Melinda Tanzola

ATLANTA – New estimates from the Centers for Disease Control and Prevention indicate that gay and bisexual men are 44 times more likely than other men, and more than 40 times more likely than women, to be diagnosed with HIV infection.

According to data presented at a CDC Conference on STD Prevention, the rate of new HIV diagnoses among men who have had sex with men in the past 5 years is 44-86 times that of other men and 40-77 times that of women.

Rates of primary and secondary syphilis are 46-89 times higher in gay and bisexual men than in other men, with rates of approximately 121 (range, 91-173) per 100,000 versus 2 per 100,000 individuals, respectively. Syphilis rates are 71-135 times higher in gay and bisexual men than in women, who were diagnosed at a rate of 1 per 100,000.

Although the disproportionate burden of HIV and syphilis in gay and bisexual men is already known, the actual disease rates in these men, compared with other populations, have been difficult to determine because there has been no consensus estimate or single data source for the size of the gay and bisexual population in the United States, explained David W. Purcell, Ph.D., of the CDC in his presentation.

Therefore, in order to estimate national disease rates, Dr. Purcell and his colleagues at the CDC first undertook an analysis to determine the size of the U.S. gay and bisexual population.

They found that gay and bisexual men account for about 4.0% (range, 2.8%-5.8%) of U.S. males aged 13 years and older.

ATLANTA – New estimates from the Centers for Disease Control and Prevention indicate that gay and bisexual men are 44 times more likely than other men, and more than 40 times more likely than women, to be diagnosed with HIV infection.

According to data presented at a CDC Conference on STD Prevention, the rate of new HIV diagnoses among men who have had sex with men in the past 5 years is 44-86 times that of other men and 40-77 times that of women.

Rates of primary and secondary syphilis are 46-89 times higher in gay and bisexual men than in other men, with rates of approximately 121 (range, 91-173) per 100,000 versus 2 per 100,000 individuals, respectively. Syphilis rates are 71-135 times higher in gay and bisexual men than in women, who were diagnosed at a rate of 1 per 100,000.

Although the disproportionate burden of HIV and syphilis in gay and bisexual men is already known, the actual disease rates in these men, compared with other populations, have been difficult to determine because there has been no consensus estimate or single data source for the size of the gay and bisexual population in the United States, explained David W. Purcell, Ph.D., of the CDC in his presentation.

Therefore, in order to estimate national disease rates, Dr. Purcell and his colleagues at the CDC first undertook an analysis to determine the size of the U.S. gay and bisexual population.

They found that gay and bisexual men account for about 4.0% (range, 2.8%-5.8%) of U.S. males aged 13 years and older.

ATLANTA – New estimates from the Centers for Disease Control and Prevention indicate that gay and bisexual men are 44 times more likely than other men, and more than 40 times more likely than women, to be diagnosed with HIV infection.

According to data presented at a CDC Conference on STD Prevention, the rate of new HIV diagnoses among men who have had sex with men in the past 5 years is 44-86 times that of other men and 40-77 times that of women.

Rates of primary and secondary syphilis are 46-89 times higher in gay and bisexual men than in other men, with rates of approximately 121 (range, 91-173) per 100,000 versus 2 per 100,000 individuals, respectively. Syphilis rates are 71-135 times higher in gay and bisexual men than in women, who were diagnosed at a rate of 1 per 100,000.

Although the disproportionate burden of HIV and syphilis in gay and bisexual men is already known, the actual disease rates in these men, compared with other populations, have been difficult to determine because there has been no consensus estimate or single data source for the size of the gay and bisexual population in the United States, explained David W. Purcell, Ph.D., of the CDC in his presentation.

Therefore, in order to estimate national disease rates, Dr. Purcell and his colleagues at the CDC first undertook an analysis to determine the size of the U.S. gay and bisexual population.

They found that gay and bisexual men account for about 4.0% (range, 2.8%-5.8%) of U.S. males aged 13 years and older.

ATLANTA — Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18-24 years: 201 women from four women's health clinics and 101 women from a university class.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, and 5% were multiple races; this information was missing for the remaining 4%. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 women with HPV and 13 women with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.”

In an interview, Dr. Royer explained that many women thought that if the health care provider performs a Pap smear, they are being tested for STDs, including HPV (41%), gonorrhea (23%), chlamydia (26%), Trichomonas species (17%), syphilis (15%), herpes (14%), HIV/AIDS (2%), and “all STDs” (6%).

“If women think they are automatically being tested for STDs during their annual Pap smear … they would have no reason to ask to be tested.”

Disclosures: None was reported.

ATLANTA — Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18-24 years: 201 women from four women's health clinics and 101 women from a university class.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, and 5% were multiple races; this information was missing for the remaining 4%. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 women with HPV and 13 women with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.”

In an interview, Dr. Royer explained that many women thought that if the health care provider performs a Pap smear, they are being tested for STDs, including HPV (41%), gonorrhea (23%), chlamydia (26%), Trichomonas species (17%), syphilis (15%), herpes (14%), HIV/AIDS (2%), and “all STDs” (6%).

“If women think they are automatically being tested for STDs during their annual Pap smear … they would have no reason to ask to be tested.”

Disclosures: None was reported.

ATLANTA — Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18-24 years: 201 women from four women's health clinics and 101 women from a university class.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, and 5% were multiple races; this information was missing for the remaining 4%. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 women with HPV and 13 women with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.”

In an interview, Dr. Royer explained that many women thought that if the health care provider performs a Pap smear, they are being tested for STDs, including HPV (41%), gonorrhea (23%), chlamydia (26%), Trichomonas species (17%), syphilis (15%), herpes (14%), HIV/AIDS (2%), and “all STDs” (6%).

“If women think they are automatically being tested for STDs during their annual Pap smear … they would have no reason to ask to be tested.”

Disclosures: None was reported.

An increase in breastfeeding rates in the United States could save billions of dollars and prevent nearly a thousand infant deaths each year, according to the findings of a recent cost analysis.

