Mother Daughter Relationship Important Key To HPV Vaccination

College women were more likely to be vaccinated against human papillomavirus (HPV) if their mothers communicated with them about sex and if they thought their mothers would approve of their getting vaccinated, according to new Dartmouth research.

Meg Gerrard, PhD, of Dartmouth Medical School and Norris Cotton Cancer Center, Megan Roberts, a PhD student at Dartmouth College, and their colleagues, surveyed 972 female undergraduates at a large Midwestern university between November 2007 and April 2009.

An anonymous questionnaire assessed the undergraduate’s sexual-risk behavior, knowledge of HPV, perceptions of HPV risk, communication from their mothers about sex-related topics (including HPV), and their current vaccination status.

Sixty-five percent of the women reported being sexually active, and 49 percent reported having received at least the first of the three-shot HPV vaccine series.

Those who were unvaccinated were more likely to be interested in future vaccination if they thought their mothers would approve. The young women’s perceptions of their risk of contracting HPV also contributed to their interest in getting vaccinated. Young women whose mothers had discussed values in relation to sex were, as a group, less interested in being vaccinated.

The authors concluded that “mother-daughter communication and approval of vaccination emerged as important predictors of young women’s HPV-vaccination behavior and intentions, even after the women were old enough to not require parental approval.” They also noted that college-age women “are still a very important population to target for vaccination.”

The study was published in the journal Pediatrics. For more information, visit: www.dartmouth.edu/

Psychologist Wins Grant To Reduce Risky Sexual Behavior Among African American Girls

Developing and evaluating a faith-based, HIV-prevention program for African-American mothers and their daughters is the focus of Dr. Chisina Kapungu’s $795,000 career development grant from the National Institute of Mental Health.

Kapungu, assistant professor of obstetrics and gynecology at the University of Illinois at Chicago, is a clinical psychologist who has worked on HIV prevention programs, conducted research on the multi-systemic factors of HIV risk in African-American adolescents, and counseled HIV-infected women and kids.

Her proposed research project will work with two Chicago churches to pilot a faith-based HIV prevention program for community-based educators to administer to women and their daughters, ages 13 to 16.

The project, while still in the development stage, is “going to be very collaborative, very much based on principles of community-based participatory research, with shared decision-making throughout the process,” said Kapungu, who developed the project while completing a post-doctoral fellowship at UIC’s Institute for Health Research and Policy.

The intervention is based on two existing HIV prevention programs — one developed by the Religious Coalition for Reproductive Choice in Washington, and the other an evidenced-based program, Sisters Informing, Healing, Living, and Empowering, recommended by the U.S. Centers for Disease Control and Prevention and proven effective among African-American women and girls.

Kapungu plans to integrate the two programs and customize the curriculum based on the needs of the community, to include information about parental monitoring, assertive communication, and negotiating safe sexual practices.

“The goal of the intervention is to decrease sexual possibility situations and delay the onset of sexual debut,” said Kapungu, who describes the intervention as not focused on condom usage.

Research has shown that family factors such as parental monitoring, communication, and parental attachment are associated with delays in sexual intercourse among adolescents, Kapungu said. “There really hasn’t been empirical work in implementing faith- and family-based HIV interventions.”

Although African Americans are 13 percent of the U.S. population, they experience 59 percent of the HIV/AIDS cases in the country, according to the CDC.

“The church has been an untapped resource within the HIV prevention field and can have a potentially important role in educating young people about sexuality and HIV,” Kapungu said. “Worldwide, faith-based organizations have focused on secondary prevention, counseling and support for infected individuals and peer education groups, but less on primary prevention.”

UIC ranks among the nation’s leading research universities and is Chicago’s largest university with 26,000 students, 12,000 faculty and staff, 15 colleges and the state’s major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

For more information, visit www.uic.edu

HIV Preventive Gel Begins Testing With $350,000 Grant

 A gel designed to protect heterosexuals from the transmission of HIV will be tested for safety at the Los Angeles Biomedical Research Institute (LA BioMed), at Harbor-UCLA Medical Center, funded by a $350,000 grant.

