The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species. (17/814)

Lactobacillus acidophilus has been reported to be the predominant vaginal species. Vaginal lactobacilli isolated from 215 sexually active women were identified using whole-chromosomal DNA probes to 20 American Type Culture Collection Lactobacillus strains. Most women were colonized by L. crispatus (32%), followed by L. jensenii (23%), a previously undescribed species designated L. 1086V (15%), L. gasseri (5%), L. fermentum (0.3%), L. oris (0.3%), L. reuteri (0.3%), L. ruminis (0.3%), and L. vaginalis (0.3%). H2O2 was produced by 95% of L. crispatus and 94% of L. jensenii isolates, compared with only 9% of L. 1086V. Colonization by L. crispatus or L. jensenii was positively associated with being white (P<.001), age >/=20 years (P=.05), barrier contraceptive usage (P=.008), and lower frequency of bacterial vaginosis (P<.001) and gonorrhea (P=.03). L. crispatus and L. jensenii, not L. acidophilus, are the most common species of vaginal lactobacilli.  (+info)

Prophylactic contraceptives for HIV/AIDS. (18/814)

The current pandemic of sexually transmitted human immunodeficiency virus (HIV) infection--the causative agent of acquired immunodeficiency syndrome (AIDS), has created an urgent need for a new type of contraceptive: one that is both a spermicide and a microbicide. Because most women at risk for HIV infection are of reproductive age (15-44 years), effective use of dual-function contraceptives is important to prevent HIV transmission and unintended pregnancies. In the absence of an effective prophylactic anti-HIV therapy or vaccine, new emphasis has been placed on the development of intravaginal microbicidal agents capable of reducing the transmission of HIV. Topical microbicidal spermicides would ideally provide a female-controlled method of self-protection against HIV as well as preventing pregnancy. However, several microbicides that are undergoing preclinical and human clinical trials contain detergent-type ingredients. The detergent-type spermicide, nonoxynol-9, the only recommended microbicide for protection against sexual transmission of HIV has been shown to cause lesions in vaginal and cervical epithelia leaving women more vulnerable to HIV infection. Therefore, a major challenge in microbicide research has been to design mechanism-based microbicides that are highly effective against pregnancy and HIV transmission while lacking detergent-type effects on epithelial cells and normal vaginal flora. We present an overview of current microbicide research and report on the identification and preclinical development of novel non-detergent spermicidal nucleoside and non-nucleoside inhibitors aimed at decreasing pregnancy and preventing sexual transmission of HIV.  (+info)

Exploring young people's difficulties in talking about contraception: how can we encourage more discussion between partners? (19/814)

Interviews were conducted with 56 young men and women aged 16-19 within the Southampton Community Health NHS Trust to explore difficulties in talking about contraception. Concern about a partner's hostile or negative reaction to any discussion about contraception was central to explaining why some people found it so difficult to initiate such discussions. Admitting the intention to have intercourse, together with a perceived association between condom use and disease prevention, were the main concerns. There was some indication of gender differences in these findings. Furthermore, this negative reaction is perceived to be exacerbated according to the partner's reputation, the potential for harming one's own reputation and whether there is a desire for a longer-term relationship with this partner. The most important outcome of the interviews was that these concerns about a partner's negative reaction were largely unjustified, with the vast majority of participants showing only positive responses to scenarios of future partners initiating discussions with them about contraception. In addition to the need to improve communication skills, the data suggest that greater awareness about the positive reactions towards such discussions should be encouraged.  (+info)

Cervical shedding of herpes simplex virus in human immunodeficiency virus-infected women: effects of hormonal contraception, pregnancy, and vitamin A deficiency. (20/814)

Genital shedding of herpes simplex virus (HSV) results in frequent transmission of infection to sexual partners and neonates. In a cross-sectional study, cervical shedding of HSV DNA was detected in 43 (17%) cervical swab samples from 273 women seropositive for HSV-1, HSV-2, and human immunodeficiency virus type 1 (HIV-1). Cervical shedding of HSV was significantly associated with oral contraception (adjusted odds ratio [aOR], 4.5; 95% confidence interval [CI], 1.7-12.2), use of depo-medroxyprogesterone acetate (aOR, 3.2; 95% CI, 1.3-7.7), and pregnancy (aOR, 7.9; 95% CI, 2.0-31.7). In the subgroup of women who were not pregnant and not using hormonal contraception (n=178), serum vitamin A was highly predictive of cervical HSV shedding: concentrations indicating severe deficiency, moderate deficiency, low-normal, and high-normal status were associated with 29%, 18%, 8%, and 2% prevalences of cervical HSV shedding, respectively (linear trend, P=.0002). Several factors appear to influence HSV reactivation in HIV-1 seropositive women.  (+info)

Highlights of trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96. (21/814)

