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1.
PLoS One ; 14(6): e0211252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31206550

RESUMO

This study assessed the prevalence and patterns of drug use among people living with HIV (PLHIV) in Spain. We conducted an observational cross-sectional study including 1401 PLHIV. Data were collected through 33 sites across Spain using an online computer-assisted self-administered interview. The survey measured use of illicit drugs and other substances, treatment adherence and health-related variables. To analyse patterns of drug use we performed cluster analysis in two stages. The most frequently consumed substances were: alcohol (86.7%), tobacco (55.0%), illicit drugs (49.5%), other substances (27.1%). The most prevalent illicit drugs used were cannabis (73.8%), cocaine powder (53.9%), and poppers (45.4%). Results found four clusters of PLHIV who used drugs. Two of them were composed mainly of heterosexuals (HTX): Cluster 1 (n = 172) presented the lowest polydrug use and they were mainly users of cannabis, and Cluster 2 (n = 84) grouped mostly men who used mainly heroin and cocaine; which had the highest percentage of people who inject drugs and presented the lowest level of treatment adherence (79.8±14.2; p < .0001). The other two clusters were composed mainly of men who have sex with men (MSM), who were mostly users of recreational drugs. Cluster 3 (n = 285) reported moderate consumption, both regarding frequency and diversity of drugs used, while Cluster 4 (n = 153) was characterized by the highest drug polyconsumption (7.4±2.2; p < .0001), and 4 grouped MSM who injected recreational drugs, and who reported the highest frequency of use of drugs in a sexual context (2.6±0.8; p < .0001) and rates of sexually transmitted infections (1.8±1.1; p < .01). This is the largest multi-centre cross-sectional study assessing the current prevalence and patterns of drug use among PLHIV in Spain. The highest prevalence of drug use was found among MSM, although HTX who used heroin and cocaine (Cluster 2) had the most problems with adherence to HIV treatment and the worst health status.


Assuntos
Infecções por HIV/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Cannabis , Cocaína , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Heroína , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Prevalência , Doenças Sexualmente Transmissíveis/etiologia , Espanha , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários
2.
Infect Dis Obstet Gynecol ; 2019: 6584101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31057323

RESUMO

Background: Sexually transmitted infections (STIs) are associated with adverse birth outcomes. Current prenatal STI screening guidelines define "risk" without explicit consideration of HIV status. Our objective was to test the hypothesis that HIV status is associated with bacterial STI in pregnant women. Methods: We designed a retrospective cohort study to identify pregnant women with HIV who delivered at our facility during 2000-2014. HIV+ women were compared to HIV- women with matching by year of delivery. Logistic regression was used to model adjusted odds of prevalent and incident STI. Prevalent STI was defined as chlamydia (CT), gonorrhea (GC), syphilis, or trichomoniasis detected on an initial prenatal screening test and incident STI as a newly positive result following a negative prenatal test. Results: The cohort included 432 women, 210 HIV+ and 222 HIV-. Most pregnant women were screened for STI (92% of HIV+ women and 74% of HIV- women). STI rates were high and particularly elevated in HIV+ women: 29% vs 18% (p=0.02), for prevalent STI and 11% vs 2% (p<0.001) for incident STI. Risk factors for prevalent STI were as follows: HIV status (aOR 3.0, CI: 1.4-6.4), Black race (aOR 2.7, 95% CI: 1.1-6.6), and more recent delivery (2007-2014 compared to 2000-2006) (aOR 2.3, CI: 1.1-4.7). HIV status was an independent risk factor for incident STI (aOR 7.2, CI: 2.1-25.0). Conclusion: Pregnant women who delivered in our center had high STI rates. Since HIV infection was independently associated with prevalent and incident STI, prenatal screening guidelines may need to incorporate HIV status as a high-risk group for repeat testing.


Assuntos
Infecções por HIV/complicações , Complicações Infecciosas na Gravidez/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , Alabama/epidemiologia , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/transmissão , Estudos de Coortes , Feminino , Gonorreia/epidemiologia , Gonorreia/transmissão , Infecções por HIV/epidemiologia , Humanos , Incidência , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Doenças Sexualmente Transmissíveis/etiologia , Sífilis/epidemiologia , Sífilis/transmissão , Tricomoníase/epidemiologia , Tricomoníase/transmissão
3.
Rev Assoc Med Bras (1992) ; 65(3): 475-484, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994850