The grant will be used for 180 volunteers, women age 18-40, to participate in a 12-week evaluation of the gel’s absorption and safety of absorption into women’s tissue. The study will be conducted at LA BioMed and an additional four sites.

The grant is supported by the International Partnership for Microbicides (IPM) a nonprofit global initiative to develop products for the reduction of HIV transmission and the U.S. Agency for International Development (USAID).

“IPM is committed to providing women with an affordable and self-initiating HIV-prevention strategy. The organization’s goal is to reduce the cycle of infection that has led to the deaths of more than 25 million people worldwide and orphaned more than 15 million children since 1981,” Dr. Susan Ballagh said, as she begun her recruitment of volunteers for LA BioMed’s study.

“If this gel is found to be safe, further testing will be undertaken to determine its effectiveness in preventing the transmission of HIV,” she concluded.

For more information on the study or how to become a part of it, visit: www.labiomed.com or call (310) 222-3840.

Encouraging Home Test Kits Could Increase HPV Detection

 

More high risk cases of human papilloma virus (HPV) could be detected by offering home testing kits to women who do not come forward for cervical screening, according to research published online in the British Medical Journal.

While cervical cancer screening programs in Western countries (U.S.) have contributed to a decrease in deaths from cervical cancer, one of the major drawbacks remains the number of women who do not come forward for smears.

Researchers in the Netherlands, led by Professor Chris Meijer from the VU University Medical Centre, investigated whether home testing kits would improve HPV detection rates. It has long been established that some strains of HPV are found in most cases of cervical cancer so early discovery is important.

As part of the Dutch cervical screening program, PROHTECT, the authors identified 28,073 women who had not responded to two invitations for screening.

Meijer and his team invited 27,792 of these women to use the Delphi Screener device to collect a cervical fluid sample at home and return it to the researchers. The remaining 281 women were recalled for a conventional cervical screening test.

The results show that over a quarter (26 percent) of the self-sampling group fulfilled the request, compared with only 1 in 7 (16 percent) of the recall group.

Participants in both groups whose samples were HPV positive were referred for further tests.

The authors conclude that using home testing kits for detecting HPV is an effective way to target women who do not attend for cervical screening and that it would lead to twice as many cases of cervical cancer being diagnosed compared with the regular screening program.

For more information, visit: www.bma.org.

UW Researchers Eliminate Cervical Cancer in Mice with FDA-Approved Drugs

Researchers at the University of Wisconsin (UW) School of Medicine and Public Health have eliminated cervical cancer in mice with two FDA-approved drugs currently used to treat breast cancer and osteoporosis.

The drugs, which keep estrogen from working in cells, also cleared precancerous growths, or lesions, in both the cervix and vagina, and prevented the onset of cancer in mice that had the precancerous lesions.

“We have begun to test whether the drugs are as effective in treating cervical cancer in human cells as they are in our mice,” said senior author Dr. Paul F. Lambert, of the McArdle Laboratory for Cancer Research and the UW-Madison Carbone Cancer Center.

The lab studies, which should take one or two years to complete, could be followed quickly with phase-two or phase-three clinical trials. Early-phase trials would not be necessary since the drugs have already been approved for clinical use, researchers said.

Lambert and his team use special mice they developed more than 20 years ago to study cervical cancer. The mice were genetically engineered to carry human papillomavirus (HPV) 16, known to be strongly associated with cervical cancer.

HPV is also the most common sexually transmitted infection in women in the United States. While new vaccines can prevent some of the many kinds of HPV infections, they do not eliminate already-existing infections or cervical cancers or precancerous lesions arising from pre-existing infections.

“Virtually all cervical cancers in women test positive for HPV 16,” said Lambert, a professor of oncology at the UW School of Medicine and Public Health.

But not everyone who becomes infected with HPV gets cervical cancer, so scientists have suspected that something else was going on.

“Since the cervix and other female reproductive organs are so responsive to estrogen, our lab and others began to focus on that hormone,” Lambert said.

