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Jeffrey D Klausner - One of the best experts on this subject based on the ideXlab platform.

  • results of a program to test women for rectal chlamydia and Gonorrhea
    Obstetrics & Gynecology, 2010
    Co-Authors: Pennan M Barry, Charlotte K Kent, Susan S Philip, Jeffrey D Klausner
    Abstract:

    OBJECTIVE: To analyze whether rectal testing among women increased chlamydia and Gonorrhea case-finding and whether reported receptive anal intercourse was a risk factor for rectal infection. METHODS: From March 2007 to August 2008, women receiving pelvic examinations at the San Francisco sexually transmitted disease clinic were tested for rectal Gonorrhea and chlamydia by using a transcription-mediated amplification assay. Results of testing and clinical and demographic data were analyzed using a crosssectional study design. RESULTS: Of 1,308 women with both rectal and vaginal tests, test results were positive for 79 patients (6.0%) for rectal chlamydia or Gonorrhea and 88 patients (6.7%) for genital chlamydia or Gonorrhea. Test results were positive for 13 patients (1.0%) at the rectum only, increasing detection from 88 to 101 patients (14.8%; 95% confidence interval 8.1–23.9). No correlation existed between reported anal sex and rectal chlamydia (P.74); however, 50% of women with rectal Gonorrhea reported anal sex compared with 21% of women without rectal Gonorrhea (P.002). CONCLUSION: Sexually transmitted disease clinics might improve chlamydia and Gonorrhea case-finding through rectal testing of women, but more study is needed to determine the effects of finding and treating such infections. Reporting anal intercourse did not predict rectal chlamydial infection among women tested at both the rectum and the vagina. (Obstet Gynecol 2010;115:753–9) LEVEL OF EVIDENCE: II

  • prevalence and incidence of pharyngeal Gonorrhea in a longitudinal sample of men who have sex with men the explore study
    Clinical Infectious Diseases, 2006
    Co-Authors: Sheldon R Morris, Jeffrey D Klausner, Susan Buchbinder, Sarah Wheeler, Beryl A Koblin, Thomas J Coates, Margaret A Chesney, Grant Colfax
    Abstract:

    Background. The prevalence of Gonorrhea of the pharynx among select samples of men who have sex with men (MSM) ranges from 9% to 15%. To our knowledge, there have been no longitudinal studies in a prospective MSM cohort to estimate pharyngeal Gonorrhea incidence or predictors of infection. We examined the prevalence, incidence, and sociodemographic and behavioral predictors of pharyngeal Gonorrhea in a cohort of sexually active, human immunodeficiency virus-negative MSM. Methods. We conducted a prospective study of pharyngeal Gonorrhea among MSM who were enrolled in a behavioral intervention study to prevent human immunodeficiency virus infection (Project EXPLORE). Participants were enrolled in this ancillary study from March 2001 through July 2003. At baseline and every 6 months thereafter until 31 July 2003, participants were tested for pharyngeal Gonorrhea and were administered a questionnaire regarding their oral sex practices. Rectal and urethral Gonorrhea testing were also performed. Results. Prevalence of pharyngeal Gonorrhea was 5.5% (136 cases diagnosed from 2475 tests). The incidence rate was 11.2 cases per 100 person-years. Pharyngeal Gonorrhea was positively associated with younger age and the number of insertive oral sex partners in the past 3 months. Ejaculation did not increase the risk of pharyngeal Gonorrhea. Gonorrhea of the pharynx was asymptomatic in 92% of cases. Conclusions. The pharynx is a common, asymptomatic reservoir for Gonorrhea in sexually active MSM.

Jane S Hocking - One of the best experts on this subject based on the ideXlab platform.

