Sexually transmitted diseases during pregnancy: screening, diagnostic, and treatment practices among prenatal care providers in Georgia.

BACKGROUND: Sexually transmitted diseases (STD) during pregnancy are associated with adverse outcomes. We conducted a prenatal care provider survey to determine STD screening, diagnosis, and treatment practices. METHODS: Standard questionnaires were mailed to Georgia-licensed obstetrician/ gynecologists, family practitioners, and nurse-midwives (N = 3,082) in 1998. RESULTS: Of the 1,300 care providers who returned the survey, 565 (44%) provided prenatal care, 390 (57%) were male, and 396 (70%) were obstetrician/ gynecologists. Overall, 553 prenatal care providers (98%) reported screening all pregnant patients for syphilis, 551 (98%) for hepatitis B, 501 (89%) for trichomonas, 474 (84%) for human immunodeficiency virus (HIV), 401 (71%) for gonorrhea, 403 (71%) for chlamydia, 475 (84%) for group B streptococci, and 130 (23%) for bacterial vaginosis (BV) (high risk). Less than 10% used amplification tests for chlamydia or gonorrhea. Most providers used appropriate regimens to treat STD in pregnant women. A written office policy on testing for BV or HIV was associated with increased screening. CONCLUSIONS: Provider education is needed about diagnosis and treatment of STD during pregnancy.

HIV risk behavior, street outreach, and condom use in eight high-risk populations.

In this paper we examine risk behavior, exposure to street outreach, and condom use in samples of injecting drug users (IDUs) and high-risk youth. We used systematic sampling methods to produce representative samples of injecting drug users IDUs (five sites) and high-risk youth (three sites). The populations surveyed engaged in high levels of sexual risk behavior: 20% to 46% reported two or more sex partners in the last month. The majority (62% to 97%) knew someone infected with HIV. Condom use rates approached national health promotion goals for nonsteady partners but not for steady or main partners. Having a condom at time of interview was the most consistent predictor of condom use at last intercourse. Many of the respondents have been in contact with street outreach programs and many acknowledged some personal risk for HIV infection. However, most of the injecting drug users and high-risk youth interviewed (and their sex partners) were still at risk through unprotected sex.

PIP: Samples of IV drug users (IVDUs) and high-risk youth were surveyed to gain insight into their HIV risk behavior, exposure to street outreach, and condom use. The IVDUs were sampled from Atlanta, Philadelphia, Chicago, New York, and Los Angeles; 69-77% are male; they are predominantly Hispanic and Black; and more than 50% were older than age 40 years. The high-risk youth were sampled from Los Angeles, San Diego, New York, and San Francisco. They were aged 12-23 years and had been recurrently without shelter during the past year, or had been without permanent shelter for the past two months, or had derived their livelihood from dealing drugs on the street, prostitution, panhandling, and crime. 65-81% are male, approximately 50% in New York are White and 78% in San Francisco, 39-54% were age 20 or older, and 52-73% were currently living on the street, although only 10-32% had stayed in a shelter during the past year. At least 75% were supported at least in part by the street economy and 15-33% identified themselves as gay or bisexual. Many of the youth covered in the survey in San Francisco were on tour with the Grateful Dead folk rock music group. 20-46% reported having two or more sex partners in the last month, up to one-third reported having no sex partner in the past month, 62-97% knew someone infected with HIV, and 18-26% of the IVDUs and 11-41% of youth reported sometimes exchanging sex for money, food, shelter, or other things. Among respondents who had sex during the past month, 17-44% reported using a condom during vaginal sex with main partners, and 55-75% with other partners. The highest rates of condom use were for anal sex, followed by vaginal and oral sex. In most categories, however, the majority of respondents were not using condoms to protect themselves from HIV or other sexually transmitted diseases. Having a condom at the time of interview was the most consistent predictor of condom use at last intercourse. Many of the respondents had been in contact with street outreach programs and many acknowledged some personal risk for HIV infection.