If 90% of U.S. families could exclusively breastfeed infants for the first 6 months of life, the United States would save $13 billion each year and prevent an excess 911 deaths, 95% of which would be in infants, said Dr. Melissa Bartick of the Cambridge Health Alliance and Harvard Medical School, Boston, and Arnold Reinhold of the Alliance for the Prudent Use of Antibiotics, both of Boston (Pediatrics 2010;125:e1048-56). An 80% compliance rate would save $10.5 billion annually and prevent 741 deaths.

These estimates are substantially higher than those reported in a 2001 publication, which stated the economic impact of suboptimal breastfeeding at $3.6 billion. The current study, which used 2005 breastfeeding rates and 2007 dollars, included more health conditions and included both direct and indirect medical costs.

Premature deaths accounted for 74% of the costs. The most costly conditions, excluding deaths, were otitis media, atopic dermatitis, childhood obesity, and lower respiratory tract infections.

According to 2005 data from the Centers for Disease Control and Prevention, 32% of infants are exclusively breastfed at 3 months of age and 12% are exclusively breastfed at 6 months. Another 43% of infants are receiving any breast milk at 6 months, and extrapolated data suggest that 59% are receiving any breast milk at 3 months.

To determine the excess costs of suboptimal breastfeeding, the authors first calculated the number of breastfed and nonbreastfed infants in the United States by multiplying breastfeeding rates by the number of births in 2005. They then calculated the incidence of each disease for each group based on the 2007 Agency for Healthcare Research and Quality report, which provides risk ratios for various diseases in breastfed versus nonbreastfed infants.

Compared with exclusive formula feeding, exclusive breastfeeding for 3 months reduces the risk of otitis media by half, necrotizing enterocolitis and related deaths by 58%, and atopic dermatitis by 32%.

Exclusive breastfeeding for 4 months reduces the risk of hospitalizations and deaths from lower respiratory tract infections by 72%. Exclusive breastfeeding for 6 months reduces the risk of gastroenteritis by 64%.

Any breastfeeding for 3 months reduces the risk of childhood asthma and related deaths by 27%, type 1 diabetes by 23%, type 1 diabetes–related deaths by 25%, and childhood obesity by 7%.

Any breastfeeding for 6 months is associated with a 36% reduction in the risk of sudden infant death syndrome, a 19% reduction in the risk of childhood acute lymphocytic leukemia and related deaths, and a 15% reduction in the risk of acute myelogenous leukemia and related deaths.

Dr. Bartick and Mr. Reinhold explained that their study was limited by inconsistencies in some of the cost and breastfeeding duration assumptions. To compensate for these limitations, the researchers erred on the conservative side of their estimates.

“We believe that true costs are higher,” they concluded. “Action to improve breastfeeding rates, duration, and exclusivity, including creation of a national infrastructure to support breastfeeding, could be cost-effective.”

The authors reported no financial relationships relevant to this article.

An increase in breastfeeding rates in the United States could save billions of dollars and prevent nearly a thousand infant deaths each year, according to the findings of a recent cost analysis.

If 90% of U.S. families could exclusively breastfeed infants for the first 6 months of life, the United States would save $13 billion each year and prevent an excess 911 deaths, 95% of which would be in infants, said Dr. Melissa Bartick of the Cambridge Health Alliance and Harvard Medical School, Boston, and Arnold Reinhold of the Alliance for the Prudent Use of Antibiotics, both of Boston (Pediatrics 2010;125:e1048-56). An 80% compliance rate would save $10.5 billion annually and prevent 741 deaths.

These estimates are substantially higher than those reported in a 2001 publication, which stated the economic impact of suboptimal breastfeeding at $3.6 billion. The current study, which used 2005 breastfeeding rates and 2007 dollars, included more health conditions and included both direct and indirect medical costs.

Premature deaths accounted for 74% of the costs. The most costly conditions, excluding deaths, were otitis media, atopic dermatitis, childhood obesity, and lower respiratory tract infections.

According to 2005 data from the Centers for Disease Control and Prevention, 32% of infants are exclusively breastfed at 3 months of age and 12% are exclusively breastfed at 6 months. Another 43% of infants are receiving any breast milk at 6 months, and extrapolated data suggest that 59% are receiving any breast milk at 3 months.

To determine the excess costs of suboptimal breastfeeding, the authors first calculated the number of breastfed and nonbreastfed infants in the United States by multiplying breastfeeding rates by the number of births in 2005. They then calculated the incidence of each disease for each group based on the 2007 Agency for Healthcare Research and Quality report, which provides risk ratios for various diseases in breastfed versus nonbreastfed infants.

Compared with exclusive formula feeding, exclusive breastfeeding for 3 months reduces the risk of otitis media by half, necrotizing enterocolitis and related deaths by 58%, and atopic dermatitis by 32%.

Exclusive breastfeeding for 4 months reduces the risk of hospitalizations and deaths from lower respiratory tract infections by 72%. Exclusive breastfeeding for 6 months reduces the risk of gastroenteritis by 64%.

Any breastfeeding for 3 months reduces the risk of childhood asthma and related deaths by 27%, type 1 diabetes by 23%, type 1 diabetes–related deaths by 25%, and childhood obesity by 7%.

Any breastfeeding for 6 months is associated with a 36% reduction in the risk of sudden infant death syndrome, a 19% reduction in the risk of childhood acute lymphocytic leukemia and related deaths, and a 15% reduction in the risk of acute myelogenous leukemia and related deaths.

Dr. Bartick and Mr. Reinhold explained that their study was limited by inconsistencies in some of the cost and breastfeeding duration assumptions. To compensate for these limitations, the researchers erred on the conservative side of their estimates.

“We believe that true costs are higher,” they concluded. “Action to improve breastfeeding rates, duration, and exclusivity, including creation of a national infrastructure to support breastfeeding, could be cost-effective.”

The authors reported no financial relationships relevant to this article.

An increase in breastfeeding rates in the United States could save billions of dollars and prevent nearly a thousand infant deaths each year, according to the findings of a recent cost analysis.

