Pelvic inflammatory disease in adolescents between the time of testing and treatment and after treatment for gonorrhoeal and chlamydial infection.

In incarcerated adolescents, 13% developed pelvic inflammatory disease (PID) between the time of testing and treatment for chlamydial and gonorrhoeal infection, and 13% developed PID in the 30 days following single-dose treatment for one or both of these infections.

Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women.

US blacks carry a disproportionate risk of heterosexually transmitted HIV. This study aimed to evaluate the association between self-reported heterosexual anal intercourse and HIV. Using respondent-driven sampling (RDS), we recruited and interviewed 909 blacks from areas of high poverty and HIV prevalence in Houston, Texas, and who reported heterosexual sex in the last year. All individuals were tested for HIV. Weighted prevalence values were calculated to account for non-random recruitment associated with RDS. The weighted population prevalence of HIV infection was 2.4% and 2.5% among men and women, respectively. Education, employment status, income and crack cocaine use were not associated with HIV infection. Lifetime injection drug use (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.31-8.33%) and heterosexual anal intercourse (OR 2.41, 95% CI 1.02-5.73%) were associated with HIV infection. Individuals who reported both injection drug use and heterosexual anal intercourse had 6.21 increased odds of HIV (95% CI 2.47-15.61%). Our results suggest that heterosexual anal sex may be a vector for HIV transmission, especially in the context of injection drug use. Prevention strategies directed at curbing the HIV epidemic among black heterosexuals require that we correctly identify the risks so that appropriate interventions can be developed.

Purulent vaginal and cervical discharge in the diagnosis of pelvic inflammatory disease.

In this structured review, we evaluated purulent vaginal and cervical discharge as diagnostic tests for pelvic inflammatory disease (PID). Using a pretest probability of PID (diagnosed clinically) of 50%, we used the odds-likelihood formulation of Bayes' theorem to calculate post-test probabilities of PID (proven by laparoscopy or endometrial biopsy). If abnormal discharge was present, the post-test probabilities of PID ranged from 50% to 73%, with a mean value of 57%. If abnormal discharge was absent, the post-test probabilities ranged from 24% to 52%, with a mean value of 39%. Therefore, the presence or absence of excess white blood cells in vaginal or cervical discharge was not particularly helpful in confirming or excluding PID in patients in whom the diagnosis was suspected from the clinical examination.

The incidence of pelvic inflammatory disease in untreated women infected with Chlamydia trachomatis: a structured review.

Because of the long-term consequences of pelvic inflammatory disease (PID), the cost-effectiveness of Chlamydia trachomatis screening depends in part on the incidence of PID in untreated, chlamydia-infected women. The aim of this study was to evaluate the original research assessing the incidence of PID following C. trachomatis infection. We conducted a thorough search of the literature and selected all available prospective cohort studies. Six studies had original data: the incidence of PID varied from 0% (97.5% confidence interval [CI] 0-12%) during one year of follow-up of 30 women to 30% (95% CI 12-54%) during 50 days of follow-up of 20 women. Studies that included asymptomatic women in other settings reported a lower incidence than those that evaluated women in sexually transmitted disease clinics. In conclusion, no study was of a size or quality to answer our research question definitively. Investigators and clinicians planning chlamydia-screening programmes need to be cognizant of the inconclusive incidence data.

Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease.

PURPOSE: We determined the incidence of Fitz-Hugh-Curtis syndrome (FHCS) in adolescents who had mild to moderately severe pelvic inflammatory disease (PID). DESIGN: Prospective cohort study. SETTING: Harris County Juvenile Detention Center, April 2000-April 2006. PARTICIPANTS: Incarcerated female adolescents. INTERVENTION: In patients who met accepted criteria for the diagnosis of PID, we determined the proportion that had right upper quadrant pain that responded to therapy for PID. They were diagnosed as having FHCS. RESULTS: The 117 subjects' mean age (SD) was 15.6 (1.8) years; 37% were Hispanic, 34% black, and 26% white. 5/117 (4.3%, 95% confidence interval 1.4-9.7%) had symptomatic FHCS. Fifteen (13%) of all subjects, including 1 with FHCS, had fever and/or nausea and vomiting (moderately severe PID): none had generalized peritonitis or tubo-ovarian abscess (severe PID). Thirty-four had chlamydial, 4 gonorrheal, and 9 combined infections. All improved with standard outpatient PID therapy. CONCLUSION: FHCS was uncommon (4%) in adolescents who had mild to moderate PID and chlamydia as the most common pathogen.