RESUMO

OBJECTIVE: To synthesize the knowledge produced in studies about the association between violence and STI during pregnancy. METHODS: In this systematic review, we conducted basic activities of identification, compilation, and registration of the trials. The instruments of data collection were studies that investigated, explicitly, relationships between violence, gestation, and STI, from July 2012 to July 2017, using PubMed, Cochrane Library, SciELO, and LILACS. RESULTS: In all, 26 articles were chosen to form the basis of the analysis of this study. The relationship between violence and STI was observed in 22 of the 26 studies, and in eight of them, the violence was practiced during the gestation period. In two studies, there was no evidence of this relationship. In one study, the lack of care for STI was attributed to the unpreparedness of health professionals. Mental disorders were cited as resulting from STI in three articles and in another as a result of violence. One study found more frequent violence against adolescents, while two others cited gestation as a protective factor. CONCLUSIONS: IPV combines characteristics that have a different expression when the woman is in the gestational period. The literature points to a relationship between IPV against women and the presence of STI. The monitoring of pregnancy, whether in the prenatal or postpartum period, offers unique opportunities for the health professional to identify situations of violence and thus provide assistance.


Assuntos
Violência por Parceiro Íntimo , Complicações Infecciosas na Gravidez/etiologia , Doenças Sexualmente Transmissíveis/etiologia , Feminino , Infecções por HIV/etiologia , Humanos , Gravidez , Fatores de Risco
4.
Obstet Gynecol ; 133(4): e296-e302, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30913202

RESUMO

Sexual violence continues to be a major public health problem affecting millions of adults and children in the United States. Medical consequences of sexual assault include sexually transmitted infections; mental health conditions, including posttraumatic stress disorder; and risk of unintended pregnancy in reproductive-aged survivors of sexual assault. Obstetrician-gynecologists and other women's health care providers play a key role in the evaluation and management of sexual assault survivors and should screen routinely for a history of sexual assault. When sexual violence is identified, individuals should receive appropriate and timely care. A clinician who examines sexual assault survivors in the acute-care setting has a responsibility to comply with state and local statutory or policy requirements for the use of evidence-gathering kits. This document has been updated to include model screening protocols and questions, relevant guidelines from other medical associations, trauma-informed care, and additional guidance regarding acute evaluation of survivors and evidence-gathering kits.


Assuntos
Vítimas de Crime , Delitos Sexuais , Vítimas de Crime/legislação & jurisprudência , Vítimas de Crime/psicologia , Vítimas de Crime/reabilitação , Feminino , Humanos , Gravidez , Delitos Sexuais/legislação & jurisprudência , Delitos Sexuais/psicologia , Doenças Sexualmente Transmissíveis/etiologia , Transtornos de Estresse Traumático/diagnóstico , Transtornos de Estresse Traumático/terapia , Estados Unidos
5.
PLoS One ; 14(2): e0209969, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30753185

RESUMO

BACKGROUND: Risky sexual behaviors are associated with the transmission of sexually transmitted infections (STIs) and unwanted pregnancies, both major health concerns for youth worldwide. This review studies the effectiveness of narrated mass media programs in promoting safer sexual practices among youth in developed and developing countries. METHODS: Electronic and manual searches were conducted to identify experimental and quasi-experimental studies with robust counterfactual designs published between 1985 and the first quarter of 2017. Effect sizes were meta-analyzed using mixed-effects models. RESULTS: Eight experimental and two quasi-experimental studies met our inclusion criteria. The aggregated sample size was 23,476 participants, with a median of 902 participants per study. Entertainment education narratives had small but significant effects for three sexual behaviors. It reduced the number of sexual partners [standardized mean difference, (SMD) = 0.17, 95% confidence interval (CI) = 0.02-0.33, three effect sizes], reduced unprotected sex (SMD = 0.08, 95% CI = 0.03-0.12, nine effect sizes), and increased testing and management for STIs (SMD = 0.29, 95% CI = 0.11-0.46, two effect sizes). The interventions were not effective in reducing inter-generational sex, measured through the age-gap with sexual partners (SMD = 0.06, 95% CI = -0.06-0.19, four effect sizes). Entertainment education had medium-size effects on knowledge outcomes (SMD = 0.67, 95% CI = 0.32-1.02, seven effect sizes), where a time-decay relationship is observed. No effects were found on attitudes. CONCLUSION: Although mass media entertainment had small effects in promoting safer sexual practices, its economies of scales over face-to-face interventions suggest its potential to be a cost-effective tool above an audience threshold. The use of study participants from the general youth population and the use of mostly effectiveness trials mitigate concerns regarding its scalability. The overall paucity of high-quality studies affirms the need for strengthening the evidence base of entertainment education. Future research should be undertaken to understand the moderator effects for different subgroups and intervention characteristics.