If 90% of U.S. families could exclusively breastfeed infants for the first 6 months of life, the United States would save $13 billion each year and prevent an excess 911 deaths, 95% of which would be in infants, said Dr. Melissa Bartick of the Cambridge Health Alliance and Harvard Medical School, Boston, and Arnold Reinhold of the Alliance for the Prudent Use of Antibiotics, both of Boston (Pediatrics 2010;125:e1048-56). An 80% compliance rate would save $10.5 billion annually and prevent 741 deaths.

These estimates are substantially higher than those reported in a 2001 publication, which stated the economic impact of suboptimal breastfeeding at $3.6 billion. The current study, which used 2005 breastfeeding rates and 2007 dollars, included more health conditions and included both direct and indirect medical costs.

Premature deaths accounted for 74% of the costs. The most costly conditions, excluding deaths, were otitis media, atopic dermatitis, childhood obesity, and lower respiratory tract infections.

According to 2005 data from the Centers for Disease Control and Prevention, 32% of infants are exclusively breastfed at 3 months of age and 12% are exclusively breastfed at 6 months. Another 43% of infants are receiving any breast milk at 6 months, and extrapolated data suggest that 59% are receiving any breast milk at 3 months.

To determine the excess costs of suboptimal breastfeeding, the authors first calculated the number of breastfed and nonbreastfed infants in the United States by multiplying breastfeeding rates by the number of births in 2005. They then calculated the incidence of each disease for each group based on the 2007 Agency for Healthcare Research and Quality report, which provides risk ratios for various diseases in breastfed versus nonbreastfed infants.

Compared with exclusive formula feeding, exclusive breastfeeding for 3 months reduces the risk of otitis media by half, necrotizing enterocolitis and related deaths by 58%, and atopic dermatitis by 32%.

Exclusive breastfeeding for 4 months reduces the risk of hospitalizations and deaths from lower respiratory tract infections by 72%. Exclusive breastfeeding for 6 months reduces the risk of gastroenteritis by 64%.

Any breastfeeding for 3 months reduces the risk of childhood asthma and related deaths by 27%, type 1 diabetes by 23%, type 1 diabetes–related deaths by 25%, and childhood obesity by 7%.

Any breastfeeding for 6 months is associated with a 36% reduction in the risk of sudden infant death syndrome, a 19% reduction in the risk of childhood acute lymphocytic leukemia and related deaths, and a 15% reduction in the risk of acute myelogenous leukemia and related deaths.

Dr. Bartick and Mr. Reinhold explained that their study was limited by inconsistencies in some of the cost and breastfeeding duration assumptions. To compensate for these limitations, the researchers erred on the conservative side of their estimates.

“We believe that true costs are higher,” they concluded. “Action to improve breastfeeding rates, duration, and exclusivity, including creation of a national infrastructure to support breastfeeding, could be cost-effective.”

The authors reported no financial relationships relevant to this article.

ATLANTA — About one in six Americans aged 14–49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr. P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999–2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988–1994.

The prevalence of HSV-2 increases with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more partners.

Biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans, Dr. Taylor explained. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection, and that HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

And because visible sores are not necessary for transmission, “many individuals are transmitting herpes to others without even knowing it,” Dr. Douglas said.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to this study, according to a spokesperson for the CDC.

'Many individuals are transmitting herpes to others without even knowing it.'

Source DR. DOUGLAS

ATLANTA — About one in six Americans aged 14–49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr. P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999–2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988–1994.

The prevalence of HSV-2 increases with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more partners.

Biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans, Dr. Taylor explained. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection, and that HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

And because visible sores are not necessary for transmission, “many individuals are transmitting herpes to others without even knowing it,” Dr. Douglas said.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to this study, according to a spokesperson for the CDC.

'Many individuals are transmitting herpes to others without even knowing it.'

Source DR. DOUGLAS

ATLANTA — About one in six Americans aged 14–49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr. P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999–2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988–1994.

The prevalence of HSV-2 increases with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more partners.

Biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans, Dr. Taylor explained. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection, and that HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

And because visible sores are not necessary for transmission, “many individuals are transmitting herpes to others without even knowing it,” Dr. Douglas said.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to this study, according to a spokesperson for the CDC.

'Many individuals are transmitting herpes to others without even knowing it.'

Source DR. DOUGLAS

Major Finding: Women who had never been tested were more than twice as likely as those who had been tested to respond that they felt embarrassed about discussing STD testing (OR, 2.37), that talking about STD testing is difficult (OR, 2.48), or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Data Source: A prospective survey on STD testing beliefs involving 302 women aged 18–24 years.

Disclosures: Dr. Royer said that she had no conflicts of interest.

ATLANTA — Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18–24 years.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, 5% were multiple races, and 4% unknown. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 with HPV and 13 with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.”

Regarding specific pathogens, participants thought that testing would include chlamydia (51%), gonorrhea (47%), syphilis (29%), Trichomonas species (21%), herpes simplex virus (28%), HPV (18%), HIV/AIDS (16%), and hepatitis B (13%).

In an interview, Dr. Royer explained that if women seeking STD testing believe that they are being tested for “all STDs,” they may inaccurately believe that they have tested negative for pathogens that have not been included, such as HIV or herpes.

Many women also thought that if the health care provider performs a Pap smear, they are being tested for STDs.

“It is striking that a quarter of women think that they are being tested for chlamydia and gonorrhea during a Pap smear,” Dr. Royer said.

Finally, many women believed that STDs could be detected by a visual inspection of the genital area.

Dr. Royer concluded that health care providers must be cognizant of women's discomfort in discussing their sexual health. “Providers should consider ways to help young women reframe the sexual health discussion from one of embarrassment to one of empowerment,” she concluded.

Major Finding: Women who had never been tested were more than twice as likely as those who had been tested to respond that they felt embarrassed about discussing STD testing (OR, 2.37), that talking about STD testing is difficult (OR, 2.48), or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Data Source: A prospective survey on STD testing beliefs involving 302 women aged 18–24 years.

Disclosures: Dr. Royer said that she had no conflicts of interest.