Impact of new diagnostic criteria on the prevalence and incidence of pelvic inflammatory disease.

STUDY OBJECTIVE: The Centers for Disease Control and Prevention (CDC) recently changed the recommended criteria for the clinical diagnosis of pelvic inflammatory disease (PID). The purpose of this study was to assess the impact of this change on the frequency with which we made a diagnosis of PID. DESIGN: prospective cohort study. SETTING: juvenile detention center. PARTICIPANTS: adolescent females. INTERVENTIONS: We used the new diagnostic criteria to determine the prevalence and incidence of PID. We then compared these values to those in a previous study of a similar cohort of youth who were evaluated with the CDC's old, more stringent clinical criteria. MAIN OUTCOME MEASURES: Prevalence and incidence of PID. INCIDENCE MEASURES: Incidence density and cumulative incidence, using the Kaplan-Meier method. Results between studies were compared using prevalence and incidence ratios. RESULTS: In sexually active adolescents (N=315), the prevalence of PID (95% confidence interval) at admission was 8.6% (5.7-12.2%). During the first 31 days of incarceration, the cumulative incidence was 7.9% (5.0-12.3%) and the incidence density was 11.1 cases/100 person-months (6.5-16.4). Comparison of these results with those of our previous study that used old diagnostic criteria yielded a prevalence ratio of 2.0 (1.0-4.2), a risk ratio (comparing cumulative incidence) of 3.6, and a rate ratio (comparing incidence density) of 3.4 (1.2-11.2). All differences were statistically significant (P<0.05). CONCLUSION: The new diagnostic criteria for PID doubled the prevalence and more than tripled the incidence of this disease in this high risk population of incarcerated adolescents.

Implementation of a screening program for chlamydial infection in incarcerated adolescents.

BACKGROUND: In collaboration with the Houston Department of Health and Human Services, the authors implemented and evaluated a urine-based chlamydia screening program in incarcerated youth in Harris County, Texas, and assessed predictor variables for infection. GOAL: To implement and evaluate chlamydia screening in incarcerated youth. STUDY DESIGN: The authors determined prevalence of chlamydial infection, treatment rates, and predictor variables in 589 youth and repeated the measures 6 months later in 975 additional youth. RESULTS: Initially, the prevalence of infection was 9.6% in males and 28.1% in females; 88% of infected youth were treated while incarcerated. White males had a significantly lower prevalence of chlamydial infection; however, consistent condom use was not associated with a lower prevalence of chlamydia. In the 6-month assessment of chlamydia prevalence in 975 youth, prevalence and treatment rates remained high and predictor variables were similar. CONCLUSION: The authors instituted a screening program for chlamydial infection in incarcerated youth that was performing well at reassessment 6 months later.

Weight change in adolescents who used hormonal contraception.

PURPOSE: (a) To compare weight change at 1 year between adolescents 13-19 years old who were using either depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OC), and (b) to determine if age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight. METHOD: The setting was a Planned Parenthood Teen Clinic with chart review of variables of interest. Excessive weight was defined as weight gain > 10%. RESULTS: Baseline variables were similar in the two groups, except that DMPA users (n = 44) had a greater mean BMI (t test, p = .05) than OC users (n = 86). Mean (standard deviation) and median weight gains at 1 year were 3.0 (4.5) and 2.4 kg in the DMPA users and 1.3 (3.9) and 1.5 kg in the OC users (difference in medians not significant, Wilcoxon rank sum test, p = .10). Fifty-six percent of DMPA and 70% of OC users lost weight or gained < 5% of their baseline weight (p = .17, Fisher exact test); 25% of DMPA users and 7% of OC users gained > 10% of their baseline weight (p = .006). Age, baseline BMI, or race/ethnicity did not affect the likelihood that either group would gain > 5% or > 10% of their baseline weight. Of adolescents who gained > 5% of baseline weight at 3 months, 13 of 14 (93%) gained even more weight at 12 months. CONCLUSIONS: The majority of adolescents who used hormonal contraception for 1 year lost weight or gained < 5% of baseline weight. DMPA users were more likely than OC users to gain > 10%. Subjects who gained > 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

PIP: This study aims to compare weight change after 1 year between adolescents aged 13-19 years who were using either depot medroxyprogesterone acetate (DMPA) or an oral contraceptive (OC). It also seeks to determine whether age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight (defined as weight gain 10%). A total of 2883 charts were reviewed for all clients attending the Planned Parenthood Teen Clinic in Texas. In the results, 56% of DMPA and 70% of OC users lost weight or gained 5% of their baseline weight; whereas 25% of DMPA users and 7% of OC users gained 10% of their baseline weight. Furthermore, age, baseline BMI, or race/ethnicity did not affect the likelihood of weight gain in both groups. The findings indicated that most adolescents who used hormonal contraception for 1 year lost weight or gained 5% of their baseline weight. DMPA users were more likely to gain 10% of their baseline weight compared to OC users. Subjects who gained 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

The epidemiology of syphilis in the waning years of an epidemic: Houston, Texas, 1991-1997.