  • risk of pelvic inflammatory disease in relation to chlamydia and Gonorrhea testing repeat testing and positivity a population based cohort study
    Clinical Infectious Diseases, 2018
    Co-Authors: Joanne Reekie, Basil Donovan, Jane S Hocking, John M Kaldor, Sallie Pearson, David B Preen, Louise M Stewart, James Ward
    Abstract:

    Background. There is uncertainty around whether the risks of pelvic inflammatory disease (PID) differ following Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (Gonorrhea) infection. We quantified the risk of PID associated with chlamydia and Gonorrhea infection and subsequent repeat infections in a whole-population cohort. Methods. A cohort of 315 123 Western Australian women, born during 1974-1995, was probabilistically linked to chlamydia and Gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2002 to 2013. Timeupdated survival analysis was used to investigate the association between chlamydia and Gonorrhea testing, and positivity, and risk of PID. Results. Over 3 199 135 person-years, 120 748 women had pathology test records for both chlamydia and Gonorrhea, 10 745 chlamydia only, and 653 Gonorrhea only. Among those tested, 16 778 (12.8%) had ≥1 positive chlamydia test, 3195 (2.6%) ≥1 positive Gonorrhea test, and 1874 (1.6%) were positive for both. There were 4819 PID presentations (2222 hospitalizations, 2597 emergency presentations). Adjusting for age, Aboriginality, year of follow-up, health area, and socioeconomic status, compared to women negative for chlamydia and Gonorrhea, the relative risk (adjusted incidence rate ratio) of PID was 4.29 (95% confidence interval [CI], 3.66-5.03) in women who were both chlamydia and Gonorrhea positive; 4.54 (95% CI, 3.87-5.33) in those only Gonorrhea positive; and 1.77 (95% CI, 1.61-1.94) in those only chlamydia positive. Conclusions. Gonorrhea infection conferred a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID. The emergence of Gonorrhea antimicrobial resistance may have a serious impact on rates of PID and its associated reproductive health sequelae.

  • frequent transmission of Gonorrhea in men who have sex with men
    Emerging Infectious Diseases, 2017
    Co-Authors: Christopher K. Fairley, Jane S Hocking, Lei Zhang, Eric P F Chow
    Abstract:

    : The rate of Gonorrhea is much higher in men who have sex with men than in heterosexuals. Because of unique behavioral characteristics, asymptomatic sites of infection, mainly the pharynx, are principal drivers of Gonorrhea prevalence in men who have sex with men. On the basis of this observation, we call for interventions.

  • persistence of neisseria gonorrhoeae dna following treatment for pharyngeal and rectal Gonorrhea is influenced by antibiotic susceptibility and reinfection
    Clinical Infectious Diseases, 2015
    Co-Authors: Melanie Bissessor, Catriona S. Bradshaw, Christopher K. Fairley, Jane S Hocking, David M Whiley, Anthony Snow, Monica M Lahra, Marcus Y Chen
    Abstract:

    To guide interpretation of Gonorrhea tests of cure using nucleic acid amplification testing, this study examined the persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal Gonorrhea. Men who had sex with men diagnosed with pharyngeal or rectal Gonorrhea underwent swabbing from the pharynx or rectum 7 and 14 days following treatment. Repeat testing for N. gonorrhoeae was undertaken using real-time polymerase chain reaction (PCR) assays targeting the opa gene and porA pseudogene. One hundred pharyngeal and 100 rectal Gonorrhea infections in 190 men were included. For pharyngeal Gonorrhea, positivity of N. gonorrhoeae DNA on both PCR assays was present at days 7 or 14 in 13% (95% confidence interval [CI], 6.4%-19.6%) and 8% (95% CI, 2.7%-13.3%), respectively. For rectal Gonorrhea, DNA positivity was present in 6% (95% CI, 1.4%-10.7%) and 8% (95% CI, 2.7%-13.3%), respectively. Among 200 baseline pharyngeal and rectal isolates, there were 10 with ceftriaxone minimum inhibitory concentration (MIC) ≥0.06 mg/L and azithromycin MIC ≥0.5 mg/L, of which 3 (30%) had DNA detected at day 14; among the 190 isolates with lower ceftriaxone and azithromycin MICs, only 13 (7%) had persistent DNA (odds ratio, 5.8 [95% CI, 1.3-25.4]; P = .019). One man initially infected with N. gonorrhoeae multiantigen sequence type 2400 had type 4244 infection at day 14, indicating reinfection. Pharyngeal and rectal Gonorrhea DNA persisted in 8% of men 14 days after treatment. Persistence was associated with elevated ceftriaxone and azithromycin MICs. Persistence can also reflect reinfection.

