Genital chlamydial infection in female and male college students

A review of more than 1,000 medical records of the University of South Florida students screened for gonorrhea, Chlamydia trachomatis, and syphilis during a period of 1 year in 1986-1987 showed genital chlamydial infection to be the most prevalent of these sexually transmitted diseases (STDs). Among normal asymptomatic female students with no known recent STD contact, 6.9% had a positive chlamydial enzyme immunoassay. Female students with vaginal symptoms had a greater tendency to be positive, and 47.8% of those with a recent STD contact tested positive for chlamydia. Males with a clinical diagnosis of nonspecific urethritis had a 50% probability of having a positive chlamydia test. Data from this study clearly support a need for a screening policy and educational program on the campus to improve control of chlamydial infection.     

Screening for Chlamydia trachomatis in college women on routine gynecological exams.

Chlamydia trachomatis infection poses a serious threat to sexually active college women. Past research has demonstrated the difficulty of predicting infection on the basis of symptoms or physical exam. Recent studies highlight the prevalence of asymptomatic chlamydia infections. This study presents the results of screening 2,303 women for chlamydia infection on routine annual gynecological examinations at a college health center during a 22-month period. A prevalence of 6% was found. The study also assessed the differences between the 140 women identified as chlamydia positive and a control sample of 140 women who were chlamydia negative. The authors compared groups for signs and symptoms that might predict infection, but found no useful predictors. In fact, 79% of the patients who tested positive had no symptoms, and 58% of these had no signs, symptoms, or concurrent infections. Routine screening of women on annual gynecological exam is necessary to bring the chlamydia epidemic under control, the authors conclude.     

Alcohol misuse among college athletes: self-medication for psychiatric symptoms?

A collegiate athlete population was surveyed for alcohol abuse as well as self-reported depression, anxiety, and other psychiatric symptoms. This study revealed that in a group of 262 athletes there were 21 percent who reported high alcohol use and problems associated with its use. Significant correlations were found between reported alcohol abuse and self-reported symptoms of depression and general psychiatric symptoms. Subjects with positive depression and psychiatric symptom ratings in the "severe" range had a significantly higher rate of alcohol abuse than subjects who had low depression and low or mild symptom ratings. Conversely, subjects reporting higher rates of alcohol misuse had more psychiatric symptoms. These findings suggest a possible causal link between psychopathology and serious alcohol abuse among college athletes. They also point to the need for routine depression and anxiety screening in college students who are typically beginning a significant exposure to alcohol.     

Man Up Monday: An integrated public health approach to increase sexually transmitted infection awareness and testing among male students at a midwest university

ABSTRACT

Objective: This campaign sought to (a) increase awareness of sexual health and chlamydia testing; (b) motivate students, particularly sexually active men who do not pursue regular sexually transmitted infection (STI) testing, to get tested; and (c) improve the capacity of the student health center to provide free chlamydia testing and treatment for all students. Participants: Students enrolled at a 4-year public research university (N = 333). Methods: Collaborative partnerships formed the foundation of a campus marketing and testing campaign, with treatment for students testing positive for chlamydia. Results: A total of 333 students were tested over 5 consecutive Mondays, showing a chlamydia incidence of 9.6%. The incidence for females and males were 8.6% and 10.8%, respectively. Conclusions: The campaign was effective in reaching men, an at-risk population not traditionally emphasized in STI testing.     

Rates of asymptomatic nonurethral gonorrhea and Chlamydia in a population of university men who have sex with men

Abstract Objectives: The study determined prevalence of asymptomatic nonurethral gonorrhea and chlamydia in men who have sex with men (MSM) seen at the Columbia University Health Service for routine care. Participants: The study enrolled 200 participants from March 2007 to May 2010. Results: Specimens were tested using culture and nucleic acid amplification testing (NAAT): 3.5% (n = 7) tested positive for pharyngeal gonorrhea by NAAT, none were positive by culture; 3% (n = 6) tested positive for rectal chlamydia by NAAT and 0.5% (n = 1) by culture. Conclusions: The incidence of pharyngeal gonorrhea and rectal chlamydia in MSM who visited the Columbia Health Service was similar to rates of asymptomatic nonurethral gonorrhea and chlamydia in studies conducted in the MSM population in non-university settings. This suggests that, following the Centers for Disease Control and Prevention guidelines, (1) 3-site testing for MSM seen at the Columbia clinic is indicated. NAAT is more sensitive than culture for nonurethral gonorrhea and chlamydia.     