Assuntos
Gravidez não Desejada , Sexo Seguro , Educação Sexual/métodos , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , Gravidez , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/etiologia , Adulto Jovem
8.
Sex Transm Dis ; 46(2): 105-111, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30640212

RESUMO

BACKGROUND: Among men who have sex with men (MSM) the relationship between sexually transmitted infections (STIs) and cannabis use is not well established. We assessed cannabis use, sexual behavior, and STIs including human immunodeficiency virus (HIV) in a diverse cohort of young MSM. METHODS: In Los Angeles, the mSTUDY cohort conducted visits every 6 months with 512 MSM between 2014 and 2017 collecting demographics, sexual behaviors, and reports of frequency of substance use. Each visit conducted testing for gonorrhea, chlamydia, and syphilis via blood, urine, and pharyngeal and rectal swabs by PCR, Human immunodeficiency virus was assessed using rapid tests for HIV-negatives and viral load for HIV-positives. We analyzed the relationship between cannabis use, sexual behaviors and STIs/HIV across 1535 visits. RESULTS: Significantly fewer participants tested positive for STIs at visits when reporting the previous 6 months use of only cannabis (11.7%) compared with no drugs (16.3%) or other drugs (20.0%, P = 0.01). Fewer MSM reporting only cannabis use than no or other drug use had been incarcerated, had incarcerated partners, experienced interpersonal violence, and were HIV-positive. In multivariable analyses visits with positive STIs were associated with other drug use (adjusted odds ratio, 1.69; 95% confidence interval, 1.03-2.78) but not use of cannabis only or no drug use after controlling for age, HIV status, new sex partners, and number of sex partners. CONCLUSIONS: When MSM reported using cannabis exclusively fewer STIs were detected and lower risk sexual engagements reported than when MSM reported no drug or other drug use.


Assuntos
Infecções por HIV/transmissão , Homossexualidade Masculina , Abuso de Maconha/virologia , Comportamento Sexual , Doenças Sexualmente Transmissíveis/etiologia , Adulto , Estudos de Coortes , Gonorreia/transmissão , Humanos , Los Angeles , Masculino , Fatores de Risco , Assunção de Riscos , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/virologia , Transtornos Relacionados ao Uso de Substâncias , Sífilis/transmissão , Adulto Jovem
9.
Infect Dis Poverty ; 8(1): 6, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30665460

RESUMO

BACKGROUND: Female sex workers (FSW) who live in urban areas in Republic of Korea have a particularly high risk of sexually transmitted diseases (STD). We investigated the prevalence of s STDs in FSWs in order to determine the factors associated with sexually transmitted infections in Korea. METHODS: Study data were collected from 832 FSWs through a 2014 survey on the prevalence of STDs in high risk populations in Republic of Korea. We assessed the associations between sexually transmitted infections and demographic and risk behaviour variables through logistic regression analysis. RESULTS: The risk probability of sexually transmitted infection was higher for those who drank alcohol often as well as those who had their first sexual experience at an early age. However, the effects of these factors were attenuated by working conditions. The risk probability of sexually transmitted infections was higher for those who engaged in sex with several customers per day as well as for those who did not practice regular condom use. CONCLUSIONS: The risk factors for sexually transmitted infections among FSWs in Republic of Korea are related to and affected by working conditions. Thus, multifaceted health interventions to protect FSWs and their sexual health are deemed necessary.


Assuntos
Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , Fatores Etários , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Assunção de Riscos , Profissionais do Sexo , Doenças Sexualmente Transmissíveis/etiologia , Adulto Jovem
10.
Enferm Infecc Microbiol Clin ; 37(3): 187-194, 2019 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30685206

RESUMO

Sexual violence is a worldwide problem with an impact on health that encompasses medical, legal and psychological aspects. Therefore the management of these patients must be multidisciplinary, and action protocols are compulsory. People who are victims of a sexual assault (SA) are at high risk of acquiring a sexually transmitted infection (STI), which must be prevented, diagnosed, treated and followed up post treatment, according to the established action protocol to prevent potential complications.