  • trends in chlamydia and Gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in australia 2002 2009
    BMC Infectious Diseases, 2011
    Co-Authors: Catriona S. Bradshaw, Lenka A. Vodstrcil, Christopher K. Fairley, Glenda Fehler, David E Leslie, Jennifer Walker, Jane S Hocking
    Abstract:

    To determine whether chlamydia positivity among heterosexual men (MSW) and chlamydia and Gonorrhea positivity among men who have sex with men (MSM), are changing. Computerized records for men attending a large sexual health clinic between 2002 and 2009 were analyzed. Chlamydia and Gonorrhea positivity were calculated and logistic regression used to assess changes over time. 17769 MSW and 8328 MSM tested for chlamydia and 7133 MSM tested for Gonorrhea. In MSW, 7.37% (95% CI: 6.99-7.77) were chlamydia positive; the odds of chlamydia positivity increased by 4% per year (OR = 1.04; 95% CI: 1.01-1.07; p = 0.02) after main risk factors were adjusted for. In MSM, 3.70% (95% CI: 3.30-4.14) were urethral chlamydia positive and 5.36% (95% CI: 4.82-5.96) were anal chlamydia positive; positivity could not be shown to have changed over time. In MSM, 3.05% (95% CI: 2.63-3.53) tested anal Gonorrhea positive and 1.83% (95% CI: 1.53-2.18) tested pharyngeal Gonorrhea positive. Univariate analysis found the odds of anal Gonorrhea positivity had decreased (OR = 0.93; 95% CI: 0.87-1.00; p = 0.05), but adjusting for main risk factors resulted in no change. Urethral Gonorrhea cases in MSM as a percentage of all MSM tested for Gonorrhea also fell (p < 0.001). These data suggest that chlamydia prevalence in MSW is rising and chlamydia and Gonorrhea prevalence among MSM is stable or declining. High STI testing rates among MSM in Australia may explain differences in STI trends between MSM and MSW.

Christopher K. Fairley - One of the best experts on this subject based on the ideXlab platform.

  • Oropharyngeal and Genital Gonorrhea Infections Among Women and Heterosexual Men Reporting Sexual Contact With Partners With Gonorrhea: Implication for Oropharyngeal Testing of Heterosexual Gonorrhea Contacts.
    Sexually Transmitted Diseases, 2019
    Co-Authors: Eric P F Chow, Marcus Y Chen, Deborah A. Williamson, Catriona S. Bradshaw, Lenka A. Vodstrcil, Sabrina Trumpour, Benjamin P. Howden, Christopher K. Fairley
    Abstract:

    BACKGROUND: There have been very limited studies of oropharyngeal Gonorrhea in heterosexuals. Routine screening of oropharyngeal Gonorrhea is not recommended in heterosexual contacts of Gonorrhea. This study aimed to examine oropharyngeal Gonorrhea positivity among heterosexuals reporting contact with a partner with Gonorrhea. METHODS: At the Melbourne Sexual Health Centre (MSHC), all heterosexual individuals reporting contact with sexual partners with Gonorrhea are tested for genital Gonorrhea. In May 2017, MSHC also included screening for oropharyngeal Gonorrhea in heterosexual contacts of Gonorrhea. All contacts of Gonorrhea among women and heterosexual men between May 2017 and November 2018 were reviewed. Site-specific Gonorrhea positivity was also calculated. RESULTS: One hundred ninety-one Gonorrhea contacts (102 heterosexual men and 89 women) were reviewed. The median age was 28 (interquartile range, 24-33) years. The Gonorrhea positivity in males was significantly higher at the oropharynx compared with urethra (18%; 95% confidence interval [CI], 11% to 26% vs 2%; 95% CI, 0% to 7%; P < 0.001); and higher at the oropharynx compared with cervicovaginal site in women (46%; 95% CI, 35% to 57% vs 36%; 95% CI, 26% to 47%; P = 0.056). Of the 100 men who did not have genital Gonorrhea, 17 (18%; 95% CI, 10% to 26%) tested positive at the oropharynx. Of the 55 women who did not have genital Gonorrhea, 21 (24%; 95% CI, 15% to 34%) tested positive at the oropharynx. Infection at both the oropharynx and genital sites was not associated with sex worker status in women. Overall, 89% and 40% of Gonorrhea in heterosexual men and women were only in the oropharynx, respectively. CONCLUSIONS: Oropharyngeal Gonorrhea testing among heterosexual contacts of Gonorrhea may be indicated given a substantial proportion of Gonorrhea contacts are only infected at this site.

  • Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018.
    Emerging Infectious Diseases, 2019
    Co-Authors: Vincent J Cornelisse, Eric P F Chow, Deborah A. Williamson, Catriona S. Bradshaw, Christopher K. Fairley
    Abstract:

    : We describe a sexual network consisting of 1 nonbinary-gendered participant and 2 male and 4 female participants in Australia, 2018. Six of 7 participants had oropharyngeal Gonorrhea in the absence of urogenital Gonorrhea. This observation supports a new paradigm of Gonorrhea transmission in which oropharyngeal Gonorrhea can be transmitted through tongue kissing.

  • frequent transmission of Gonorrhea in men who have sex with men
    Emerging Infectious Diseases, 2017
    Co-Authors: Christopher K. Fairley, Jane S Hocking, Lei Zhang, Eric P F Chow
    Abstract:

    : The rate of Gonorrhea is much higher in men who have sex with men than in heterosexuals. Because of unique behavioral characteristics, asymptomatic sites of infection, mainly the pharynx, are principal drivers of Gonorrhea prevalence in men who have sex with men. On the basis of this observation, we call for interventions.

  • persistence of neisseria gonorrhoeae dna following treatment for pharyngeal and rectal Gonorrhea is influenced by antibiotic susceptibility and reinfection
    Clinical Infectious Diseases, 2015
    Co-Authors: Melanie Bissessor, Catriona S. Bradshaw, Christopher K. Fairley, Jane S Hocking, David M Whiley, Anthony Snow, Monica M Lahra, Marcus Y Chen
    Abstract:

    To guide interpretation of Gonorrhea tests of cure using nucleic acid amplification testing, this study examined the persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal Gonorrhea. Men who had sex with men diagnosed with pharyngeal or rectal Gonorrhea underwent swabbing from the pharynx or rectum 7 and 14 days following treatment. Repeat testing for N. gonorrhoeae was undertaken using real-time polymerase chain reaction (PCR) assays targeting the opa gene and porA pseudogene. One hundred pharyngeal and 100 rectal Gonorrhea infections in 190 men were included. For pharyngeal Gonorrhea, positivity of N. gonorrhoeae DNA on both PCR assays was present at days 7 or 14 in 13% (95% confidence interval [CI], 6.4%-19.6%) and 8% (95% CI, 2.7%-13.3%), respectively. For rectal Gonorrhea, DNA positivity was present in 6% (95% CI, 1.4%-10.7%) and 8% (95% CI, 2.7%-13.3%), respectively. Among 200 baseline pharyngeal and rectal isolates, there were 10 with ceftriaxone minimum inhibitory concentration (MIC) ≥0.06 mg/L and azithromycin MIC ≥0.5 mg/L, of which 3 (30%) had DNA detected at day 14; among the 190 isolates with lower ceftriaxone and azithromycin MICs, only 13 (7%) had persistent DNA (odds ratio, 5.8 [95% CI, 1.3-25.4]; P = .019). One man initially infected with N. gonorrhoeae multiantigen sequence type 2400 had type 4244 infection at day 14, indicating reinfection. Pharyngeal and rectal Gonorrhea DNA persisted in 8% of men 14 days after treatment. Persistence was associated with elevated ceftriaxone and azithromycin MICs. Persistence can also reflect reinfection.

