Incidence and risk factors for acquisition of sexually transmitted diseases in heterosexuals with multiple partners.

BACKGROUND AND OBJECTIVES: The incidence of four STDs that are mainly transmitted during vaginal intercourse, and risk factors for acquisition during follow-up were studied in a cohort of heterosexuals with multiple partners in Amsterdam, the Netherlands. These heterosexuals with > or = 5 different sexual partners in the preceding 6 months were recruited from an STD clinic and participated voluntarily in a longitudinal HIV study between 1987 and 1991. STUDY DESIGN: Using survival techniques, the authors analyzed data on general characteristics, sexual behavior, reported and diagnosed STDs of 155 men and 234 women participating at least twice in the HIV study and returning regularly. RESULTS: The majority of women were prostitutes and the majority of men were clients of prostitutes. For men and women, the 2-year cumulative incidence were 2.7% (95% confidence interval [95% CI] 0.9-8.3) and 0.8% (95% CI 0.1-5.8), respectively, for syphilis, 8.5% (95% CI 3.9-18.0) and 5.3% (95% CI 2.6-10.8) for gonorrhea, 20.2% (95% CI 12.5-31.9) and 31.9% (95% CI 23.7-42.2) for Chlamydia trachomatis infection, and 24.5% (95% CI 17.3-34.2) for trichomoniasis (examination in women only). Among men, STD(s) diagnosed at entry was found to be an independent predictor of infection with any of these STDs during follow-up (relative hazard (RH) = 2.58, 95% CI 1.18-5.64). Among women, risk factors were age < or = 25 years (RH = 1.82, 95% CI 1.13-2.19) and current report of commercial unprotected vaginal contacts (RH = 2.19, 95% CI 1.11-4.13). Among women, trichomoniasis during follow-up was predicted by current report of commercial contacts (RH = 2.59, 95% CI 1.16-5.79). C. trachomatis infection in women was associated with native country outside the Netherlands (RH = 2.47, 95% CI 1.38-4.43), reported history of STDs in the 4 months before the study (RH = 2.92, 95% CI 1.39-6.14) and age < or = 25 years (RH = 1.90, 95% CI 1.06-3.40). CONCLUSIONS: This study shows that STDs were common among this group of heterosexuals, despite regularly participating in the HIV study in which consistent condom use was promoted. Prevention efforts should be intensified for men and women having commercial sexual contacts, young women, and individuals with a history of STDs.

Regional distribution and incidence of human papillomavirus infections among heterosexual men and women with multiple sexual partners: a prospective study.

OBJECTIVE: To assess prevalence, incidence and potential risk factors of human papillomavirus (HPV) infection among heterosexual men and women with multiple partners and to identify niches of HPV-infection. DESIGN: A prospective study of heterosexual men and women with multiple partners attending an STD clinic as participants in a study on HIV from May 1988 until January 1991. Routine STD examination and physical examination using colposcopy were performed, interviews with standardised questionnaires were administered. Specimens for HPV DNA detection by polymerase chain reaction were collected from multiple sites of the genital, anorectal and oral regions. In women cervical cytology was performed. SETTING: The STD Clinic of the Municipal Health Service of Amsterdam. PARTICIPANTS: 162 women and 85 men entered the study, 110 women and 48 men were followed up. RESULTS: At entry of the study 37 (23%) women and 24 (28%) men were found positive for HPV DNA at any site. Only in one woman was oral presence of HPV DNA found during follow-up. Abnormal cervical cytology was observed in four women. In multivariate analysis, diagnosis of condylomata [odds ratio (OR) 5.61, 95% confidence interval (CI) 1.86 to 16.90)], reporting genital dermatological abnormalities (OR 3.72, 95% CI 1.38 to 9.99) and age (OR per year 0.93, 95% CI 0.88 to 0.99) predicted independently the presence of HPV DNA in women at entry of the study. In women 59 of the 99 (60%) HPV infections were observed in the genital region and 40% in the anorectal region: in men these figures were 65% and 35%, respectively. The incidence of HPV infection was 47.1 and 50.5 per 100 person-years for women and men respectively. At least 20/99 (20%) infections in women were intermediate or long persistent and only 3/48 (6%) HPV infections in men (P = 0.03). No risk factor for persistency could be determined, either in women or in men. CONCLUSIONS: HPV infection was found to be a multicentric genital and/or anorectal event both in women and men. The oral presence of HPV DNA was detected only once in one of the participants. In women persistent HPV infection was more common than in men. Independent predictors for presence of HPV DNA in women were diagnosis of condylomata acuminata, reporting genital dermatologic abnormalities and age. Incidence of HPV infection in women turned out to be 47.1 infections per 100 person-years and for men 50.5 per 100 person-years.

