SARS-CoV-2 serosurvey across multiple waves of the COVID-19 pandemic in New York City between 2020-2023.

Sero-monitoring provides context to the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and changes in population immunity following vaccine introduction. Here, we describe results of a cross-sectional hospital-based study of anti-spike seroprevalence in New York City (NYC) from February 2020 to July 2022, and a follow-up period from August 2023 to October 2023. Samples from 55,092 individuals, spanning five epidemiological waves were analyzed. Prevalence ratios (PR) were obtained using Poisson regression. Anti-spike antibody levels increased gradually over the first two waves, with a sharp increase during the 3rd wave coinciding with SARS-CoV-2 vaccination in NYC resulting in seroprevalence levels >90% by July 2022. Our data provide insights into the dynamic changes in immunity occurring in a large and diverse metropolitan community faced with a new viral pathogen and reflects the patterns of antibody responses as the pandemic transitions into an endemic stage.

Intermittent cytomegalovirus infection alters neurobiological metabolism and induces cognitive deficits in mice.

Risk factors contributing to dementia are multifactorial. Accumulating evidence suggests a role for pathogens as risk factors, but data is largely correlative with few causal relationships. Here, we demonstrate that intermittent murine cytomegalovirus (MCMV) infection of mice, alters blood brain barrier (BBB) permeability and metabolic pathways. Increased basal mitochondrial function is observed in brain microvessels cells (BMV) exposed to intermittent MCMV infection and is accompanied by elevated levels of superoxide. Further, mice score lower in cognitive assays compared to age-matched controls who were never administered MCMV. Our data show that repeated systemic infection with MCMV, increases markers of neuroinflammation, alters mitochondrial function, increases markers of oxidative stress and impacts cognition. Together, this suggests that viral burden may be a risk factor for dementia. These observations provide possible mechanistic insights through which pathogens may contribute to the progression or exacerbation of dementia.

Consensus-based recommendations for the care of women with a breech presenting fetus.

OBJECTIVE: To establish consensus related to aspects of breech presentation and care. DESIGN: A multinational, three round e-Delphi study. PARTICIPANTS: A panel of 15 midwives, four obstetricians and an academic with knowledge and/or experience of caring for women with a breech presenting fetus. METHODS: An initial survey of 45 open-ended questions. Answers were coded and amalgamated to form 448 statements in the second round and three additional statements in the third round. Panellists were asked to provide their level of agreement for each statement using a 5-point Likert scale. Consensus was deemed met if 70% of panellists responded with strongly agree to somewhat agree, or strongly disagree to somewhat disagree after the second round. FINDINGS: Results led to the development of a consensus-based care pathway for women with a breech presenting fetus and a skills development framework for clinicians. KEY CONCLUSIONS: A cultural shift is beginning to occur through the provision of physiological breech workshops offered by various organisations and may result in greater access to skilled and experienced clinicians for women desiring a vaginal breech birth, ultimately improving the safety of breech birth. IMPLICATIONS FOR PRACTICES: The care pathway and skills development framework can be used by services wishing to make changes to their current practices related to breech presentation and increase the level of skill in their workforce.

Continuous observations of the surface energy budget and meteorology over the Arctic sea ice during MOSAiC.

The Multidisciplinary drifting Observatory for the Study of Arctic Climate (MOSAiC) was a yearlong expedition supported by the icebreaker R/V Polarstern, following the Transpolar Drift from October 2019 to October 2020. The campaign documented an annual cycle of physical, biological, and chemical processes impacting the atmosphere-ice-ocean system. Of central importance were measurements of the thermodynamic and dynamic evolution of the sea ice. A multi-agency international team led by the University of Colorado/CIRES and NOAA-PSL observed meteorology and surface-atmosphere energy exchanges, including radiation; turbulent momentum flux; turbulent latent and sensible heat flux; and snow conductive flux. There were four stations on the ice, a 10 m micrometeorological tower paired with a 23/30 m mast and radiation station and three autonomous Atmospheric Surface Flux Stations. Collectively, the four stations acquired ~928 days of data. This manuscript documents the acquisition and post-processing of those measurements and provides a guide for researchers to access and use the data products.

