VACCINATION IS NOT A PROMISCUITY SHOT

An analysis of data from a large managed care organization in the Atlanta area found no link between human papillomavirus vaccination and increased sexual activity in a cohort of young females.1 Researchers examined data on 1,398 females who were enrolled for care and were 11–12 years old (the recommended age for initiation of the three‐part vaccine series) in 2006–2007; they used the organization's electronic medical records to assess cohort members’ receipt of STD‐ and pregnancy‐related services (testing, diagnosis and counseling), as well as contraceptive counseling, through 2010. Thirty‐five percent of the cohort received at least one part of the HPV vaccine regimen at age 11–12. This group had made more health care visits in the previous year than had other cohort members (mean, 2.6 vs. 2.1), and they were more likely to be white (38% vs. 26%); the two groups lived in areas of comparable socioeconomic status. Multivariate analyses revealed no significant differences between the groups in their receipt of the services examined. Despite the study's limitations (for example, some cohort members may have received additional services elsewhere), the analysts write, the findings provide “clinical validation” of previous work, which has been mainly cross‐sectional and based on self‐reported data.

1. Bednarczyk RA et al., Sexual activity–related outcomes after human papillomavirus vaccination of 11‐ to 12‐year‐olds, Pediatrics, 2012, 130(5):798–805.

COSTS OF NOT CIRCUMCISING

The prevalence of neonatal male circumcision, and Medicaid coverage for the procedure, has been declining in the United States, and the result could be dramatic increases in infections and treatment costs.1 Analysts ran a simulation to assess the effects of a drop in the circumcision rate from the 2010 level of 55% to 10%—the level in Europe, where the procedure is not routinely covered by insurance. According to the model, for males, lifetime HIV prevalence would rise by 12%, human papillomavirus (HPV) infection by 29%, herpes simplex type 2 by 20% and urinary tract infections in infants by 212%. For females, the lifetime prevalence of both bacterial vaginosis and trichomoniasis would increase by 51%, and that of various strains of HPV by 13–18%. As a result, lifetime health care costs would increase by $407 per male infant and by $43 per female; nearly 80% of the added cost would be attributable to the increased HIV prevalence among men. The analysts note that because the model considered only direct medical costs and only a particular set of possible conditions related to circumcision, the projected cost increases are “highly conservative.”

1. Kacker S et al., Costs and effectiveness of neonatal male circumcision, Archives of Pediatrics & Adolescent Medicine, 2012, 166(10):910–918.

WHY GO TO A CLINIC?

Women surveyed at family planning clinics in 2011–2012 gave multiple reasons for choosing these sites; the reasons most commonly cited as very important (reported by 80–84% of women) were that staff treat patients respectfully, services are confidential, care is free or low‐cost, and staff are knowledgeable about women's health.1 Findings were similar regardless of women's age, parity or poverty status. The survey included 2,094 women visiting 22 clinics in 13 states, of whom 48% were visiting the clinic for contraceptive services, 27% for an annual gynecologic exam, 10% for a pregnancy test and the rest for other services. All of the clinics were in communities that had comprehensive primary care providers, and three in five women had received care from a provider other than the family planning clinic in the past year. Fifty‐seven percent of women had some kind of insurance, but one‐third of this group did not plan to use it to pay for their clinic visit; asked why they were not planning to use their insurance, the largest proportion of women (29%) said that they did not think it covered the services they were seeking. Given women's apparent preference for obtaining contraceptive care from specialized clinics, the researchers conclude, these providers may have an important role to play under health care reform, when demand for primary care services is expected to surge.

1. Frost JJ, Gold RB and Bucek A, Specialized family planning clinics in the United States: why women choose them and their role in meeting women's health care needs, Women's Health Issues, 2012, 22(6):e519–e525, doi:10.1016/j.whi.2012.09.002, accessed Nov. 21, 2012.

BENEFITS OF FREE STUFF

In the St. Louis area, where the Contraceptive CHOICE Project provided nearly 10,000 women at risk for unintended pregnancy with free long‐acting reversible contraceptives between 2007 and 2011, data on abortions and teenage pregnancy suggest that the intervention has had an effect.1 In 2010, the teenage pregnancy rate in the area served by the project was 6.3 per 1,000; the nationwide rate was 34.3 per 1,000. The number of abortions in the St. Louis area fell by 21% between 2008 and 2010, but was unchanged in the rest of Missouri. During that same period, the annual abortion rate ranged from 4.4 to 7.5 per 1,000 among project participants and was 13.4–17.0 in the St. Louis region overall; nationally, the rate was 19.6 per 1,000 in 2008. Additionally, the proportion of abortions that were repeat procedures declined in the St. Louis area, although it increased elsewhere in the state. According to the analysts, “providing no‐cost contraception and promoting the use of highly effective contraceptive methods has the potential to reduce unintended pregnancies in the United States.”