Hepatitis B virus infection in a group of heterosexuals with multiple partners in Amsterdam, The Netherlands: implications for vaccination?

The aim of the study was to assess prevalence and incidence of hepatitis B virus (HBV) infection among heterosexual men and women with multiple partners attending a sexually transmitted disease (STD) clinic and to establish risk factors of HBV infection in order to consider immunisation for those subjects. A prospective study of heterosexual men and women selected on having multiple partners and presenting to an STD clinic as new patients was carried out from October 1987 through December 1989. Follow-up continued until December 1990 at the STD clinic of the Municipal Health Service of Amsterdam. Five hundred ninety-eight men and women entered the study. More than 70% of both women and men had had commercial sexual partners in the last 5 years. Three hundred eighty-one participants were born in HBV low endemic countries, 205 came from HBV intermediate endemicity regions. The prevalence of HBV markers in both men and women from low endemic regions was 10%, and for men and women from middle endemic regions 42% and 19%, respectively. Logistic regression analysis showed that number of years involved in commercial sex was an independent risk factor in male participants from HBV low endemic regions (odds ratio [OR] 1.10 per year) and for women sexual contact with men at high risk of HBV infection (OR 2.59).(ABSTRACT TRUNCATED AT 250 WORDS)

Perceiving AIDS-related risk: accuracy as a function of differences in actual risk.

This study investigates the perceived risk of an HIV infection. Cognitive antecedents of biases in risk perception and their effects on behavioral intentions were investigated. The purpose of this study was to determine the relative accuracy of risk assessments for samples that vary in actual risk for AIDS. Subjects were citizens of Amsterdam, heterosexuals with private partners, gay men, and heterosexuals with prostitution partners. Although optimistically biased in all samples, perceptions of risk were related to previous risk behavior in high-risk samples only. Pessimism was more pronounced in samples higher at risk. Optimists had lower levels of previous risk behavior and increased intentions to adopt safe sex practices. Ss in samples higher at risk had, therefore, relatively adequate perceptions of risk.

Prevalence of human papillomavirus infections among heterosexual men and women with multiple sexual partners.

A prospective study of 65 men and 111 women with multiple heterosexual partners was designed to assess the prevalence and potential risk factors of genital human papillomavirus (HPV) infections. In addition, the HPV reservoir in genital, rectal, and oral mucosa was examined. The specimens for the detection of HPV DNA were taken from different sites such as the urethra and coronal sulcus (men), cervix and labia minora (women), anus, rectum, tongue, and buccal mucosa (both men and women). Women underwent speculum examination and colposcopic evaluation of the anogenital region, and a smear for routine cytological classification was also taken. In men, the anogenital region was examined clinically and colposcopically. The polymerase chain reaction (PCR) was used for the detection of HPV types 6/11, 16, 18, and 33. A high prevalence of HPV infection at one or more sites was detected, in 32% of the male and in 23% of the female participants. Seventeen percent of the male distal urethral specimens were positive for HPV DNA. From the female cervical specimens 14% were found positive. Ten proctal specimens (five men and five women) were positive for HPV DNA without any discernible lesion. The persons from whom these samples were taken denied anal insertive intercourse. No oral manifestation of HPV infection was detected. In both men and women a difference between HPV DNA-positive and -negative persons was not found in relation to known risk factors associated HPV infection.(ABSTRACT TRUNCATED AT 250 WORDS)

The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals.