BACKGROUND: National and local syphilis rates have fallen since 1990. Accurate epidemiologic information about the distribution of syphilis during the waning years of an epidemic are important to health care organizations so that they can specifically target screening and intervention programs. GOALS: To describe the epidemiology of syphilis in Houston, Texas, from 1991 through 1997. STUDY DESIGN: Descriptive evaluation of morbidity surveillance data from the Houston Department of Health and Human Services. RESULTS: Between 1991 and 1997, rates for syphilis fell 61%. Rates for primary and secondary syphilis fell 90% among men and women in all race/ethnicity groups; early latent rates fell 81% among blacks, 57% among Hispanics, and 50% among whites. Late latent rates were stable among blacks and whites and increased among Hispanics. The proportion of total cases identified as late latent disease increased from 16% in 1991 to 63% in 1997. Congenital syphilis rates have remained at approximately 2 per 1,000 live births since 1993. CONCLUSION: Syphilis continues to be a problem in Houston. The medical community and HIV/STD prevention programs need to be vigilant in actively screening high-risk individuals to identify syphilis at earlier stages of the disease and to prevent congenital syphilis.

Problems in physician's classification and reporting of congenital syphilis.

The diagnosis of congenital syphilis (CS) in newborns can only be made through a review of the mothers' testing and treatment history and through the infants' clinical and laboratory findings. We describe difficulties in the classification of CS by physicians and the health department during a recent syphilis epidemic. The records of infants identified as potential cases of CS by laboratory testing, discharge diagnosis, or health department records were reviewed by epidemiologists. The reasons for concordance and discordance in classification between the physician and the epidemiologist were determined. Congenital syphilis was identified in 126 infants. Seventeen cases were discordant and 12 cases concordant but the physician's classification was for incorrect reasons. Misclassification occurred because physicians lacked data known to the health department (n=7), health departments lacked data known to the physician (n=1), and physicians misinterpreted the case definition for CS (n=21). Suggestions for improving the diagnosis and reporting of CS are included.

Congenital syphilis in Harris County, Texas, USA, 1990-92: incidence, causes and risk factors.

From local health department data, we determined the 1990-92 incidence of congenital syphilis (CS) in Harris County, Texas, USA, applying for the first time the Centers for Disease Control and Prevention (CDC) 1990 surveillance case definition to a population-based sample. We also evaluated factors that discriminated between women whose infants were or were not cases. The incidence of CS per 1000 live births was 3.2 in 1990, 4.6 in 1991 and 4.2 in 1992. Because of failure to apply part of the case definition, the local health department reported only 60% (418/694) of the cases that we identified. In the multivariate analysis, the significant factors for CS were lack of prenatal care and late latent syphilis. No factor identified high-risk women to target for special public health interventions. Improved laboratory services and better education of local providers and surveillance workers will solve some problems in the diagnosis and therapy of syphilis during pregnancy. Ambiguity in the CDC's case definition of CS needs correction.

Problems in the current case definitions of congenital syphilis.

During the course of a population-based epidemiologic study of congenital syphilis, we found discrepancies and problems of validity in the case definitions of congenital syphilis of the Centers for Disease Control and Prevention and other experts. We analyzed these problems and determined their impact on case classification in our study. The most important problem that we found was the case definitions' lack of a valid scientific basis for the classification of symptom-free infants born to mothers who have been treated for syphilis but have uncertain infection status (286 infants in our study). The classification of these infants is based on diagnostic tests whose sensitivity and specificity are unknown. In our study, we found that results of some tests were rarely positive and that values for others were similar to those in uninfected infants. We believe that symptom-free infants of treated mothers of uncertain infection status should be classified as cases, pending the development of better diagnostic tests for congenital syphilis. The economic impact of treating these infants can be lessened by obtaining fewer diagnostic tests and by use of one injection of penicillin rather than a 10- to 14-day course, an approach suggested by a literature review. Use of infants' diagnostic tests to classify any other group of symptom-free infants does not seem appropriate, even though this is often recommended.

