for Health Statistics. Overall, both the estimated number and rate of hospitalizations for PID among women aged 15 to 44 years rose slightly. For the seven-year period, an estimated average of 267,200 women were hospitalized annually for PID, with hospitalization rates averaging 5.3 per 1,000 women. Risk of hospitalization for PID was greatest among women in their 20s. Divorced or separated women were considerably more likely to have been hospitalized than single or married women. Although nonwhite women had estimated average rate 2.5 times higher than for white women, the trend of hospitalizations for PID among nonwhite women appeared relatively stable while the trend among young white women showed measurable increases.
Although dilatation and evacuation (D&E) is currently the most common method of midtrimester abortion in the United States, the intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha combined (U-P) has been proposed as a safer technique. To evaluate the comparative safety of U-P and D&E, we analyzed 2,805 U-P and 9,572 D&E abortions at 13 to 24 menstrual weeks' gestation. The U-P procedure resulted in significantly more serious complications than D&E (1.03 v 0.49 per 100 abortions). After adjusting for patient age, race, parity, follow-up information, and preexisting conditions, the relative risk of serious complications associated with U-P was 1.9 (95% confidence interval, 1.2 to 3.1). This advantage for D&E stems from its applicability to the 13- to 16-week interval. Although D&E appears to be safer overall in the midtrimester, for women obtaining abortion after 16 weeks, the rates of serious complications were comparable, with a relative risk of 1.0 (95% confidence interval, 0.4 to 2.5).
Past sexually transmitted disease (STD) control efforts in the United States of America have generally permitted a timely response to changes in intervention technology, antibiotic resistance, public funding, and media interest. Today, however, the expansion of STD organisms and syndromes at logarithmic rates has taxed our traditional labour intensive control approaches. We describe briefly the history of STD control strategies in the United States, discuss the seven components upon which current efforts are based, and speculate about our future programme initiatives.
Ectopic pregnancy has recently become a major cause of maternal mortality in the United States. Despite its increasing public health impact, relatively little is known about the clinical epidemiology of this condition. Therefore, the authors investigated all reported deaths from ectopic pregnancy in the United States occurring in 1979 and 1980, to determine characteristics of, and risk factors for, fatal ectopic pregnancy. Most women (85%) died from hemorrhage. Abdominal and interstitial implantations were more likely to become symptomatic later in gestation and to be fatal than were tubal implantations. Of those deaths for which circumstances were known, more prompt diagnosis and treatment of ectopic pregnancy by health professionals might have prevented one-half of the deaths. One-third of the deaths might have been prevented if the women had notified or visited a physician more promptly after the onset of symptoms. Timelier action by women and health professionals could reduce ectopic pregnancy mortality.
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