Heidi Splete

The rate of any type of pregnancy-related hospitalization for stroke in the United States increased from approximately 4,000 in 1994-1995 to about 6,000 in 2006-2007, based on data from a nationwide sample of more than 64 million pregnant women, according to findings published in the September issue of Stroke.

This 54% increase can be explained largely by postpartum hospitalizations in women with heart disease or hypertensive disorders, said Dr. Elena V. Kuklina and her associates at the Centers for Disease Control and Prevention in Atlanta.

The researchers compared ICD-9 code data from 1994 to 1995 with data from 2006 to 2007. Types of stroke included cerebral venous thrombosis, hemorrhagic, ischemic, subarachnoid, transient ischemic attack, and unspecified (Stroke 2011 July 28 [doi:10.1161/strokeaha.110.610592]).

Overall, hypertensive disorders were present in 11%, 23%, and 28% of prenatal, delivery, and postpartum hospitalizations, respectively, in 1994-1995, and these numbers increased to 17%, 29%, and 41% in 2006-2007. Only the increase in postpartum hospitalizations for stroke was statistically significant.

Heart disease was a complication in pregnancy-related hospitalizations for stroke in 16% of prenatal hospitalizations, 8% of delivery hospitalizations, and 9% of postpartum hospitalizations in 1994-1995, whereas that was the case in 16%, 8%, and 12% of the hospitalizations, respectively, in 2006-2007.

The rate of any stroke per 1,000 deliveries increased significantly for prenatal hospitalizations and postpartum hospitalizations between the two time periods (from 0.15 to 0.22 and from 0.12 to 0.22, respectively). However, the rate of any stroke during delivery hospitalizations remained unchanged at 0.27.

After adjusting for confounding variables, patients who were hospitalized with hypertensive disorders during pregnancy, during delivery, and post partum were 1.8, 5.6, and 3.5 times more likely, respectively, to have indications of stroke, compared with patients without hypertensive disorders, the researchers noted.

In addition, patients who were hospitalized with heart disease during the prenatal period and the delivery period were, respectively, 9.4 times as likely and 5.4 times as likely to have indications of stroke.

The current recommendations from the American Heart Association and the American Stroke Association for managing pregnant women with a history of noncardioembolic stroke or at risk of cardioembolic stroke include treatment with anticoagulant therapy in the form of unfractionated heparin or low-molecular-weight heparin until week 13, followed by low dose aspirin for the rest of the pregnancy (Stroke 2011;42:227-76).

The findings support data from previous studies at single institutions, although they were limited by the use of ICD-9 codes that were not validated by a review of medical records, the researchers noted.

However, the findings suggest that cardiovascular disease surveillance of pregnant women remains essential to improving both the design of future studies and the clinical care of pregnant women, Dr. Kuklina and her associates added.

Dr. Kuklina and her associates said they had no relevant financial disclosures.

The rate of any type of pregnancy-related hospitalization for stroke in the United States increased from approximately 4,000 in 1994-1995 to about 6,000 in 2006-2007, based on data from a nationwide sample of more than 64 million pregnant women, according to findings published in the September issue of Stroke.

This 54% increase can be explained largely by postpartum hospitalizations in women with heart disease or hypertensive disorders, said Dr. Elena V. Kuklina and her associates at the Centers for Disease Control and Prevention in Atlanta.

The researchers compared ICD-9 code data from 1994 to 1995 with data from 2006 to 2007. Types of stroke included cerebral venous thrombosis, hemorrhagic, ischemic, subarachnoid, transient ischemic attack, and unspecified (Stroke 2011 July 28 [doi:10.1161/strokeaha.110.610592]).

Overall, hypertensive disorders were present in 11%, 23%, and 28% of prenatal, delivery, and postpartum hospitalizations, respectively, in 1994-1995, and these numbers increased to 17%, 29%, and 41% in 2006-2007. Only the increase in postpartum hospitalizations for stroke was statistically significant.

Heart disease was a complication in pregnancy-related hospitalizations for stroke in 16% of prenatal hospitalizations, 8% of delivery hospitalizations, and 9% of postpartum hospitalizations in 1994-1995, whereas that was the case in 16%, 8%, and 12% of the hospitalizations, respectively, in 2006-2007.

The rate of any stroke per 1,000 deliveries increased significantly for prenatal hospitalizations and postpartum hospitalizations between the two time periods (from 0.15 to 0.22 and from 0.12 to 0.22, respectively). However, the rate of any stroke during delivery hospitalizations remained unchanged at 0.27.

After adjusting for confounding variables, patients who were hospitalized with hypertensive disorders during pregnancy, during delivery, and post partum were 1.8, 5.6, and 3.5 times more likely, respectively, to have indications of stroke, compared with patients without hypertensive disorders, the researchers noted.

In addition, patients who were hospitalized with heart disease during the prenatal period and the delivery period were, respectively, 9.4 times as likely and 5.4 times as likely to have indications of stroke.

The current recommendations from the American Heart Association and the American Stroke Association for managing pregnant women with a history of noncardioembolic stroke or at risk of cardioembolic stroke include treatment with anticoagulant therapy in the form of unfractionated heparin or low-molecular-weight heparin until week 13, followed by low dose aspirin for the rest of the pregnancy (Stroke 2011;42:227-76).

The findings support data from previous studies at single institutions, although they were limited by the use of ICD-9 codes that were not validated by a review of medical records, the researchers noted.

However, the findings suggest that cardiovascular disease surveillance of pregnant women remains essential to improving both the design of future studies and the clinical care of pregnant women, Dr. Kuklina and her associates added.

Dr. Kuklina and her associates said they had no relevant financial disclosures.

The rate of any type of pregnancy-related hospitalization for stroke in the United States increased from approximately 4,000 in 1994-1995 to about 6,000 in 2006-2007, based on data from a nationwide sample of more than 64 million pregnant women, according to findings published in the September issue of Stroke.

This 54% increase can be explained largely by postpartum hospitalizations in women with heart disease or hypertensive disorders, said Dr. Elena V. Kuklina and her associates at the Centers for Disease Control and Prevention in Atlanta.

The researchers compared ICD-9 code data from 1994 to 1995 with data from 2006 to 2007. Types of stroke included cerebral venous thrombosis, hemorrhagic, ischemic, subarachnoid, transient ischemic attack, and unspecified (Stroke 2011 July 28 [doi:10.1161/strokeaha.110.610592]).

Overall, hypertensive disorders were present in 11%, 23%, and 28% of prenatal, delivery, and postpartum hospitalizations, respectively, in 1994-1995, and these numbers increased to 17%, 29%, and 41% in 2006-2007. Only the increase in postpartum hospitalizations for stroke was statistically significant.

Heart disease was a complication in pregnancy-related hospitalizations for stroke in 16% of prenatal hospitalizations, 8% of delivery hospitalizations, and 9% of postpartum hospitalizations in 1994-1995, whereas that was the case in 16%, 8%, and 12% of the hospitalizations, respectively, in 2006-2007.

The rate of any stroke per 1,000 deliveries increased significantly for prenatal hospitalizations and postpartum hospitalizations between the two time periods (from 0.15 to 0.22 and from 0.12 to 0.22, respectively). However, the rate of any stroke during delivery hospitalizations remained unchanged at 0.27.

After adjusting for confounding variables, patients who were hospitalized with hypertensive disorders during pregnancy, during delivery, and post partum were 1.8, 5.6, and 3.5 times more likely, respectively, to have indications of stroke, compared with patients without hypertensive disorders, the researchers noted.

In addition, patients who were hospitalized with heart disease during the prenatal period and the delivery period were, respectively, 9.4 times as likely and 5.4 times as likely to have indications of stroke.

The current recommendations from the American Heart Association and the American Stroke Association for managing pregnant women with a history of noncardioembolic stroke or at risk of cardioembolic stroke include treatment with anticoagulant therapy in the form of unfractionated heparin or low-molecular-weight heparin until week 13, followed by low dose aspirin for the rest of the pregnancy (Stroke 2011;42:227-76).

The findings support data from previous studies at single institutions, although they were limited by the use of ICD-9 codes that were not validated by a review of medical records, the researchers noted.

However, the findings suggest that cardiovascular disease surveillance of pregnant women remains essential to improving both the design of future studies and the clinical care of pregnant women, Dr. Kuklina and her associates added.

Dr. Kuklina and her associates said they had no relevant financial disclosures.

QUEBEC CITY – Be sure to screen men who have sex with men for gonorrhea, and don’t ignore the rectum, based on data from 1,076 MSM.

"Rectal gonorrhea probably predisposes individuals to HIV infection," said Dr. Marcus Chen of the University of Melbourne.

Gonorrhea infection of the pharynx and rectum is usually asymptomatic, but data show that these areas can be reservoirs of infection that can be transmitted during oral or anal sex, Dr. Chen said.