Six decades of North American bird banding records reveal plasticity in migration phenology.

The timing of avian migration has evolved to exploit critical seasonal resources, yet plasticity within phenological responses may allow adjustments to interannual resource phenology. The diversity of migratory species and changes in underlying resources in response to climate change make it challenging to generalize these relationships. We use bird banding records during spring and fall migration from across North America to examine macroscale phenological responses to interannual fluctuations in temperature and long-term annual trends in phenology. In total, we examine 19 species of North American wood warblers (family Parulidae), summarizing migration timing from 2,826,588 banded birds from 1961 to 2018 across 46 sites during spring and 124 sites during fall. During spring, warmer spring temperatures at banding locations translated to earlier median passage dates for 16 of 19 species, with an average 0.65-day advancement in median passage for every 1°C increase in temperature, ranging from 0.25 to 1.26 days °C-1 . During the fall, relationships were considerably weaker, with only 3 of 19 species showing a relationship with temperature. In those three cases, later departure dates were associated with warmer fall periods. Projecting these trends forward under climate scenarios of temperature change, we forecast continued spring advancements under shared socioeconomic pathways from 2041 to 2060 and 2081 to 2100 and more muted and variable shifts for fall. These results demonstrate the capacity of long-distance migrants to respond to interannual fluctuations in temperatures, at least during the spring, and showcase the potential of North American bird banding data understanding phenological trends across a wide diversity of avian species.

Women's experiences of breech birth decision making: An integrated review.

INTRODUCTION: Currently, caesarean section is the primary mode of birth for a breech presenting fetus, leading to a deskilling of clinicians and limitation of birth choices for women. The aim of this review is to present a synthesized summary of existing literature related to women's experiences of breech birth mode decision-making. METHODS: A systematic search of the literature was conducted in April 2021, utilizing five databases to identify and obtain peer-reviewed articles meeting the predetermined selection criteria. RESULTS: Four major categories were synthesized from the integrated review: 1) Women who desire a vaginal birth may experience a range of negative emotions such as feelings of disempowerment, loss, uncertainty and a sense of isolation; 2) Women who experience a breech presentation at term experience significant pressures to conform to expectations of medical professionals and their families due to perceptions of risk related to breech birth; 3) Breech birth decision-making in a limiting system; and 4) Overall satisfaction with the decision to plan a vaginal breech birth. CONCLUSION: Women with a breech presenting fetus at term experience a complex range of emotions and internal and external pressures due to perceptions of risk around breech birth. Midwives were seen as helpful throughout the breech experience. The reduced caesarean section rate for breech, observed in studies exploring specialized care pathways or dedicated services, could reduce the incidence of Severe Acute Maternal Morbidity.

Breech presentation management: A critical review of leading clinical practice guidelines.

PROBLEM: Clinical practice guidelines are designed to guide clinicians and consumers of maternity services in clinical decision making, but recommendations are often consensus based and differ greatly between leading organisations. BACKGROUND: Breech birth is a divisive clinical issue, however vaginal breech births continue to occur despite a globally high caesarean section rate for breech presenting fetuses. Inconsistencies are known to exist between clinical practice guidelines relating to the management of breech presentation. AIM: The aim of this review was to critically evaluate and compare leading obstetric clinical practice guidelines related to the management of breech presenting fetuses. METHODS: Leading obstetric guidelines were purposively obtained for review. Analysis was conducted using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist and reviewing the content of each guideline. FINDINGS: Antenatal care recommendations and indications for Caesarean Section were relatively consistent between clinical guidelines. However, several inconsistencies were found among the other recommendations in terms of birth mode counselling, intrapartum management and the basis for recommendations. DISCUSSION: Inconsistencies noted in the clinical practice guidelines have the potential to cause issues related to valid consent and create confusion among clinicians and maternity consumers. CONCLUSION: Clinical practice guidelines, which focus on the risks of a Vaginal Breech Birth without also discussing the risks of a Caesarean Section when a breech presentation is diagnosed, has the potential to sway clinician attitudes and impact birth mode decision-making in maternity consumers. To respect pregnant women's autonomy and fulfil the legal requirements of consent, clinicians should provide balanced counselling.

