WELL, THAT DIDN’T TAKE LONG

Once a teenage woman begins having sex, it may not be long before she has an STD, according to findings from a longitudinal study of 14–17-year-olds attending three urban adolescent medicine clinics.1 One-quarter of young women received a diagnosis of chlamydia, gonorrhea or trichomoniasis within one year after initiating intercourse; half had a diagnosis within two years of first having sex.

The median interval between first intercourse and first diagnosis was shorter for chlamydia (three years) than for gonorrhea (five years) or trichomoniasis (six years). Three-quarters of women who had a first STD diagnosis had a second one (of the same or a different disease) within two years; nine in 10 had a second diagnosis within four years. Overall, half of women had had their first STD test within a year of first having sex, but those who started having intercourse very early had waited longer. The investigators stress that STD screening should begin within a year after young women first have intercourse and should be repeated every 3–4 months.

1. Tu W et al., Time from first intercourse to first sexually transmitted infection diagnosis among adolescent women, Archives of Pediatrics and Adolescent Medicine, 2009, 163(12):1106–1111.

FERTILITY AFTER MISCARRIAGE

Women who have a miscarriage have a good chance of later giving birth, and this chance does not appear to be affected by the approach to managing the miscarriage.1 In a controlled trial in southwestern England, women having a first-trimester miscarriage were randomly assigned to one of three management approaches: surgical evacuation of the uterus; medical treatment with mifepristone, misoprostol or both; or no active intervention. Among those who replied to a follow-up questionnaire, 84% reported a subsequent pregnancy; within five years after the miscarriage, eight in 10 women in each study group had had a live birth. The number of pregnancies before the miscarriage was not related to fertility within the next five years, but women who had had previous miscarriages were less likely than others to give birth.

1. Smith LFP, Ewings PD and Quinlan C, Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial, BMJ, 2009,339:b3827, DOI: 10.1136/bmj.b3827.

MEDICATION ABORTION, ITALIAN STYLE

Mifepristone is now available for use in medication abortions in Italy.1 The country’s pharmaceutical agency gave the pill the okay in July 2009, but a parliamentary inquiry into the drug’s safety held up final approval until December. The Italian twist to this method of ending pregnancies is that it may be used only within the first seven weeks, it must be administered in a hospital and women must remain hospitalized until the abortion is complete. Mifepristone is available in most of Europe, as well as in the United States. Opposition to its use in Italy has come not only from the government but also from the Vatican, which has threatened to excommunicate anyone who uses it, provides it or encourages its use.

1. BBC News, Abortion pill gets final approval in Italy, Dec. 10, 2009, <http://news.bbc.co.uk/2/hi/8405197.stm>, accessed Dec. 24, 2009.

A MATCH MADE IN HEAVEN?

In 2001, a joint effort by two federally funded programs, the Title X family planning program and the Minority AIDS Initiative, got under way to enhance Title X–supported clinics’ ability to provide HIV prevention education, counseling, testing and related referrals; results so far suggest that the collaboration has been successful on several fronts.1 During the program’s first three-year period, roughly $15 million went to 33 projects in 19 states and territories; in the second three years, about $28 million went to 63 projects in 27 states and territories. Activities included national- and project-level training on counseling, testing, informed consent, cultural competence and other issues, as well as a variety of approaches to launching integrated HIV prevention and family planning services. Between 2001 and 2007, some 941,859 clinic clients received HIV prevention counseling, and 539,667 went on to get tested for the virus; 1,692, who otherwise may not have undergone testing, were found to be infected. The vast majority of those who tested positive belonged to minority racial or ethnic groups. The projects’ success, according to researchers, “is a strong indication of the feasibility of providing HIV-prevention services at family planning service delivery sites.”

1. Tran NT et al., Collaboration for the integration of HIV prevention at Title X family planning service delivery sites, Public Health Reports, 2010, 125(Suppl. 1):47–54.

WHAT’S IN A LABEL? NOT NEARLY ENOUGH

It is fairly well established that “nonheterosexual” youths encounter different health risks and social challenges than their heterosexual peers, but just who are these nonheterosexual young people? Results of a 2001 survey of Quebec high school students illustrate the difficulties of trying to apply this label on the basis of just a question or two, as is common practice.1 The researchers asked youths about three dimensions of their sexuality not usually studied together—identity, attractions and behavior—and found that no one of these yielded a clear answer. Thirteen percent of the nearly 2,000 participants gave at least one response that classified them as not exclusively heterosexual: Three percent said that they were gay, lesbian or bisexual; 9% reported same-gender attraction; and 4% said that they had had a same-gender sex partner. The question about identity captured 52% of these youths, the one about attraction 71% and the one about behavior 31%. Because all adolescents with a nonexclusively heterosexual identity “are potentially at risk for the ill effects of direct and indirect discrimination,” the investigators comment, it is imperative for both researchers and clinicians to assess multiple dimensions of teenagers’ sexuality.