Understanding the natural history and transmissibility of the infection may help control the spread of gonorrhea in MSM, but data on the transmissibility of gonorrhea from the pharynx and rectum are limited, said Dr. Chen, who presented the data at the congress of the International Society for Sexually Transmitted Diseases Research.

In this study, Dr. Chen and his colleagues identified the gonococcal bacterial loads at the pharynx and rectum.

The study population included 1,076 consecutive MSM who were tested for gonorrhea at a single health center between January 2010 and April 2010. The mean age of the study population was 32 years.

Rectal and pharyngeal swabs were taken from each patient, and the samples were testing using both culture and polymerase chain reaction (PCR). A total of 1,011 rectal samples and 1,076 pharyngeal samples were analyzed.

Overall, the prevalence of pharyngeal gonorrhea was 4%, the prevalence of rectal gonorrhea was 5%, and the prevalence of gonorrhea in both locations was 1%. There were no symptomatic pharyngeal infections, but the prevalence of symptomatic rectal infections was 16%.

The bacterial loads were significantly higher in rectal infections, compared with pharyngeal (18,960 vs. 2,100 copies per swab), and higher in symptomatic rectal infections, compared with asymptomatic samples (278,800 vs. 13,980 copies per swab), Dr. Chen noted.

The sensitivity of the gonorrhea culture, compared with PCR, was 39% with a specificity of 53%, Dr. Chen noted. Consequently, bacterial loads were significantly higher in the positive cultures, compared with the negative cultures, for both types of gonorrhea.

The study is the first to compare the bacterial loads of gonorrhea in the pharynx and the rectum, Dr. Chen said. "Lower bacterial loads in the pharynx, compared with the rectum, point to possible lower transmission risk," he said. But more research is needed, including prospective studies to quantify the transmission of gonorrhea between MSM partners, he added.

Findings from additional studies could help doctors design more effective ways to screen for and control gonorrhea in the MSM population, Dr. Chen said.

Dr. Chen said that he had no financial conflicts to disclose.

QUEBEC CITY – Be sure to screen men who have sex with men for gonorrhea, and don’t ignore the rectum, based on data from 1,076 MSM.

"Rectal gonorrhea probably predisposes individuals to HIV infection," said Dr. Marcus Chen of the University of Melbourne.

Gonorrhea infection of the pharynx and rectum is usually asymptomatic, but data show that these areas can be reservoirs of infection that can be transmitted during oral or anal sex, Dr. Chen said.

Understanding the natural history and transmissibility of the infection may help control the spread of gonorrhea in MSM, but data on the transmissibility of gonorrhea from the pharynx and rectum are limited, said Dr. Chen, who presented the data at the congress of the International Society for Sexually Transmitted Diseases Research.

In this study, Dr. Chen and his colleagues identified the gonococcal bacterial loads at the pharynx and rectum.

The study population included 1,076 consecutive MSM who were tested for gonorrhea at a single health center between January 2010 and April 2010. The mean age of the study population was 32 years.

Rectal and pharyngeal swabs were taken from each patient, and the samples were testing using both culture and polymerase chain reaction (PCR). A total of 1,011 rectal samples and 1,076 pharyngeal samples were analyzed.

Overall, the prevalence of pharyngeal gonorrhea was 4%, the prevalence of rectal gonorrhea was 5%, and the prevalence of gonorrhea in both locations was 1%. There were no symptomatic pharyngeal infections, but the prevalence of symptomatic rectal infections was 16%.

The bacterial loads were significantly higher in rectal infections, compared with pharyngeal (18,960 vs. 2,100 copies per swab), and higher in symptomatic rectal infections, compared with asymptomatic samples (278,800 vs. 13,980 copies per swab), Dr. Chen noted.

The sensitivity of the gonorrhea culture, compared with PCR, was 39% with a specificity of 53%, Dr. Chen noted. Consequently, bacterial loads were significantly higher in the positive cultures, compared with the negative cultures, for both types of gonorrhea.

The study is the first to compare the bacterial loads of gonorrhea in the pharynx and the rectum, Dr. Chen said. "Lower bacterial loads in the pharynx, compared with the rectum, point to possible lower transmission risk," he said. But more research is needed, including prospective studies to quantify the transmission of gonorrhea between MSM partners, he added.

Findings from additional studies could help doctors design more effective ways to screen for and control gonorrhea in the MSM population, Dr. Chen said.

Dr. Chen said that he had no financial conflicts to disclose.

QUEBEC CITY – Be sure to screen men who have sex with men for gonorrhea, and don’t ignore the rectum, based on data from 1,076 MSM.

"Rectal gonorrhea probably predisposes individuals to HIV infection," said Dr. Marcus Chen of the University of Melbourne.

Gonorrhea infection of the pharynx and rectum is usually asymptomatic, but data show that these areas can be reservoirs of infection that can be transmitted during oral or anal sex, Dr. Chen said.

Understanding the natural history and transmissibility of the infection may help control the spread of gonorrhea in MSM, but data on the transmissibility of gonorrhea from the pharynx and rectum are limited, said Dr. Chen, who presented the data at the congress of the International Society for Sexually Transmitted Diseases Research.

In this study, Dr. Chen and his colleagues identified the gonococcal bacterial loads at the pharynx and rectum.

The study population included 1,076 consecutive MSM who were tested for gonorrhea at a single health center between January 2010 and April 2010. The mean age of the study population was 32 years.

Rectal and pharyngeal swabs were taken from each patient, and the samples were testing using both culture and polymerase chain reaction (PCR). A total of 1,011 rectal samples and 1,076 pharyngeal samples were analyzed.

Overall, the prevalence of pharyngeal gonorrhea was 4%, the prevalence of rectal gonorrhea was 5%, and the prevalence of gonorrhea in both locations was 1%. There were no symptomatic pharyngeal infections, but the prevalence of symptomatic rectal infections was 16%.

The bacterial loads were significantly higher in rectal infections, compared with pharyngeal (18,960 vs. 2,100 copies per swab), and higher in symptomatic rectal infections, compared with asymptomatic samples (278,800 vs. 13,980 copies per swab), Dr. Chen noted.

The sensitivity of the gonorrhea culture, compared with PCR, was 39% with a specificity of 53%, Dr. Chen noted. Consequently, bacterial loads were significantly higher in the positive cultures, compared with the negative cultures, for both types of gonorrhea.

The study is the first to compare the bacterial loads of gonorrhea in the pharynx and the rectum, Dr. Chen said. "Lower bacterial loads in the pharynx, compared with the rectum, point to possible lower transmission risk," he said. But more research is needed, including prospective studies to quantify the transmission of gonorrhea between MSM partners, he added.

Findings from additional studies could help doctors design more effective ways to screen for and control gonorrhea in the MSM population, Dr. Chen said.

Dr. Chen said that he had no financial conflicts to disclose.

QUEBEC CITY – Be sure to screen men who have sex with men for gonorrhea, and don’t ignore the rectum, based on data from 1,076 MSM.

"Rectal gonorrhea probably predisposes individuals to HIV infection," said Dr. Marcus Chen of the University of Melbourne.

Gonorrhea infection of the pharynx and rectum is usually asymptomatic, but data show that these areas can be reservoirs of infection that can be transmitted during oral or anal sex, Dr. Chen said.

Understanding the natural history and transmissibility of the infection may help control the spread of gonorrhea in MSM, but data on the transmissibility of gonorrhea from the pharynx and rectum are limited, said Dr. Chen, who presented the data at the congress of the International Society for Sexually Transmitted Diseases Research.

In this study, Dr. Chen and his colleagues identified the gonococcal bacterial loads at the pharynx and rectum.

The study population included 1,076 consecutive MSM who were tested for gonorrhea at a single health center between January 2010 and April 2010. The mean age of the study population was 32 years.

Rectal and pharyngeal swabs were taken from each patient, and the samples were testing using both culture and polymerase chain reaction (PCR). A total of 1,011 rectal samples and 1,076 pharyngeal samples were analyzed.

Overall, the prevalence of pharyngeal gonorrhea was 4%, the prevalence of rectal gonorrhea was 5%, and the prevalence of gonorrhea in both locations was 1%. There were no symptomatic pharyngeal infections, but the prevalence of symptomatic rectal infections was 16%.

The bacterial loads were significantly higher in rectal infections, compared with pharyngeal (18,960 vs. 2,100 copies per swab), and higher in symptomatic rectal infections, compared with asymptomatic samples (278,800 vs. 13,980 copies per swab), Dr. Chen noted.

The sensitivity of the gonorrhea culture, compared with PCR, was 39% with a specificity of 53%, Dr. Chen noted. Consequently, bacterial loads were significantly higher in the positive cultures, compared with the negative cultures, for both types of gonorrhea.

The study is the first to compare the bacterial loads of gonorrhea in the pharynx and the rectum, Dr. Chen said. "Lower bacterial loads in the pharynx, compared with the rectum, point to possible lower transmission risk," he said. But more research is needed, including prospective studies to quantify the transmission of gonorrhea between MSM partners, he added.