Assuntos
Delitos Sexuais , Doenças Sexualmente Transmissíveis/etiologia , Adulto , Criança , Abuso Sexual na Infância , Humanos , Guias de Prática Clínica como Assunto , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia
11.
Sex Transm Infect ; 95(3): 175-180, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30171171

RESUMO

OBJECTIVES: Foster care history is associated with many health and social problems, including sexual risk behaviours, HIV and other sexually transmitted infections (STIs). This cross-sectional study compares sexual risk behaviours among a sample of young adult substance users in Miami (N=602) with and without foster care histories. METHODS: Participants completed a comprehensive assessment which included sections on foster care, sexual risk behaviours and related health and social problems. Logistic regression was used to examine the relationship between foster care history, associated syndemic vulnerabilities and increased likelihood of having a prior HIV/STI diagnosis. RESULTS: Bivariate analyses indicated that foster care alumni were more likely to report a prior HIV/STI diagnosis, higher condomless sex frequencies, being high on alcohol or drugs during sex, sexual victimisation and a history of homelessness compared with other participants in the sample (p<0.05). Multivariate analyses revealed that foster care history, sexual victimisation and group sex participation are associated with a prior HIV/STI diagnosis (p<0.05). Group sex participation doubled the odds of a prior HIV/STI diagnosis for foster care alumni, compared with other participants (p<0.5). CONCLUSIONS: This exploratory study identifies characteristics that distinguish foster care alumni from non-alumni and signals the need to better serve the sexual and related health needs of individuals with foster care histories. Clinicians and healthcare providers should provide foster care alumni with detailed HIV/STI risk reduction information and resources and services to address related syndemic vulnerabilities (eg, victimisation and homelessness).


Assuntos
Cuidados no Lar de Adoção , Disparidades em Assistência à Saúde , Assunção de Riscos , Doenças Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Criança , Estudos Transversais , Feminino , Florida/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Humanos , Masculino , Doenças Sexualmente Transmissíveis/etiologia , Adulto Jovem
12.
J Med Internet Res ; 20(12): e10683, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563809

RESUMO

BACKGROUND: Studies have reported on the proportion of the population looking for potential sexual partners using internet sites and smartphone apps, but few have investigated those who have sex with these partners, arguably a more important target group for health promotion. OBJECTIVE: This study aimed to determine the proportion of people who have had sex with someone they met on an internet site or a smartphone app in the previous year. METHODS: We analyzed data from the 2012-2013 Second Australian Study of Health and Relationships, a nationally representative telephone survey of Australian residents aged 16-69 years (N=20,091). The participation rate for the telephone survey was 66.22%. The prevalence of looking for a potential partner, physically meeting, and having sex with someone first met through an internet site or a smartphone app was estimated. Multivariate logistic regression was used for men and women separately to determine demographic and behavioral factors associated with having had sex with someone met on an internet site or a smartphone app in the last year. RESULTS: Overall, 12.09% of respondents had looked for potential partners using these technologies and 5.40% had done so in the last year. In the last year, 2.98% had met someone in person and 1.95% reported having had sex with someone first met on an internet site or a smartphone app. The prevalence of all behaviors was greater in men than in women and in younger respondents than in older respondents. Among sexually active men, factors associated with having had sex with someone met using internet sites or smartphone apps included identifying as gay or bisexual (adjusted odds ratio, AOR: 15.37, 95% CI 8.34-28.35), having either 2-3 or >3 sexual partners in the last year (AOR: 9.20, 95% CI 9.20-34.68 and AOR: 35.77, 95% CI 18.04-70.94, respectively), having had a sexually transmissible infection (STI) test in the past year (AOR: 2.02, 95% CI 1.21-3.38), or an STI in the last year (AOR: 3.15, 95% CI 1.25-7.97). Among sexually active women, factors associated with having had sex with someone met on an internet site or a smartphone app were as follows: having either 2-3 or >3 sexual partners in the last year (AOR: 32.01, 95% CI 13.17-77.78 and AOR: 71:03, 95 % CI 27.48-183.57, respectively), very low and low income (vs very high AOR: 3.40, 95% CI 1.12-10.35), and identifying as lesbian or bisexual (AOR: 2.27, 95% CI 1.04-4.49). CONCLUSIONS: More than a third of adults who had looked for potential partners using websites and apps each year had sex with such partners, and those who had done so were more sexually active, suggesting that dating and hookup websites and applications are suitable settings for targeted sexual health interventions.