1. Igaruta K et al., Concordance and discrepancy in sexual identity, attraction, and behavior among adolescents, Journal of Adolescent Health, 2009, 45(6):602–608.

RUNNING AWAY LINKED TO SEXUAL INITIATION

Teenage women who run away from home are at increased risk of becoming sexually experienced within a year, according to an analysis based on two waves of data from the National Longitudinal Study of Adolescent Health (Add Health).1 In a subsample of 11–18-year-old women who were sexually inexperienced at Wave 1 of the survey, the proportion who had begun having intercourse by Wave 2, about a year later, was 17% among those who had never run away within the past year and 35% among those who had done so at least once. The difference remained statistically significant in analyses controlling for a range of demographic, socioeconomic and risk-related characteristics (odds ratio, 1.7). Because runaways included in Add Health were youngsters who had returned home, the analysts conclude that returning does not “insulate” youth from sexual risk. In fact, they contend that a history of running away “may be an important social characteristic in adolescents’ medical histories.”

1. Thrane LE and Chen X, Impact of running away on girls’ sexual onset, Journal of Adolescent Health, 2010, 46(1):32–36.

DOWN DIAGNOSES ON THE RISE

Although the number of births in England and Wales changed little between 1989 and 2008, the number of Down syndrome diagnoses (made prenatally and postnatally) increased by 71%.1 The change largely reflects that couples are waiting longer to start their families and the risk rises dramatically with maternal age. However, throughout the period, nine in 10 women who learned that they were carrying a fetus with the disorder terminated their pregnancy; as a result, the number of infants born with Down syndrome declined by only 1%. In the absence of screening technologies that became available over the 20-year period, that number would have risen by 48%. Analysts who examined these data, which come from a national registry that captures nearly all Down syndrome diagnoses, comment that similar trends have been reported in other countries as well. They recommend continued monitoring of these trends “to ensure that appropriate resources are available both for the potentially increasing number of therapeutic abortions” and for the long-term care of infants born with the disorder.

1. Morris JK and Alberman E, Trends in Down’s syndrome live births and antenatal diagnoses in England and Wales from 1989 to 2008: analysis of data from the National Down Syndrome Cytogenic Register, BMJ, 2009, 339:b3794, DOI: 10.1136/bmj.b3794.

WHAT’S KEY IN PROGRAMS FOR BLACK WOMEN

A meta-analysis of data from 37 studies conducted between 1988 and 2007 reveals that behavioral interventions have been effective at reducing black women’s STD risk and zeroes in on the most effective program features.1 Overall, 33 studies showed that for up to one year of follow-up, intervention participants had 37% lower odds than controls of ever having unprotected sex; 17 studies demonstrated a 19% reduction in the odds of any STD diagnosis among participants during follow-up periods as long as one year. Among the intervention characteristics that emerged as most important for success were use of gender- or culture-specific materials, provision by a woman, inclusion of empowerment issues and skills training in condom use and negotiating safer sex, and use of role-playing. While emphasizing the importance of these features, the researchers also note that “individual behavioral change does not occur in a vacuum” and that addressing community-level and structural factors that affect STD risk also is essential.

1. Crepaz N et al., The efficacy of HIV/STI behavioral interventions for African American females in the United States: a meta-analysis, American Journal of Public Health, 2009, 99(11):2069–2078.

A WINNING COMBINATION

Combining universal prenatal screening for HIV with partner notification appears to be effective in reaching individuals who are unknowingly infected. 1 Between 2002 and 2005, some 30% of 18–30-year-old women in North Carolina who received an HIV diagnosis were pregnant at the time. Women who were pregnant when they learned of their infection were not distinguished by typical behavioral risk factors, but they were more likely to be Hispanic than non-Hispanic (prevalence ratio, 1.6). Hispanic women who were pregnant at the time of the HIV diagnosis were significantly less likely than their non-Hispanic counterparts to have had a previous HIV test (12% vs. 30%). Women who were pregnant at diagnosis were more likely than others to have had a partner who did not know he was infected until he was contacted through the partner notification program. The findings, according to researchers, support universal testing as part of prenatal care and suggest the need to explore barriers to testing among Hispanic women.

1. Torrone EA et al., Pregnancy and HIV infection in young women in North Carolina, Public Health Reports, 2010, 125(1):96–102.