Treponemal specific tests for the serodiagnosis of syphilis. Syphilis and HIV Study Group.

OBJECTIVES: To determine the rate of concordance of the Microhemagglutination Assay for Antibodies to T. pallidum (MHA-TP) and the Fluorescent Treponemal Antibody-Absorption test (FTA-ABS) prior to therapy in patients with early stage syphilis and to assess the incidence of and associated risk factors for seroreversion of these treponemal specific tests during the first year after therapy for early syphilis. DESIGN: Multicenter, prospective, cohort treatment study of patients with early syphilis. METHODS: Five hundred twenty-five patients were enrolled in a study to evaluate the response of early syphilis to either benzathine penicillin 2.4 million units intramuscularly once or this therapy plus amoxicillin 2 g and probenecid 500 mg orally both three times daily for 10 days. Serologic and clinical follow-up was conducted at intervals over 1 year. MHA-TP and FTA-ABS tests were performed on serologic specimens from each patient visit. RESULTS: Enrollment specimens showed 5% discordant MHA-TP and FTA-ABS results with 85% of these demonstrating a nonreactive MHA-TP. This occurred most commonly in primary syphilis. In patients who had a 1-year serologic follow-up with FTA-ABS or MHA-TP, seroreversion occurred in 9% and 5% of cases, respectively. No association between HIV-seropositivity and TST seroreversion was demonstrated. CONCLUSION: The MHA-TP may be less sensitive than the FTA-ABS for identifying patients with primary syphilis. Treponemal specific tests may become nonreactive during the first year after therapy for early syphilis.

Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility.

OBJECTIVE: We evaluated the relationship between delayed care of symptomatic pelvic inflammatory disease and impaired fertility. STUDY DESIGN: We used data from a cohort of women with clinically recognized pelvic inflammatory disease. Case patients were women with either ectopic pregnancy or infertility (n = 76); controls were women with intrauterine pregnancies (n = 367). RESULTS: Women who delayed seeking care for pelvic inflammatory disease were three times more likely to experience infertility or ectopic pregnancy than women who sought care promptly after adjustment for age, organism, year of diagnosis, and history of recent gynecologic events (95% confidence interval = 1.27, 6.11). This association was strongest for women with chlamydia; 17.8% (18/101) of those who delayed seeking care had impaired fertility, whereas 0.0% (0/13) of those who sought care promptly suffered known sequelae. CONCLUSIONS: Women with pelvic inflammatory disease who delay seeking care are at increased risk for infertility and ectopic pregnancy. Furthermore, our data suggest that prompt evaluation and treatment of chlamydial pelvic inflammatory disease can prevent these sequelae.

Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results.

From 1960 10 1984, 2,501 women underwent diagnostic laparoscopy (index laparoscopy) because of a clinical suspicion of acute pelvic inflammatory disease (PID). Of these women, 1,844 had abnormal laparoscopic findings (patients) and 657 had normal findings (control subjects). The reproductive events after index laparoscopy of 1,732 patients and 601 control subjects were followed. The patients and control subjects were followed for a total of 13,400 and 3,958 woman-years, respectively. During the follow-up period, 1,309 (75.6%) of the patients and 451 (75.0%) of the control subjects attempted to conceive. Of these women, 209 (16.0%) of the patients and 12 (2.7%) of the control subjects failed to conceive. A total of 141 (10.8%) of the patients and 0 (0%) of the control subjects had confirmed tubal factor infertility, 21 (1.6%) of the patients and 3 (0.7%) control subjects had other causes of infertility, and 47 (3.6%) patients and 9 (2.0%) control subjects did not have a complete infertility evaluation. Additional information on tubal morphology (hysterosalpingography, laparoscopy, or laparotomy) in women from couples for whom evaluation was incomplete indicated that 165 (12.2%) patients and 4 (0.9%) of the control subjects had abnormal tubal function or morphology after index laparoscopy. Tubal factor infertility after PID was associated with number and severity of PID episodes. The ectopic pregnancy rate for first pregnancy after index laparoscopy was 9.1% among the patients and 1.4% among control subjects.

Breast-feeding among women attending women, infants, and children clinics in Georgia, 1987.