Variations in bone status of contralateral and regional sites in young athletic women.

To determine if volleyball (VB), basketball (BB), soccer (SO) and swimming (SW) programs were associated with site-specific differences in contralateral, regional, and total body bone mineral density (BMD), 62 eumenorrheic female athletes [BB (N = 7), VB (N = 11), SO (N = 9), and SW (N = 7)] and controls participated in the study. The controls were categorized as either moderately active control (MOD) (N = 17) or sedentary control (SED) (N = 11) based on fitness and activity assessments. Contralateral, total body, lumbar (L2-L4), and femur BMD were measured (Lunar DPX). The between sport contralateral comparisons indicated that VB and BB had significantly greater leg and arm measurements than all other groups, while the within contralateral comparisons revealed significantly greater right arm measurements for all groups, except SW. No significant differences were found for the within group contralateral leg comparisons, except VB. VB and BB had significantly higher (P < or = 0.05) total body and lumbar BMD values than SW, MOD, and SED. At the femur neck, trochanter, and Ward's triangle, BB showed significantly higher BMD than SW, MOD, and SED. Only BB had significantly higher Ward's triangle BMD than SW, MOD, and SED. Our findings show site-specific differences in BMD associated with selected sports' programs.

Weight-training injuries. Common injuries and preventative methods.

The use of weights is an increasingly popular conditioning technique, competitive sport and recreational activity among children, adolescents and young adults. Weight-training can cause significant musculoskeletal injuries such as fractures, dislocations, spondylolysis, spondylolisthesis, intervertebral disk herniation, and meniscal injuries of the knee. Although injuries can occur during the use of weight machines, most apparently happen during the aggressive use of free weights. Prepubescent and older athletes who are well trained and supervised appear to have low injury rates in strength training programmes. Good coaching and proper weightlifting techniques and other injury prevention methods are likely to minimise the number of musculoskeletal problems caused by weight-training.

Weight-training injuries in children and adolescents.

Thousands of children and adolescents participate in weight lifting for recreation or as a means of training for sports. Weight lifting can cause serious musculoskeletal injuries, such as ruptured intervertebral discs, spondylolysis and spondylolisthesis, fractures and meniscal injuries of the knee. Deaths related to weight lifting have been reported. Although the incidence of weight-lifting injuries is not well documented in children and adolescents, several reports indicate that few injuries occur in carefully supervised programs. The most common cause of injury appears to be loss of form when heavy weights are lifted. Proper technique, good supervision and training programs appropriate to the athlete's level of physical and emotional maturity are important.

Injury and illness surveillance at local Special Olympic Games.

The purposes of this study were to: determine the incidence of injury and illness among Special Olympic athletes at local competitions; assess the relative risk of medical problems among Down's syndrome athletes; and compare the relative risk of sports injury incurred by athletes participating in various Special Olympic events. Health stations were set up at all sports venues and injury/illness surveillance records were kept for all injury/illness encounters during a 3-day competition for 777 Special Olympic athletes. A total of 3.5% of the athletes required injury/illness care during the games. Down's syndrome athletes were 3.2 times as likely to encounter a medical problem. Track and field events provided the least activity time and the most injuries. These data suggest that Special Olympic games at the local level are safe and that planners should prepare to treat more illnesses than injuries at such competitions.

Bone density in eumenorrheic female college athletes.

Information is limited on the effect of exercise on bone density in young eumenorrheic athletes. We studied 12 Caucasian intercollegiate volleyball players (V), nine basketball players (B), ten swimmers (S), and 13 non-athletes (N) with bone density measurements by photon absorptiometry of their calcaneus and lumbar spine (L2-L4). The effect of athletic status on bone density was analyzed by multivariate analysis of covariance, with height and weight as covariates. The bone densities reported below are mean +/- SE, adjusted for the covariates; units = g.cm-2, P less than 0.005. The swimmers had a significantly lower mean density in the lumbar spine than all other groups; the non-athletes' mean density was also lower than that of volleyball players (V = 1.31 +/- 0.03, B = 1.26 +/- 0.04, N = 1.18 +/- 0.03, S = 1.05 +/- 0.03). The volleyball and basketball players' mean calcaneal densities were greater than those of the swimmers and non-athletes (V = 0.530 +/- 0.017, B = 0.564 +/- 0.023, N = 0.438 +/- 0.018, S = 0.375 +/- 0.019). The higher bone densities for athletes in vertical weight-bearing activities are consistent with some but not all published data. The swimmers' low bone density in the lumbar spine, less than published values for amenorrheic runners, was unexpected.