Women's experiences of breech birth and disciplinary power.

AIMS: To explore women's experiences of breech pregnancy and birth to identify areas in practice for improvement. DESIGN: A descriptive exploratory study was conducted involving 20 women who had experienced a breech birth between 2013 and 2018. METHODS: Semi-structured interviews were audio recorded and transcribed. Transcripts were examined using a free-form 'circling and parking' style of analysis. Foucault's concepts of power/knowledge were utilized to describe existing power relations. RESULTS: Women experienced varying degrees of disciplinary power throughout their experiences. Knowledge was used as a means of enforcing disciplinary power by some clinicians and by women to 'arm' themselves and 'fight' to regain what they perceived as a loss of power and autonomy. Midwives were seen as navigators of a restrictive, medicalized healthcare system. CONCLUSION: By better understanding the power dynamics which exist as well as the stages women go through when experiencing a breech presentation, there remains the potential to identify areas in practice which need improving, and aid clinicians in better supporting women through what can be a very difficult time.

Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study.

BACKGROUND: The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. OBJECTIVE: This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women's experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. METHODS: A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals' knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. RESULTS: Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. CONCLUSIONS: The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23514.

ELTD1 as a biomarker for multiple sclerosis: Pre-clinical molecular-targeted studies in a mouse experimental autoimmune encephalomyelitis model.

Multiple sclerosis (MS) and glioblastoma (GBM) are two distinct diseases that affect the central nervous system (CNS). However, perturbation in CNS vasculature are hallmarks of both diseases. ELTD1 (epidermal growth factor, latrophilin, and 7 transmembrane domain containing protein 1 on chromosome 1) is associated with vascular development, and has been linked with tumor angiogenesis. In glioblastomas, we detected over-expression of ELTD1, and found that an antibody targeting ELTD1 could increase animal survival and decrease tumor volumes in a xenograft GBM model. RNA-seq analysis of the preclinical data in the model for GBM identified that some of the molecular pathways affected by the anti-ELTD1 antibody therapy are also found to be associated with MS. In this study, we used molecular-targeted (mt) MR imaging and immunohistochemistry to assess ELTD1 levels in experimental autoimmune encephalomyelitis (EAE), a mouse model of MS. Specifically, we found that ELTD1 is readily detected in the brains of mice with EAE and is predominantly found in the corpus callosum. In addition, we found that the blood-brain barrier (BBB) was compromised in the brains of EAE mice using contrast-enhanced MRI (CE-MRI), as well as altered relative cerebral blood flow (rCBF) in the brains and cervical spinal cords of these mice using perfusion imaging, compared to controls. These findings indicate that ELTD1 may be a promising biomarker for CNS-inflammation in MS.

Landmark Technique vs Ultrasound-Guided Approach for Posterior Tibial Nerve Block in Cadaver Models.