American College Health Association Annual Pap Test and Sexually Transmitted Infection Survey: 2006

Objective: The authors describe the cervical cytology and sexually transmitted infection (STI) testing patterns of US college health centers. Participants and Methods: A total of 128 self-selected US college health centers—representing more than 2 million college students—completed an online survey during February and March 2007. Results: Almost 13% of cervical cytology results were abnormal; most of these were atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions. In women, 2.9% of chlamydia tests and 0.4% of gonorrhea tests were positive. Human immunodeficiency virus (HIV) and syphilis tests were positive in 0.1% and 0.3% of students tested, respectively. Herpes simplex virus type 1 (HSV-1) accounted for 59.9% of genital herpes infections. Conclusions: College health centers are important sources for Pap and STI test data. Pap tests frequently yield low-grade abnormalities, and screening tests for chlamydia and especially gonorrhea are infrequently positive. Rates of HIV and syphilis in this population are low, raising concerns about positive predictive value when screening low-risk students. A majority of genital herpes infections are caused by HSV-1.     

Pelvic inflammatory disease

Pelvic inflammatory disease (PID), an infection of the fallopian tubes that is becoming increasingly common, is characterized by pain in the abdomen and other symptoms similar to those of appendicitis and ectopic pregnancy. A variety of organisms has been associated with it: gonococcus, chlamydia, and mycoplasma, almost all of which are sexually transmitted. They can also enter the pelvic cavity through several mechanisms (flare-ups of infection following menstruation; IUD insertions; abortions; and operations which involve entering the pelvic cavity). Gonococcal and chlamydial infections are usually asymptomatic and can live in the mucous membranes of the mouth, eye, and anus as well as in the urogenital tract. PID attacks usually occur during and immediately after menstruation when there is no mucus plug in the fallopian tube at that time. To control PID, women have to diagnose seemingly minor infections and treat them appropriately. Women who are having routine gynecological checkups should be tested for gonococcus and vaginal infections. Although IUD use has been associated with PID attacks, other forms of contraception - pills, condoms, and foam, protect against PID attack.     

Risk factors for Chlamydia trachomatis infection in a California collegiate population

Chlamydia trachomatis infection in college students has not undergone a detailed large-scale evaluation. The authors undertook a cross-sectional study of 4,086 students enrolled on the campuses of California State University, Sacramento, and 3 local community colleges from fall 2000 through spring 2002. They used an outreach screening model to determine the presence of infection by testing urine for chlamydial DNA by polymerase chain reaction. Participants completed demographic and behavioral risk questionnaires and a chlamydia knowledge assessment. Overall, 3.4% of participants tested positive for infection. Screening of male and female students was evenly distributed and incidence rates for males (3.03%) and females (3.78%) were similar Variables associated with significantly increased risk were younger than 25 years, ethnicity other than White, more than one sexual partner in the preceding year or a new partner in the preceding 2 months, and current symptoms. Innovative outreach programs to screen a majority of at-risk college students should be developed.     

Risk Factors for Chlamydia Trachomatis Infection in a California Collegiate Population

Abstract

Chlamydia trachomatis infection in college students has not undergone a detailed large-scale evaluation. The authors undertook a cross-sectional study of 4,086 students enrolled on the campuses of California State University, Sacramento, and 3 local community colleges from fall 2000 through spring 2002. They used an outreach screening model to determine the presence of infection by testing urine for chlamydial DNA by polymerase chain reaction. Participants completed demographic and behavioral risk questionnaires and a chlamydia knowledge assessment. Overall, 3.4% of participants tested positive for infection. Screening of male and female students was evenly distributed and incidence rates for males (3.03%) and females (3.78%) were similar. Variables associated with significantly increased risk were younger than 25 years, ethnicity other than White, more than one sexual partner in the preceding year or a new partner in the preceding 2 months, and current symptoms. Innovative outreach programs to screen a majority of at-risk college students should be developed.     