1. Peipert JF et al., Preventing unintended pregnancies by providing no‐cost contraception, Obstetrics & Gynecology, 2012, 120(6):1291–1297.

IF THEY ONLY KNEW…

You might think that if women who are at high risk of cervical cancer knew about the factors linked to the disease, they would have fairly accurate perceptions of their risk. But this was not the case in a sample of British university students surveyed in 2011.1 At study enrollment, 606 women were randomly assigned to receive a specific amount of information about cervical cancer: a basic explanation of the disease or that explanation supplemented by a description of behavioral risk factors, the role of human papillomavirus (HPV) or both. Women underestimated their cervical cancer risk at baseline and did so to a greater extent immediately after receiving information about the disease. This change was evident for those who had received information about behavioral risk factors, with or without information about HPV, but not for those who had been informed only that HPV is a risk factor. Moreover, it was significant for women who reported low‐risk behaviors, but not for those who had ever smoked, had first had sex at a very young age or had had multiple partners—behaviors specifically described as risk factors. The reduced perceived risk associated with receipt of information about risk factors, the investigators write, “is of concern” because lowered risk perceptions could lead to lowered use of cervical screening.

1. Nadarzynski T et al., Perceived risk of cervical cancer among pre–screening age women (18–24 years): the impact of information about cervical cancer risk factors and the causal role of HPV, Sexually Transmitted Infections, 2012, 88(6):400–406.

HOW DOES HIV SPREAD?

In 2010, some 61% of HIV infections diagnosed in individuals aged 13 or older in the United States were attributable to male‐to‐male sexual contact, 28% to heterosexual contact, 8% to injection‐drug use, 3% to a combination of male‐to‐male sexual contact and injection‐drug use, and a negligible proportion to other causes.1 The distribution was essentially the same in metropolitan statistical areas (defined as those with populations of 500,000 or more); in smaller metropolitan areas and in rural areas, the proportion attributable to same‐sex behavior between men was 54–56%, and that for heterosexual contact was 32–33%. Eight in 10 men whose infection was linked to same‐sex behavior lived in metropolitan statistical areas. Seven metropolitan statistical areas accounted for half of infections attributable to this factor; the four with the largest proportions of cases in this transmission category (78–82%) were in California. According to analysts at the Centers for Disease Control and Prevention, who examined HIV surveillance data from 564 areas, “the geographic disparity in HIV burden…indicates a need to target [men who have sex with men]…in areas where persons are at greatest risk for HIV.”

1. Clark H et al., HIV infections attributed to male‐to‐male sexual contact—metropolitan statistical areas, United States and Puerto Rico, 2010, Morbidity and Mortality Weekly Report, 2012, 61(47):962–966.

NOT BREAST‐FEEDING IS NOT THE ANSWER

Mother‐to‐infant transmission is the most frequent cause of hepatitis C infection in children, but avoidance of breast‐feeding does not appear warranted as a preventive measure, according to findings from a systematic review of English‐language studies published between 1947 and 2012.1 Investigators evaluated randomized trials and observational studies for inclusion in the review, which also looked at research on associations between vertical transmission and both mode of delivery (vaginal vs. cesarean) and labor management. Neither breast‐feeding nor delivery mode was associated with transmission risk; some evidence suggested a positive association between duration of rupture of membranes and risk. The investigators point out that their final sample “was restricted to observational studies, most with methodologic shortcomings…and small sample sizes.” Nevertheless, they conclude that “no perinatal management strategy has clearly been shown to reduce risk for [hepatitis C] transmission.”

1. Cottrell EB et al., Reducing risk for mother‐to‐infant transmission of hepatitis C virus: a systematic review for the U.S. Preventive Services Task Force, Annals of Internal Medicine, 2012, <http://annals.org/article.aspx?articleid=1402436>, accessed Dec. 6, 2012.

MULTIPURPOSE MESH

A nanofiber mesh developed at the University of Washington has the potential to prevent both pregnancy and STD acquisition by simultaneously releasing multiple drugs and functioning as a physical barrier to sperm.1 The drug‐eluting mesh, which was tested with a nonhormonal compound that could offer advantages over the common spermicide nonoxynol‐9, was effective in inhibiting HIV‐1 infection in vitro while physically preventing sperm penetration. It is intended for topical use, and the researchers envision its being inserted “simply with a tampon applicator”; as such, it would offer women a discreet method that they control, with “wholly reversible” contraceptive effects. According to the researchers, the fibers’ “functional combination…cannot be accomplished with any single technology currently in the development pipeline.” They further note that drug‐eluting fibers could also have other uses related to reproductive health—for example, in vaccine administration or STD treatment.

1. Ball C et al., Drug‐eluting fibers for HIV‐1 inhibition and contraception, PloS One, 2012, 7(11): e49792, doi:10.1371/journal.pone.0049792, accessed Dec. 7, 2012.