COMMENTARY

December 2004: The Year in Review -- Ob/Gyn & Women's Health

Ursula Snyder, PhD

Disclosures

January 24, 2005

Sexually Transmitted Infections and HIV/AIDS

A study published in 2004 indicates that on the basis of data from 2000, nearly half of all young Americans contracted an STI by age 25. Human papillomavirus (HPV) infection, trichomoniasis, and chlamydial infections accounted for most of these.[60]

Chlamydia. A study of the prevalence of chlamydial infection in young adults between 18 and 26 years of age revealed that nearly 5% of young women had chlamydial infection; black women had the highest prevalence -- nearly 14%.[61] Another study published in 2004 has found that DMPA was significantly associated with increased acquisition of cervical chlamydial and gonococcal infections.[62] A study by a group at the CDC showed that among persons with known Chlamydia exposure, consistent condom use significantly reduced prevalence.[63]

Human papillomavirus. A study that will be published in early January 2005 has found that HPV was detected in about 45% of sexually active teenage girls, 14 to 17 years of age, who attended a primary clinic in Indianapolis.[64] In this sample, 85% of the women were black, 11% were white, and 3% were Hispanic. High-risk subtypes were found in about 39% of the collected specimens, low-risk subtypes were found in about 20%, and many of the specimens contained multiple subtypes.

Syphilis. This year, the US Preventive Services Task Force (USPSTF) updated their guidelines for screening for syphilis and now strongly recommend screening tests for pregnant women. (See Medscape Medical News CME story.)

The United Nations annual AIDS epidemic update was released in December 2004. Worldwide, the number of women with HIV has increased during the past 2 years. According to the report, East Asia had the largest increase with 56%, followed by Eastern Europe and Central Asia with 48%. In sub-Saharan Africa, young women make up 75% of all those between 15 and 24 years of age living with HIV. (See Women and AIDS.)

In the United States, about 30% of 40,000 annual new HIV infections occur among women. The CDC has estimated that approximately 75% of women were infected through heterosexual sex. Of newly infected women, approximately 64% are black, 18% are white, 18% are Hispanic, and a small percentage are members of other racial/ethnic groups.[65]

This past summer, results on an intervention uniquely designed to reduce HIV transmission in black adolescent girls were published.[66] The intervention consisted of four 4-hour group sessions that emphasized ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The comparison emphasized exercise and nutrition. The outcomes were reported as follows:

Using generalized estimating equation analyses over the 12-month follow-up, adolescents in the intervention were more likely to use a condom at last intercourse, less likely to have a new vaginal sex partner in the past 30 days, and more likely to apply condoms to sex partners and had better condom application skills, a higher percentage of condom-protected sex acts, fewer unprotected vaginal sex acts, and higher scores on measures of mediators. Promising effects were also observed for chlamydia infections and self-reported pregnancy.

Take note, this success was achieved with only 16 hours of education! (See Medscape Medical News CME story.)

The CDC has also estimated that on the order of 300 infants are born infected with HIV annually in the United States. A multicenter study, the Mother-Infant Rapid Intervention At Delivery (MIRIAD) study published this summer indicates that rapid HIV testing is feasible and accurate.[67] (See Medscape Medical News CME story.) In an editorial comment on the study,[68] Harvard researchers write:

These results have important implications for individual US patients, but their real potential for a substantial public health impact on mother-to-child HIV transmission depends on being able to translate these results into effective point-of-care screening programs for women in sub-Saharan Africa...The ability to screen women rapidly for HIV infection and offer antiretroviral therapy has the potential to prevent HIV transmission to hundreds of thousands of infants that otherwise might occur.

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