Dr. Sang-Hyuk Chung, a postdoctoral fellow in Lambert’s lab, zeroed in on one of the two receptors that mediate estrogen function in cells-estrogen receptor (ER) alpha. He crossed his HPV mice with mice in which ER alpha had been knocked out, then gave the animals estrogen. When the mice didn’t develop cervical cancer or even precancerous lesions, Chung knew that ER alpha was an essential player in the slow cancerous process.

“We then wanted to learn if drugs that interfere with the receptor and block estrogen’s ability to bind to it could be used to treat or prevent cervical cancer,” he said.

Chung turned to an ER alpha blocker used to treat breast cancer, fulvestrant, and tested it on the HPV-positive mice with cervical cancer. After one month, he found that 11 of 13 mice lost all signs of cancer. But cancer remained in all the control mice that hadn’t gotten the drug.

“It was amazing to see that not only was the cancer gone, but all the precancerous lesions that give rise to cancer were also gone,” said Lambert.

Chung then tested a second drug, raloxifene, which is used to treat breast cancer and osteoporosis, to make sure that the first results weren’t a fluke. He found the same strong, blocking effect.

Finally, the researchers gave the drugs to animals with the precancerous lesions and found that the ER alpha blockers prevented the lesions from progressing to cancer.

Lambert’s team is now testing human cervical cancer cell lines to see if ER alpha blockers stop the growth of the malignant cells. The next step will be to test the drugs on tissue samples removed from women following surgery for the cervical cancer.

“We can’t be sure how the science will translate from animals to humans,” says Lambert, “but we have faith in our mouse model. There are many similarities in how cervical cancer develops and manifests itself in women and in mice.”

The study was published in the Proceedings of the National Academy of Sciences. For more information, visit: http://www.pnas.org/

HIV/AIDS Prevention Grants Offered To Community Organizations

The National AIDS Fund (NAF) and Johnson and Johnson partnered to offer grants to community based organizations (CBO) to reduce the burden of HIV/AIDS among women and families.

The GENERATIONS Initiative for its third round (GEN III) will focus on strengthening women and families affected by HIV/AIDS through prevention techniques.

The deadline to apply is Nov. 2, 2009. An estimated 6-8 grants are available totaling to a possible $160,000 over three phases.

The grant award process for GEN III will consist of three distinct, but linked phases: a four month Formative Phase, a four-month Pilot Phase and a 20-month Implementation Phase, the partnership said.

Selected grantees will be awarded a preliminary Formative Phase grant of $10,000. Upon successful completion of the Formative Phase, grantees will be awarded a Pilot Phase grant of $25,000; upon successful completion of the Pilot Phase, grantees will be awarded the first installment of the Implementation Phase grant totaling $125,000, the partnership said.

“Only applicants initially selected as GEN III grantees and awarded a Formative Phase grant are eligible for subsequent grants. While receipt of a formative phase grant does not automatically guarantee receipt of a pilot phase or implementation phase grant, our intent in selecting GEN III grantees is to fully support them through the entire 28-month period, provided they meet pre-determined grant and programmatic requirements,” the partnership pointed out.

The first two phases last for four months each, beginning March 1, 2010. The implementation phase will last for 20 months, starting Nov. 1, 2010.

Two types of proposals will be considered:

* Seeking to adapt previously tested evidence-based HIV prevention interventions; or

* Seeking to implement innovative or emerging HIV prevention interventions that are grounded in established theories of behavior change or based on scientific evidence and can be evaluated and replicated in other communities.

Eligible organizations must have a proven track record of its delivery of HIV/AIDS prevention programs, services, tools and previous commitment. Priority will be given to applicants in New York, New Jersey, Florida, Puerto Rico, California, Michigan, Illinois, Washington, D.C., Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina, but all states are encouraged to apply.

Aside from the money the grantees will be awarded, technical assistance (TA), program evaluation and community building support will be offered by the partnership to develop the prevention intervention program.

TA is a range of outside support services meant to assist:

* organizations in their assessment of the specific needs of their target population;

* the design components of their proposed HIV prevention intervention;

* the development of educational materials, presentations and other program curricula; and

* other aspects of project design and implementation.

The NAF is responsible for covering the costs of the TA as well as selecting and pairing them with the grantees. Participation for this part of the grant is mandatory.