BACKGROUND: The use of ultrasound for peripheral nerve blocks has proven extremely useful for improving the accuracy and efficacy of many regional anesthetic techniques. There remain a few nerve blocks which have lagged behind in employing the assistance of ultrasound consistently, one of which is the ankle block. This block is commonly utilized for either surgical anesthesia or post-operative analgesia for a variety of foot and ankle procedures. The objective of this study was to compare the accuracy of traditional anatomical landmark-guided technique with an ultrasound-guided approach for ankle block by assessing the spread of injectate along the posterior tibial nerve (PTN) in cadaver models. MATERIALS AND METHODS: Ten below-knee cadaver specimens were used for this study. Five were randomly chosen to undergo anatomical landmark-guided PTN blocks, and five were selected for ultrasound-guided PTN blocks. The anatomical landmark technique was performed by identifying the medial malleolus and Achilles tendon and inserting the needle (4 cm long, 21G Braun® Stimuplex) at the midpoint of the two structures, aiming toward the medial malleolus and advancing until bone was contacted. The ultrasound technique was performed with a linear probe identifying the medial malleolus and the PTN, with the needle subsequently advanced in-plane with a posterior to anterior trajectory until the tip was adjacent to the nerve. Each specimen was injected with 2 mL of acrylic dye. All the specimens were dissected following injection to determine which nerves had been successfully coated with dye. RESULTS: The PTN was successfully coated with dye in all five (100%) ultrasound-guided blocks. In the anatomical landmark group, two (40%) PTN were successfully coated with dye. Of the three unsuccessful attempts, two specimens were noted to have dye injected posterior to the PTN; dye was injected into the flexor digitorum longus tendon in one. CONCLUSION: The base of evidence has dramatically increased in recent years in support of the use of ultrasound in regional anesthesia. This study substantiates the superiority of ultrasound guidance for ankle block by demonstrating a 100% success rate of delivering a simulated nerve block to the correct anatomic location.

Women's mobile phone use in birth suite: A West Australian perspective.

Research investigating childbearing women's use of digital technology focuses on pregnancy and parenting, with none examining usage during labour. We explored the importance of having a mobile phone and how it was used in birth suite. This cohort study utilised women on a postnatal ward. Women (n = 300) who felt it was important to have a mobile phone were more likely than those who did not, to use their phone for social media and within an hour of birth. Few women used their phone whilst feeding their baby or felt phone usage would impact on quality time with their baby.

Family Caregivers' Confidence Caring for Relatives in Hospice Care at Home: An Exploratory Qualitative Study.

OBJECTIVES:: Although the experiences of family caregivers have received attention, little research has specifically explored caregivers' confidence. Evidence shows that caregivers of hospice patients do not feel confident or prepared to care for relatives or friends who die at home. AIM:: We aimed to elicit the views, feelings, and experiences of primary caregivers who provide unpaid care to dying family members in the home setting to better understand what contributes to their confidence during end-of-life care. DESIGN:: The exploratory, cross-sectional design involved semistructured, in-depth interviews. A narrative analysis that focused on form and content was chosen to analyze the data. PARTICIPANTS:: Sixteen bereaved caregivers (14 individuals and 1 brother/sister dyad) from the midwestern United States who received support from 1 hospice participated in the study. RESULTS:: Four storylines running longitudinally through the interviews were identified as shaping, giving meaning to, and contextualizing caregivers' confidence: values/relationships, stories of terminal illness, needs, and support. Caregivers' confidence is shaped by the terminal illness of the person for whom they care and caregivers' values and relationships. It is also influenced by their needs and the sources and strength of support they receive. CONCLUSIONS:: This research developed understanding about family provision of end-of-life care at home. Better comprehension of caregivers' experiences can help professional hospice and palliative care staff to understand what aids caregivers to be more confident.

Midwifery students' understanding and knowledge of normal birth before 'delivery' of curriculum.

OBJECTIVE: To generate new knowledge that describes and explains the views and understanding, regarding midwifery and normal birth, that newly enrolled midwifery students hold at the commencement of their midwifery education. DESIGN: A qualitative descriptive approach was used in conjunction with an anonymous questionnaire. SETTING: A tertiary University in Western Australia FINDINGS: Eighteen postgraduate midwifery students (PG), and twenty undergraduate midwifery students (UG), completed the questionnaire.Postgraduate midwifery students with a nursing background had a pronounced medical terminology and philosophy, as opposed to undergraduate midwifery students. IMPLICATIONS FOR PRACTICE: Midwifery educators will need to ensure the teaching of midwifery philosophy and normal birth at the commencement of midwifery courses, before historical perspectives and anatomy and physiology. Students need to be aware that birth is not reliant on risk management or student's personal values, otherwise it will be difficult for new midwifery students to understand birth as a normal, physiological process.

Sex-specific hypothalamic-pituitary-gonadal axis sensitivity in migrating songbirds.