Assuntos
Internet/instrumentação , Parceiros Sexuais/psicologia , Doenças Sexualmente Transmissíveis/etiologia , Smartphone/instrumentação , Adolescente , Adulto , Idoso , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/psicologia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-30518101

RESUMO

The aim of this study was to assess the association between lifetime spousal violence victimization, spousal violence perpetration, and physical health outcomes and behaviours among women in India. In the 2015⁻2016 National Family Health Survey, a sample of ever-married women (15⁻49 years) (N = 66,013) were interviewed about spousal violence. Results indicate that 29.9% of women reported lifetime spousal physical violence victimization and 7.1% lifetime spousal sexual violence victimization (31.1% physical and/or sexual violence victimization), and 3.5% lifetime spousal physical violence perpetration. Lifetime spousal violence victimization and lifetime spousal violence perpetration were significantly positively correlated with asthma, genital discharge, genital sores or ulcers, sexually transmitted infections (STIs), tobacco use, alcohol use, and termination of pregnancy, and negatively associated with daily consumption of dark vegetables. In addition, lifetime spousal violence victimization was positively associated with being underweight, high random blood glucose levels, and anaemia, and negatively correlated with being overweight or obese. Lifetime spousal violence perpetration was marginally significantly associated with hypertension. The study found in a national sample of women in India a decrease of lifetime physical and/or sexual spousal violence victimization and an increase of lifetime spousal physical violence perpetration from 2005/5 to 2015/6. The results support other studies that found that, among women, lifetime spousal physical and/or sexual spousal violence victimization and lifetime spousal physical violence perpetration increase the odds of chronic conditions, physical illnesses, and health risk behaviours.


Assuntos
Doença Crônica/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Comportamentos de Risco à Saúde , Maus-Tratos Conjugais/estatística & dados numéricos , Adolescente , Adulto , Anemia/epidemiologia , Anemia/etiologia , Asma/epidemiologia , Asma/etiologia , Vítimas de Crime/psicologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Hiperglicemia/epidemiologia , Hiperglicemia/etiologia , Hipertensão/epidemiologia , Hipertensão/etiologia , Índia/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/etiologia , Maus-Tratos Conjugais/psicologia , Magreza/epidemiologia , Magreza/etiologia , Adulto Jovem
14.
Int J Drug Policy ; 61: 31-37, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30388567

RESUMO

BACKGROUND: Sexualised substance use, or 'chemsex' has been shown to be a major factor driving the syndemic of HIV/AIDS in communities of gay, bisexual, and other men who have sex with men (GBMSM) around the world. However, there is a paucity of research on chemsex among GBMSM in Singapore due to punitive drug laws and the criminalisation of sexual behaviour between men. This qualitative descriptive study is the first to explore perceptions towards, motivators to engaging in, and the barriers to addressing the harms associated with chemsex among GBMSM in Singapore. METHODS: We conducted 30 semi-structured in-depth interviews with self-identifying GBMSM between the ages of 18-39 in Singapore following a purposive sampling strategy. Interview topics included participants' perceptions of drug use among GBMSM in Singapore, perceptions towards chemsex, reasons for drug use and chemsex, and recommendations to address the harms associated with chemsex in Singapore. Interviews were audio-recorded, transcribed, coded, and analysed using thematic analysis. RESULTS: Participants reported that it was common to encounter chemsex among GBMSM in Singapore as it could be easily accessed or initiated using social networking phone apps. Enhancement and prolongation of sexual experiences, fear of rejection from sexual partners and peers, and its use as a means of coping with societal rejection were three main reasons cited for engaging in chemsex. The impact of punitive drug laws on disclosure and stigmatisation of GBMSM who use drugs were reported to be key barriers towards addressing chemsex. Participants suggested using gay-specific commercial venues as avenues for awareness and educational campaigns, and social media to reach out to younger GBMSM. CONCLUSIONS: This study highlights the complexities behind chemsex use among GBMSM in Singapore, and the range of individual to institutional factors to be addressed. We recommend that community-based organisations and policy-makers find ways to destigmatise discussion of chemsex and provide safe spaces to seek help for drug use.


