Human papillomavirus deoxyribonucleic acid in cervix only detected in girls after coitus.

In a prospective cohort study on the prevalence of HPV in a group of female Swedish students, we obtained repeated cytological specimens during a period of 2 years, for cytological diagnosis and PCR detection of HPV. The group comprised 98 girls, sampled between 15 and 17 years, and 82 of them completed the study. The girls were also followed every sixth month by a structured face-to-face interview regarding sexuality. Only the sexually experienced girls harboured HPV-DNA in the cervix with a cumulative prevalence of 37% and HPV16 was the most common type encountered. Almost half of the infected girls were lacking any clinical or subclinical signs of HPV infection. There was a positive correlation between the presence of HPV and the number of coital partners. The time period since coitarche also had importance for the HPV detection rate.

Comparison of development of serum antibodies to HPV16 and HPV33 and acquisition of cervical HPV DNA among sexually experienced and virginal young girls. A longitudinal cohort study.

OBJECTIVES: To study the importance of sexual activity and early coitus debut on the risk for acquiring infection with human papillomavirus (HPV) type 16 or 33. STUDY DESIGN: Ninety-eight healthy adolescent girls were followed up with consecutive interviews and donations of serum and cervical brush samples during 2 years. RESULTS: Fourteen percent of sexually experienced girls had serum immunoglobulin G to HPV16 and/or HPV33 capsids, and 14% also had cervical HPV16 or HPV33 DNA. Seropositivity for HPV correlated with detection of cervical HPV DNA. None of the 36 girls without coital experience was seropositive or harbored cervical HPV DNA. Seropositivity for HPV was correlated strongly with the number of sexual partners: Odds ratio for > 1 sexual partner was 16.3 (P < 0.001), and for early coitus debut (younger than 17 years of age), it was 14.3 (P < 0.002). CONCLUSIONS: Both HPV serology and HPV DNA testing indicated that the number of sexual partners and earliness of coitus debut determined the risk for acquiring HPV infection and that nonsexually transmitted infections are rare or nonexistent among adolescent girls.

Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls.

AIM: To compare life-style and reproductive health care factors in girls with a coitus debut < 15 years of age and girls with a later debut. METHODS: Girls resident in the municipality of Karlstad, Sweden, starting their upper secondary school education were invited to attend the teenage clinic during two years (five visits). Gynecological examinations were performed and questions were asked about possible symptoms, sexual activity, contraception and sexually transmitted diseases. RESULTS: Ninety-eight girls accepted the invitation to participate and 88 girls completed all visits (mean age on admission 16 years). Median age for coitarche was 16 years. A sexual debut < 15 years was reported by 17 girls (19.3%), 54 (61.4%) had their debut > or = 15 years and 17 girls (19.3%) had not had their sexual debut on completion of this study. Girls with an early sexual debut had a greater number of sexually transmitted diseases (p < 0.05) and more cervical atypias (p < 0.05), and more often had a menarcheal age < 13 years (p < 0.05), > two brothers and/or sisters (p < 0.01), were more often not living with their parents (p < 0.01) and reported a greater number of life-time partners (p < 0.06) than the remainder, Girls with a sexual debut < 15 years started drinking alcohol earlier than others (p < 0.01). There was a greater proportion of smokers among girls with an early sex debut compared to the remainder (p < 0.05). CONCLUSIONS: Early sexual debut is associated with an earlier menarche and a more premature adult life-style and is an important indicator for continued risk behavior regarding reproductive health.

The relationship between knowledge about sexually transmitted diseases and actual sexual behaviour in a group of teenage girls.