Web-based survey 'Contraception and attitudes to sexual behaviour' completed by women accessing a UK menopause website

Background and methodology Sociodemographic trends mean increasing numbers of new relationships in later life. These trends may not only have health consequences for women and health services but also impact on the targeting of sexual health messages. This study aimed to examine attitudes and knowledge surrounding contraception, sexual health and unwanted pregnancy among those accessing the website www.menopausematters.co.uk. A voluntary online survey was completed. RESULTS: Survey was completed by 550 respondents. Three hundred and sixty-six women, 94% of whom self-classified as pre- or perimenopausal, had been sexually active with a male partner in the previous four weeks. Commonest contraceptive methods used by perimenopausal and postmenopausal women were condoms, combined oral contraceptive pill (COCP) and male sterilization. Up to 42% of women surveyed were unhappy with their contraception. A total of 27% premenopausal, 32% perimenopausal women and 40% postmenopausal used no contraception. One-third of women were unhappy about this and 19 unplanned pregnancies had occurred. The majority of women were informed regarding COCP use over 35 years, hormone replacement therapy, emergency contraception and ceasing contraception. The majority of women were unaware that more terminations of pregnancy are performed in women over 40 than any other age group per total pregnancies.Almost a third of women were unaware that chlamydia incidence is increasing in older women. Most would use condoms in new relationship. Discussion and conclusions Women accessing www.menopausematters.co.uk are well informed about contraception and sexual health. The majority of those accessing the site are sexually active, but many use no contraception, or are unhappy with their chosen method, leaving them vulnerable to unwanted pregnancy or sexually transmitted infection.     

Development of Sexual Expectancies among Adolescents: Contributions by Parents,Peers and the Media

To expand the scant research on sexual expectancies development among non–sexually active adolescents, we examined the relationship between adolescents' exposure to four socializing agents—mother/female guardian, father/male guardian, peers, and television programs with high sexual content—and their endorsement of four sexual expectancies: social benefit, pleasure, social risk, and health risk. Data are from Waves 2 and 3 of a three-wave annual longitudinal study conducted among California adolescents, the majority of whom were not sexually active (N = 914, 84%). Structural equation models were conducted to examine cross-sectional and longitudinal associations between the socializing agents and the sexual expectancies. Cross-sectional results indicate associations between peer sexual communication and social benefit, pleasure, and social risk expectancies. A positive association was found between exposure to music videos and social benefit expectancies, and a negative association was found between exposure to music videos and health risk expectancies. Longitudinal results suggest that communication with peers positively predicted pleasure expectancies and negatively predicted social risk expectancies. No other socializing agents were associated with any sexual expectancies. An invariance test found that significant correlations were similar across the different age groups. Results suggest that efforts to support positive sexual decision making among non–sexually active adolescents should target peer sexual communication.     

The effect of a college sexual assault prevention program on first-year students' victimization rates

OBJECTIVE: Although a variety of sexual assault prevention programs are currently available to college health professionals, there is a dearth of information about the effect of these programs on sexual assault victimization rates. PARTICIPANTS: The authors evaluated the efficacy of a sexual assault prevention program for first-year students at a college in the Northeast (N = 1,982). METHODS: They used a retrospective cohort design and assessed the prevalence of sexual assault victimization among students exposed to the sexual assault prevention program and students 1 year their senior who were not exposed. RESULTS: Students who had no exposure were more likely to report that they were sexually assaulted during their first year of college (odds ratio = 1.74, 95% confidence interval [1.32-2.29]). Results suggest that the program was effective for males and females, but not for students with a prior history of sexual assault victimization. Gay, lesbian, and bisexual students were at increased risk for victimization as compared with heterosexual students, and students who drank alcohol or engaged in binge drinking were at increased risk as compared with alcohol abstinent students. CONCLUSIONS: Findings suggest that this program had a positive effect on victimization rates for certain sub-groups of students.     