OBJECTIVES: To study risk factors for sexually transmitted diseases (STDs) and sexual behaviour. Especially to assess whether there is a higher risk of being infected with STDs among ethnic minorities, and if so for what reasons. SETTING: STD-clinic of the Municipal Health Service of Amsterdam, the Netherlands. SUBJECTS: Cross-sectional study of heterosexuals (255 men and 343 women) with multiple sexual partners, who participated between October 1987 and January 1990. RESULTS: Besides STD-related complaints, ethnicity was an important independent predictor of one or more diagnosed genital STDs. STD-prevalence was higher among men born in Turkey (47%, OR = 3.4) and men born in Surinam (36%, OR = 2.1), compared with Dutch men (21%). While Turkish men had mainly riskful sexual behaviour with prostitutes, Surinam men had more often riskful sexual contact with private partners. Among women, STD prevalence was higher among West-European (38%, OR = 2.3) and Latin-American women (30%, OR = 1.6), compared with Dutch women (21%). Latin American women had more often riskful sexual contact with clients; sexual behaviour of West-European women was riskful with both clients and private partners. CONCLUSIONS: Prevention activities should be directed at specific sexual and ethnic groups, sources of information should be carefully selected, and some groups should be addressed differently with regard to language but to content as well.

Prevalence of hepatitis C virus infections among heterosexuals with multiple partners.

A study among heterosexual men and women with multiple sexual partners was carried out to assess the seroprevalence of antibody against hepatitis C virus (HCV). The 468 participants were recruited among visitors to the Clinic for Sexually Transmitted Diseases in Amsterdam. Sera were tested by an enzyme-linked immunosorbent assay (ELISA; Ortho), a recombinant-based immunoblot assay (RIBA; Chiron), and the polymerase chain reaction (PCR). A total of 468 persons were tested, and seven (1.5%) were found ELISA positive. Another 25 (5%) were ELISA indeterminate. Six of the seven ELISA-positive cases were RIBA positive. Further serum samples from five HCV ELISA-positive persons were tested by PCR, and four were found to be positive. The HCV ELISA-positive/RIBA-indeterminate reaction was PCR negative. None of the 17 RIBA-tested sera of the ELISA-indeterminate group yielded a positive result. There was a good correlation between an ELISA optical density/cut-off ratio greater than 2 and a positive RIBA result. The risk factor for HCV appeared to be the type of sexual partner, i.e., belonging to a "high-risk" group for human immunodeficiency virus infection and origin from hepatitis B-endemic countries. It is concluded that HCV may be transmitted through heterosexual contact but probably with low efficiency.

Limited changes in sexual behaviour of heterosexual men and women with multiple partners in The Netherlands.

To study changes in sexual behaviour, heterosexuals with multiple sexual partners were recruited through an STD-clinic and asked to return every 4 months for follow-up. Between October 1987 and June 1989, 512 heterosexuals entered the study and 140 men and 200 women had at least one follow-up visit. No changes were found between 3 visits in the kind of sexual techniques practiced. Condom use during vaginal intercourse with commercial partners (prostitutes or clients) was relatively high and remained high, but was low and remained at that level with private partners. Men and women reduced their number of private sexual partners by 50%, but the decline in the number of commercial partners was nonsignificant. Although more information is needed about the underlying social-psychological aspects of behavioural change, it seems necessary to redesign prevention activities to stress the effectiveness of condoms and to encourage condom use especially among heterosexuals with multiple private partners.

Prevalence of human T-cell leukemia virus antibody among heterosexuals living in Amsterdam, The Netherlands.