Findings from additional studies could help doctors design more effective ways to screen for and control gonorrhea in the MSM population, Dr. Chen said.

Dr. Chen said that he had no financial conflicts to disclose.

QUEBEC CITY – Be sure to screen men who have sex with men for gonorrhea, and don’t ignore the rectum, based on data from 1,076 MSM.

"Rectal gonorrhea probably predisposes individuals to HIV infection," said Dr. Marcus Chen of the University of Melbourne.

Gonorrhea infection of the pharynx and rectum is usually asymptomatic, but data show that these areas can be reservoirs of infection that can be transmitted during oral or anal sex, Dr. Chen said.

Understanding the natural history and transmissibility of the infection may help control the spread of gonorrhea in MSM, but data on the transmissibility of gonorrhea from the pharynx and rectum are limited, said Dr. Chen, who presented the data at the congress of the International Society for Sexually Transmitted Diseases Research.

In this study, Dr. Chen and his colleagues identified the gonococcal bacterial loads at the pharynx and rectum.

The study population included 1,076 consecutive MSM who were tested for gonorrhea at a single health center between January 2010 and April 2010. The mean age of the study population was 32 years.

Rectal and pharyngeal swabs were taken from each patient, and the samples were testing using both culture and polymerase chain reaction (PCR). A total of 1,011 rectal samples and 1,076 pharyngeal samples were analyzed.

Overall, the prevalence of pharyngeal gonorrhea was 4%, the prevalence of rectal gonorrhea was 5%, and the prevalence of gonorrhea in both locations was 1%. There were no symptomatic pharyngeal infections, but the prevalence of symptomatic rectal infections was 16%.

The bacterial loads were significantly higher in rectal infections, compared with pharyngeal (18,960 vs. 2,100 copies per swab), and higher in symptomatic rectal infections, compared with asymptomatic samples (278,800 vs. 13,980 copies per swab), Dr. Chen noted.

The sensitivity of the gonorrhea culture, compared with PCR, was 39% with a specificity of 53%, Dr. Chen noted. Consequently, bacterial loads were significantly higher in the positive cultures, compared with the negative cultures, for both types of gonorrhea.

The study is the first to compare the bacterial loads of gonorrhea in the pharynx and the rectum, Dr. Chen said. "Lower bacterial loads in the pharynx, compared with the rectum, point to possible lower transmission risk," he said. But more research is needed, including prospective studies to quantify the transmission of gonorrhea between MSM partners, he added.

Findings from additional studies could help doctors design more effective ways to screen for and control gonorrhea in the MSM population, Dr. Chen said.

Dr. Chen said that he had no financial conflicts to disclose.

QUEBEC CITY – Be sure to screen men who have sex with men for gonorrhea, and don’t ignore the rectum, based on data from 1,076 MSM.

"Rectal gonorrhea probably predisposes individuals to HIV infection," said Dr. Marcus Chen of the University of Melbourne.

Gonorrhea infection of the pharynx and rectum is usually asymptomatic, but data show that these areas can be reservoirs of infection that can be transmitted during oral or anal sex, Dr. Chen said.

Understanding the natural history and transmissibility of the infection may help control the spread of gonorrhea in MSM, but data on the transmissibility of gonorrhea from the pharynx and rectum are limited, said Dr. Chen, who presented the data at the congress of the International Society for Sexually Transmitted Diseases Research.

In this study, Dr. Chen and his colleagues identified the gonococcal bacterial loads at the pharynx and rectum.

The study population included 1,076 consecutive MSM who were tested for gonorrhea at a single health center between January 2010 and April 2010. The mean age of the study population was 32 years.

Rectal and pharyngeal swabs were taken from each patient, and the samples were testing using both culture and polymerase chain reaction (PCR). A total of 1,011 rectal samples and 1,076 pharyngeal samples were analyzed.

Overall, the prevalence of pharyngeal gonorrhea was 4%, the prevalence of rectal gonorrhea was 5%, and the prevalence of gonorrhea in both locations was 1%. There were no symptomatic pharyngeal infections, but the prevalence of symptomatic rectal infections was 16%.

The bacterial loads were significantly higher in rectal infections, compared with pharyngeal (18,960 vs. 2,100 copies per swab), and higher in symptomatic rectal infections, compared with asymptomatic samples (278,800 vs. 13,980 copies per swab), Dr. Chen noted.

The sensitivity of the gonorrhea culture, compared with PCR, was 39% with a specificity of 53%, Dr. Chen noted. Consequently, bacterial loads were significantly higher in the positive cultures, compared with the negative cultures, for both types of gonorrhea.

The study is the first to compare the bacterial loads of gonorrhea in the pharynx and the rectum, Dr. Chen said. "Lower bacterial loads in the pharynx, compared with the rectum, point to possible lower transmission risk," he said. But more research is needed, including prospective studies to quantify the transmission of gonorrhea between MSM partners, he added.

Findings from additional studies could help doctors design more effective ways to screen for and control gonorrhea in the MSM population, Dr. Chen said.

Dr. Chen said that he had no financial conflicts to disclose.

QUEBEC CITY  – Oral metronidazole was not more effective for bacterial vaginosis when combined with clindamycin or a probiotic, based on data from 450 women.

"Bacterial vaginosis is the most common cause of infections in women worldwide," said Dr. Catriona Bradshaw of the University of Melbourne. Current monotherapy treatments are not highly effective, and up to 50-60% of women have recurrent bacterial vaginosis (BV) after treatment. Dr. Bradshaw and her colleagues examined whether a combination of oral and vaginal therapy could be more effective.

Data on the efficacy of vaginal probiotics for BV are limited, said Dr. Bradshaw. But the growing awareness of and interest in probiotics helped drive the study, she said.

In this study, 150 women were randomized to each of three treatments: oral metronidazole plus vaginal clindamycin, oral metronidazole plus a vaginal probiotic, or oral metronidazole plus a placebo. The women ranged in age from 18 to 50 years, all had bacterial vaginosis, and none were HIV positive. There were no significant demographic or behavioral differences among the three groups. Dr. Bradshaw presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Overall, 382 (85%) of the women had baseline Nugent scores of 7-10 – which is considered highly positive for bacterial vaginosis – on a scale of 0-10.

In the intent-to-treat population, the cumulative 6-month BV recurrent rate was 28%. The hazard ratio for BV recurrence at 6 months posttreatment was 1.09 for the clindamycin group and 1.03 for the probiotic group, compared with 1.00 for the placebo group.

The cumulative 6-month recurrence rate for abnormal vaginal flora was 54%, and the hazard ratio for the recurrence of abnormal flora was 1.01 for the clindamycin group and 0.97 for the probiotic group, compared with 1.0 for the placebo group.

The self-reported adherence to vaginal therapy in the clindamycin, probiotic, and placebo groups was 88%, 77%, and 78%, respectively, and to oral metronidazole was more than 90% for all three study arms Dr. Bradshaw said.

The most common self-reported side effect was vaginal itching or soreness, reported by approximately one-third of the patients in each treatment group.

"The implications for clinicians are to keep an open mind about BV and to keep an eye on the literature to look for improved therapies," she said. Also, clinicians should inform patients about the limitations of current therapies. "A lot of women are quite disappointed when their BV comes back," she said.

Dr. Bradshaw said that she had no financial conflicts to disclose.

QUEBEC CITY  – Oral metronidazole was not more effective for bacterial vaginosis when combined with clindamycin or a probiotic, based on data from 450 women.

"Bacterial vaginosis is the most common cause of infections in women worldwide," said Dr. Catriona Bradshaw of the University of Melbourne. Current monotherapy treatments are not highly effective, and up to 50-60% of women have recurrent bacterial vaginosis (BV) after treatment. Dr. Bradshaw and her colleagues examined whether a combination of oral and vaginal therapy could be more effective.

Data on the efficacy of vaginal probiotics for BV are limited, said Dr. Bradshaw. But the growing awareness of and interest in probiotics helped drive the study, she said.

In this study, 150 women were randomized to each of three treatments: oral metronidazole plus vaginal clindamycin, oral metronidazole plus a vaginal probiotic, or oral metronidazole plus a placebo. The women ranged in age from 18 to 50 years, all had bacterial vaginosis, and none were HIV positive. There were no significant demographic or behavioral differences among the three groups. Dr. Bradshaw presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Overall, 382 (85%) of the women had baseline Nugent scores of 7-10 – which is considered highly positive for bacterial vaginosis – on a scale of 0-10.

In the intent-to-treat population, the cumulative 6-month BV recurrent rate was 28%. The hazard ratio for BV recurrence at 6 months posttreatment was 1.09 for the clindamycin group and 1.03 for the probiotic group, compared with 1.00 for the placebo group.

The cumulative 6-month recurrence rate for abnormal vaginal flora was 54%, and the hazard ratio for the recurrence of abnormal flora was 1.01 for the clindamycin group and 0.97 for the probiotic group, compared with 1.0 for the placebo group.