OBJECTIVES: This report presents key findings from a comprehensive report on pregnancies and pregnancy rates for U.S. women. The study incorporates birth, abortion, and fetal loss data to compile national estimates of pregnancy rates according to a variety of characteristics including age, race, Hispanic origin, and marital status. Summary data are presented for 1976-96. Data from the National Survey of Family Growth (NSFG) are used to show information on sexual activity and contraceptive practices, as well as women's reports of pregnancy intentions. METHODS: Tabular and graphic data on pregnancy rates by demographic characteristics are presented and interpreted. Birth data are from the birth registration system for all births registered in the United States and reported by State health departments to NCHS; abortion data are from The Alan Guttmacher Institute (AGI) and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC); and fetal loss data are from pregnancy history information collected in the NSFG. RESULTS: In 1996 an estimated 6.24 million pregnancies resulted in 3.89 million live births, 1.37 million induced abortions, and 0.98 million fetal losses. The pregnancy rate in 1996 was 104.7 pregnancies per 1,000 women aged 15-44 years, 9 percent lower than in 1990 (115.6), and the lowest recorded since 1976 (102.7). Since 1990 rates have dropped 8 percent for live births, 16 percent for induced abortions, and 4 percent for fetal losses. The teenage pregnancy rate has declined considerably in the 1990's, falling 15 percent from its 1991 high of 116.5 per 1,000 women aged 15-19 to 98.7 in 1996. Among the factors accounting for this decline are decreased sexual activity, increases in condom use, and the adoption of the injectable and implant contraceptives.  (+info)

Immunological block to mammalian fertilization: survival and organ distribution of immunoglobulin which inhibits fertilization in vivo. (22/814)

Fertilization of golden hamster eggs was blocked both in vitro and in vivo by antibodies produced in rabbits against specific hamster ovarian antigens (HOA). Antibodies against HOA bound to surfaces of the hamster egg zona pellucida and prevented spermatozoa from attaching to the zona and entering eggs in vitro. Fertilization in animals could be blocked for four estrous cycles by a single intraperitoneal injection of anti-HOA immunoglobulin, but not by control immunoglobulin. The in vivo fate of anti-HOA immunoglobulin was analyzed by simultaneous injection of 125I-anti-HOA IgG and control 131I-IgG. Both anti-HOA IgG and control IgG appeared in a variety of organs (lung, kidney, spleen, liver, and uterus) shortly after injection, but disappeared rapidly with no detectable differences in organ half lives. However, in the ovary anti-HOA IgG (but not control IgG) persisted at high levels during the period of infertility. Quantitative precipitin analysis of organ homogenates indicated that a high percentage of anti-HOA IgG in the ovary (but not in the other organs tested) was immunologically indistinguishable from IgG indicating lack of radiolabel metabolism and reincorporation. The results are discussed in terms of the development of a specific immunological block to fertility.  (+info)

Accutane-exposed pregnancies--California, 1999. (23/814)

Accutane (Roche Laboratories, Nutley, New Jersey), known by the generic name "isotretinoin," is a prescription oral medication approved by the Food and Drug Administration (FDA) to treat severe, recalcitrant nodular acne. It is also a known human teratogen that can cause multiple major malformations. Embryopathy associated with the mother's exposure to isotretinoin during the first trimester of pregnancy includes craniofacial, cardiac, thymic, and central nervous system malformations . In response to FDA recommendations, the manufacturer began a pregnancy-prevention program (PPP) in 1988 that included educational materials for physicians and patients and offered women reimbursement for contraceptive counseling by a physician. The PPP coordinators asked reproductive-aged women being treated with isotretinoin to enroll voluntarily in the Boston University Accutane Survey (BUAS). The total number of reproductive-aged women taking isotretinoin in the United States is unknown; however, 454,273 women enrolled in the BUAS from 1989 to October 1999. BUAS has estimated that 38%-40% of reproductive-aged women taking isotretinoin chose to enroll in the survey (BUAS, unpublished data, 1999). Although isotretinoin is contraindicated in pregnancy and has a package label warning users to avoid pregnancy while taking it, exposed pregnancies occur. Approximately 900 pregnancies occurred among BUAS enrollees during 1989-1998 (BUAS, unpublished data, 1999). Roche Laboratories began direct-to-consumer print advertisements in 1996, added television and radio advertisements to selected cities in 1997, and expanded the campaign to the entire United States in 1998.  (+info)

Potential impact of hormonal male contraception: cross-cultural implications for development of novel preparations. (24/814)

The prospect of a hormonal male contraceptive is no longer distant. Data on the potential impact of this improvement in contraceptive provision, however, is limited, particularly between different cultures. We have therefore carried out a multi-centre study to assess men's attitudes to proposed novel hormonal methods. Questionnaire-based structured interviews were administered to men in Edinburgh, Cape Town, Shanghai and Hong Kong. Approximately 450 men were interviewed in Edinburgh, Shanghai and Hong Kong, and a slightly larger group (n = 493) in Cape Town to give samples (n > 150) of black, coloured and white men. Knowledge of existing male and female methods of contraception was high in all centres and groups. The majority of men welcomed a new hormonal method of contraception, 44-83% stating that they would use a male contraceptive pill. Overall, a pill was more acceptable than an injectable form (most popularly given at 3-6 month intervals); long-acting implants were least so except in Shanghai. Familiarity with comparable female methods appeared to influence acceptability, for both oral and injectable methods. Hong Kong was the only centre where a male method (condom) was currently the most commonly used; men there appeared to rate the convenience of condoms highly while being least likely to think that they provided effective protection against pregnancy compared to other centres, and were least enthusiastic about novel male methods. The acceptability of potential male hormonal methods of contraception was high in some groups but showed wide variability, determining factors including cultural background and current contraceptive usage. These results suggest that the emerging emphasis that men should have greater involvement in family planning will be substantiated when appropriate contraceptive methods become available.  (+info)