ATLANTA — Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18–24 years.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, 5% were multiple races, and 4% unknown. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 with HPV and 13 with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.”

Regarding specific pathogens, participants thought that testing would include chlamydia (51%), gonorrhea (47%), syphilis (29%), Trichomonas species (21%), herpes simplex virus (28%), HPV (18%), HIV/AIDS (16%), and hepatitis B (13%).

In an interview, Dr. Royer explained that if women seeking STD testing believe that they are being tested for “all STDs,” they may inaccurately believe that they have tested negative for pathogens that have not been included, such as HIV or herpes.

Many women also thought that if the health care provider performs a Pap smear, they are being tested for STDs.

“It is striking that a quarter of women think that they are being tested for chlamydia and gonorrhea during a Pap smear,” Dr. Royer said.

Finally, many women believed that STDs could be detected by a visual inspection of the genital area.

Dr. Royer concluded that health care providers must be cognizant of women's discomfort in discussing their sexual health. “Providers should consider ways to help young women reframe the sexual health discussion from one of embarrassment to one of empowerment,” she concluded.

Major Finding: Women who had never been tested were more than twice as likely as those who had been tested to respond that they felt embarrassed about discussing STD testing (OR, 2.37), that talking about STD testing is difficult (OR, 2.48), or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Data Source: A prospective survey on STD testing beliefs involving 302 women aged 18–24 years.

Disclosures: Dr. Royer said that she had no conflicts of interest.

ATLANTA — Many young women are uncomfortable talking to their health care providers about their sexual health and lack accurate information about the STD testing process, based on the results of a survey on STD testing beliefs.

In the study presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention, Dr. Heather R. Royer of the University of Wisconsin, Madison, recruited 302 women aged 18–24 years.

Participants were an average of 20 years old; 78% were white, 13% were nonwhite, 5% were multiple races, and 4% unknown. The group was well educated, with 75% having some college or technical school experience. Nearly two-thirds of participants (62%) had undergone any prior STD testing, with 13% (44 women) having been diagnosed with an STD, including 23 with HPV and 13 with chlamydia.

The vast majority of respondents (84%) said that they would rather not go to their family doctor for STD testing; 79% said that it is easier to talk with an STD testing specialist than with a family doctor. Moreover, 88% said that it is easier to talk with a female health care provider than a male.

Nearly a quarter of participants said that they feel embarrassed about talking with a health care provider about STD testing (23%) and that talking with a health care provider about STD testing is difficult (22%).

Dr. Royer found significant associations between never having been tested for STDs and reporting embarrassment about sexual health communication. Women who had never been tested were more than twice as likely as those who had been tested to respond that they feel embarrassed about discussing STD testing (odds ratio, 2.37); that talking about STD testing is difficult (OR, 2.48); or that filling out forms about their sexual past is embarrassing (OR, 2.06).

Women also lacked knowledge about the STD testing process: 41% assumed that STD testing includes screening for “all STDs.”

Regarding specific pathogens, participants thought that testing would include chlamydia (51%), gonorrhea (47%), syphilis (29%), Trichomonas species (21%), herpes simplex virus (28%), HPV (18%), HIV/AIDS (16%), and hepatitis B (13%).

In an interview, Dr. Royer explained that if women seeking STD testing believe that they are being tested for “all STDs,” they may inaccurately believe that they have tested negative for pathogens that have not been included, such as HIV or herpes.

Many women also thought that if the health care provider performs a Pap smear, they are being tested for STDs.

“It is striking that a quarter of women think that they are being tested for chlamydia and gonorrhea during a Pap smear,” Dr. Royer said.

Finally, many women believed that STDs could be detected by a visual inspection of the genital area.

Dr. Royer concluded that health care providers must be cognizant of women's discomfort in discussing their sexual health. “Providers should consider ways to help young women reframe the sexual health discussion from one of embarrassment to one of empowerment,” she concluded.

Type 2 diabetes screening is cost effective when started between the ages of 30 and 45 years and repeated every 3–5 years, according to a mathematical model.

According to the model, which simulated the effects of various screening strategies in a population of 325,000 nondiabetic 30-year-olds representative of the U.S. population, repeated routine screening would offer significant benefits over no screening, including reducing rates of myocardial infarction and diabetes-related microvascular complications (legal blindness, end-stage renal disease, or amputations) by three to nine events per 1,000 people each, and increasing the number of quality-adjusted life-years (QALY) by more than 50 years.

Screening would have a negligible effect on the incidence of stroke (preventing up to one event per 1,000 people), though most of the strategies evaluated in the study would prevent an estimated two to five deaths per 1,000 people (Lancet 2010 March 30 [doi:10.1016/S0140-6736(09)62162-0]).

In their study, Dr. Richard Kahn and his colleagues evaluated eight screening scenarios that included different starting ages (30, 45, or 60 years), different screening intervals (every 6 months, yearly, every 3 or 5 years), and strategies of screening the entire population versus screening only patients who reach a certain blood pressure threshold. There also was a control group.

All screening strategies reduced the time that individuals remained undiagnosed before the development of symptoms. The lead-time gained with each strategy over no screening ranged from 1.8 years for screening starting at age 60 years to 6.3 years for screening starting at age 30 years.

The investigators calculated the costs of these screening strategies using the Archimedes model, a large-scale, person-by-person model that incorporates physiology, disease, and health care system costs.

The cost-effectiveness of the strategies was reported in terms of cost per QALY, which factors in the duration individuals spend with a diabetes-related disorder and the estimated negative impact for each disorder.

Five of the eight strategies cost $10,500 or less per QALY, but differed in their benefit. “The appropriate choice of strategy would deliver the greatest benefit, while having a low cost per QALY,” explained Dr. Kahn, chief scientific and medical officer of the American Diabetes Association, and his coinvestigators. Therefore, they recommended starting screening at 30 or 45 years of age and repeating every 3–5 years.

Dr. Kahn and his associates noted that this type of age-specific screening would provide more than twice the QALY benefit of screening, because the cost of the office visit would be attributed to the visit for hypertension management.