In seasonally migratory species, the overlap between the migratory and breeding life history stages is a balance between the physiological and behavioral requirements of each stage. Previous studies investigating the degree to which songbirds prepare for breeding during spring migration have focused on either circulating hormone levels or direct measures of gonadal recrudescence. In this study, we evaluated the phenology of breeding preparation in a long-distance migratory songbird, the Swainson's Thrush (Catharus ustulatus), by assessing hypothalamic-pituitary-gonadal (HPG) axis sensitivity with gonadotropin-releasing hormone (GnRH) bioassays throughout the migratory period. During spring migration both males and females had a significant response to GnRH injections as reflected in elevated testosterone levels. The magnitude of response to GnRH injections, Rpotential, in females stayed consistent throughout spring migration; however, Rpotential in males increased as the migratory season progressed. It is clear that at least some degree of endocrinological breeding development occurs either before or during spring migration in both sexes, however the phenology appears to be sex specific. In males this breeding development continues at a relatively steady pace throughout the migratory period while in females, relatively little endocrine breeding development occurs during migration. These sex-specific differences in the phenology of the endocrine breeding development warrant future investigations for both male and female songbirds. Moreover, research focused on how physiological breeding development is balanced with the expression of migratory traits in long-distance songbird migrants is needed.

A cross-national study to objectively evaluate the quality of diverse simulation approaches for undergraduate nursing students.

The aim of this paper is to report the results of a cross-national study that evaluated a range of simulation sessions using an observation schedule developed from evidence-based quality indicators. Observational data were collected from 17 simulation sessions conducted for undergraduate nursing students at three universities in Australia and the United Kingdom. The observation schedule contained 27 questions that rated simulation quality. Data were collected by direct observation and from video recordings of the simulation sessions. Results indicated that the highest quality scores were for provision of learning objectives prior to the simulation session (90%) and debriefing (72%). Student preparatiosn and orientation (67%) and perceived realism and fidelity (67%) were scored lower than other components of the simulation sessions. This observational study proved to be an effective strategy to identify areas of strength and those needing further development to improve simulation sessions.

Seasonal Patterns in Eastern Equine Encephalitis Virus Antibody in Songbirds in Southern Maine.

The intent of this study was to assess passerine eastern equine encephalitis virus (EEEv) seroprevalence during the breeding season in southern Maine by testing songbird species identified in the literature as amplifying hosts of this virus. In 2013 and 2014, we collected serum samples from songbirds at a mainland site and an offshore island migratory stopover site, and screened samples for EEEv antibodies using plaque reduction neutralization tests. We compared seasonal changes in EEEv antibody seroprevalence in young (hatched in year of capture) and adult birds at the mainland site, and also compared early season seroprevalence in mainland versus offshore adult birds. EEEv seroprevalence did not differ significantly between years at either site. During the early season (May), EEEv antibody seroprevalence was substantially lower (9.6%) in the island migrant adults than in mainland adults (42.9%), 2013-2014. On the mainland, EEEv antibody seroprevalence in young birds increased from 12.9% in midseason (June-August) to 45.6% in late season (September/October), 2013-2014. Seroprevalence in adult birds did not differ between seasons (48.8% vs. 53.3%). EEEv activity in Maine has increased in the past decade as measured by increased virus detection in mosquitoes and veterinary cases. High EEEv seroprevalence in young birds-as compared to that of young birds in other studies-corresponded with two consecutive active EEEv years in Maine. We suggest that young, locally hatched songbirds be sampled as a part of long-term EEEv surveillance, and provide a list of suggested species to sample, including EEEv "superspreaders."

Hospice volunteers: bridging the gap to the community?

