doc_clotaire
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A 26-year-old homosexual man comes to clinic to receive the results of an HIV test. While he has had no specific symptoms, he was concerned, as he has had two episodes of unprotected sex in the past, though he routinely wears condoms now. The patient denies any signs or symptoms of sexually transmitted diseases (STDs), and reports being in good health. He is currently involved in a long-term monogamous relationship, but just “wants to be safe”. He is relieved to hear that his HIV screening test (an Elisa based assay with a confirmatory Western Blot) is negative. Which of the following is an appropriate strategy to advise to reduce the risk of STDs?
A. Annual screening for chlamydial infection
B. Annual screening for HIV infection
C. Polymerase chain reaction (PCR) for HIV
D. Use of nonoxynol-9 coated condoms
E. Vaccination with hepatitis A and B vaccine
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| sprint123
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D...
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| Justice
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doc_clotaire wrote:
...though he routinely wears condoms now...
Sounds funny... Must be said "uses" instead of "wears"...
Yep, only (D)
Doc_clotaire,
Is this a UW Q?
Thanks...
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| sachida
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D : nothing else protects from STDs..
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| Aashi
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E. Vaccination with hepatitis A and B vaccine
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| nadiabarati
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D as sachida says the reason.
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| muna
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D
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| Justice
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Aashi wrote:
E. Vaccination with hepatitis A and B vaccine
Is Hep A a STD? Or how does anti Hep A vaccination help prevent STD?
Edited by Justice on 04/16/07 - 08:10 PM
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| Aashi
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Justice, Hep A is considered as an STD in homosexuals and hep B and A are only the vaccine preventable STD in such population, and this guy is using condoms on regular basis,and why do we have to prescribe an additional pack of condoms to a person who have them at home , so the only option that made some sense to me is E..
GL
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| Justice
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Guys, just to continue our discussion...
Look at this abstract below (link is also provided).
The baseline is that the use of nonoxynol-9 (a spermicide) coated condoms can resulst in UTI in females due to changes in normal vaginal flora and recolonization with E. Coli... Kind of frustrating, but UTIs aren't STD, are they?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd...
Am J Epidemiol. 1996 Sep 1;144(5):512-20. Related Articles, Links
Click here to read
Association between use of spermicide-coated condoms and Escherichia coli urinary tract infection in young women.
Fihn SD, Boyko EJ, Normand EH, Chen CL, Grafton JR, Hunt M, Yarbro P, Scholes D, Stergachis A.
Northwest Health Services Research and Development Field Program, Veterans Affairs Medical Center, Seattle, WA 98108, USA.
Diaphragm/spermicide use increases the risk of urinary tract infection (UTI). To determine whether spermicide-coated condoms are also associated with an increased risk of UTI, the authors conducted a case-control study at a large health maintenance organization in Seattle, Washington. Cases were sexually active young women with acute UTI caused by Escherichia coli, identified from computerized laboratory files during 1990-1993. Age-matched controls were randomly selected from the enrollment files of the plan. Of 1,904 eligible women, 604 cases and 629 controls (65%) were interviewed. During the previous year, 40% of the cases and 31% of the controls had been exposed to any type of condom. The unadjusted odds ratio for UTI increased with frequency of condom exposure from 0.91 (95% confidence interval (CI) 0.65-1.28) for weekly or less during the previous month to 2.11 (95% CI 1.37-3.26) for more than once weekly. Exposure to spermicide-coated condoms conferred a higher risk of UTI, with odds ratios ranging from 1.09 (95% CI 0.58-2.05) for use weekly or less to 3.05 (95% CI 1.47-6.35) for use more than once weekly. In multivariate analyses, intercourse frequency (odds ratio (OR) = 1.14 per weekly episode), history of UTI (OR = 2.64), and frequency of spermicide-coated condom exposure (OR = 3.34 for more than once weekly and 5.65 for use more than twice weekly) were independent predictors of UTI. Spermicide-coated condoms were responsible for 42% of the UTIs among women who were exposed to these products.
PIP: A large population-based case-control study found that condoms coated with the spermicide nonoxynol-9 were responsible for 42% of urinary tract infections (UTIs) in women exposed to these products. 604 women 18-40 years old who presented to a health maintenance organization in Seattle, Washington, during 1990-93 with acute UTI caused By Escherichia coli served as cases; 629 age-matched controls were randomly selected from the health facility's files. In the preceding month, nonoxynol-coated condoms had been used by 35% of cases and 25% of controls. The unadjusted odds ratios for having an acute UTI among women who had used any type of condom in the previous month and previous year were 1.24 (95% confidence interval, 0.94-1.63) and 1.47 (1.16-1.85), respectively. The UTI risks for women who used the nonoxynol-9 coated condoms in the previous month and more than twice a week during the past year were 1.72 (1.08-2.75) and 2.39 (1.10-5.16), respectively. Independent predictors of UTI, identified through multivariate analyses, included intercourse frequency (odds ratio of 1.14 per weekly episode), past history of UTI (2.64), and frequency of coated condom exposure (3.34 for more than once weekly and 5.65 for use more than twice weekly). Among cases exposed to spermicide-coated condoms during the previous month, 41.9% of UTIs were due to coated condoms. The association confirmed in this study is supported by research indicating that nonoxynol-9 induces changes in the normal vaginal flora that facilitate colonization with coliform bacteria.
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| Justice
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Aashi wrote:Justice, Hep A is considered as an STD in homosexuals and hep B and A are only the vaccine preventable STD in such population, and this guy is using condoms on regular basis,and why do we have to prescribe an additional pack of condoms to a person who have them at home , so the only option that made some sense to me is E.. GL
Aashi, thanks a lot... Glad that you are back into the discussions
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| doc_clotaire
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Welcome back Aashi !
Answer E ( Vaccination with Hepatitis A and B vaccine ) for the same reason Aashi just explained
Hep A is now considered as a STDs in homosexual acquired by licking the anogenital area or through oral sex
Edited by Aashi on 04/17/07 - 09:51 AM. Reason: To avoid unwanted confusion abt the right answer.
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| sachida
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Well questions asks "Which of the following is an appropriate strategy to advise to reduce the risk of STDs? "
So doing vaccination for Hep A & B prevents two STDs
Advising condom use prevents ALL STDs (except Hep A , I guess).
Person HAD unprotected sex. So your advice is to confirm and perpetuate the use of safe methods. To me vaccine is not the answer to this question.
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