Assuntos
Homossexualidade Masculina/psicologia , Comportamento Sexual/efeitos dos fármacos , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Minorias Sexuais e de Gênero/psicologia , Adolescente , Adulto , Redução do Dano , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevista Psicológica , Masculino , Motivação , Pesquisa Qualitativa , Assunção de Riscos , Doenças Sexualmente Transmissíveis/etiologia , Doenças Sexualmente Transmissíveis/psicologia , Singapura , Transtornos Relacionados ao Uso de Substâncias , Sexo sem Proteção/efeitos dos fármacos , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
15.
Ann Emerg Med ; 72(6): 703-712.e1, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30251627

RESUMO

STUDY OBJECTIVE: We evaluate the additive value of pelvic examinations in predicting sexually transmitted infection for young female patients with suspected cervicitis or pelvic inflammatory disease in a pediatric emergency department (ED). METHODS: This was a prospective observational study of female patients aged 14 to 20 years who presented to an urban academic pediatric ED with a complaint of vaginal discharge or lower abdominal pain. Enrolled patients provided a urine sample for chlamydia, gonorrhea, and trichomonas testing, which served as the criterion standard for diagnosis. A practitioner (pediatric ED attending physician, emergency medicine or pediatric resident, pediatric ED fellow, or advanced practice provider) obtained a standardized history from the patient to assess for cervicitis or pelvic inflammatory disease according to the Centers for Disease Control and Prevention criteria. They then recorded the likelihood of cervicitis or pelvic inflammatory disease on a 100-mm visual analog scale. The same practitioner then performed a pelvic examination and again recorded the likelihood of cervicitis or pelvic inflammatory disease on a visual analog scale with this additional information. Using the results of the urine sexually transmitted infection tests, the practitioner calculated and compared the test characteristics of history alone and history with pelvic examination. RESULTS: Two hundred eighty-eight patients were enrolled, of whom 79 had positive urine test results for chlamydia, gonorrhea, or trichomonas, with a sexually transmitted infection rate of 27.4% (95% confidence interval [CI] 22.6% to 32.8%). The sensitivity of history alone in diagnosis of cervicitis or pelvic inflammatory disease was 54.4% (95% CI 42.8% to 65.5%), whereas the specificity was 59.8% (95% CI 52.8% to 66.4%). The sensitivity of history with pelvic examination in diagnosis of cervicitis or pelvic inflammatory disease was 48.1% (95% CI 36.8% to 59.5%), whereas the specificity was 60.7% (95% CI 53.8% to 67.3%). The information from the pelvic examination changed management in 71 cases; 35 of those cases correlated with the sexually transmitted infection test and 36 did not. CONCLUSION: For young female patients with suspected cervicitis or pelvic inflammatory disease, the pelvic examination does not increase the sensitivity or specificity of diagnosis of chlamydia, gonorrhea, or trichomonas compared with taking a history alone. Because the test characteristics for the pelvic examination are not adequate, its routine performance should be reconsidered.


Assuntos
Exame Ginecológico/métodos , Doença Inflamatória Pélvica/complicações , Doenças Sexualmente Transmissíveis/diagnóstico , Cervicite Uterina/complicações , Adolescente , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/etiologia , Infecções por Chlamydia/urina , Feminino , Gonorreia/diagnóstico , Gonorreia/etiologia , Gonorreia/urina , Humanos , Doença Inflamatória Pélvica/urina , Estudos Prospectivos , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/etiologia , Doenças Sexualmente Transmissíveis/urina , Tricomoníase/diagnóstico , Tricomoníase/urina , Serviços Urbanos de Saúde , Cervicite Uterina/urina , Adulto Jovem
16.
Sex Reprod Healthc ; 17: 19-25, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30193715

RESUMO

OBJECTIVE: Alcohol use has consistently been shown to be related to sexual risk-taking behaviours. To assess what factors may contribute to the sexual risk decision-making process, this study examined the relationships among alcohol use (frequency, quantity, and binge drinking), cognitive appraisals of sexual risk taking, sex-related alcohol expectancies, and STI-protective self-efficacy. METHOD: 138 sexually-active university students who drink alcohol completed scales measuring alcohol consumption, appraisals of consequences, sex-related alcohol expectancies, and items regarding STI-protective self-efficacy. RESULTS: Increasing levels of binge drinking were negatively associated with STI-protective self-efficacy. A moderated mediation analysis revealed that for binge drinkers, stronger appraisals of the positive consequences for having sexual intercourse while intoxicated predicted lower STI-protective self-efficacy indirectly through increasing rates of sex-related alcohol risk expectancies. CONCLUSION: Findings provide evidence of a need to target binge drinkers and increase their STI-protective self-efficacy by shifting their focus from positive consequences to negative risk consequences of engaging in sexual intercourse while intoxicated.


