The geography of sexual partnerships in Baltimore: applications of core theory dynamics using a geographic information system.

OBJECTIVE: Gonorrhea has a focused geographic distribution characterized by high incidence rates in defined "core" areas and decreased incidence as the radial distance from the central core increases. Dense cor group transmission has long been hypothesized. METHODS: We have previously mapped sexually transmitted disease (STD) rates in Baltimore census tracts using STD morbidity data interfaced with a geographic information system. Core areas were defined using a standard definition based on gonorrhea distribution. We studied spatial distance patterns between sexual partners, using the residential addresses of 572 individuals, representing 286 dyad partnerships recruited as part of an epidemiology and behavioral study. To determine if partners lived closer together than would be expected, a modified bootstrap algorithm using Monte Carlo models was developed to compare the distances between partners' residences and all other possible residences. RESULTS: Two distinct (east and west) core areas were previously identified. Compared with randomly selected Baltimore addresses, partners tended to reside closer to one another than would be expected by chance (z = -1.8), with a median distance of 1.7 kilometers. Within the core areas, women resided a median of 547 meters from their partner, and men resided a median of 339 meters from their reported partners. When all partnerships were considered, the median distance was 1,699 meters. Of the 500 simulation models, the minimum median distance was 4,889 meters. CONCLUSIONS: Partners of patients in core areas in Baltimore live remarkably close to one another, and the partner selection patterns in general indicate nonrandom distribution. Geographic information system-determined patterns of STD patients residing in hyperendemic census tracts support the core theory of disease transmission. In these areas, targeted geographically based interventions may be warranted.

Bacterial vaginosis is not associated with circumcision status of the current male partner.

OBJECTIVE: Bacterial vaginosis (BV) is common in sexually active women, and in a large proportion the underlying aetiology is unknown. We evaluated partner circumcision status as a potential risk and hypothesised that women with uncircumcised partners were at increased risk for BV. METHODS: Retrospective audit of a partner study (272 heterosexual couples) conducted in Baltimore between 1990 and 1992. BV defined by clinical criteria and circumcision status of males was determined by physical examination. RESULTS: BV was diagnosed in 83 (30%) female partners; 75 (27%) males were uncircumcised. In males and females respectively, gonorrhoea was diagnosed in 20% and 16%, and chlamydia in 7% and 11%. In women with circumcised partners, 58/197 (29%) had BV compared with 25/75 (33%) with uncircumcised partners (p = 0.53). CONCLUSION: Women with uncircumcised current partners are not at increased risk for BV.

Susceptibility to vaccine-preventable diseases in a sexually transmitted disease clinic population.

BACKGROUND AND OBJECTIVE: Sexually transmitted disease (STD) clinics often serve a population that has low medical care utilization. The objective of this study was to determine the susceptibility of an STD clinic population to vaccine-preventable diseases. STUDY DESIGN: A cross-sectional study of immunization practices and susceptibility to vaccine-preventable diseases was undertaken by enrolling consecutive patients attending an STD clinic. Demographic information and a history of disease or immunization was assessed by interview. Immunity to measles and rubella was determined by measuring IgG antibodies by ELISA assays. RESULTS: Of the 288 patients evaluated, the mean age was 28 years and 70.5% were male. Serologically, 16.3% were susceptible to rubella and 8% to measles. Only 8% reported hepatitis B immunization. Although measles protection was high, nearly one in six was susceptible to rubella. Hepatitis B immunization was severely underused. CONCLUSION: Baltimore STD clinic patients may benefit from an enhanced rubella and hepatitis B prevention strategy.

Reasons for not using condoms of clients at urban sexually transmitted diseases clinics.

BACKGROUND AND GOAL: Greater understanding of the factors related to inconsistent condom use is essential in the development of strategies to promote condom use among clients who access public, inner-city sexually transmitted diseases (STD) clinics. Therefore, this study aimed to explore reasons for not using condoms among 260 predominantly African American heterosexual male and female clients presenting for care at two inner-city STD clinics. STUDY DESIGN: Clients selected for this descriptive analysis reported having had at least one unprotected episode of sexual intercourse in the last 10 episodes. In face-to-face interviews, clients provided information about sexual activity, sexual partners, and condom use in the previous 30 days. In addition, they were asked to indicate the main reason for not using condoms when having unprotected sex. RESULTS: Content analysis showed six major categories of reasons for not using condoms: reasons related to partner relationships, reasons related to sexual sensation, reasons related to situational constraint, reasons related to condoms themselves, reasons related to pregnancy, and reasons related to types of sexual activity. Most frequent explanations given for not using condoms included partner trust (19.6%), the feel of condoms (11.9%), and lack of condom availability (11.5%). Clients also reported barriers to condom use that included beliefs about condom sensation and partner relationships. CONCLUSIONS: These results show the continued barriers that exist with respect to condom use in at-risk populations and emphasize the need to tailor meaningful interventions in order to promote condom use among persons who, for differing reasons, choose not to use them.

Uterine stromal sarcoma cell line. A cytogenetic and electron microscopic study.

Uterine sarcomas constitute approximately 3% of all malignant uterine corpus tumors. Of these, the tumors that originate solely in the stromal elements of the uterine wall are relatively infrequent and have not been well characterized cytogenetically. We report data from a low-grade endometrial stromal sarcoma both at the time of resection and after months in long-term tissue culture. Cytogenetic analysis showed a clonal population of cells with an abnormal karyotype of 46,XX,del(5)(q31.1),der(7)t(6;7)(p21;p22) which remained unchanged in long-term culture. Electron microscopy suggests that these cells are similar to other neoplastic cells in having immature-appearing nuclei surrounded by a relatively mature cytoplasm (with well-developed organelles). Determination of the specificity of these observations must await study of additional stromal sarcomas.

[Hypophosphatasia: a family study]. / Ipofosfatasia: studio di una famiglia.

Diagnostic pathway and 5-years follow-up of a case of childhood-form hypophosphatasia (a severe form of vitamin D resistant rickets) are described. Family study led to the identification of five affected relatives (father, sister, paternal uncle, first-cousins), two with severe clinical evidence. Inheritance pattern in this family is compatible with autosomal dominant transmission.