In an editorial, Dr. Guy Rutten noted that these opportunistic screening strategies did carry the lowest cost per QALY. The current study “provides further evidence that screening for diabetes should be combined with screening for hypertension and lipid tests,” concluded Dr. Rutten of the University Medical Center Utrecht in the Netherlands (Lancet 2010 March 30 [doi:10.1016/S0140-6736(10)60455-2]).

Although this is not the first cost-effectiveness study to be done in diabetes, Dr. Kahn and his associates said, this analysis provides new information based on several factors: It incorporates sequential, rather than one-time, screening; it is based on a representative sample of the population in the United States; it assumes that patients with diabetes will receive treatment according to the most recent recommendations; it evaluates a range of screening strategies; and it utilizes the Archimedes model, which has been validated in epidemiologic studies.

Disclosures: Funding for the study was provided by Novo Nordisk, Bayer Pharmaceuticals, and Pfizer. Dr. Kahn and his associates said they had no conflicts of interest. Dr. Rutten also reported having no conflicts of interest.

Type 2 diabetes screening is cost effective when started between the ages of 30 and 45 years and repeated every 3–5 years, according to a mathematical model.

According to the model, which simulated the effects of various screening strategies in a population of 325,000 nondiabetic 30-year-olds representative of the U.S. population, repeated routine screening would offer significant benefits over no screening, including reducing rates of myocardial infarction and diabetes-related microvascular complications (legal blindness, end-stage renal disease, or amputations) by three to nine events per 1,000 people each, and increasing the number of quality-adjusted life-years (QALY) by more than 50 years.

Screening would have a negligible effect on the incidence of stroke (preventing up to one event per 1,000 people), though most of the strategies evaluated in the study would prevent an estimated two to five deaths per 1,000 people (Lancet 2010 March 30 [doi:10.1016/S0140-6736(09)62162-0]).

In their study, Dr. Richard Kahn and his colleagues evaluated eight screening scenarios that included different starting ages (30, 45, or 60 years), different screening intervals (every 6 months, yearly, every 3 or 5 years), and strategies of screening the entire population versus screening only patients who reach a certain blood pressure threshold. There also was a control group.

All screening strategies reduced the time that individuals remained undiagnosed before the development of symptoms. The lead-time gained with each strategy over no screening ranged from 1.8 years for screening starting at age 60 years to 6.3 years for screening starting at age 30 years.

The investigators calculated the costs of these screening strategies using the Archimedes model, a large-scale, person-by-person model that incorporates physiology, disease, and health care system costs.

The cost-effectiveness of the strategies was reported in terms of cost per QALY, which factors in the duration individuals spend with a diabetes-related disorder and the estimated negative impact for each disorder.

Five of the eight strategies cost $10,500 or less per QALY, but differed in their benefit. “The appropriate choice of strategy would deliver the greatest benefit, while having a low cost per QALY,” explained Dr. Kahn, chief scientific and medical officer of the American Diabetes Association, and his coinvestigators. Therefore, they recommended starting screening at 30 or 45 years of age and repeating every 3–5 years.

Dr. Kahn and his associates noted that this type of age-specific screening would provide more than twice the QALY benefit of screening, because the cost of the office visit would be attributed to the visit for hypertension management.

In an editorial, Dr. Guy Rutten noted that these opportunistic screening strategies did carry the lowest cost per QALY. The current study “provides further evidence that screening for diabetes should be combined with screening for hypertension and lipid tests,” concluded Dr. Rutten of the University Medical Center Utrecht in the Netherlands (Lancet 2010 March 30 [doi:10.1016/S0140-6736(10)60455-2]).

Although this is not the first cost-effectiveness study to be done in diabetes, Dr. Kahn and his associates said, this analysis provides new information based on several factors: It incorporates sequential, rather than one-time, screening; it is based on a representative sample of the population in the United States; it assumes that patients with diabetes will receive treatment according to the most recent recommendations; it evaluates a range of screening strategies; and it utilizes the Archimedes model, which has been validated in epidemiologic studies.

Disclosures: Funding for the study was provided by Novo Nordisk, Bayer Pharmaceuticals, and Pfizer. Dr. Kahn and his associates said they had no conflicts of interest. Dr. Rutten also reported having no conflicts of interest.

Type 2 diabetes screening is cost effective when started between the ages of 30 and 45 years and repeated every 3–5 years, according to a mathematical model.

According to the model, which simulated the effects of various screening strategies in a population of 325,000 nondiabetic 30-year-olds representative of the U.S. population, repeated routine screening would offer significant benefits over no screening, including reducing rates of myocardial infarction and diabetes-related microvascular complications (legal blindness, end-stage renal disease, or amputations) by three to nine events per 1,000 people each, and increasing the number of quality-adjusted life-years (QALY) by more than 50 years.

Screening would have a negligible effect on the incidence of stroke (preventing up to one event per 1,000 people), though most of the strategies evaluated in the study would prevent an estimated two to five deaths per 1,000 people (Lancet 2010 March 30 [doi:10.1016/S0140-6736(09)62162-0]).

In their study, Dr. Richard Kahn and his colleagues evaluated eight screening scenarios that included different starting ages (30, 45, or 60 years), different screening intervals (every 6 months, yearly, every 3 or 5 years), and strategies of screening the entire population versus screening only patients who reach a certain blood pressure threshold. There also was a control group.

All screening strategies reduced the time that individuals remained undiagnosed before the development of symptoms. The lead-time gained with each strategy over no screening ranged from 1.8 years for screening starting at age 60 years to 6.3 years for screening starting at age 30 years.

The investigators calculated the costs of these screening strategies using the Archimedes model, a large-scale, person-by-person model that incorporates physiology, disease, and health care system costs.

The cost-effectiveness of the strategies was reported in terms of cost per QALY, which factors in the duration individuals spend with a diabetes-related disorder and the estimated negative impact for each disorder.

Five of the eight strategies cost $10,500 or less per QALY, but differed in their benefit. “The appropriate choice of strategy would deliver the greatest benefit, while having a low cost per QALY,” explained Dr. Kahn, chief scientific and medical officer of the American Diabetes Association, and his coinvestigators. Therefore, they recommended starting screening at 30 or 45 years of age and repeating every 3–5 years.