Assuntos
Bebedeira , Tomada de Decisões , Assunção de Riscos , Sexo Seguro , Autoeficácia , Doenças Sexualmente Transmissíveis , Universidades , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Sexo Seguro/psicologia , Doenças Sexualmente Transmissíveis/etiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Estudantes , Reino Unido , Adulto Jovem
17.
PLoS One ; 13(6): e0198683, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29889865

RESUMO

BACKGROUND: HIV and other sexually transmitted infections (STI) frequently co-occur. We conducted HIV diagnostic testing in an assessment of the etiologies of major STI syndromes in Zimbabwe. METHODS: A total of 600 patients were enrolled at six geographically diverse, high-volume STI clinics in Zimbabwe in 2014-15: 200 men with urethral discharge, 200 women with vaginal discharge, and 100 men and 100 women each with genital ulcer disease (GUD). Patients completed a questionnaire, underwent a genital examination, and had specimens taken for etiologic testing. Patients were offered, but not required to accept, HIV testing using a standard HIV algorithm in which two rapid tests defined a positive result. RESULTS: A total of 489 participants (81.5%) accepted HIV testing; 201 (41.1%) tested HIV-1-positive, including 16 (11.9%) of 134 participants who reported an HIV-negative status at study enrollment, and 58 (28.2%) of 206 participants who reported their HIV status as unknown. Of 147 who self-reported being HIV-positive at study enrollment, 21 (14.3%) tested HIV negative. HIV infection prevalence was higher in women (47.3%) than in men (34.8%, p<0.01), and was 28.5% in men with urethral discharge, 40.5% in women with vaginal discharge, 45.2% in men with GUD, and 59.8% in women with GUD (p<0.001). CONCLUSIONS: The high prevalence of HIV infection in STI clinic patients in Zimbabwe underscores the importance of providing HIV testing and referral for indicated prevention and treatment services for this population. The discrepancy between positive self-reported and negative study HIV test results highlights the need for operator training, strict attention to laboratory quality assurance, and clear communication with patients about their HIV infection status.


Assuntos
Infecções por HIV/diagnóstico , Doenças Sexualmente Transmissíveis/diagnóstico , Adolescente , Adulto , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Herpes Simples/complicações , Herpes Simples/diagnóstico , Humanos , Masculino , Prevalência , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/etiologia , Descarga Vaginal/complicações , Descarga Vaginal/diagnóstico , Adulto Jovem , Zimbábue/epidemiologia
18.
Eur J Pediatr ; 177(9): 1343-1350, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29938356

RESUMO

Recognizing child sexual abuse (CSA) in children is difficult, as there can be many hurdles in the assessment of alleged CSA. With this paper, we try to improve the recognition of CSA by discussing: (1) the difficulties regarding this matter and (2) the diagnostic evaluation of alleged CSA, combining both practical clinical recommendations based on recent research. Children are restrained to disclose CSA due to various reasons, such as fears, shame, and linguistic or verbal limitations. Associations between CSA and urogenital or gastrointestinal symptoms, internalizing and externalizing behavioral problems, post-traumatic stress symptoms, and atypical sexual behavior in children have been reported. However, these symptoms are non-specific for CSA. The majority of sexually abused children do not display signs of penetrative trauma at anogenital examination. Diagnosing a STI in a child can indicate CSA. However, other transmission routes (e.g., vertical transmission, auto-inoculation) need to be considered as well.Conclusion: The assessment consists of medical interview and child interview (parents and child separate and together) with special attention to the child's development and behavior (problems), psychosocial situation and physical complaints, the child's mental health, and the child's trauma history; anogenital examination should be done in all cases of alleged CSA. The examination should be documented by photo or video graphically. Recent research suggests that videography may be the preferred method, and testing on STIs. The assessment should be done multidisciplinary by experienced professionals. Health-care professionals who care for children need to know how child protective agencies and law enforcement are organized. In case there are concerns about a child's safety, the appropriate authorities should be alarmed. What is Known: • Sexual abuse in children often remains unrecognized in the majority of cases. What is New: • Research suggests that videographic documentation is preferred above photographic documentation for anogenital examination; observations of children's behavioral reactions during examinations might be valuable in the evaluation of suspected sexual abuse; nucleic acid amplification testing can be used on vaginal swabs or urine samples for chlamydia and gonorrhea; the CRIES-13 and the CAPS-CA can be used to assess trauma-symptoms in children after sexual abuse.