To determine the heterosexual spread of human T-cell leukemia virus (HTLV-I) infections, a cohort of 472 individuals with more than 5 heterosexual partners in the 6 months before entry was studied. They were recruited from visitors to the Clinic for Sexually Transmitted Diseases of the Municipal Health Service. Half of the study group was born in the Netherlands, 13% in Surinam or the Dutch Antilles, and 8% in Turkey or Morocco. Seventy percent were involved in commercial sex. Three persons were positive for HTLV-I, with serum antibodies against p19, p24, p28, gp46, and gp61 in Western immunoblot (WIB) and radio-immunoprecipitation assay (RIPA). Two of them originated from Surinam and the third was a Dutch woman. Two other individuals were HIV-positive, 19% had hepatitis B virus (HBV)-markers and 6% Treponema pallidum reacted in the hemagglutination assay (TPHA). It is concluded that HTLV-I circulates in the Surinamese population in Amsterdam and there was no evidence of appreciable heterosexual transmission.

[HIV prevalence among heterosexual subjects with multiple partners in Amsterdam]. / HIV-prevalentie onder heteroseksuelen met veel wisselende partners in Amsterdam.

To study the prevalence of HIV-infection among heterosexuals with multiple partners, participants were recruited from a STD clinic in Amsterdam. In 1988, 785 visitors met the selection criteria, of whom 361 (46%) finally participated. An HIV prevalence of 2/361 (0.6%) was found among participants. To test representativity, participants and refusers were compared on demographic characteristics and prevalence of STDs. Male refusers were on average younger, had on average fewer partners and relatively more often had a foreign nationality. Female refusers had on average fewer partners. No differences were found in the prevalence of STDs between participants and refusers. Because of the high refusal rate and differences between participants and refusers, the HIV prevalence found is not representative of heterosexuals with multiple partners.

Heterosexuals at risk for HIV: differences between private and commercial partners in sexual behaviour and condom use.

To study the prevalence of HIV and other sexually transmitted diseases (STDs), sexual behaviour and condom use among heterosexuals, 193 women and 157 men entered a longitudinal study. Participants were recruited through an STD clinic, and had had five or more heterosexual partners in the preceding 6 months but had no other AIDS risk factors. Participants were divided in groups with respect to private and/or commercial sexual partners. One hundred and thirty-six (71%) women worked as prostitutes and had, on average, 115 customers a month, and 99 (63%) men had visited, on the average, eight prostitutes in the past 4 months. One hundred and seventy-one (89%) women (114 prostitutes) had had, on average, four partners, and 112 (78%) men (of whom 64 had visited prostitutes) had had, on average, seven private partners in the past 4 months. Vaginal intercourse was often or always reported by all participants whilst anal contact was seldom reported. Non-high-risk sexual techniques (for example, oro-oral, masturbation) were practised more frequently with private than with commercial partners (P less than 0.001). Although no differences were found in the frequency of practising high-risk sexual techniques (for example, vaginal, ano-genital), differences were found for frequency of condom use. Condom use during vaginal intercourse was reported more frequently with commercial than with private partners (P less than 0.01). However, if the number of partners is taken into account, prostitutes had unprotected vaginal intercourse with an estimated average number of 160 partners in 4 months, which is far more than customers (seven) and men and women with private partners only (four).(ABSTRACT TRUNCATED AT 250 WORDS)

Influenza-like syndrome in homosexual men: a prospective diagnostic study.

In the course of a prospective study of the prevalence and incidence of infection with the human immunodeficiency virus (HIV) and risk factors for the acquired immune deficiency syndrome among 961 homosexual men, 97 initially HIV antibody seronegative men reported a febrile period lasting at least three days. In 60 of these men serological evidence for an infection was found: influenza A or B virus (17 men), HIV (14), Epstein-Barr virus (seven), parainfluenza virus type I, 11 or Ill (five), hepatitis A virus (three), cytomegalovirus (three), adenovirus (two), respiratory syncytial virus (two), hepatitis B virus (one) and Toxoplasma gondii (one). Combined infections were found in five men. A total of 17 men seroconverted for HIV antibody. The clinical symptoms of acute HIV infection closely resembled those of influenza A or B infection. Skin rashes also occurred frequently in men with HIV infection. HIV antibody seroconversion gives rise to a number of different symptoms and primary HIV infection should be included in the differential diagnosis of prolonged febrile illness in those at risk of HIV infection.