“A second core component of GEN III is the provision of independent evaluators who will work with grantee program staff to design an evaluation plan, create evaluation tools and protocols, analyze process and outcome data, and review evaluation results and their implications for programmatic design, implementation, and quality assurance,” NAF said.

The NAF will cover the costs of the evaluator as well as help each CBO select the appropriate match to the project.

Finally, each grantee will become a part of a learning community where they can converse, share experiences and learn from each other. This learning community will be fostered in a number of ways:

* At least four national convenings held during the grant period. Grantees are required to be present at each convening. Travel and accommodations for convening attendees will be supported by NAF. The first convening will occur in March 2010, shortly after the GEN III grant period begins.

*Quarterly conference calls. Grantees are required to meet via conference call at least on a quarterly basis to share progress and updates and discuss relevant topics.

For complete proposal details: http://www.aidsfund.org/wp/wp-content/uploads/2009/08/gen-iii-request-for-proposals.pdf.

To complete and submit the application: https://www.grantrequest.com/SID_352/Default.asp?CT=CT&SA=SNA&FID=35019.

For more information, visit: www.aidsfund.org.

HPV Vaccine Study Shows Why Few Women Getting Shots

Sales of Merck’s HPV vaccine, Gardasil, declined by a third this year, and three years after the FDA approved the drug an estimated three out of four women remain unvaccinated—despite millions spent on advertising and lobbying for government mandates. A recent marketing study offers a reason.

Michelle Steward, assistant professor of marketing at Wake Forest University, and several colleagues conducted an experiment with women, ages 18 to 30, and found that they were more likely to consider being vaccinated for HPV after participating in a survey than as a result of commercial advertising or a government mandate.

“The educational cues in the survey are the least coercive and appear to prompt more thinking about the risks of not being vaccinated than laws, which may produce a negative backlash or advertisements, of which consumers might be skeptical,” said Steward.

“The results would suggest that Merck’s money may be best spent engaging people through a survey on relevant health topics to get the consumer to think about their own risks. There’s nothing to suggest that there would be any difference in males’ reactions. If Merck gains FDA approval to market Gardasil for boys, the advantages of surveys versus mandates or advertising would remain the same.

“Determining how best to move consumers from hearing about a drug or vaccination to actually using the product should rival R&D in importance to a firm,” Steward said.

The study, “The Influence of Different Types of Cues-to-Action on Vaccination Behavior: An Exploratory Study,” will be published in the spring edition of the Journal of Marketing Theory and Practice.

For more information, visit: www.wfu.edu.

Contraceptive Ring Enters Testing For HIV Prevention

The new device is a vaginal ring that releases multiple types of non-hormonal agents and microbicides, which would prevent conception as well as sexually transmitted HIV infection.

Worldwide, there are about 5 million new infections and 3 million deaths per year due to HIV/AIDS. If proven successful in future clinical trials, the new device could provide women with the stone to kill two birds – protecting themselves from unintended pregnancy and sexually transmitted infection (STI).

The ring may also someday represent a novel method to prevent STIs for those with aversion to currently available methods, with hormonally derived active agents, or with allergies to latex condoms, researchers said.

“This device is a new approach to birth control, because it avoids the long-term use of hormonal methods that have been associated with increased risk of certain cancers,” said Dr. Brij Saxena, lead author and the Harold and Percy Uris Professor of Reproductive Biology and professor of endocrinology in the Department of Obstetrics and Gynecology at Weill Cornell Medical College. “At the same time, this is the first device to simultaneously offer the possibility to prevent unintended pregnancy and HIV transmission.”

“No one has ever conquered a viral epidemic with treatment, so prevention is the most effective option. Ideally, an HIV vaccine is the most desirable method, but that is not foreseeable in the near future,” explained Dr. Jeffrey Laurence, co-author of the study and attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “The next best thing would be something that would prevent infection and put the power in the susceptible female partner’s control. That’s the potential a device such as this can offer.”