The self-reported adherence to vaginal therapy in the clindamycin, probiotic, and placebo groups was 88%, 77%, and 78%, respectively, and to oral metronidazole was more than 90% for all three study arms Dr. Bradshaw said.

The most common self-reported side effect was vaginal itching or soreness, reported by approximately one-third of the patients in each treatment group.

"The implications for clinicians are to keep an open mind about BV and to keep an eye on the literature to look for improved therapies," she said. Also, clinicians should inform patients about the limitations of current therapies. "A lot of women are quite disappointed when their BV comes back," she said.

Dr. Bradshaw said that she had no financial conflicts to disclose.

QUEBEC CITY  – Oral metronidazole was not more effective for bacterial vaginosis when combined with clindamycin or a probiotic, based on data from 450 women.

"Bacterial vaginosis is the most common cause of infections in women worldwide," said Dr. Catriona Bradshaw of the University of Melbourne. Current monotherapy treatments are not highly effective, and up to 50-60% of women have recurrent bacterial vaginosis (BV) after treatment. Dr. Bradshaw and her colleagues examined whether a combination of oral and vaginal therapy could be more effective.

Data on the efficacy of vaginal probiotics for BV are limited, said Dr. Bradshaw. But the growing awareness of and interest in probiotics helped drive the study, she said.

In this study, 150 women were randomized to each of three treatments: oral metronidazole plus vaginal clindamycin, oral metronidazole plus a vaginal probiotic, or oral metronidazole plus a placebo. The women ranged in age from 18 to 50 years, all had bacterial vaginosis, and none were HIV positive. There were no significant demographic or behavioral differences among the three groups. Dr. Bradshaw presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Overall, 382 (85%) of the women had baseline Nugent scores of 7-10 – which is considered highly positive for bacterial vaginosis – on a scale of 0-10.

In the intent-to-treat population, the cumulative 6-month BV recurrent rate was 28%. The hazard ratio for BV recurrence at 6 months posttreatment was 1.09 for the clindamycin group and 1.03 for the probiotic group, compared with 1.00 for the placebo group.

The cumulative 6-month recurrence rate for abnormal vaginal flora was 54%, and the hazard ratio for the recurrence of abnormal flora was 1.01 for the clindamycin group and 0.97 for the probiotic group, compared with 1.0 for the placebo group.

The self-reported adherence to vaginal therapy in the clindamycin, probiotic, and placebo groups was 88%, 77%, and 78%, respectively, and to oral metronidazole was more than 90% for all three study arms Dr. Bradshaw said.

The most common self-reported side effect was vaginal itching or soreness, reported by approximately one-third of the patients in each treatment group.

"The implications for clinicians are to keep an open mind about BV and to keep an eye on the literature to look for improved therapies," she said. Also, clinicians should inform patients about the limitations of current therapies. "A lot of women are quite disappointed when their BV comes back," she said.

Dr. Bradshaw said that she had no financial conflicts to disclose.

QUEBEC CITY – Oral metronidazole was not more effective for bacterial vaginosis when combined with clindamycin or a probiotic, based on data from 450 women.

"Bacterial vaginosis is the most common cause of infections in women worldwide," said Dr. Catriona Bradshaw of the University of Melbourne. Current monotherapy treatments are not highly effective, and up to 50-60% of women have recurrent bacterial vaginosis (BV) after treatment. Dr. Bradshaw and her colleagues examined whether a combination of oral and vaginal therapy could be more effective.

Data on the efficacy of vaginal probiotics for BV are limited, said Dr. Bradshaw. But the growing awareness of and interest in probiotics helped drive the study, she said.

In this study, 150 women were randomized to each of three treatments: oral metronidazole plus vaginal clindamycin, oral metronidazole plus a vaginal probiotic, or oral metronidazole plus a placebo. The women ranged in age from 18 to 50 years, all had bacterial vaginosis, and none were HIV positive. There were no significant demographic or behavioral differences among the three groups. Dr. Bradshaw presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Overall, 382 (85%) of the women had baseline Nugent scores of 7-10 – which is considered highly positive for bacterial vaginosis – on a scale of 0-10.

In the intent-to-treat population, the cumulative 6-month BV recurrent rate was 28%. The hazard ratio for BV recurrence at 6 months posttreatment was 1.09 for the clindamycin group and 1.03 for the probiotic group, compared with 1.00 for the placebo group.

The cumulative 6-month recurrence rate for abnormal vaginal flora was 54%, and the hazard ratio for the recurrence of abnormal flora was 1.01 for the clindamycin group and 0.97 for the probiotic group, compared with 1.0 for the placebo group.

The self-reported adherence to vaginal therapy in the clindamycin, probiotic, and placebo groups was 88%, 77%, and 78%, respectively, and to oral metronidazole was more than 90% for all three study arms Dr. Bradshaw said.

The most common self-reported side effect was vaginal itching or soreness, reported by approximately one-third of the patients in each treatment group.

"The implications for clinicians are to keep an open mind about BV and to keep an eye on the literature to look for improved therapies," she said. Also, clinicians should inform patients about the limitations of current therapies. "A lot of women are quite disappointed when their BV comes back," she said.

Dr. Bradshaw said that she had no financial conflicts to disclose.

QUEBEC CITY – Oral metronidazole was not more effective for bacterial vaginosis when combined with clindamycin or a probiotic, based on data from 450 women.

"Bacterial vaginosis is the most common cause of infections in women worldwide," said Dr. Catriona Bradshaw of the University of Melbourne. Current monotherapy treatments are not highly effective, and up to 50-60% of women have recurrent bacterial vaginosis (BV) after treatment. Dr. Bradshaw and her colleagues examined whether a combination of oral and vaginal therapy could be more effective.

Data on the efficacy of vaginal probiotics for BV are limited, said Dr. Bradshaw. But the growing awareness of and interest in probiotics helped drive the study, she said.

In this study, 150 women were randomized to each of three treatments: oral metronidazole plus vaginal clindamycin, oral metronidazole plus a vaginal probiotic, or oral metronidazole plus a placebo. The women ranged in age from 18 to 50 years, all had bacterial vaginosis, and none were HIV positive. There were no significant demographic or behavioral differences among the three groups. Dr. Bradshaw presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Overall, 382 (85%) of the women had baseline Nugent scores of 7-10 – which is considered highly positive for bacterial vaginosis – on a scale of 0-10.

In the intent-to-treat population, the cumulative 6-month BV recurrent rate was 28%. The hazard ratio for BV recurrence at 6 months posttreatment was 1.09 for the clindamycin group and 1.03 for the probiotic group, compared with 1.00 for the placebo group.

The cumulative 6-month recurrence rate for abnormal vaginal flora was 54%, and the hazard ratio for the recurrence of abnormal flora was 1.01 for the clindamycin group and 0.97 for the probiotic group, compared with 1.0 for the placebo group.

The self-reported adherence to vaginal therapy in the clindamycin, probiotic, and placebo groups was 88%, 77%, and 78%, respectively, and to oral metronidazole was more than 90% for all three study arms Dr. Bradshaw said.

The most common self-reported side effect was vaginal itching or soreness, reported by approximately one-third of the patients in each treatment group.

"The implications for clinicians are to keep an open mind about BV and to keep an eye on the literature to look for improved therapies," she said. Also, clinicians should inform patients about the limitations of current therapies. "A lot of women are quite disappointed when their BV comes back," she said.

Dr. Bradshaw said that she had no financial conflicts to disclose.

QUEBEC CITY – Oral metronidazole was not more effective for bacterial vaginosis when combined with clindamycin or a probiotic, based on data from 450 women.

"Bacterial vaginosis is the most common cause of infections in women worldwide," said Dr. Catriona Bradshaw of the University of Melbourne. Current monotherapy treatments are not highly effective, and up to 50-60% of women have recurrent bacterial vaginosis (BV) after treatment. Dr. Bradshaw and her colleagues examined whether a combination of oral and vaginal therapy could be more effective.

Data on the efficacy of vaginal probiotics for BV are limited, said Dr. Bradshaw. But the growing awareness of and interest in probiotics helped drive the study, she said.

In this study, 150 women were randomized to each of three treatments: oral metronidazole plus vaginal clindamycin, oral metronidazole plus a vaginal probiotic, or oral metronidazole plus a placebo. The women ranged in age from 18 to 50 years, all had bacterial vaginosis, and none were HIV positive. There were no significant demographic or behavioral differences among the three groups. Dr. Bradshaw presented the findings at a congress of the International Society for Sexually Transmitted Diseases Research.

Overall, 382 (85%) of the women had baseline Nugent scores of 7-10 – which is considered highly positive for bacterial vaginosis – on a scale of 0-10.