PURPOSE: To assess longitudinally the relationship between knowledge about sexually transmitted diseases (STDs) and sexual behaviour, contraceptive use, STD protection and social class in a group of Swedish teenage girls. METHODS: Girls starting their upper secondary school education were invited to attend a teenage clinic during a period of 2 years (5 visits). Questions were asked about family situation, sexual activity, contraceptives, STD protection and knowledge about STD. Gynaecological examinations were performed on entry and completion, and when necessary during the observation period. RESULTS: Eighty-eight girls completed all visits during the observation period. At 16 years of age there were no significant differences in knowledge about various STD and STD protection between girls from different social classes or with respect to coital experience, age of coitarche and the subsequent number of sexual partners at 18 years of age. At 18 years of age there was a better knowledge about STDs and the need for STD protection (p < 0.01) among girls with coital experience compared with those who had no coital experience. Girls reporting many lifetime partners were best informed, but in spite of solid knowledge they did not protect themselves from infection. Even though 34% of the girls with coital experience were found to harbour a STD during the course of this study, almost all girls denied the possibility of having acquired or transmitted an infection. CONCLUSIONS: Although girls were well-informed about sexually transmitted diseases and knew how to avoid infections this knowledge had little influence on behaviour.

The influence of social class on parity and psychological reactions in women coming for induced abortion.

OBJECTIVE: To test the hypothesis that the correlation between legal abortion and socio-economic conditions, known from the time when abortion was restricted, has current validity. To evaluate the effect of social class on network support and psychological reactions. DESIGN: Consecutive sampling and semistructured personal interviewing. SUBJECTS: 444 women living in the city of Gothenburg and applying for legal termination of pregnancy in the first trimester. SETTING: The department of gynaecology at a university hospital with primary care responsibility for legal abortions. RESULTS: The 667 health administration districts of Gothenburg were ranked into four groups according to the mean income. Women living in lower socio-economic districts were younger. Irrespective of age, previous experience of induced abortion was more common among them (p < 0.001). Unsatisfactory network response or support was common (37%), but equally shared between the social classes. Discontinuation of oral contraception during the previous six months was twice as common among teenagers (40.0%) as among other women (p < 0.001) but without social differences. Pitman's permutation test was used for statistical analyses. CONCLUSION: Socio-economic conditions have a strong and inverse correlation to previous experience of induced abortion. Psychological reactions and needs did not vary with class.

PIP: Given attempts on the part of the Swedish parliament to restrict access to abortion, investigations of the social class composition of current abortion seekers are essential. In this study, socioeconomic data were collected on 444 consecutive first-trimester abortions performed at Sweden's University of Gothenburg Hospital in 1986-87. Gothenburg's 667 districts were classified into four strata on the basis of mean income for males 25-49 years of age and percentages of home ownership and families receiving social welfare. 45 abortion patients were in group A (high income), 74 in group B, 98 in group C, and 227 in group D (poverty level). Mean gestational age was similar (9.4 weeks) in all groups, but low-income abortion patients were significantly younger and had twice the rate of prior abortions than the most affluent women (48.9% versus 24.4%). Moreover, 15.4% of the poorest women compared to only 2.2% of the wealthiest women had undergone another abortion within two years of the index pregnancy termination. There were no significant differences along social class lines in terms of emotional responses to the need for abortion or perceptions of support from significant others. Overall, these findings confirm that any attempts to curtail abortion rights would have the greatest impact on low-income women. They further suggest a need for increased family planning program resources in low-income districts, including distribution of free contraception, to reduce the high incidence of repeat abortion.

Prevalence of antibodies to herpes simplex virus types 1 and 2, Epstein-Barr virus and cytomegalovirus in teenage girls.

Seropositivity to herpes virus type 1 (HSV-1), herpes virus type 2 (HSV-2), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) was estimated in a group of 98 16-year-old Swedish girls. Antibodies to HSV-1 were seen in 41% of the girls and to HSV-2 in 1%, and antibodies to CMV in 45 and to EBV in 82%. In girls with coitus experience, there was significantly higher prevalence of HSV-1 and EBV antibodies, compared with girls with no sexual contact. The age of coitarche or number of coitus partners did not affect the rate of seropositivity. During 2 years of follow-up, 13 girls seroconverted. All but one EBV-seroconverting girl, were sexually active, and no girl converted for more than one type of virus. We concluded that transmission of herpes viruses is common in adolescence, and sexuality, even with regard to its close association with kissing, is one important determinant.