The vaginally inserted ring is incorporated with multiple antiviral drugs that prevent HIV infection and are time-released over a period up to 28 days. The compounds tested were a newly developed anti-HIV agent, Boc-lysinated betulonic acid, TMC120 (dapivirine), PMPA, and 3′-azido-3′-deoxythymidine (AZT or zidovudine), which, when combined, were found to block infection in human cells exposed to the virus in a laboratory setting, researchers said.

“The combination of these antiviral drugs has proven to be potent agents that may block infection by the HIV virus,” said Saxena.

The ring is also incorporated with compounds that prevent conception by arresting sperm motility, raising vaginal mucous viscosity, and sustaining the acidity of the vagina in which sperm do not survive.
Traditionally, similar devices have used hormonal compounds that have been linked to increased risk of breast and cervical cancers, or spermicidal compounds that kill sperm, but may lead to irritation and inflammation. Past findings published in the journal Contraception found the device to be highly effective in animal models and in laboratory testing, said researchers.

“The compounds in the device are natural materials that are already approved by the U.S. Food and Drug Administration for use in humans,” explained Saxena.

The study was supported by grants by the National Institutes of Health, International Partnership for Microbicides and BioRing LLC, and published in the journal AIDS.

For more information, visit www.med.cornell.edu.

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Anti-HIV Gel Effective For Women In Large-Scale Study

An investigational vaginal gel intended to prevent HIV infection in women has demonstrated signs of success in a clinical trial conducted in Africa and the United States. Findings of the recently concluded study, funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, were presented at the Conference on Retroviruses and Opportunistic Infections in Montreal.

The study investigators found the microbicide gel—known as PRO 2000 (Indevus Pharmaceuticals, Inc., Lexington, Mass.)—to be safe and approximately 30 percent effective; 33 percent effectiveness would have been considered statistically significant, NIAID said.

“Although more data are needed to conclusively determine whether PRO 2000 protects women from HIV infection, the results of this study are encouraging,” said NIAID Director Dr. Anthony S. Fauci.

The Phase II/IIb clinical trial, which enrolled more than 3,000 women, is NIH’s first large clinical study of a microbicide.

“An effective microbicide would be a valuable tool that women could use to protect themselves against HIV and one that could substantially reduce the number of new HIV infections worldwide,” Fauci added.

“The study, while not conclusive, provides a glimmer of hope to millions of women at risk for HIV, especially young women in Africa,” added lead investigator Dr. Salim S. Abdool Karim, MBChB, from the Center for the AIDS Program of Research in South Africa, who presented the findings at CROI. “It provides the first signal that a microbicide gel may be able to protect women from HIV infection.”

Currently, women make up half of all people worldwide living with HIV. In sub-Saharan Africa, women represent nearly 60 percent of adults living with HIV, and in several southern African countries young women are at least three times more likely to be HIV-positive than young men. In most cases, women become infected with HIV through sexual intercourse with an infected male partner. An effective microbicide could provide women with an HIV prevention method they initiate. This would be particularly helpful in situations where it is difficult or impossible for women to refuse sex or negotiate condom use with their male partners.

The study, known as HPTN 035, began in 2005 and enrolled 3,099 women at six sites in Africa and one in the United States. The clinical trial tested two candidate microbicide gels for safety and their ability to prevent HIV infection: PRO 2000 (0.5 percent dose), and BufferGel (ReProtect Inc., Baltimore). The U.S. Agency for International Development provided funding to manufacture BufferGel for the HPTN 035 study. PRO 2000 inhibits the entry of HIV into cells; BufferGel boosts the natural acidity of the vagina in the presence of seminal fluid, which can help to inactivate HIV and other pathogens.

The volunteers in HPTN 035 were divided at random into four equal-sized groups:

• Those using BufferGel prior to engaging in sexual intercourse
• Those using PRO 2000 before engaging in sexual intercourse
• Women using placebo gel prior to engaging in sexual intercourse
• Those who did not use gel before engaging in sexual intercourse

All participants received detailed information about the possible risks and benefits of trial participation before enrollment and were monitored monthly while in the study, which averaged 20 months. In addition, all the women were counseled on safe sex practices, given condoms, and tested and treated for sexually transmitted infections throughout the study.