  • substantial increases in chlamydia and Gonorrhea positivity unexplained by changes in individual level sexual behaviors among men who have sex with men in an australian sexual health service from 2007 to 2013
    Sexually Transmitted Diseases, 2015
    Co-Authors: Eric P F Chow, Marcus Y Chen, Catriona S. Bradshaw, Glenda Fehler, David M Whiley, Jane Tomnay, Tim R H Read, Ian Denham, Christopher K. Fairley
    Abstract:

    To determine the risk-adjusted temporal trend of Gonorrhea and chlamydia positivity and associated risk behaviors among men who have sex with men (MSM) attending a sexual health clinic in Melbourne in Australia. METHODS: Gonorrhea and chlamydia positivity by anatomical site adjusted for year of test, age, number of sexual partners, and condom use among MSM attending Melbourne Sexual Health Centre from 2007 to 2013 were calculated using generalized estimating equation regression models. RESULTS: A total of 12,873 MSM were included with a median age of 30.0 years. The proportion with pharyngeal, urethral, and anal Gonorrhea was 1.7%, 2.3%, and 2.9%, respectively. The adjusted odds of Gonorrhea positivity increased by 9% (95% confidence interval [CI], 3%-15%), 11% (95% CI, 6%-17%), and 12% (95% CI, 7%-17%) per year, respectively. The proportion of MSM who were infected with anal chlamydia was 5.6%, with an average increase of 6% (95% CI, 3%-10%) per year; however, no significant change was observed in urethral chlamydia positivity (adjusted odds ratio, 1.02; 95% CI, 0.98-1.06). Increases in Gonorrhea and chlamydia positivity were primarily restricted to MSM who reported more than 10 partners in 12 months. The number of partners in the last 12 months fell from 16.6 to 10.5, whereas consistent condom use with casual partners decreased from 64.6% to 58.9% over the study period. CONCLUSIONS: Gonorrhea and chlamydia have increased among MSM despite the decrease in the number of sexual partners and are occurring primarily in MSM with high numbers of partners and persist after adjusting for known risk factors, suggesting that unmeasured factors (e.g., more assortative mixing patterns) may explain the observed changes.

Matthew R Golden - One of the best experts on this subject based on the ideXlab platform.

  • assessing trends in chlamydia positivity and Gonorrhea incidence and their associations with the incidence of pelvic inflammatory disease and ectopic pregnancy in washington state 1988 2010
    Sexually Transmitted Diseases, 2016
    Co-Authors: Miranda S Moore, Matthew R Golden, Delia Scholes, Roxanne P Kerani
    Abstract:

    BackgroundChlamydia and Gonorrhea screening for women is beneficial if it prevents serious reproductive sequelae, such as pelvic inflammatory disease (PID) and ectopic pregnancy (EP). We assessed trends in PID and EP among women in Washington and their association with Gonorrhea incidence and chlamy

  • Gonorrhea treatment practices in the std surveillance network 2010 2012
    Sexually Transmitted Diseases, 2015
    Co-Authors: Roxanne P Kerani, Kyle T. Bernstein, Mark Stenger, Hillard Weinstock, Mary Reed, Christina Schumacher, Michael C Samuel, Margaret Eaglin, Matthew R Golden
    Abstract:

    BackgroundReplacing oral treatments with ceftriaxone is a central component of public health efforts to slow the emergence of cephalosporin-resistant Neisseria gonorrhoeae in the United States; US Gonorrhea treatment guidelines were revised accordingly in 2010. However, current US Gonorrhea treatmen

  • effect of expedited treatment of sex partners on recurrent or persistent Gonorrhea or chlamydial infection
    The New England Journal of Medicine, 2005
    Co-Authors: Matthew R Golden, Matthew Hogben, Hunter H Handsfield, William L H Whittington, Cheryl Malinski, James P Hughes, Walter E Stamm, Agnes Clark, Jennifer R L Helmers, Katherine K Thomas
    Abstract:

    background Many sex partners of persons with Gonorrhea or chlamydial infections are not treated, which leads to frequent reinfections and further transmission. methods We randomly assigned women and heterosexual men with Gonorrhea or chlamydial infection to have their partners receive expedited treatment or standard referral. Patients in the expedited-treatment group were offered medication to give to their sex partners, or if they preferred, study staff members contacted partners and provided them with medication without a clinical examination. Patients assigned to standard partner referral were advised to refer their partners for treatment and were offered assistance notifying partners. The primary outcome was persistent or recurrent Gonorrhea or chlamydial infection in patients 3 to 19 weeks after treatment. results Persistent or recurrent Gonorrhea or chlamydial infection occurred in 121 of 931 patients (13 percent) assigned to standard partner referral and 92 of 929 (10 percent) assigned to expedited treatment of sexual partners (relative risk, 0.76; 95 percent confidence interval, 0.59 to 0.98). Expedited treatment was more effective than standard referral of partners in reducing persistent or recurrent infection among patients with Gonorrhea (3 percent vs. 11 percent, P=0.01) than in those with chlamydial infection (11 percent vs. 13 percent, P=0.17) (P=0.05 for the comparison of treatment effects) and remained independently associated with a reduced risk of persistent or recurrent infection after adjustment for other predictors of infection at follow-up (relative risk, 0.75; 95 percent confidence interval, 0.57 to 0.97). Patients assigned to expedited treatment of sexual partners were significantly more likely than those assigned to standard referral of partners to report that all of their partners were treated and significantly less likely to report having sex with an untreated partner. conclusions Expedited treatment of sex partners reduces the rates of persistent or recurrent Gonorrhea or chlamydial infection.