Assuntos
Abuso Sexual na Infância/diagnóstico , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pais , Exame Físico/métodos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/etiologia
19.
AIDS Rev ; 20(1): 71, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29628512

RESUMO

Pre-exposure prophylaxis (PrEP) with oral Truvada (tenofovir plus emtricitabine) is effective at preventing HIV infection in high-risk homosexual men. In the United States, PrEP was approved in 2012 and is reimbursed by Medicaid and the majority of private insurers. The situation is diverse and not uniform in the European Union, being PrEP more widely used in France than in the rest of countries. Concerns have been raised that PrEP use may be accompanied by the phenomena of risk compensation or behavioral disinhibition, whereby PrEP users' perception of decreased risk of HIV acquisition may lead them to engage in overall riskier sexual practices and increase their chances of acquiring sexually transmitted infections (STIs) (Blumenthal, et al. Virtual Mentor. 2014;16:909-15). Modifiable factors that may influence the acquisition of STI include condom use, number of partners, partner characteristics, and healthcare-seeking behaviors. In addition, MSM may alter HIV risk mitigation practices while on PrEP by decreasing seroadaptive practices such as serosorting that is seeking a partner of similar perceived serostatus (Khosopour, et al. AIDS Behav. 2017;21:2935-44). High rates of STI have been reported among PrEP users, as well as high rates of condomless sex, and increasing rates of STI over time (Liu, et al. JAMA Intern Med. 2016;176:75-84; Kojima, et al. AIDS, 2016;30:2251-2). In a new study conducted in Montreal, Canada, increases in the rates of STI in PrEP users were demonstrated measuring incidence rates of STI before and following the initiation of PrEP in the same cohort. The authors measured the incidence of gonorrhea, chlamydia, and/or syphilis in 109 HIV-seronegative homosexual men 12 months before and 12 months after beginning Truvada for HIV prevention (Nguyen, et al. AIDS. 2018;32:523-30). New episodes of gonorrhea, chlamydia, and/or syphilis rose in the cohort after providing Truvada, as shown in Figure 1. Moreover, the incidence of three or more STI increased from 3.7 to 9.2 cases per 100 personyears in this cohort. The Canadian study highlighted that the rate of STI with PrEP was also higher than in a group of 86 homosexual men that had undergone PEP in Montreal during 2010-2015. Other findings of the study we the high rate of STI with anorectal location, symptomless STI (e.g., chlamydia) and the frequency of sex partners contacted by internet. The increased rates of STI in PrEP users suggest a need to reinforce counseling and STI diagnosis and treatment efforts. Although PrEP may provide a public health benefit beyond the immediate prevention of HIV infection as result of bringing into care high-risk homosexual men who might not otherwise be seeking care for STI, doctors in charge must take this opportunity for informing adequately on STI and the risks inherent to multiple and occasional sexual contacts.


Assuntos
Profilaxia Pré-Exposição , Doenças Sexualmente Transmissíveis/epidemiologia , Canadá , Estudos de Coortes , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/etiologia
20.
Epidemiol Rev ; 40(1): 27-39, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29554240

RESUMO

Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental health drive vulnerability to HIV and related infections, as well as risk of arrest, detention, and incarceration. In this paper, we systematically review published data on HIV, sexually transmitted infections, viral hepatitis, and tuberculosis among incarcerated transgender people; describe potential structural determinants of HIV risk and transmission; identify gaps in the literature; and make recommendations for research and interventions to address this neglected population. We found that HIV and related infections among incarcerated transgender people have received little attention in the epidemiologic literature. The limited data available, which date from 1992, demonstrate high prevalence of HIV and sexually transmitted infections in this population internationally. Transgender people who had not had genital surgery were typically placed in jails and prisons corresponding to birth-assigned sex rather than gender identity. Once incarcerated, they routinely faced harassment, physical abuse, and sexual violence from inmates and staff and denial of access to medically necessary gender-affirming therapies. More HIV research with incarcerated transgender populations is urgently needed to inform correctional policy change that centers human rights and structural interventions, such as stigma reduction, pre-arrest diversion, and access to HIV prevention methods and gender-affirming care during incarceration.


Assuntos
Saúde Global/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Hepatite Viral Humana/epidemiologia , Prisioneiros/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Pessoas Transgênero , Tuberculose/epidemiologia , Vítimas de Crime/psicologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Hepatite Viral Humana/etiologia , Hepatite Viral Humana/psicologia , Hepatite Viral Humana/transmissão , Humanos , Masculino , Prevalência , Fatores de Risco , Doenças Sexualmente Transmissíveis/etiologia , Doenças Sexualmente Transmissíveis/psicologia , Doenças Sexualmente Transmissíveis/transmissão , Pessoas Transgênero/psicologia , Tuberculose/etiologia , Tuberculose/psicologia , Tuberculose/transmissão
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