Diagnosis and Treatment of Secondary Syphilis in Women.

Secondary syphilis develops approximately 3 to 12 weeks following undetected and untreated primary syphilis. Despite historically low rates of syphilis infection in 2000, the United States is now experiencing an alarming resurgence in primary, secondary, and congenital syphilis. This case report describes an unexpected presentation in a young woman presenting for an initial well-woman examination. Social and behavioral drivers of syphilis infection, diagnosis, and treatment are presented. Implications for women's health are examined. The need for new and more effective preventive health strategies is reviewed.

Racial and Ethnic Group Knowledge, Perceptions and Behaviors about Human Papillomavirus, Human Papillomavirus Vaccination, and Cervical Cancer among Adolescent Females.

STUDY OBJECTIVE: Human papillomavirus (HPV) vaccines provide an opportunity to greatly reduce the burden of cervical cancer. Although there has been improvement in uptake, there are notable ethnic/racial disparities. This qualitative study was conducted to better understand factors related to vaccine uptake among female adolescents from 3 racial/ethnic groups: African American (AA), Hispanic, and Caucasian. Findings can inform the development of optimal messages and strategies for clinical and population-based interventions. DESIGN AND SETTING: This mixed-methods descriptive study included completion of a brief structured survey and focus group discussion. Six focus groups were conducted with female adolescents, 2 each in the AA, Hispanic, and Caucasian groups. Brief structured survey questions and the focus group protocol addressed knowledge, perceptions, and behaviors related to HPV, HPV vaccination, and cervical cancer. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Participants were 60 female adolescents (ages 13-19, mean age = 16.6 years) recruited from high schools, public health clinics, and churches. RESULTS: Themes across questions were remarkably similar among AA, Hispanic, and Caucasian participants. Each group had high awareness of the terms HPV, HPV vaccination, and cervical cancer, but with little in-depth knowledge about these topics. There was a high acceptance of HPV vaccination. Misperceptions about optimal cervical cancer prevention strategies such as simply knowing one's partner and good hygiene were most common among Hispanic adolescents. Awareness about Pap testing was most common among Caucasian adolescents. CONCLUSION: Predominantly uniform perceptions of HPV vaccines across racial/ethnic groups suggest a "one size fits all" approach will likely have greater reach with cervical cancer prevention messaging than culturally tailored interventions.

Cervical Cancer Prevention Knowledge and Abnormal Pap Test Experiences Among Women Living with HIV/AIDS.

Cervical cancer prevention knowledge deficits persist among women living with HIV/AIDS (WLHA) despite increased risk of developing cervical dysplasia/cancer. We examined associations between WLHA's cervical cancer prevention knowledge and abnormal Pap test history. We recruited 145 urban and rural WLHA from Ryan White-funded clinics and AIDS service organizations located in the southeastern USA between March 2011 and April 2012. For this analysis, women who reported a history of cervical cancer (n = 3) or had a complete hysterectomy (n = 14) and observations with missing data (n = 22) were excluded. Stata/IC 13 was used to perform cross-tabulations and chi-squared tests. Our sample included 106 predominantly non-Hispanic Black (92%) WLHA. Mean age was 46.3 ± 10.9 years. Half (50%) had ≤ high school education. One third (37%) had low health literacy. The majority (83 %) had a Pap test <1 year ago, and 84 % knew that WLHA should have a Pap test every year, once two tests are normal. Many (68%) have had an abnormal Pap test. Abnormal Pap test follow-up care knowledge varied. While 86% knew follow-up care could include a repeat Pap test, only 56% knew this could also include an HPV test. Significantly, more women who had an abnormal Pap test knew follow-up care could include a biopsy (p = 0.001). For WLHA to make informed/shared decisions about their cervical health, they need to be knowledgeable about cervical cancer care options across the cancer control continuum. Providing WLHA with prevention knowledge beyond screening recommendations seems warranted given their increased risk of developing cervical dysplasia/neoplasia.