  • partner management for gonococcal and chlamydial infection expansion of public health services to the private sector and expedited sex partner treatment through a partnership with commercial pharmacies
    Sexually Transmitted Diseases, 2001
    Co-Authors: Matthew R Golden, Hunter H Handsfield, William L H Whittington, Cheryl Malinski, Agnes M Clark, James P Hughes, Pamina M Gorbach, King K Holmes
    Abstract:

    Background Public health partner notification (PN) services currently affect only a small minority of patients with Gonorrhea or chlamydial infection and new approaches to PN are needed.Objectives To expand PN for Gonorrhea and chlamydial infection to private sector patients and to assess the feasib

Jeannette R. Ickovics - One of the best experts on this subject based on the ideXlab platform.

  • racial residential segregation and rates of Gonorrhea in the united states 2003 2007
    American Journal of Public Health, 2012
    Co-Authors: Katie B Biello, Jeannette R. Ickovics, Trace Kershaw, Robert Nelson, Matthew Hogben, Linda M Niccolai
    Abstract:

    Objectives. In the United States, Black persons are disproportionately affected by sexually transmitted infections (STIs), including Gonorrhea. Individual behaviors do not fully explain these racial disparities. We explored the association of racial residential segregation with Gonorrhea rates among Black persons and hypothesized that specific dimensions of segregation would be associated with Gonorrhea rates.Methods. We used 2003 to 2007 national STI surveillance data and 2000 US Census Bureau data to examine associations of 5 dimensions of racial residential segregation and a composite measure of hypersegregation with Gonorrhea rates among Black persons in 257 metropolitan statistical areas, overall and by sex and age. We calculated adjusted rate ratios with generalized estimating equations.Results. Isolation and unevenness were significantly associated with Gonorrhea rates. Centralization was marginally associated with Gonorrhea. Isolation was more strongly associated with Gonorrhea among the younger a...

  • pregnant adolescents at risk sexual behaviors and sexually transmitted disease prevalence
    American Journal of Obstetrics and Gynecology, 2003
    Co-Authors: Linda M Niccolai, Kathleen A Ethier, Jessica B Lewis, Trace Kershaw, Jeannette R. Ickovics
    Abstract:

    OBJECTIVE: The purpose of this study was to determine the level of high-risk sexual behaviors and the prevalence of chlamydia and Gonorrhea among pregnant adolescents. STUDY DESIGN: These analyses used data from 203 pregnant and 209 nonpregnant adolescents who were recruited from public health clinics. Data sources included interviewer-administered questionnaires, ligase chain reaction tests for chlamydia/Gonorrhea in the third trimester of pregnancy, and state health department reports of chlamydia/Gonorrhea. Statistical analyses included logistic regression. RESULTS: Pregnant adolescents were significantly more likely to have not used condoms during sexual intercourse in the past 30 days compared with nonpregnant adolescents, although other sexual risk behaviors were reduced. Nineteen percent of pregnant adolescents had chlamydia or Gonorrhea diagnosed during the pregnancy. CONCLUSION: Pregnant adolescents have high levels of sexually transmitted diseases during pregnancy, and many adolescents use condoms inconsistently. Prenatal care providers may be in a unique position to decrease sexually transmitted diseases among pregnant adolescents by encouraging the reduction of risk behaviors and aggressively screening for sexually transmitted diseases as part of routine prenatal care.