In the intent-to-treat population, the cumulative 6-month BV recurrent rate was 28%. The hazard ratio for BV recurrence at 6 months posttreatment was 1.09 for the clindamycin group and 1.03 for the probiotic group, compared with 1.00 for the placebo group.

The cumulative 6-month recurrence rate for abnormal vaginal flora was 54%, and the hazard ratio for the recurrence of abnormal flora was 1.01 for the clindamycin group and 0.97 for the probiotic group, compared with 1.0 for the placebo group.

The self-reported adherence to vaginal therapy in the clindamycin, probiotic, and placebo groups was 88%, 77%, and 78%, respectively, and to oral metronidazole was more than 90% for all three study arms Dr. Bradshaw said.

The most common self-reported side effect was vaginal itching or soreness, reported by approximately one-third of the patients in each treatment group.

"The implications for clinicians are to keep an open mind about BV and to keep an eye on the literature to look for improved therapies," she said. Also, clinicians should inform patients about the limitations of current therapies. "A lot of women are quite disappointed when their BV comes back," she said.

Dr. Bradshaw said that she had no financial conflicts to disclose.

The estimated overall rate of new HIV infections in the United States has remained stable at approximately 50,000 over the past 3 years – but infection rates increased significantly among young men who have sex with men and in young, black MSM, in particular, according to a report from the Centers for Disease Control and Prevention.

The findings were presented Aug. 3 in a teleconference and published online in the journal PLoS ONE (2011 Aug. 3;6:e17502 [doi:10.1371/journal.pone.0017502]).

The estimated overall yearly number of new cases of HIV infection between 2006 and 2009 in males and females aged 13 years and older was 48,600 in 2006, 56,000 in 2007, 47,800 in 2008, and 48,100 in 2009, according to lead study author Joseph Prejean, Ph.D., of the CDC’s Division of HIV/AIDS Prevention.

The CDC study’s estimates were based on incidence surveillance data from 16 states and two cities.

Overall, the rates of new infections were not significantly different for most subgroups when analyzed by age, race, and transmission category. But, "gay and bisexual men of all races remain most affected by HIV in the United States," Dr. Prejean said. "MSM represented 61% of all new cases in 2009," he added.

The incidence of new HIV infections among black MSM aged 13-29 years increased by 48% during the study period, from 4,400 in 2006 to 6,500 in 2009.

"We don’t have all the answers about what might be driving this trend, but we do know that individual risk factors alone do not account for it," Dr. Prejean said. "We think there are more complex factors at work."

For example, young black men have higher rates of syphilis, which can increase the risk of HIV transmission, he said. In addition, many young black men have limited access to care and often face stigma associated with homosexuality, he added.

Overall, black and Hispanic men and women had significantly higher rates of HIV infection, compared with whites, and these trends did not change significantly over the study period.

"HIV is preventable, and we need to do more to prevent it," CDC Director Thomas Frieden said during the teleconference. Approximately 1.2 million people in the United States are infected with HIV, and 1 in 5 doesn’t know he or she is infected, he added.

Dr. Frieden emphasized that knowing one’s HIV status is key to reducing HIV infection rates, and he encouraged doctors to promote routine HIV testing.

HIV testing "is something that we go through, and that we encourage patients to go through. It is like other medical tests," said Dr. Frieden. "That doesn’t mean that anyone should be tested against their will or without their knowledge," he added. But data have shown that when HIV testing is part of the routine, testing rates go up and detection rates for previously undiagnosed infection go up, he said.

"Physicians also need to link people to [HIV] care," Dr. Frieden said. "One concerning trend is that one-third of people who test positive for HIV don’t appear to be entering care promptly."

The CDC recommends that all Americans aged 13-64 years receive an HIV test at least once during their lives, said Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Those people with ongoing risks or concerns are encouraged to get tested more frequently, he said.

There are many types of point-of-care testing available to make it easier for physicians to talk with patients about HIV and provide testing at the local level, Dr. Fenton added.

The CDC funded the study, and the authors said they had no financial conflicts to disclose. Read the complete article online at PLoS ONE.

The estimated overall rate of new HIV infections in the United States has remained stable at approximately 50,000 over the past 3 years – but infection rates increased significantly among young men who have sex with men and in young, black MSM, in particular, according to a report from the Centers for Disease Control and Prevention.

The findings were presented Aug. 3 in a teleconference and published online in the journal PLoS ONE (2011 Aug. 3;6:e17502 [doi:10.1371/journal.pone.0017502]).

The estimated overall yearly number of new cases of HIV infection between 2006 and 2009 in males and females aged 13 years and older was 48,600 in 2006, 56,000 in 2007, 47,800 in 2008, and 48,100 in 2009, according to lead study author Joseph Prejean, Ph.D., of the CDC’s Division of HIV/AIDS Prevention.

The CDC study’s estimates were based on incidence surveillance data from 16 states and two cities.

Overall, the rates of new infections were not significantly different for most subgroups when analyzed by age, race, and transmission category. But, "gay and bisexual men of all races remain most affected by HIV in the United States," Dr. Prejean said. "MSM represented 61% of all new cases in 2009," he added.

The incidence of new HIV infections among black MSM aged 13-29 years increased by 48% during the study period, from 4,400 in 2006 to 6,500 in 2009.

"We don’t have all the answers about what might be driving this trend, but we do know that individual risk factors alone do not account for it," Dr. Prejean said. "We think there are more complex factors at work."

For example, young black men have higher rates of syphilis, which can increase the risk of HIV transmission, he said. In addition, many young black men have limited access to care and often face stigma associated with homosexuality, he added.

Overall, black and Hispanic men and women had significantly higher rates of HIV infection, compared with whites, and these trends did not change significantly over the study period.

"HIV is preventable, and we need to do more to prevent it," CDC Director Thomas Frieden said during the teleconference. Approximately 1.2 million people in the United States are infected with HIV, and 1 in 5 doesn’t know he or she is infected, he added.

Dr. Frieden emphasized that knowing one’s HIV status is key to reducing HIV infection rates, and he encouraged doctors to promote routine HIV testing.

HIV testing "is something that we go through, and that we encourage patients to go through. It is like other medical tests," said Dr. Frieden. "That doesn’t mean that anyone should be tested against their will or without their knowledge," he added. But data have shown that when HIV testing is part of the routine, testing rates go up and detection rates for previously undiagnosed infection go up, he said.

"Physicians also need to link people to [HIV] care," Dr. Frieden said. "One concerning trend is that one-third of people who test positive for HIV don’t appear to be entering care promptly."

The CDC recommends that all Americans aged 13-64 years receive an HIV test at least once during their lives, said Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Those people with ongoing risks or concerns are encouraged to get tested more frequently, he said.

There are many types of point-of-care testing available to make it easier for physicians to talk with patients about HIV and provide testing at the local level, Dr. Fenton added.

The CDC funded the study, and the authors said they had no financial conflicts to disclose. Read the complete article online at PLoS ONE.

The estimated overall rate of new HIV infections in the United States has remained stable at approximately 50,000 over the past 3 years – but infection rates increased significantly among young men who have sex with men and in young, black MSM, in particular, according to a report from the Centers for Disease Control and Prevention.

The findings were presented Aug. 3 in a teleconference and published online in the journal PLoS ONE (2011 Aug. 3;6:e17502 [doi:10.1371/journal.pone.0017502]).

The estimated overall yearly number of new cases of HIV infection between 2006 and 2009 in males and females aged 13 years and older was 48,600 in 2006, 56,000 in 2007, 47,800 in 2008, and 48,100 in 2009, according to lead study author Joseph Prejean, Ph.D., of the CDC’s Division of HIV/AIDS Prevention.

The CDC study’s estimates were based on incidence surveillance data from 16 states and two cities.

Overall, the rates of new infections were not significantly different for most subgroups when analyzed by age, race, and transmission category. But, "gay and bisexual men of all races remain most affected by HIV in the United States," Dr. Prejean said. "MSM represented 61% of all new cases in 2009," he added.

The incidence of new HIV infections among black MSM aged 13-29 years increased by 48% during the study period, from 4,400 in 2006 to 6,500 in 2009.

"We don’t have all the answers about what might be driving this trend, but we do know that individual risk factors alone do not account for it," Dr. Prejean said. "We think there are more complex factors at work."

For example, young black men have higher rates of syphilis, which can increase the risk of HIV transmission, he said. In addition, many young black men have limited access to care and often face stigma associated with homosexuality, he added.

Overall, black and Hispanic men and women had significantly higher rates of HIV infection, compared with whites, and these trends did not change significantly over the study period.

"HIV is preventable, and we need to do more to prevent it," CDC Director Thomas Frieden said during the teleconference. Approximately 1.2 million people in the United States are infected with HIV, and 1 in 5 doesn’t know he or she is infected, he added.

Dr. Frieden emphasized that knowing one’s HIV status is key to reducing HIV infection rates, and he encouraged doctors to promote routine HIV testing.