Dr. Kahn and his associates noted that this type of age-specific screening would provide more than twice the QALY benefit of screening, because the cost of the office visit would be attributed to the visit for hypertension management.

In an editorial, Dr. Guy Rutten noted that these opportunistic screening strategies did carry the lowest cost per QALY. The current study “provides further evidence that screening for diabetes should be combined with screening for hypertension and lipid tests,” concluded Dr. Rutten of the University Medical Center Utrecht in the Netherlands (Lancet 2010 March 30 [doi:10.1016/S0140-6736(10)60455-2]).

Although this is not the first cost-effectiveness study to be done in diabetes, Dr. Kahn and his associates said, this analysis provides new information based on several factors: It incorporates sequential, rather than one-time, screening; it is based on a representative sample of the population in the United States; it assumes that patients with diabetes will receive treatment according to the most recent recommendations; it evaluates a range of screening strategies; and it utilizes the Archimedes model, which has been validated in epidemiologic studies.

Disclosures: Funding for the study was provided by Novo Nordisk, Bayer Pharmaceuticals, and Pfizer. Dr. Kahn and his associates said they had no conflicts of interest. Dr. Rutten also reported having no conflicts of interest.

Major Finding: Among 236 men without urethral symptoms or concerns, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge that was visible upon examination.

Data Source: An observational study.

Disclosures: None reported.

ATLANTA — Asymptomatic urethritis is relatively common even in men reporting no urethral concerns, according to study findings suggesting that routine genital examination may help diagnose unsuspected sexually transmitted diseases.

Of 236 men, aged 16–63, recruited from a Seattle emergency department waiting room who reported having no urethral symptoms or concerns, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge that was visible upon examination by the study clinician. Another 2% of men had visible discharge without microscopic evidence of inflammation, according to Catherine M. Wetmore, whose results were presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

“Conventional wisdom suggests that women frequently experience asymptomatic reproductive tract infections but that men are generally more aware of potential signs/symptoms of infection,” Ms. Wetmore explained in a written statement. However, urethral discharge was visibly detectable in nearly 10% of these men reporting no urethral signs or symptoms.

Moreover, 80% of men with visible discharge had microscopic evidence of urethral inflammation, defined as having at least five polymorphonuclear neutrophils (PMNs) per high-power field over at least three fields on a urethral gram-stain.

Ms. Wetmore, of the University of Washington, Seattle, and her colleagues also evaluated the incidence of sexually transmitted infections (STIs) in these men. Nearly one in five men (18%) with asymptomatic urethritis, and 4% of men without urethritis, had detectable STIs, including Mycoplasma genitalium (9% and 2%, respectively), Chlamydia trachomatis (8% and 2%, respectively) and Trichomonas vaginalis (3% and 1%, respectively). No cases of gonorrhea were detected.

Participants were an average of 37–39 years old; 52% were African American, 33% were white, 2% were Asian/Pacific Islander, and the remainder were other races.

In a multivariate analysis, factors that were independently associated with an increased risk of asymptomatic urethritis included having a detected STI, older age, race (African American vs. white), having a greater number of recent sex partners, being uncircumcised, having had recent anal sex, and having voided at least 2 hours before the exam.

Although Ms. Wetmore was hesitant to make clinical recommendations, she noted that her findings suggest that a genital examination may provide an opportunity for diagnosing and treating unsuspected sexually transmitted infections.

She reported having no conflicts of interest.

Major Finding: Among 236 men without urethral symptoms or concerns, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge that was visible upon examination.

Data Source: An observational study.

Disclosures: None reported.

ATLANTA — Asymptomatic urethritis is relatively common even in men reporting no urethral concerns, according to study findings suggesting that routine genital examination may help diagnose unsuspected sexually transmitted diseases.

Of 236 men, aged 16–63, recruited from a Seattle emergency department waiting room who reported having no urethral symptoms or concerns, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge that was visible upon examination by the study clinician. Another 2% of men had visible discharge without microscopic evidence of inflammation, according to Catherine M. Wetmore, whose results were presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

“Conventional wisdom suggests that women frequently experience asymptomatic reproductive tract infections but that men are generally more aware of potential signs/symptoms of infection,” Ms. Wetmore explained in a written statement. However, urethral discharge was visibly detectable in nearly 10% of these men reporting no urethral signs or symptoms.

Moreover, 80% of men with visible discharge had microscopic evidence of urethral inflammation, defined as having at least five polymorphonuclear neutrophils (PMNs) per high-power field over at least three fields on a urethral gram-stain.

Ms. Wetmore, of the University of Washington, Seattle, and her colleagues also evaluated the incidence of sexually transmitted infections (STIs) in these men. Nearly one in five men (18%) with asymptomatic urethritis, and 4% of men without urethritis, had detectable STIs, including Mycoplasma genitalium (9% and 2%, respectively), Chlamydia trachomatis (8% and 2%, respectively) and Trichomonas vaginalis (3% and 1%, respectively). No cases of gonorrhea were detected.

Participants were an average of 37–39 years old; 52% were African American, 33% were white, 2% were Asian/Pacific Islander, and the remainder were other races.

In a multivariate analysis, factors that were independently associated with an increased risk of asymptomatic urethritis included having a detected STI, older age, race (African American vs. white), having a greater number of recent sex partners, being uncircumcised, having had recent anal sex, and having voided at least 2 hours before the exam.

Although Ms. Wetmore was hesitant to make clinical recommendations, she noted that her findings suggest that a genital examination may provide an opportunity for diagnosing and treating unsuspected sexually transmitted infections.

She reported having no conflicts of interest.

Major Finding: Among 236 men without urethral symptoms or concerns, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge that was visible upon examination.

Data Source: An observational study.

Disclosures: None reported.

ATLANTA — Asymptomatic urethritis is relatively common even in men reporting no urethral concerns, according to study findings suggesting that routine genital examination may help diagnose unsuspected sexually transmitted diseases.