Breast-feeding is an important determinant of the health and nutritional status of children, particularly in lower socioeconomic populations. A major goal of the Georgia Special Supplemental Food Program for Women, Infants, and Children (WIC) is to increase the practice of breast-feeding among the women it serves. Breast-feeding practices were determined among a random sample of 404 women from a cohort of 2010 who attended WIC prenatal clinics in Georgia in 1986 and were expected to deliver in February 1987. Respondents were interviewed 6 months postpartum. Of these women, 24% initially breast-fed, but only 6% continued for 6 months or longer. The initiation of breast-feeding was associated with greater maternal education and with being married. The adjusted odds of breast-feeding for mothers who were married or living as married were 3.0 (95% confidence interval, 1.7 to 5.3) times greater than for mothers who were not married or living as married. Mothers with more than 12 years, 12 years, or 10 to 11 years of education were 5.2 (1.8 to 15.3), 2.7 (1.0 to 6.9), and 2.5 (0.9 to 6.9) times more likely, respectively, to breast-feed than mothers with 9 or fewer years of education. After adjustment was made for marital status and education, the remaining variables (ethnicity, parity, age, and employment status) did not influence the initiation of breast-feeding in this low-income population. The need for vigorous promotion of breast-feeding by the Georgia WIC program is emphasized by the low rate of initiation and short duration of breast-feeding in this low-income population.

Sex partner recruitment as risk factor for STD: clustering of risky modes.

Nine hundred and fourteen heterosexual persons who requested care at STD clinics in South Carolina responded to self-administered questions on STD history, socio-demographic characteristics, number of sexual partners, and sexual partner choice. These data and the current STD diagnosis were analysed using multivariate techniques. Sexual behaviors of men and women were different. Men reported greater number of partners and less discriminating sex partner recruitment patterns. Age, rural/urban residence, race, and number of sex partners were independent predictors of gonorrhea infection among men. Among women, age, rural/urban residence, and not knowing the most recent sex partner very well emerged as independent predictors of infection.

Recurrence of low birth weight in siblings.

The recurrence of low birth weight (LBW, less than 2500 g) in full siblings was studied in 3286 singleton infants born between 1966 and 1986 to 1677 male U.S. Army veterans who were part of a nationwide health study. Hospital of birth medical records were abstracted for these children. Mean birth weights, risks of LBW, LBW occurring with preterm delivery (less than 37 weeks) (LBW/p), and LBW in term infants (LBW/t) were examined in successive singleton siblings according to LBW status of prior siblings. The risk of LBW in infants who had prior siblings with LBW was 9.9%, compared with a risk of 2.8% in infants who had prior siblings without LBW (OR = 3.8, 95% CI 2.0-7.3). The excess recurrence of LBW was specifically due to LBW/p. Infants with prior siblings with LBW/p were at high tisk of LBW/p (OR = 9.2, CI 4.4-19.6) but not of LBW/t (OR = 2.0, CI 0.1-9.1). Using modified logistic regression techniques that incorporate familial risks and the effects of other risk factors, the excess sibling recurrence risk of LBW and LBW/p could not be explained by the tendency for recurrence in siblings of other risk factors for LBW, such as pregnancy complications, maternal illnesses, and birth defects. Although the familial factors involved in LBW may or may not be genetic in nature, such factors need to be investigated in epidemiologic studies of LBW and prematurity.

Recurrence risk of neonatal hyperbilirubinemia in siblings.

The recurrence of neonatal hyperbilirubinemia (NHB) in full siblings was studied in 3301 live infants born between 1966 and 1986 to 1669 male US Army veterans who were part of a nationwide health study. The study population included 580 sibships with one infant, 679 with two, and 410 with three or more. Hospital of birth medical records were abstracted on these children. Neonatal hyperbilirubinemia was defined as present if the recorded peak bilirubin level was greater than 205 mumol/L in the absence of hemolytic disease of the newborn. The risk of NHB in newborns who have one or more prior sibs with NHB was 3.1 times higher than that of newborns who have prior sibs without NHB (10.3% vs 3.6%). Simultaneous adjustment for risk factors for NHB, such as feeding patterns, year of birth, maternal obstetric events, and infant health variables, did not explain the excess risk of NHB in sibs. Moreover, the risk of severe NHB (peak bilirubin level, greater than 257 mumol/L) in newborns who have one or more prior sibs with severe NHB was 12.5 times higher than that of newborns who have prior sibs without severe NHB (10.5% vs 0.9%). Separate analyses in sibships where all sibs were breast-fed and in sibships where all sibs were bottle-fed gave similar results. These data clearly suggest the familial nature of NHB. The higher risk of recurrence of NHB in sibs does not seem to be due to known environmental risk factors for NHB.