Racial disparities in cervical cancer mortality in an African American and European American cohort in South Carolina.

South Carolina (SC) has some of the largest health disparities in the nation, in particular cancer mortality rates that disfavor African Americans (AA) in comparison to European Americans (EA) with 37% higher incidence and 61% higher mortality rates for AA women compared to EA women. Consequently, the purpose of this investigation was to examine and compare the impact of race on survival among cervical cancer patients in SC. Data from the SC Central Cancer Registry on all AA and EA cervical cancer patients in SC were analyzed for this investigation. All women greater than 19 years of age with a histopathologically-confirmed cervical neoplasm were included. Kaplan Meier survival curves were calculated and compared for each racial group using the log rank test statistic. Significant differences between races were noted for alcohol use, grade, histology, marital status, and vital status. AA women with cervical cancer had significantly decreased survival compared to EA women (49% vs. 66%, p < 0.01). This same trend was noted for all grade, histology, and stage types. We found significantly decreased survival among AA women with cervical cancer compared to EA women, which persisted even among AA and EA women with the same disease stage, grade, or histology. The causes of these disparities are most likely multi-faceted and interdependent. These findings emphasize the need for intervention into the myriad of factors ranging from the biological and genetic to the environmental and structural barriers impacting cervical cancer mortality.

Life stressors are an important reason for women discontinuing follow-up care for cervical neoplasia.

Although studies have addressed psychosocial factors associated with obtaining follow-up care for an abnormal Pap test, none have explored the effect of stressful life events in predicting the receipt of follow-up care for an abnormal Pap test. Data from a program (1995-2001) that provided free follow-up care for women with low-grade cervical lesions (n = 601) was used to determine whether life stressors increased risk of study discontinuation. Women were interviewed at baseline and offered follow-up at 4- to 6-month intervals for up to 24 months. Of the 556 women recruited and interviewed (92% response rate), 53 were referred out because they had high-grade cervical lesions and 33 had a health condition precluding follow-up. Among 470 women who began follow-up, 175 (37.2%) discontinued before completing three visits. Women who discontinued were significantly more likely to report more stressful life events in the past year [age-adjusted relative risk (aRR), 1.19; 95% confidence interval (95% CI), 1.08-1.30; 17-item scale]. Events most strongly associated with discontinuation included having a problem with a boss (aRR, 1.9; 95% CI, 1.5-2.4), severe physical partner violence (aRR, 1.7; 95% CI, 1.3-2.2), being homeless (aRR, 2.1; 95% CI, 1.6-2.8), and having an unplanned pregnancy (aRR, 1.5, 95% CI, 1.2-2.1). Life stressors may be important predictors of discontinuation of free follow-up care among women in need of immediate follow-up care to prevent lesion progression.

Active and passive smoking, high-risk human papillomaviruses and cervical neoplasia.

Few studies have evaluated the role of passive smoke exposure and cervical neoplasia risk. We assessed the role of active and passive cigarette smoke exposure and risk of cervical squamous intraepithelial lesion (SIL) in a case-control study based in a South Carolina Health Department; 59 high-grade SIL (HSIL) cases, 313 low-grade SIL (LSIL) cases and 427 controls were recruited and interviewed. Passive cigarette smoke exposure was significantly (P < 0.05) associated with high grade SIL (adjusted odds ratio (aOR) = 2.2) and low-grade SIL (aOR = 1.4). Active smoking was associated with SIL only among White women (aOR = 1.8). High-risk human papillomaviruses (HR-HPVs) appear to interact with active cigarette smoking to increase HSIL risk. HSIL cases compared with LSIL cases were significantly more likely to be HR-HPV positive current smokers (aOR = 3.0; 95% CI: (1.2, 7.7)). These data suggest that active and perhaps passive smoke exposure may be important co-factors in HSIL development among HR-HPV positive women.