Of 236 men, aged 16–63, recruited from a Seattle emergency department waiting room who reported having no urethral symptoms or concerns, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge that was visible upon examination by the study clinician. Another 2% of men had visible discharge without microscopic evidence of inflammation, according to Catherine M. Wetmore, whose results were presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

“Conventional wisdom suggests that women frequently experience asymptomatic reproductive tract infections but that men are generally more aware of potential signs/symptoms of infection,” Ms. Wetmore explained in a written statement. However, urethral discharge was visibly detectable in nearly 10% of these men reporting no urethral signs or symptoms.

Moreover, 80% of men with visible discharge had microscopic evidence of urethral inflammation, defined as having at least five polymorphonuclear neutrophils (PMNs) per high-power field over at least three fields on a urethral gram-stain.

Ms. Wetmore, of the University of Washington, Seattle, and her colleagues also evaluated the incidence of sexually transmitted infections (STIs) in these men. Nearly one in five men (18%) with asymptomatic urethritis, and 4% of men without urethritis, had detectable STIs, including Mycoplasma genitalium (9% and 2%, respectively), Chlamydia trachomatis (8% and 2%, respectively) and Trichomonas vaginalis (3% and 1%, respectively). No cases of gonorrhea were detected.

Participants were an average of 37–39 years old; 52% were African American, 33% were white, 2% were Asian/Pacific Islander, and the remainder were other races.

In a multivariate analysis, factors that were independently associated with an increased risk of asymptomatic urethritis included having a detected STI, older age, race (African American vs. white), having a greater number of recent sex partners, being uncircumcised, having had recent anal sex, and having voided at least 2 hours before the exam.

Although Ms. Wetmore was hesitant to make clinical recommendations, she noted that her findings suggest that a genital examination may provide an opportunity for diagnosing and treating unsuspected sexually transmitted infections.

She reported having no conflicts of interest.

ATLANTA — Urethritis is relatively common even in men reporting no urethral symptoms, according to study findings suggesting that routine genital examination may help diagnose unsuspected sexually transmitted diseases.

Of 236 men, aged 16-63, recruited from a Seattle emergency department waiting room who reported having no urethral symptoms, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge visible upon examination. Another 2% of men had visible discharge without microscopic evidence of inflammation, Catherine M. Wetmore reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

“Conventional wisdom suggests that women frequently experience asymptomatic reproductive tract infections but that men are generally more aware of potential signs/symptoms of infection,” she noted in a statement. Yet urethral discharge was visible in nearly 10% of these men reporting no urethral symptoms. Moreover, 80% of men with visible discharge had microscopic evidence of urethral inflammation (at least five polymorphonuclear neutrophils per high-power field over at least three fields on a urethral gram-stain).

Ms. Wetmore, of the University of Washington, Seattle, and her colleagues also evaluated the incidence of sexually transmitted infections (STIs) in these men. Nearly one in five men (18%) with asymptomatic urethritis, and 4% of men without urethritis, had detectable STIs, including Mycoplasma genitalium (9% and 2%), Chlamydia trachomatis (8% and 2%), and Trichomonas vaginalis (3% and 1%). No cases of gonorrhea were detected.

Patients were an average of 37-39 years old; 52% were African American, 33% were white, 2% were Asian/Pacific Islander, and the remainder were other races.

In a multivariate analysis, factors independently associated with an increased risk of asymptomatic urethritis included having a detected STI, older age, race (African American vs. white), having a greater number of recent sex partners, being uncircumcised, having had recent anal sex, and having voided at least 2 hours before the exam.

Ms. Wetmore noted that her findings suggest that a genital exam may provide an opportunity to diagnose and treat unsuspected sexually transmitted infections.

Disclosures: Ms. Wetmore reported having no conflicts of interest.

ATLANTA — Urethritis is relatively common even in men reporting no urethral symptoms, according to study findings suggesting that routine genital examination may help diagnose unsuspected sexually transmitted diseases.

Of 236 men, aged 16-63, recruited from a Seattle emergency department waiting room who reported having no urethral symptoms, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge visible upon examination. Another 2% of men had visible discharge without microscopic evidence of inflammation, Catherine M. Wetmore reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

“Conventional wisdom suggests that women frequently experience asymptomatic reproductive tract infections but that men are generally more aware of potential signs/symptoms of infection,” she noted in a statement. Yet urethral discharge was visible in nearly 10% of these men reporting no urethral symptoms. Moreover, 80% of men with visible discharge had microscopic evidence of urethral inflammation (at least five polymorphonuclear neutrophils per high-power field over at least three fields on a urethral gram-stain).

Ms. Wetmore, of the University of Washington, Seattle, and her colleagues also evaluated the incidence of sexually transmitted infections (STIs) in these men. Nearly one in five men (18%) with asymptomatic urethritis, and 4% of men without urethritis, had detectable STIs, including Mycoplasma genitalium (9% and 2%), Chlamydia trachomatis (8% and 2%), and Trichomonas vaginalis (3% and 1%). No cases of gonorrhea were detected.

Patients were an average of 37-39 years old; 52% were African American, 33% were white, 2% were Asian/Pacific Islander, and the remainder were other races.

In a multivariate analysis, factors independently associated with an increased risk of asymptomatic urethritis included having a detected STI, older age, race (African American vs. white), having a greater number of recent sex partners, being uncircumcised, having had recent anal sex, and having voided at least 2 hours before the exam.

Ms. Wetmore noted that her findings suggest that a genital exam may provide an opportunity to diagnose and treat unsuspected sexually transmitted infections.

Disclosures: Ms. Wetmore reported having no conflicts of interest.

ATLANTA — Urethritis is relatively common even in men reporting no urethral symptoms, according to study findings suggesting that routine genital examination may help diagnose unsuspected sexually transmitted diseases.