HIV testing "is something that we go through, and that we encourage patients to go through. It is like other medical tests," said Dr. Frieden. "That doesn’t mean that anyone should be tested against their will or without their knowledge," he added. But data have shown that when HIV testing is part of the routine, testing rates go up and detection rates for previously undiagnosed infection go up, he said.

"Physicians also need to link people to [HIV] care," Dr. Frieden said. "One concerning trend is that one-third of people who test positive for HIV don’t appear to be entering care promptly."

The CDC recommends that all Americans aged 13-64 years receive an HIV test at least once during their lives, said Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Those people with ongoing risks or concerns are encouraged to get tested more frequently, he said.

There are many types of point-of-care testing available to make it easier for physicians to talk with patients about HIV and provide testing at the local level, Dr. Fenton added.

The CDC funded the study, and the authors said they had no financial conflicts to disclose. Read the complete article online at PLoS ONE.

Major Finding: Omentectomy improved several metabolic parameters after 90 days in patients undergoing Roux-en-Y surgery.

Data Source: Data from 29 nondiabetic adults.

Disclosures: Dr. Dillard said he had no financial conflicts.

SAN DIEGO – Adding omentectomy to Roux-en-Y gastric bypass surgery improved levels of lipids, glucose, and adipokines 90 days after the procedure in nondiabetic patients.

Visceral fat predicts incipient diabetes and cardiovascular disease, but the effect of reducing visceral fat tissue on metabolic risk factors is unknown, said Dr. Troy Dillard of the Oregon Health & Science University in Portland, Ore., at the meeting.

Omentectomy is the surgical removal of the omentum, a fold of visceral fat. To determine the impact of adding omentectomy to gastric bypass surgery, Dr. Dillard and colleagues randomized 29 nondiabetic adults aged 18 years and older to Roux-en-Y alone or Roux-en-Y plus omentectomy. Baseline characteristics including age, gender, and body mass index were similar between the groups.

At 90 days after surgery, body mass index was significantly lower in both groups compared with baseline. But only the omentectomy patients showed significant decreases in fasting glucose, total cholesterol, and very low-density lipoprotein cholesterol, as well as significant increases in their total adiponectin ratios.

Among the omentectomy patients, fasting glucose decreased from 101 mg/dL at baseline to 87 mg/dL after 90 days. Total cholesterol decreased from 191 mg/dL to 163 mg/dL, and VLDL cholesterol decreased from 37 to 21 mg/dL). Triglycerides also decreased significantly, from 179 to 106 mg/dL. Adiponectin increased significantly in the omentectomy group, from 7.2 mcg/mL at baseline to 8.6 mcg/mL after 90 days.

Two patients in the omentectomy group developed gastroenterostomy stenosis and were treated with outpatient endoscopic balloon dilation.

However, any positive effects from the omentectomy seen at 90 days “are likely dwarfed by the metabolic improvements at long-term follow-up conferred by marked weight loss” with the gastric bypass surgery, Dr. Dillard noted.

His study looked at short-term 90-day follow up data, but the long-term clinical benefits of omentectomy remain uncertain, and additional studies are needed.

Long-term follow-up data from other studies suggest that omentectomy is not a beneficial procedure to add to Roux-en-Y gastric bypass, Dr. Dillard said in an interview.

But the type of surgery might make a difference, he noted. “In subjects who are undergoing gastric banding, omentectomy has been shown to be beneficial in long-term follow-up studies. However, more studies are needed in that population to validate that finding” he said.

“At this time, our findings do not indicate that omentectomy should be routinely added to laparoscopic Roux-en-Y gastric bypass, and we look forward to further data to clarify whether subjects undergoing gastric banding will benefit from this procedure.”

The improvements seen on the omentectomy group in Dr. Dillard's study were not explained by differences in total weight loss or inflammatory markers, he said, and the findings support the hypothesis that removing visceral fat tissue might offer metabolic benefits to patients at increased risk for diabetes and heart disease.

Major Finding: Omentectomy improved several metabolic parameters after 90 days in patients undergoing Roux-en-Y surgery.

Data Source: Data from 29 nondiabetic adults.

Disclosures: Dr. Dillard said he had no financial conflicts.

SAN DIEGO – Adding omentectomy to Roux-en-Y gastric bypass surgery improved levels of lipids, glucose, and adipokines 90 days after the procedure in nondiabetic patients.

Visceral fat predicts incipient diabetes and cardiovascular disease, but the effect of reducing visceral fat tissue on metabolic risk factors is unknown, said Dr. Troy Dillard of the Oregon Health & Science University in Portland, Ore., at the meeting.

Omentectomy is the surgical removal of the omentum, a fold of visceral fat. To determine the impact of adding omentectomy to gastric bypass surgery, Dr. Dillard and colleagues randomized 29 nondiabetic adults aged 18 years and older to Roux-en-Y alone or Roux-en-Y plus omentectomy. Baseline characteristics including age, gender, and body mass index were similar between the groups.

At 90 days after surgery, body mass index was significantly lower in both groups compared with baseline. But only the omentectomy patients showed significant decreases in fasting glucose, total cholesterol, and very low-density lipoprotein cholesterol, as well as significant increases in their total adiponectin ratios.

Among the omentectomy patients, fasting glucose decreased from 101 mg/dL at baseline to 87 mg/dL after 90 days. Total cholesterol decreased from 191 mg/dL to 163 mg/dL, and VLDL cholesterol decreased from 37 to 21 mg/dL). Triglycerides also decreased significantly, from 179 to 106 mg/dL. Adiponectin increased significantly in the omentectomy group, from 7.2 mcg/mL at baseline to 8.6 mcg/mL after 90 days.

Two patients in the omentectomy group developed gastroenterostomy stenosis and were treated with outpatient endoscopic balloon dilation.

However, any positive effects from the omentectomy seen at 90 days “are likely dwarfed by the metabolic improvements at long-term follow-up conferred by marked weight loss” with the gastric bypass surgery, Dr. Dillard noted.

His study looked at short-term 90-day follow up data, but the long-term clinical benefits of omentectomy remain uncertain, and additional studies are needed.

Long-term follow-up data from other studies suggest that omentectomy is not a beneficial procedure to add to Roux-en-Y gastric bypass, Dr. Dillard said in an interview.

But the type of surgery might make a difference, he noted. “In subjects who are undergoing gastric banding, omentectomy has been shown to be beneficial in long-term follow-up studies. However, more studies are needed in that population to validate that finding” he said.

“At this time, our findings do not indicate that omentectomy should be routinely added to laparoscopic Roux-en-Y gastric bypass, and we look forward to further data to clarify whether subjects undergoing gastric banding will benefit from this procedure.”

The improvements seen on the omentectomy group in Dr. Dillard's study were not explained by differences in total weight loss or inflammatory markers, he said, and the findings support the hypothesis that removing visceral fat tissue might offer metabolic benefits to patients at increased risk for diabetes and heart disease.

Major Finding: Omentectomy improved several metabolic parameters after 90 days in patients undergoing Roux-en-Y surgery.

Data Source: Data from 29 nondiabetic adults.

Disclosures: Dr. Dillard said he had no financial conflicts.

SAN DIEGO – Adding omentectomy to Roux-en-Y gastric bypass surgery improved levels of lipids, glucose, and adipokines 90 days after the procedure in nondiabetic patients.

Visceral fat predicts incipient diabetes and cardiovascular disease, but the effect of reducing visceral fat tissue on metabolic risk factors is unknown, said Dr. Troy Dillard of the Oregon Health & Science University in Portland, Ore., at the meeting.

Omentectomy is the surgical removal of the omentum, a fold of visceral fat. To determine the impact of adding omentectomy to gastric bypass surgery, Dr. Dillard and colleagues randomized 29 nondiabetic adults aged 18 years and older to Roux-en-Y alone or Roux-en-Y plus omentectomy. Baseline characteristics including age, gender, and body mass index were similar between the groups.

At 90 days after surgery, body mass index was significantly lower in both groups compared with baseline. But only the omentectomy patients showed significant decreases in fasting glucose, total cholesterol, and very low-density lipoprotein cholesterol, as well as significant increases in their total adiponectin ratios.

Among the omentectomy patients, fasting glucose decreased from 101 mg/dL at baseline to 87 mg/dL after 90 days. Total cholesterol decreased from 191 mg/dL to 163 mg/dL, and VLDL cholesterol decreased from 37 to 21 mg/dL). Triglycerides also decreased significantly, from 179 to 106 mg/dL. Adiponectin increased significantly in the omentectomy group, from 7.2 mcg/mL at baseline to 8.6 mcg/mL after 90 days.

Two patients in the omentectomy group developed gastroenterostomy stenosis and were treated with outpatient endoscopic balloon dilation.

However, any positive effects from the omentectomy seen at 90 days “are likely dwarfed by the metabolic improvements at long-term follow-up conferred by marked weight loss” with the gastric bypass surgery, Dr. Dillard noted.