College students' knowledge and health beliefs about AIDS: implications for education and prevention

A questionnaire designed to measure the application of the dimensions of the Health Belief Model (HBM) to AIDS prevention and to practicing safer sex was administered to 139 undergraduates aged 22 years and under. Students generally had good knowledge about the facts of AIDS, which was consistent with other studies. We found an important difference between students' beliefs about practicing safer sex to prevent AIDS depending on whether their level of knowledge was high or low. The HBM posits that all of its dimensions must be present in order for belief to be followed by action. However, students with low knowledge indicated that the perceived barriers to practicing safer sex were higher than did students with high knowledge about AIDS. These results suggest that special efforts need to be made to teach students with low knowledge more about AIDS and that the barriers to safer sex can and should be overcome. There were no differences between students known to be sexually active compared with those who may or may not have been sexually active. One explanation was a possibly high number of students in the group identified as "perhaps sexually active" who actually were sexually active. Similarly, there were no differences between college students who did or did not know someone with AIDS, but this may have been due to the small number of students who did know such a person. Students' preferences for the format and methodology of AIDS education also were presented. In general, the students preferred small-group discussions and formats such as movies or panel discussions where they could remain "anonymous."(ABSTRACT TRUNCATED AT 250 WORDS)     

Development of a carpal tunnel syndrome screening method using structured interviews and vibrotactile testing

Carpal tunnel syndrome (CTS) is a debilitating and expensive health problem. An inexpensive screening method that would differentiate between people who do not have CTS and those that may have CTS would be useful. The screening methodology investigated here had two phases: a structured interview and provocative vibrotactile testing (VT). The control group (n = 36) was composed of asymptomatic college students and faculty, the case group was composed of patients currently visiting an occupational medicine clinic for symptoms consistent with CTS. The case group was subdivided into positive and negative for nerve conduction latency, NCL+ (n = 21) and NCL- (n = 13), respectively. Using a scored, structured interview, 33 of the controls and none of the symptomatic cases were identified as non-CTS. The results from the provocative flexion VT indicated that if the difference between the age corrected baseline and the threshold at 15 minutes is 15 microm or more, the subject was likely to be NCL+ (odds ratio 12.6, 95% CI 3.8 to 41.8). Further research may improve this screening methodology to not only determine whether or not a person has CTS, but also to determine the level of median nerve impingement or damage.     

Part II: differences between sexually victimized and nonsexually victimized male adolescent sexual abusers and delinquent youth: further group comparisons of developmental antecedents and behavioral challenges

In a recent paper published in the Journal of Child Sexual Abuse, we assessed the differences between sexually victimized and nonsexually victimized male adolescent sexual abusers ( Burton, Duty, & Leibowitz, 2011 ). We found that the sexually victimized group had more severe developmental antecedents (e.g., trauma and early exposure to pornography) and behavioral difficulties (sexual aggression, arousal, pornography use, and nonsexual offenses). The present study compares sexually victimized and nonsexually victimized adolescent sexual abusers with a group of nonsexually victimized delinquent youth. Findings included that delinquent youth had fewer behavioral and developmental problems than the comparison groups. In addition, sexually victimized sexual abusers had the highest mean scores on trauma and personality measures. Implications for research and treatment are offered.     

The association of campus resources for gay,lesbian, and bisexual students with college students' condom use

The author and colleagues examined campus resources for gay, lesbian, and bisexual (GLB) students at 119 US colleges to determine how the presence of such resources affected sexually active students' condom use. A random sample of unmarried, sexually active college students surveyed in 1999 completed questionnaires. Condom use was compared across schools with different levels of GLB resources. Condom use rates, analyzed by sex and sex-partner groups, ranged from 32% to 52%. With additional college variables controlled for, GLB resources were positively associated with the proportion of sexually active students who used condoms (p < .001). This association existed primarily for students with only opposite-sex partners. The author's findings suggest that campus resources for GLB students may be associated with college students' condom use.     