Current demographic, policy and management changes are a challenge to hospices to develop their volunteering practices. The study upon which this paper is based aimed to explore good practice in volunteer involvement and identify ways of improving care through developing volunteering. The project consisted of a narrative literature review; a survey of volunteer managers; and organisational case studies selected through purposive diversity sampling criteria. A total of 205 staff, volunteers, patients and relatives were interviewed across 11 sites in England in 2012. This article focuses on one of the findings - the place that volunteers occupy between the hospice and the community beyond its walls. External changes and pressures in society were impacting on volunteer management, but were viewed as requiring a careful balancing act to retain the 'spirit' of the hospice philosophy. Honouring the developmental history of the hospice was vital to many respondents, but viewed less positively by those who wished to modernise. Hospices tend to be somewhat secluded organisations in Britain, and external links and networks were mostly within the end-of-life care arena, with few referring to the wider volunteering and community fields. Volunteers were seen as an informal and symbolic 'link' to the local community, both in terms of their 'normalising' roles in the hospice and as providing a two-way flow of information with the external environment where knowledge of hospice activities remains poor. The diversity of the community is not fully represented among hospice volunteers. A few hospices had deliberately tried to forge stronger interfaces with their localities, but these ventures were often controversial. The evidence suggests that there is substantial scope for hospices to develop the strategic aspects of volunteering through greater community engagement and involvement and by increasing diversity and exploiting volunteers' 'boundary' position more systematically to educate, recruit and raise awareness.

Repeat infection with Neisseria gonorrhoeae among active duty U.S. Army personnel: a population-based case-series study.

Little information is known on the rate of repeat gonorrhea infection among U.S. military personnel. We analyzed all gonorrhea cases reported to the Defense Medical Surveillance System during 2006-2012 to determine the rate of repeat infection. During the seven-year study period, 17,602 active duty U.S. Army personnel with a first incident gonorrhea infection were reported. Among the 4987 women with a first gonorrhea infection, 14.4% had at least one repeat infection. Among the 12,615 men with a first gonorrhea infection, 13.7% had at least one repeat infection. Overall, the rate of repeat gonorrhea infection was 44.5 and 48.9 per 1000 person-years for women and men, respectively. Service members aged 17-19 years (hazard ratio [HR] for women = 1.51; HR for men = 1.71), African-American personnel (HR for women = 1.26; HR for men = 2.17), junior enlisted personnel (HR for women = 2.64; HR for men = 1.37), and those with one year or less of service (HR for women = 1.23; HR for men = 1.37) were at higher risk of repeat infection. The findings from this study highlight the need to develop targeted prevention initiatives including education, counseling, and retesting to prevent gonorrhea reinfections among U.S. Army personnel.

Association of Bacterial Vaginosis With Chlamydia and Gonorrhea Among Women in the U.S. Army.

INTRODUCTION: Bacterial vaginosis (BV) is a common vaginal condition in women of reproductive age, which has been associated with Chlamydia trachomatis and Neisseria gonorrhoeae among commercial sex workers and women attending sexually transmitted infection clinics. Pathogen-specific associations between BV and other sexually transmitted infections among U.S. military women have not been investigated. METHODS: A population-based, nested case-control study was conducted of all incident chlamydia and gonorrhea cases reported to the Defense Medical Surveillance System during 2006-2012. Using a density sampling approach, for each chlamydia or gonorrhea case, 10 age-matched (±1 year) controls were randomly selected from those women who were never diagnosed with these infections. Incidence rate ratios were estimated using conditional logistic regression. Statistical analysis was carried out in December 2015. RESULTS: A total of 37,149 chlamydia cases and 4,987 gonorrhea cases were identified during the study period. Antecedent BV was associated with an increased risk of subsequent chlamydia (adjusted incidence rate ratio=1.51; 95% CI=1.47, 1.55) and gonorrhea (adjusted incidence rate ratio=2.42; 95% CI=2.27, 2.57) infections. For every one additional episode of BV, the risk of acquiring chlamydia and gonorrhea infections increased by 13% and 26%, respectively. A monotonic dose-response relationship was also noted between antecedent BV and subsequent chlamydia and gonorrhea infection. In addition, an effect modification on the additive scale was found between BV and African-American race for gonorrhea, but not for chlamydia. CONCLUSIONS: Among U.S. Army women, antecedent BV is associated with an increased risk of subsequent chlamydia and gonorrhea infection.