Anti-sperm IgA antibodies against the equatorial segment of the human spermatozoon are associated with impaired sperm penetration and subfertility.

OBJECTIVE: To determine the prevalence of antibodies directed against the equatorial segment of the spermatozoon in (a) serum in both sexes in relation to age and fertility status and (b) semen of infertile men with tail-to-tail sperm agglutination in relation to in vitro sperm penetration capacity. MATERIAL: Serum samples were obtained from 30 neonates, 11 prepubertal children, 30 adolescents, 60 adults aged 20-50 years, and 60 adults over the age of 70. Semen samples were obtained from 62 men with normal sperm counts and sperm morphology but with tail-to-tail agglutination. METHODS: Sperm antibodies were demonstrated with an immunoperoxidase assay. Sperm penetration capacity was measured with a modified Kremer capillary test. RESULTS: Serum anti-sperm antibodies were absent in children but appeared in teen-age boy (10%) and in adult men (20%) and women (30%). Lower prevalence of serum anti-sperm antibodies was noted for old individuals of both sexes (6-10%). Among individuals with a history of infertility, a significantly higher frequency of anti-sperm antibody-positive men (P < .001) and (P < .05) was found as compared to fertile controls. Presence of IgA antibodies bound to the equatorial segment of spermatozoa was associated with impaired in vitro sperm penetration capacity. No IgG or IgM anti-sperm antibodies bound to the equatorial segment were demonstrable. CONCLUSIONS: Seminal IgA antibodies bound to sperm are associated with impaired sperm penetration.

Auto-immunity to spermatozoa and quality of semen in men with spinal cord injury.

OBJECTIVE: To determine the presence of anti-sperm antibodies in serum, and on spermatozoa, in men with spinal cord injury. DESIGN: Thirty men whose injury occurred 1 to 18 years ago compared with 30 men with normal semen. PATIENTS AND INTERVENTIONS: Eighteen tetraplegic and 12 paraplegic patients were treated with vibrator or rectal electrostimulation, yielding a total of 25 ejaculates. RESULTS: Semen analyses (WHO): volume low, with concentration > 100 million/mL in 80%; 8/30 exhibited sperm agglutinating antibodies, but with low titres. CONCLUSIONS: Low titres of serum antibodies and absence of attached IgA antibodies indicate autoimmunity is not the cause of low sperm motility and penetration capacity in these patients.

Risk factors for Chlamydia trachomatis infection in 6810 young women attending family planning clinics.

Screening programmes are important for the control of Chlamydia trachomatis (Ct) infection, a disease spread mainly by asymptomatic carriers. Risk factors for Ct infection were assessed in 6810 consecutive asymptomatic young women seeking contraceptive advice. All women filled in a questionnaire and were offered Ct testing. Of the 5785 who consented to testing, 425 (7.3%) were Ct culture positive. Four variables were significantly related to increased risk of being infected: age 18-23 years, duration of present relationship less than 1 year, non-use of condoms, and a history of not having had a previous genital infection. It is not possible to devise screening criteria that would effectively identify women at high risk. Therefore a screening programme should be targeted at all sexually active young people. However, if after some years the programme succeeds in lowering general Ct prevalence, these factors may be important when selecting patients for Ct testing.

PIP: Screening programs are important for the control of Chlamydia trachomatis (CT) infection, a disease spread mainly by asymptomatic carriers. Risk factors for CT infection were assessed in 6810 consecutive asymptomatic young women seeking contraceptive advice. All women filled in a questionnaire and were offered CT testing. Of the 5785 who consented to testing, 425 (7.3%) were CT culture positive. 4 variables were significantly related to increased risk of being infected; ages 18-23 years, duration of present relationship 1 year, nonuse of condoms, and a history of not having had a previous genital infection. It is not possible to devise screening criteria that would effectively identify women at high risk. Therefore, a screening program should target all sexually active young people. However, if after some years the program succeeds in lowering general CT prevalence, these factors may be important when selecting patients for CT testing.

