Serologic detection of herpes simplex virus type 2 antibodies among pregnant women using a point-of-care test from Focus Diagnostics.

BACKGROUND: Serologic assays that identify herpes simplex type 2 (HSV-2) type-specific antibodies have been commercially available for more than a decade. Greater acceptance of these tests is hindered by uncertainty regarding their performance in real-world clinical settings. OBJECTIVES: The primary objective was to compare the test characteristics of the Focus HerpeSelect Express Assay (EA) versus the Focus HerpeSelect enzyme linked immunoassay (ELISA) for detection of HSV-2 type-specific antibodies among pregnant women enrolled from 3 geographic sites with varying prevalences of HSV-2 infection. A second objective was to evaluate the performance of a HSV-2 testing strategy in which EA screens and ELISA confirms HSV-2 serodiagnosis. STUDY DESIGN: We enrolled 399 pregnant women from Atlanta, GA, Moorestown, NJ, and Pittsburgh, PA into this cross-sectional investigation. Capillary whole blood was obtained from study participants, and evaluated for the presence of type-specific HSV-2 antibodies using the EA. Serum samples were also obtained from all study participants for subsequent identification of HSV-2 type-specific antibodies using both ELISA and the Focus Immunoblot assays. RESULTS: We observed 96.2% agreement between results obtained with EA and ELISA. Overall, when compared to ELISA results, the sensitivity of EA for detection of HSV-2 type-specific antibodies was 94.2% and the specificity was 97.1%. Using Immunoblot results as our standard for performance calculations, the positive predictive value (PPV) of HSV-2 serodiagnosis increased from 91.7% to 98.2% when ELISA was used to confirm EA testing. CONCLUSIONS: EA provides similar results to ELISA for the identification of HSV-2 type-specific antibodies among pregnant women. As use of the point-of-care (POC) EA in conjunction with confirmatory ELISA testing improves the PPV of HSV-2 serodiagnosis compared to the use of EA or ELISA testing alone, validation of this diagnostic algorithm in other at-risk populations may be warranted.

Estimating dissemination of Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines from a survey of physicians.

Periodically, the Centers for Disease Control and Prevention (CDC) produce guidelines for the treatment of sexually transmitted diseases (STDs) in the USA. To date, few evaluations of the dissemination of these guidelines exist. A paper and pencil survey was distributed via priority mail to a sample of Atlanta-area physicians, 416 (34%) of whom responded with complete data. Physicians were drawn from private practice, managed-care settings and public settings. In all, 85% of respondents treated STD, with a further 10% referring cases. Of those treating STD, 56% owned a copy of the 2002 CDC Treatment Guidelines, and 26% knew how to access them. The corresponding figures for physicians not treating STD were 25% and 30%. Of the physicians who did have copies, half had accessed the internet for their copies. Acquisition of, or the knowledge of how to acquire, the CDC STD Treatment Guidelines was widespread. The internet may be an effective and cost-saving means of disseminating the guidelines, although the continued need for print distribution should not be discounted.

Sexual history-taking among primary care physicians.

BACKGROUND: Because many people seek sexual healthcare in settings where they seek primary healthcare, the extent to which primary care physicians take sexual histories is important. We surveyed Atlanta-area primary care physicians to estimate the extent to which they take sexual histories as well as the components of those histories and the circumstances under which they are taken. METHODS: Four-hundred-sixteen physicians in four specialties (obstetrics/gynecology, internal medicine, general/family practice, pediatrics) responded to a mail survey conducted during 2003-2004. Respondents answered whether they asked about sexual activity at all, including specific components of a comprehensive sexual history such as sexual as sexual orientation, numbers of partners and types of sexual activity, during routine exams, initial exams, complaint-based visits or never. Respondents also reported their opinions on whether they felt trained and comfortable taking sexual histories. RESULTS: Respondents (51% male, 58% white) saw an average of 94 patients per week. A majority (56%) felt adequately trained, while 79% felt comfortable taking sexual histories. Almost three in five (58%) asked about sexual activity at a routine visit, but much smaller proportions (12-34%) asked about the components of a sexual history. However, 76% of physicians reported asking about sexual history (61-75% for various components) if they felt it would be relevant to the chief complaint. CONCLUSIONS: Most physicians report feeling comfortable taking sexual histories and will do so if the patient's apparent complaint is related to sexual health. But sexual histories as part of routine and preventive healthcare are less common, and many physicians miss essential components of a comprehensive sexual history. Structural changes and suggestions for training to enhance sexual history-taking are discussed.