Participants reported regular use of the investigational gels (81 percent of sex acts) and nearly all (99 percent) said they would use the products if approved for HIV prevention. Condom usage was also high throughout the course of the trial (74 percent).

In the final analysis, 194 women in the study became infected with HIV. Of these infections, 36 occurred in the PRO 2000 group, 54 in the BufferGel group, 51 in the placebo group and 53 in those who did not use gel. Based on these data, PRO 2000 was 30 percent effective, while BufferGel had no detectable preventive effect on HIV infection. Both PRO 2000 and BufferGel were found to be safe.

HPTN 035 was conducted by the Microbicide Trials Network (MTN), an HIV/AIDS clinical trials network established in 2006 by NIAID with co-funding by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the NIH. Prior to the establishment of the MTN, the study was led by the NIAID-funded HIV Prevention Trials Network (HPTN), from which the study gets its name.

Dr. Roberta J. Black, chief of the Microbicide Research Branch in NIAID’s Division of AIDS, says, “Although a statistically significant protective effect was not observed, HPTN 035 successfully met its goal of determining whether either of the two candidate microbicides had sufficient promise to be considered for testing in a larger Phase III clinical study.”

Study participants are being informed of the findings and counseled on the continued need to follow safe sex practices in order to avoid possible HIV exposure. Women who became infected with HIV during the trial were counseled and referred to appropriate medical care and support, including antiretroviral therapy. These same women were also given the opportunity to participate in MTN 015, a clinical study examining the nature of HIV progression and treatment response in HIV-infected women who were using topical microbicides or oral antiretrovirals as an HIV preventive measure when they acquired HIV infection.

A separate clinical study sponsored by the Medical Research Council (MRC) and the Department for International Development of the United Kingdom that is currently testing PRO 2000 (0.5 percent dose) in preventing HIV infection among women in Africa could provide further insight into the microbicide’s effectiveness. That Phase III study involving nearly 9,400 women is set to conclude in August 2009.

For more information, please visit: www.niaid.nih.gov.

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CDC Report Finds High Burden Of STDs, Especially Among Women And Racial Minorities