Genital papillomavirus infection in women treated for chlamydial infection.

Samples for chlamydia testing were taken from 298 and PAP smear from 284 non-pregnant sexually active young women in a midwife-run family planning dervice. Chlamydia was found in 36 (12.1%). Three women (1.1%) had cytological atypia corresponding to CIN I or II. Koilocytosis was seen in 9 smears (2.8%). Thirty-two of the chlamydia-positive women were followed for a mean of 15 months by a gynaecologist with chlamydia tests, colposcopy, PAP-smears and in some cases biopsies. There were 7 reinfections with chlamydia (22%). Signs of genital papillomavirus infection (GPVI) were found in 24 of the 32 chlamydia cases during follow-up. Twenty chlamydia-positive patients had abnormal colposcopy, 15 of them had other changes suggestive of GPVI, seven of these had CIN I or II. At follow-up 6 patients had cytologic atypia (18.8%) compared with the average 1.5% in this department during this period. Among 12 patients with normal colposcopy there were no cytological changes. Chlamydial infection calls for increased alertness regarding abnormal vaginal cytology even among young patients not commonly included in PAP smear screening programmes.

Estimation of a preference matrix for women's choice of male sexual partner according to rate of partner change, using partner notification data.

Data from a study of partner notification for venereal chlamydial infection are used to estimate the contact preference matrix, according to sexual contact activity levels of the male partners, of young heterosexual women. A method for correcting data for the bias introduced by studying infected women only is presented. Results indicate that an overall proportional mixing model is not an adequate description of the mixing pattern.

Choice of sexual partner according to rate of partner change and social class of the partners.

Models for the spread of sexually transmitted diseases, including AIDS, rely on sexual partner mixing patterns in the population. From data acquired through partner notification for infection with Chlamydia trachomatis among young people in Gothenburg, Sweden, it was possible to construct contact matrices for the variables 'rate of partner change' and 'social class' of the partners in pair formations. These matrices show a restricted mixing between these two variables for young heterosexual women. Therefore random mixing models will probably overestimate rate of spread and possibly final size of an epidemic of a sexually transmitted disease.

Epidemiologic characteristics of two different populations of women with Chlamydia trachomatis infection and their male partners.

Two groups of women under the age of 26 with chlamydial infection (A-asymptomatic women from a screening program, B-traditional STD clinic patients) and their partners were compared with respect to history of STD, sexual behavior, contraception, and indices for income and social welfare expense. The mean number of partners was 1.3 in group A and 1.8 in group B. Women in group B, in spite of more frequent condom use, demonstrated greater risk behavior both with respect to STD and to unwanted pregnancy and also had higher indices for social welfare expense. More group A partners than group B partners were asymptomatic and chlamydia negative. Group B partners also more often had low income as well as high social welfare expense indices. In both groups, complicated chains of transmission were found, and the need for expert contact tracing in both types of patient groups is stressed.

Contact tracing in the control of genital Chlamydia trachomatis infection.

Four different types of contact tracing for partners of Chlamydia trachomatis infected patients were compared with respect to reinfections during two 15-month periods in 1979/80 and in 1983/84. Between the two study periods a gradual improvement in contact tracing occurred. No reduction in overall reinfections was observed in the second period, reinfections occurring within 12 weeks were similar in the two periods. Treatment of the regular partner (by giving the woman a prescription for her partner) without examination or further partner follow-up resulted in few reinfections. A system of partner referral without verification that partners actually appeared for examination resulted in significantly more reinfections by the regular partner than a system with non-mandatory verification: 60 of 997 women (6%) compared with 6 of 645 (1%). The addition of C. trachomatis infection to the existing STD legislation resulted in fewer identified partners refusing examination than previously, one of 254 men (0.4%) compared with 40 of 223 (18%) before legal inclusion.