Of 236 men, aged 16-63, recruited from a Seattle emergency department waiting room who reported having no urethral symptoms, 16% had microscopic evidence of inflammation and nearly half of those men (7% of the total group) had discharge visible upon examination. Another 2% of men had visible discharge without microscopic evidence of inflammation, Catherine M. Wetmore reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

“Conventional wisdom suggests that women frequently experience asymptomatic reproductive tract infections but that men are generally more aware of potential signs/symptoms of infection,” she noted in a statement. Yet urethral discharge was visible in nearly 10% of these men reporting no urethral symptoms. Moreover, 80% of men with visible discharge had microscopic evidence of urethral inflammation (at least five polymorphonuclear neutrophils per high-power field over at least three fields on a urethral gram-stain).

Ms. Wetmore, of the University of Washington, Seattle, and her colleagues also evaluated the incidence of sexually transmitted infections (STIs) in these men. Nearly one in five men (18%) with asymptomatic urethritis, and 4% of men without urethritis, had detectable STIs, including Mycoplasma genitalium (9% and 2%), Chlamydia trachomatis (8% and 2%), and Trichomonas vaginalis (3% and 1%). No cases of gonorrhea were detected.

Patients were an average of 37-39 years old; 52% were African American, 33% were white, 2% were Asian/Pacific Islander, and the remainder were other races.

In a multivariate analysis, factors independently associated with an increased risk of asymptomatic urethritis included having a detected STI, older age, race (African American vs. white), having a greater number of recent sex partners, being uncircumcised, having had recent anal sex, and having voided at least 2 hours before the exam.

Ms. Wetmore noted that her findings suggest that a genital exam may provide an opportunity to diagnose and treat unsuspected sexually transmitted infections.

Disclosures: Ms. Wetmore reported having no conflicts of interest.

Major Finding: The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected.

Data Source: Data gathered from 7,293 participants in the National Health and Nutrition Examination Survey.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr. P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

He added that herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it.”

While the CDC does not recommend routine HSV-2 screening for the general population, Dr. Douglas and his colleagues said that testing may be useful in at-risk populations, such as those with multiple sex partners, HIV-positive individuals, and gay and bisexual men.

“We can't afford to be complacent about this infection,” concluded Dr. Douglas.

Major Finding: The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected.

Data Source: Data gathered from 7,293 participants in the National Health and Nutrition Examination Survey.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr. P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

He added that herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it.”

While the CDC does not recommend routine HSV-2 screening for the general population, Dr. Douglas and his colleagues said that testing may be useful in at-risk populations, such as those with multiple sex partners, HIV-positive individuals, and gay and bisexual men.

“We can't afford to be complacent about this infection,” concluded Dr. Douglas.

Major Finding: The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected.

Data Source: Data gathered from 7,293 participants in the National Health and Nutrition Examination Survey.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Rates of infection were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'Shan Taylor, Dr. P.H., an Epidemic Intelligence Service officer at the CDC.

These estimates, based on data gathered from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

He added that herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it.”

While the CDC does not recommend routine HSV-2 screening for the general population, Dr. Douglas and his colleagues said that testing may be useful in at-risk populations, such as those with multiple sex partners, HIV-positive individuals, and gay and bisexual men.

“We can't afford to be complacent about this infection,” concluded Dr. Douglas.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Infection rates were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'shan Taylor, Dr.P.H., of the CDC.

These estimates, based on data from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

Herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it,” said Dr. Douglas.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study, according to a spokesperson for the CDC.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Infection rates were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'shan Taylor, Dr.P.H., of the CDC.

These estimates, based on data from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

Herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it,” said Dr. Douglas.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study, according to a spokesperson for the CDC.

ATLANTA — About one in six Americans aged 14-49 years is infected with herpes simplex virus type 2 (HSV-2), and 81% of these individuals are unaware of their infection, according to data presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The overall seroprevalence of HSV-2 in a national survey conducted from 2005 to 2008 was 16%, with women and African Americans disproportionately affected. Infection rates were almost twice as high in women than in men (21% vs. 12%) and were more than three times higher in African Americans than in whites (39% vs. 12%). The population most affected was African American women, who had a herpes prevalence of 48%.

“As stark as these disparities are, they are not substantially different from CDC's previous estimates of these populations,” said the lead study author, La'shan Taylor, Dr.P.H., of the CDC.

These estimates, based on data from 7,293 participants in the National Health and Nutrition Examination Survey (NHANES), indicate that the prevalence of HSV-2 has remained stable since the 1999-2004 estimate of 17%, which had followed a decreasing trend in herpes prevalence that had occurred in the last decade, down from 21% in 1988-1994.

The prevalence of HSV-2 increased with age, from 1.4% among 14- to 19-year-olds to 26% among 40- to 49-year-olds, reflecting the lifelong, incurable nature of the infection. Those with a higher number of lifetime sex partners were also more likely to have HSV-2 infection, with the prevalence ranging from 4% among those with 1 lifetime sex partner to 27% in those with 10 or more reported partners.

Regarding the gender and ethnic disparities in herpes prevalence, Dr. Taylor explained that biological factors among women may increase their susceptibility to HSV-2 infection, and that complex social, biological, and environmental factors could contribute to the higher HSV-2 prevalence among African Americans. “Once this disparity exists, herpes infections are likely perpetuated because of the higher prevalence of infections within black communities,” she said.

Dr. John M. Douglas, director of CDC's Division of STD Prevention, commented that the high prevalence of herpes in African Americans is particularly concerning given the linkage between HSV-2 infection and HIV. Studies have shown that individuals with genital herpes are two to three times more likely to acquire HIV infection. Moreover, among HIV-infected individuals, HSV-2 coinfection increases the likelihood of transmitting HIV. Dr. Douglas suggested that the high rates of genital herpes among African Americans might be contributing to the high rates of HIV in this population.

Herpes can cause symptoms other than genital sores, including redness or burning in the genital area that can be mild or mistaken for another condition. Visible sores are not necessary for transmission; individuals with no visible sores or symptoms can still transmit the infection. Thus, “many individuals are transmitting herpes to others without even knowing it,” said Dr. Douglas.

Disclosures: Dr. Douglas and Dr. Taylor have no conflicts of interest related to the findings of this study, according to a spokesperson for the CDC.