Physicians' STD diagnosis and screening practices in the South.

OBJECTIVES: Sexually transmitted diseases (STDs) remain at high levels in the South compared with the rest of the nation. Physician diagnosis levels and screening behaviors fall among the elements about which more knowledge is needed to address these high levels. This article assesses Southern physicians' STD diagnosis histories and screening behaviors, focusing on curable STDs. METHODS: The sample included 1,306 physicians practicing in 13 Southern states and in the District of Columbia. These physicians formed part of a larger survey (n = 4,233) and answered questions concerning STD diagnosis history and screening behaviors. Analyses focus on chlamydial infection and gonorrhea individually, as well as composite statistics for gonorrhea, chlamydial infection, syphilis, pelvic inflammatory disease, trichomoniasis, and nongonococcal urethritis. RESULTS: Approximately 80% of physicians had diagnosed a curable STD, and 56% screened for any STD. The most common diagnosis techniques were culture and DNA probe. Several variables were individually associated with screening and diagnostic methods. Being female, African-American, or an obstetrician/gynecologist were associated with increased likelihood to screen for STDs in multivariate analyses. CONCLUSIONS: Southern physicians were less likely to screen for STDs than their counterparts in other areas of the United States, although they were more likely to have diagnosed STDs. Results suggest that some targeted and evaluated screening practices may be useful in this area of the country.

Adolescent beliefs about infertility.

PURPOSE: Explore adolescents' definition of fertility and range of beliefs regarding causes of infertility. METHODS: Qualitative study involving five focus groups that met between April 2001 and December 2001 at a hospital-based adolescent health center. All groups were led by one experienced moderator and observed by two investigators. Audiotapes of the group discussions were transcribed and reviewed independently by three investigators who met and reached consensus on underlying themes. RESULTS: Most adolescents generally understood fertility as the ability to become pregnant. Ten themes emerged as causes of infertility. Anatomic/gynecologic causes generated the most responses and most detailed discussion (e.g., "The coating on the egg is too hard and the sperm can't get in to fertilize the egg."). Other commonly mentioned causes were male factors (e.g., "He cannot produce sperm."), sexually transmitted infections (e.g., "like chlamydia caused scarring in the fallopian tubes"), genetics (e.g.,"a birth defect") and substance use (e.g., "if a man smoke weed all day, the egg may not develop because of problems with his sperm"). Less commonly mentioned themes were stress, contraception, environmental toxins, violence and injury. CONCLUSIONS: Most adolescents defined fertility as the ability to become pregnant and reported an extensive range of beliefs about the causes of infertility. Providers should consider eliciting adolescents' definitions of fertility and also exploring beliefs about causes of infertility with their patients when counseling about sexuality and contraception to determine if an adolescent has inaccurate beliefs about their fertility.

Attitudes and experiences with levonorgestrel 100 microg/ethinyl estradiol 20 microg among women during a 3-month trial.

To describe attitudes and experiences with a low-dose oral contraceptive pill (Alesse) over 3 months, women aged 18 years and older (n = 218) were enrolled from 16 locations to evaluate their experiences with Alesse. The questionnaire assessed demographic and personal characteristics, attitudes and experiences, and satisfaction. The participants had a mean age of 26.7 years and most were single, Caucasian, had completed high school, had a regular sexual partner, and had previously used OCs. Sixty percent of participants could discuss pill use easily with their mothers, 92% with friends, and 96% with partners; 45% of the women were unsure about their mother's previous OC use. Of the 11 side effects assessed, the most frequently anticipated side effect was weight gain. There was a significant relationship between anticipated and reported side effects for weight and mood changes; however, there remained a number of women for whom these differed. Most (90%) were satisfied with Alesse. Even when beginning on 20 microg pills, some women may still anticipate side effects such as weight gain typically associated with higher doses of estrogen. Healthcare providers should assess women's attitudes and anticipated experiences with OCs and counsel accordingly.