Sexually transmitted diseases--knowledge and attitudes among young people. Developments in Sweden between 1986 and 1988.

Pupils aged 18 to 19 years at colleges and technical schools in a small town and a rural area filled in questionnaires concerning sexually transmitted diseases (STD) in May 1986 and May 1988. The questions covered knowledge and sources of information about STD. The influence of knowledge on attitudes and actual behavior was studied. Knowledge about STD was fairly good and increased between the two study periods. Schoolteachers and the media were important sources of information. Girls knew more than boys, and more often discussed STD with adults and friends. Small differences emerged between the urban and rural areas and between pupils attending theoretical and practical courses. Attitudes seemed to change with time but it is not clear whether this has resulted in changes in actual behavior.

Postabortal endometritis in chlamydia-negative women--association with preoperative clinical signs of infection.

The relations between clinical signs of infection and postoperative endometritis were studied among 429 women with negative preoperative chlamydial and gonococcal cultures. Clue cells and a vaginal smear not dominated by rods and positive amine tests were more common among the 12 patients (2.8%) with endometritis. In the stepwise logistic regression procedure the presence of greater than 20% clue cells remained statistically significant and was associated with the highest relative risk, 5.6, with 95% confidence limits 1.82-17.2. This also implies clinical significance--women with clue cells constitute a group at risk of postabortal endometritis.

Intermittent prophylactic treatment of recurrent vaginal candidiasis by postmenstrual application of a 500 mg clotrimazole vaginal tablet.

The therapeutic efficacy of intermittent, monthly, postmenstrual prophylaxis with a single 500 mg clotrimazole vaginal tablet (n = 33) was compared with placebo tablets (n = 29) in 62 woman (age 28.1, SD 7.2 years) with recurrent vulvovaginal candidiasis. The number of episodes of acute vulvovaginal candidiasis experienced during the year prior to inclusion was 6.3, SD 1.9. The cumulative recurrence frequency after 6 months intermittent prophylaxis with clotrimazole (30.3%) was lower (p less than 0.001) than that recorded for the women who received placebo (79.3%). After an additional 6 months observation period without treatment there was no significant difference in the cumulative recurrence frequency between the groups (clotrimazole 84.9%; placebo 86.2%). The vagina was recolonised with Candida albicans in 70% of the women after 6 months prophylactic treatment with clotrimazole and in 86% of the women who had received placebo. Thus, this study has demonstrated that postmenstrual prophylactic treatment with a single 500 mg clotrimazole vaginal tablet, applied monthly, prevents recurrence of symptoms, although it does not eliminate yeasts from the vagina.

Quality of semen after repeated ejaculation treatment in spinal cord injury men.

The study was designed to document the effects of regular drainage after penile vibrator stimulation on the quality of semen in SCI men. Twenty three tetraplegics and 9 paraplegics, 18 to 40 years of age and with neurological levels ranging from C4 to L1, were examined between 1 and 23 years after injury (median 2 years). None had ejaculated after the injury. Penile vibrator stimulation was tried in patients with cervical or thoracic lesions who showed reflex hip flexion on scratching the soles of the feet, 29 out of 32, and rectal electrostimulation in the remaining 3 low lesions with no reflex function in lumbar and sacral segments. The stimulation yielded semen in 29 (91%) of the men; 22 had antegrade and 7 retrograde ejaculation. Sixteen of the 22 patients with antegrade ejaculation entered a home programme of vibrator stimulation prescribed once weekly. Four to 6 months of stimulation resulted in a rise of semen volume and of fructose and acid phosphatase levels in the seminal plasma, suggesting improved function of the seminal vesicles and the prostate. The percentage of motile sperms was low both before and after the treatment period. Despite this, the total count of motile sperms per ejaculate was already high in the patient's first ejaculates compared to the laboratory normal standard, and further clearly increased after the stimulation period. A standardised functional test measuring sperm penetration capacity showed strong evidence of long term stimulation effect. It is suggested that the test is used in the assessment of fertility potential in SCI men.