Reported cases of chlamydia and gonorrhea in the United States exceeded 1.4 million in 2007, according to an annual report by the Centers for Disease Control and Prevention (CDC). These diseases continue to be the most commonly reported infectious diseases in the nation and pose persistent and preventable threats to fertility in the U.S. The report, “Sexually Transmitted Disease Surveillance 2007”, shows persistent racial disparities across these and other sexually transmitted diseases (STD), and a particularly heavy burden of disease among women. The report also found continued increases in syphilis. This disease, while once on the verge of elimination, began re-emerging as a threat in 2001 and increased 15.2 percent between 2006 and 2007. “The widespread occurrence of these diseases should serve as a stark reminder that STDs remain a serious health threat in the United States, especially for women and racial and ethnic minorities,” said Dr. John M. Douglas, Jr., director of CDC’s Division of STD Prevention. “Left untreated, chlamydia and gonorrhea can cause infertility, affecting a woman’s chance to bear children later in life. Such a severe consequence is entirely avoidable, if as a nation we work together to increase the use of proven prevention tools and make them widely available to those who need them,” he said. Women Bear Heavy STD Burden, Including Risk of Infertility Women continue to bear a disproportionate burden of the long-term health consequences of STDs. In 2007, the chlamydia rate among women was three times that of men (543.6 cases per 100,000 women, compared to 190 cases per 100,000 men). The gonorrhea rate was also higher among women (123.5 per 100,000 women, compared to 113.7 per 100,000 among men). Although the two diseases can be easily diagnosed and treated, they often have no symptoms and go undetected. If left untreated, up to 40 percent of chlamydia and gonorrhea infections in women can result in pelvic inflammatory disease – a condition that causes as many as 50,000 women to become infertile each year. Untreated chlamydia or gonorrhea can also cause ectopic pregnancy, chronic pelvic pain, and other serious health problems. The report found that there were more than 1.1 million chlamydia cases reported in 2007, up from about one million in 2006, making it the largest number of cases ever reported to CDC for any condition. Gonorrhea, the second most commonly reported infectious disease, had more than 350,000 cases reported in 2007. However, it is estimated that more than half of all new infections with chlamydia and gonorrhea continue to go undiagnosed, underscoring the importance of increased screening. CDC recommends annual chlamydia screening for all sexually active women under 26 years old, and supports U.S. Preventive Services Task Force recommendations to screen high-risk, sexually active women for gonorrhea. STDs Take Heaviest Toll on Racial Minorities, Especially Black Women CDC’s 2007 STD surveillance report also indicates ongoing racial disparities in the three most common reportable STDs, with African-Americans bearing the greatest burden. While representing 12 percent of the U.S. population, blacks had about 70 percent of reported gonorrhea cases and almost half of all chlamydia and syphilis cases (48 percent and 46 percent respectively) in 2007. STDs take an especially heavy toll on black women 15 to 19 years of age, who account for the highest rates of both chlamydia (9,646.7 per 100,000 population) and gonorrhea (2,955.7 per 100,000 population) of any group. STDs in this age group are of particular concern because of the potential threat of these two diseases to a woman’s fertility. Studies have shown that one of the most important social determinants of sexual health is socioeconomic status. Higher rates of poverty among blacks than whites, and socioeconomic barriers to quality healthcare and STD prevention and treatment services have been associated with higher prevalence and incidence of STDs among racial and ethnic minorities. “The racial disparities in rates of STDs are among the worst health disparities in the nation for any health condition,” stressed Douglas. “We must intensify efforts to reach these communities with needed screening and treatment services. Testing and the knowledge of infection is a critical first step toward reducing the continued consequences of these diseases.” Growing Threat of Syphilis Syphilis, a disease close to being eliminated as a public health threat less than a decade ago, has increased each year since 2000 and remains a serious threat to the health of gay and bisexual men. In 2007, men who have sex with men (MSM) continued to account for the majority of primary and secondary (P&S) syphilis cases, representing 65 percent of the 11,466 P&S syphilis cases reported. Increased transmission among MSM is believed to be the primary driver of increased rates of syphilis overall in the United States. Syphilis among MSM is of particular concern because it can facilitate HIV transmission and lead to irreversible complications such as strokes, especially in those who already have HIV. CDC recommends that all MSM be tested for syphilis at least annually. Additionally, while P&S syphilis continues to occur at substantially lower levels among women than men (1.1 cases per 100,000 among females compared to 6.6 among males), syphilis rates have been increasing among women and infants in recent years, reversing years of decline in these populations. Syphilis rates among women have increased since 2004, and the rate of congenital syphilis increased for the second consecutive year in 2007. Because untreated syphilis can be transmitted from a pregnant woman to her infant and result in stillbirths, infant deaths, or severe complications in children who survive, CDC recommends that all women be screened for syphilis during the early stages of pregnancy. Intensified Efforts Needed to Address Significant Gaps in STD Prevention To reduce the toll of STDs and protect the health of millions of Americans, expanded prevention efforts are urgently needed. CDC estimates that almost 19 million new sexually transmitted infections occur each year, and almost half of those are among 15- to 24-year-olds. In addition to the threat of infertility, increased risk of HIV acquisition, and other health risks, STDs also have a substantial economic impact. CDC estimates STDs cost the U.S. health care system as much as $15.3 billion annually. CDC supports a comprehensive approach to STD prevention through screening, treatment, and behavioral interventions, with a focus on reducing health disparities, especially those occurring among racial and ethnic groups. To further progress against the most widespread reportable STDs, CDC, along with the Partnership for Prevention and eight other leading STD organizations, recently established the National Chlamydia Coalition. CDC also has been working with partners and community leaders across the nation on syphilis elimination efforts since 1999, yet successes in some areas and populations continue to be offset by increases in others, as programs must continually shift efforts to address emerging needs. Ultimately, successful elimination of this disease will require intensified efforts at the federal, state and local level to reach the diverse and expanded populations now at risk, CDC said. The full report is available at: http://www.cdc.gov/std/stats07/