His study looked at short-term 90-day follow up data, but the long-term clinical benefits of omentectomy remain uncertain, and additional studies are needed.

Long-term follow-up data from other studies suggest that omentectomy is not a beneficial procedure to add to Roux-en-Y gastric bypass, Dr. Dillard said in an interview.

But the type of surgery might make a difference, he noted. “In subjects who are undergoing gastric banding, omentectomy has been shown to be beneficial in long-term follow-up studies. However, more studies are needed in that population to validate that finding” he said.

“At this time, our findings do not indicate that omentectomy should be routinely added to laparoscopic Roux-en-Y gastric bypass, and we look forward to further data to clarify whether subjects undergoing gastric banding will benefit from this procedure.”

The improvements seen on the omentectomy group in Dr. Dillard's study were not explained by differences in total weight loss or inflammatory markers, he said, and the findings support the hypothesis that removing visceral fat tissue might offer metabolic benefits to patients at increased risk for diabetes and heart disease.

Major Finding: Among women in the United States, nearly 60% of all new herpes infections in 2007–2008 occurred in non-Hispanic blacks.

Data Source: NHANES data from 1988–1994 and 1999–2008.

Disclosures: The researchers reported having no financial conflicts of interest.

QUEBEC CITY – The incidence of herpes simplex virus type 2 in the United States has remained stable within gender and ethnic groups over the past 2 decades, with young black women remaining at the highest risk for infection, according to an analysis of data from the National Health and Nutrition Examination Surveys for 1988–1994 and 1999–2008.

Herpes simplex virus type 2 (HSV-2) infections have a 16% seroprevalence among 14- to 49-year-olds in the United States, said Dr. Sarah M. Gerver of Imperial College, London. Dr. Gerver presented the findings at the meeting.

She and her associates at Imperial College and the Centers for Disease Control and Prevention in Atlanta combined NHANES data with a predictive model to estimate HSV-2 incidence per 100 person-years at risk.

Overall, the age-adjusted incidence rates over the past 20 years were stable in all sex and ethnic groups with two exceptions, noted Dr. Gerver and her colleagues.

Incidence rates in Mexican American women and non-Hispanic white women had decreased after 2001 and 2002, respectively.

The age-adjusted incidence of HSV-2 in non-Hispanic white men, non-Hispanic black men, and Mexican American men remained stable at approximately 0.4, 1.4, and 0.7 per 100 person-years at risk, respectively. Non-Hispanic black women had the greatest incidence of HSV-2, which held steady over the study period at approximately 2.2 per 100 person-years at risk.

The incidence rate among 25-year-old non-Hispanic black women was more than 13 times greater than in white men of the same age, the researchers noted.

From 1988 to 2008, HSV-2 incidence rates peaked between ages 25 and 35 years for all sex and ethnic groups with the exception of Mexican American men, for whom the incidence remained stable by age.

In 2007–2008, the most recent year included in the study, an estimated 753,519 new HSV-2 infections occurred among 14- to 49-year-olds in the United States, comprising 392,208 in men and 361,311 in women. Approximately 53% of the new infections in men occurred in non-Hispanic whites, and half of these occurred in men aged 18–29 years, according to the researchers.

More than half of the HSV-2 infections in women occurred in those aged 14–24 years (204,550); including 40,520 in girls aged 14–17 years and 164,030 in young women aged 18–24 years.

And among women, “nearly 60% of all new infections were in non-Hispanic blacks, a group that accounts for less than 15% of the female population [in the United States],” the researchers noted.

The findings were limited by the researchers' assumption of perfect comparability of the HSV-2 seroprevalence estimates across age, race, and time.

But the stability of the long-term trends in HSV-2 incidence suggests a need for more targeted intervention programs, especially for those at highest risk, the researchers said.

“This information on the detailed distribution of new infections can help improve the efficiency of interventions,” they wrote.

Major Finding: Among women in the United States, nearly 60% of all new herpes infections in 2007–2008 occurred in non-Hispanic blacks.

Data Source: NHANES data from 1988–1994 and 1999–2008.

Disclosures: The researchers reported having no financial conflicts of interest.

QUEBEC CITY – The incidence of herpes simplex virus type 2 in the United States has remained stable within gender and ethnic groups over the past 2 decades, with young black women remaining at the highest risk for infection, according to an analysis of data from the National Health and Nutrition Examination Surveys for 1988–1994 and 1999–2008.

Herpes simplex virus type 2 (HSV-2) infections have a 16% seroprevalence among 14- to 49-year-olds in the United States, said Dr. Sarah M. Gerver of Imperial College, London. Dr. Gerver presented the findings at the meeting.

She and her associates at Imperial College and the Centers for Disease Control and Prevention in Atlanta combined NHANES data with a predictive model to estimate HSV-2 incidence per 100 person-years at risk.

Overall, the age-adjusted incidence rates over the past 20 years were stable in all sex and ethnic groups with two exceptions, noted Dr. Gerver and her colleagues.

Incidence rates in Mexican American women and non-Hispanic white women had decreased after 2001 and 2002, respectively.

The age-adjusted incidence of HSV-2 in non-Hispanic white men, non-Hispanic black men, and Mexican American men remained stable at approximately 0.4, 1.4, and 0.7 per 100 person-years at risk, respectively. Non-Hispanic black women had the greatest incidence of HSV-2, which held steady over the study period at approximately 2.2 per 100 person-years at risk.

The incidence rate among 25-year-old non-Hispanic black women was more than 13 times greater than in white men of the same age, the researchers noted.

From 1988 to 2008, HSV-2 incidence rates peaked between ages 25 and 35 years for all sex and ethnic groups with the exception of Mexican American men, for whom the incidence remained stable by age.

In 2007–2008, the most recent year included in the study, an estimated 753,519 new HSV-2 infections occurred among 14- to 49-year-olds in the United States, comprising 392,208 in men and 361,311 in women. Approximately 53% of the new infections in men occurred in non-Hispanic whites, and half of these occurred in men aged 18–29 years, according to the researchers.

More than half of the HSV-2 infections in women occurred in those aged 14–24 years (204,550); including 40,520 in girls aged 14–17 years and 164,030 in young women aged 18–24 years.

And among women, “nearly 60% of all new infections were in non-Hispanic blacks, a group that accounts for less than 15% of the female population [in the United States],” the researchers noted.

The findings were limited by the researchers' assumption of perfect comparability of the HSV-2 seroprevalence estimates across age, race, and time.

But the stability of the long-term trends in HSV-2 incidence suggests a need for more targeted intervention programs, especially for those at highest risk, the researchers said.

“This information on the detailed distribution of new infections can help improve the efficiency of interventions,” they wrote.

Major Finding: Among women in the United States, nearly 60% of all new herpes infections in 2007–2008 occurred in non-Hispanic blacks.

Data Source: NHANES data from 1988–1994 and 1999–2008.

Disclosures: The researchers reported having no financial conflicts of interest.

QUEBEC CITY – The incidence of herpes simplex virus type 2 in the United States has remained stable within gender and ethnic groups over the past 2 decades, with young black women remaining at the highest risk for infection, according to an analysis of data from the National Health and Nutrition Examination Surveys for 1988–1994 and 1999–2008.

Herpes simplex virus type 2 (HSV-2) infections have a 16% seroprevalence among 14- to 49-year-olds in the United States, said Dr. Sarah M. Gerver of Imperial College, London. Dr. Gerver presented the findings at the meeting.

She and her associates at Imperial College and the Centers for Disease Control and Prevention in Atlanta combined NHANES data with a predictive model to estimate HSV-2 incidence per 100 person-years at risk.

Overall, the age-adjusted incidence rates over the past 20 years were stable in all sex and ethnic groups with two exceptions, noted Dr. Gerver and her colleagues.

Incidence rates in Mexican American women and non-Hispanic white women had decreased after 2001 and 2002, respectively.

The age-adjusted incidence of HSV-2 in non-Hispanic white men, non-Hispanic black men, and Mexican American men remained stable at approximately 0.4, 1.4, and 0.7 per 100 person-years at risk, respectively. Non-Hispanic black women had the greatest incidence of HSV-2, which held steady over the study period at approximately 2.2 per 100 person-years at risk.

The incidence rate among 25-year-old non-Hispanic black women was more than 13 times greater than in white men of the same age, the researchers noted.

From 1988 to 2008, HSV-2 incidence rates peaked between ages 25 and 35 years for all sex and ethnic groups with the exception of Mexican American men, for whom the incidence remained stable by age.

In 2007–2008, the most recent year included in the study, an estimated 753,519 new HSV-2 infections occurred among 14- to 49-year-olds in the United States, comprising 392,208 in men and 361,311 in women. Approximately 53% of the new infections in men occurred in non-Hispanic whites, and half of these occurred in men aged 18–29 years, according to the researchers.

More than half of the HSV-2 infections in women occurred in those aged 14–24 years (204,550); including 40,520 in girls aged 14–17 years and 164,030 in young women aged 18–24 years.