Disparities Between HIV Testing Levels and the Self-Reported HIV-Negative Status of Sexually Active College Students

The methodological issues of using self-reported human immunodeficiency virus (HIV) testing history to determine HIV infection status are understudied. This study aimed to assess the disparities between HIV testing history and self-reported HIV status, with a specific objective of estimating the prevalence of self-reported HIV-negative status in sexually active students who had never had an HIV test (inaccurate self-disclosure). Participants were recruited from four Hong Kong universities; 255 students were included in the analysis, with 16.1% of participants being men who have sex with men (MSM). Overall, 81.6% of participants reported they never had been tested for HIV, with inaccurate self-disclosure by 65.9% of participants. Among participants who used condoms inconsistently, only 20.2% had had HIV tests, with inaccurate self-disclosure by 66.7% of subjects. Among MSM students, only 36.6% had had HIV tests, with inaccurate self-disclosure by 61.0% of participants. Among MSM students who used condoms inconsistently, only 35.1% had had HIV tests, with inaccurate self-disclosure by 62.2% of participants. The findings raise concerns about the use of self-reported HIV status in clinical practice and research. The low prevalence of HIV testing found suggests that interventions to promote HIV testing should be continued.     

Tuberculosis screening for international students

Nonimmigrant, international students entering colleges in the United States are not required to undergo screening for tuberculosis (TB). Thirty-nine percent of active TB cases in the United States are in foreign-born individuals. In an effort to minimize the occurrence of active TB on a community campus with an increasing international student population, the college health service implemented a TB-screening policy for all newly enrolled international students. For the 1997/98 school year, 171 international students from 70 different countries enrolled in classes. Fifty-nine students (35%) screened for TB had a positive skin test (greater than 10 mm induration). Of those, 34 initiated isoniazid therapy, and 27 successfully completed the prescribed regimen under supervision of the campus health office.     

Correlates of male condom use skills among high-risk women in South Africa

This exploratory study examined the performance of 295 South African women--who recently traded sex for goods or had unprotected sex--on a male condom use mastery index. Bivariate and multivariate logistic regression analyses were conducted to determine whether age, marital status, highest education obtained, male condom use at first penetrative sex, receiving prior demonstration of male condom use, recent sexually transmitted infection symptoms, and recently trading sex were significantly associated with index scores. Adjusted odds ratios indicated that age and sexually transmitted infection symptoms were negatively associated with condom skills; women who were older and had a higher number of recent sexually transmitted infection symptoms were more likely to have lower scores. Furthermore, participants executed, on average, approximately one third of condom use steps correctly. These findings suggest a need for increased behavioral skills training for women engaging in sexual risk behaviors because many lack the skills required to use a male condom properly.     

Human Immunodeficiency Virus and Chlamydia/Gonorrhea Testing Among Heterosexual College Students: Who Is Getting Tested and Why Do Some Not?

Abstract

Objective: This study explored college students’ reported history of human immunodeficiency virus (HIV) and chlamydia/gonorrhea and characteristics of students reporting testing. Additionally, it assessed their motivation regarding future testing and reasons for lack of motivation. Participants: The sample consisted of 292 sexually experienced college students self-identifying as heterosexual at a midwestern university. Methods: Participants completed a 26-item survey during the 2010–2011 academic year. Results: Demographics (sex, age, race/ethnicity), behaviors (higher numbers of sex partners, currently not using condoms), and motivation for future testing distinguished those who had been tested ever and those who had not. Half of participants were not motivated to seek testing in the next 3 months; the most common reason for no motivation being perceived lack of risk. Conclusions: Interventions promoting testing can use these findings to target those likely to never have been tested. These results also highlight the need to find ways to motivate students to get tested.