And among women, “nearly 60% of all new infections were in non-Hispanic blacks, a group that accounts for less than 15% of the female population [in the United States],” the researchers noted.

The findings were limited by the researchers' assumption of perfect comparability of the HSV-2 seroprevalence estimates across age, race, and time.

But the stability of the long-term trends in HSV-2 incidence suggests a need for more targeted intervention programs, especially for those at highest risk, the researchers said.

“This information on the detailed distribution of new infections can help improve the efficiency of interventions,” they wrote.

Approximately 80% of patients with early rheumatoid arthritis can discontinue infliximab for at least 1 year with no ill effects, according to data from 104 patients.

“Even temporary cessation can benefit both the individual patient and, given the high costs of TNF blockers, society as a whole,” said Dr. M. van den Broek of Leiden University Medical Center, the Netherlands, and colleagues.

To determine the duration of decreased disease activity after discontinuing infliximab, they conducted a post hoc analysis of data from the Dutch Behandel Strategieen study, a multicenter, randomized, single-blind trial comparing four treatment strategies in RA patients who had not previously received disease-modifying antirheumatic drugs (DMARDs).

In the post hoc analysis, 104 adult RA patients discontinued infliximab when their disease activity score (DAS) was 2.4 or less for 6 months. The follow-up period ranged from 14 to 103 months, with a median of 7 years. The patients' average age was 56 years, and 65% were women (Ann. Rheum. Dis. 2011;70:1389-94).

After cessation of infliximab, the DAS remained at 2.4 or less in 43 of 77 patients (56%) initially treated with infliximab and in 11 of 27 patients (41%) who were in a delayed infliximab treatment group.

In 50 patients (34 from the initial infliximab treatment group and 16 from the delayed infliximab group), the DAS increased above 2.4 over a median of 17 months, and infliximab was reintroduced. But 27 of the 34 patients in the initial treatment group and 15 of the 16 patients in the delayed treatment group (84% overall) regained a DAS of 2.4 or less within 3 months of reintroducing infliximab, the researchers noted.

Radiographs of joints before and after discontinuation of infliximab were available for 90 patients. These images showed no increase in joint damage progression in the year after discontinuation of infliximab, compared with the previous year.

At the time of infliximab cessation, the mean DAS was 1.3 and the median symptom duration was 23 months. The median infliximab treatment was 11 months.

Independent risk factors for infliximab reintroduction were identified as being treatment duration of 18 months or longer, the presence of a shared epitope, and smoking, judging from findings from a multivariate analysis.

“The rate of serious infections was higher after the reintroduction of infliximab compared with during the initial treatment period or the period of infliximab cessation,” the researchers noted. But the difference could reflect patient selection, longer duration of symptoms, or more severe RA, they said.

The study was limited in part by patient selection and by the lack of shared epitope data for all patients, but the findings suggest that infliximab can be discontinued for at least 1 year in 80% of early RA patients, the researchers said.

Approximately 80% of patients with early rheumatoid arthritis can discontinue infliximab for at least 1 year with no ill effects, according to data from 104 patients.

“Even temporary cessation can benefit both the individual patient and, given the high costs of TNF blockers, society as a whole,” said Dr. M. van den Broek of Leiden University Medical Center, the Netherlands, and colleagues.

To determine the duration of decreased disease activity after discontinuing infliximab, they conducted a post hoc analysis of data from the Dutch Behandel Strategieen study, a multicenter, randomized, single-blind trial comparing four treatment strategies in RA patients who had not previously received disease-modifying antirheumatic drugs (DMARDs).

In the post hoc analysis, 104 adult RA patients discontinued infliximab when their disease activity score (DAS) was 2.4 or less for 6 months. The follow-up period ranged from 14 to 103 months, with a median of 7 years. The patients' average age was 56 years, and 65% were women (Ann. Rheum. Dis. 2011;70:1389-94).

After cessation of infliximab, the DAS remained at 2.4 or less in 43 of 77 patients (56%) initially treated with infliximab and in 11 of 27 patients (41%) who were in a delayed infliximab treatment group.

In 50 patients (34 from the initial infliximab treatment group and 16 from the delayed infliximab group), the DAS increased above 2.4 over a median of 17 months, and infliximab was reintroduced. But 27 of the 34 patients in the initial treatment group and 15 of the 16 patients in the delayed treatment group (84% overall) regained a DAS of 2.4 or less within 3 months of reintroducing infliximab, the researchers noted.

Radiographs of joints before and after discontinuation of infliximab were available for 90 patients. These images showed no increase in joint damage progression in the year after discontinuation of infliximab, compared with the previous year.

At the time of infliximab cessation, the mean DAS was 1.3 and the median symptom duration was 23 months. The median infliximab treatment was 11 months.

Independent risk factors for infliximab reintroduction were identified as being treatment duration of 18 months or longer, the presence of a shared epitope, and smoking, judging from findings from a multivariate analysis.

“The rate of serious infections was higher after the reintroduction of infliximab compared with during the initial treatment period or the period of infliximab cessation,” the researchers noted. But the difference could reflect patient selection, longer duration of symptoms, or more severe RA, they said.

The study was limited in part by patient selection and by the lack of shared epitope data for all patients, but the findings suggest that infliximab can be discontinued for at least 1 year in 80% of early RA patients, the researchers said.

Approximately 80% of patients with early rheumatoid arthritis can discontinue infliximab for at least 1 year with no ill effects, according to data from 104 patients.

“Even temporary cessation can benefit both the individual patient and, given the high costs of TNF blockers, society as a whole,” said Dr. M. van den Broek of Leiden University Medical Center, the Netherlands, and colleagues.

To determine the duration of decreased disease activity after discontinuing infliximab, they conducted a post hoc analysis of data from the Dutch Behandel Strategieen study, a multicenter, randomized, single-blind trial comparing four treatment strategies in RA patients who had not previously received disease-modifying antirheumatic drugs (DMARDs).

In the post hoc analysis, 104 adult RA patients discontinued infliximab when their disease activity score (DAS) was 2.4 or less for 6 months. The follow-up period ranged from 14 to 103 months, with a median of 7 years. The patients' average age was 56 years, and 65% were women (Ann. Rheum. Dis. 2011;70:1389-94).

After cessation of infliximab, the DAS remained at 2.4 or less in 43 of 77 patients (56%) initially treated with infliximab and in 11 of 27 patients (41%) who were in a delayed infliximab treatment group.

In 50 patients (34 from the initial infliximab treatment group and 16 from the delayed infliximab group), the DAS increased above 2.4 over a median of 17 months, and infliximab was reintroduced. But 27 of the 34 patients in the initial treatment group and 15 of the 16 patients in the delayed treatment group (84% overall) regained a DAS of 2.4 or less within 3 months of reintroducing infliximab, the researchers noted.

Radiographs of joints before and after discontinuation of infliximab were available for 90 patients. These images showed no increase in joint damage progression in the year after discontinuation of infliximab, compared with the previous year.

At the time of infliximab cessation, the mean DAS was 1.3 and the median symptom duration was 23 months. The median infliximab treatment was 11 months.

Independent risk factors for infliximab reintroduction were identified as being treatment duration of 18 months or longer, the presence of a shared epitope, and smoking, judging from findings from a multivariate analysis.

“The rate of serious infections was higher after the reintroduction of infliximab compared with during the initial treatment period or the period of infliximab cessation,” the researchers noted. But the difference could reflect patient selection, longer duration of symptoms, or more severe RA, they said.

The study was limited in part by patient selection and by the lack of shared epitope data for all patients, but the findings suggest that infliximab can be discontinued for at least 1 year in 80% of early RA patients, the researchers said.

QUEBEC CITY – Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men.

Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however "less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea," Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening.

In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests.

Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea.

The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance.

Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and 3 cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively.

The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia.

The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively.

There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted.

Test results were no different based on whether the patient or the health care provider collected samples first.

Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples.

"I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own," Dr. Sexton said.

The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted.

Dr. Sexton had no financial conflicts to disclose. Test kits used in the study were provided by Gen-Probe.

QUEBEC CITY – Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men.

Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however "less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea," Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening.

In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests.

Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea.

The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance.

Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and 3 cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively.

The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia.

The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively.

There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted.

Test results were no different based on whether the patient or the health care provider collected samples first.

Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples.

"I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own," Dr. Sexton said.

The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted.

Dr. Sexton had no financial conflicts to disclose. Test kits used in the study were provided by Gen-Probe.

QUEBEC CITY – Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men.

Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however "less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea," Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening.

In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests.

Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea.

The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance.

Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and 3 cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively.

The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia.

The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively.

There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted.

Test results were no different based on whether the patient or the health care provider collected samples first.

Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples.

"I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own," Dr. Sexton said.

The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted.

Dr. Sexton had no financial conflicts to disclose. Test kits used in the study were provided by Gen-Probe.