Harold C Wiesenfeld

Magee-Womens Hospital, Pittsburgh, Pennsylvania, United States

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Publications (82)407 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Longitudinal studies have consistently found a significant association between bacterial vaginosis (BV) and acquisition of sexually transmitted diseases (STDs). However, there is limited prospective data to confirm these findings. Methods: We conducted a prospective, randomized, open-label trial of home screening and treatment of young women with asymptomatic BV who were also at high risk for STD. These women were screened every 2 months for 12 months and randomized to treatment with oral metronidazole 500 mg twice daily for 7 days versus observation alone. The primary outcome was the incidence of gonorrhea and/or chlamydia. Results: 1365 subjects were enrolled in the study across 10 sites. Adherence with mailing specimens obtained at home was excellent in both groups (84-88%). The incidence of gonorrhea and/or chlamydia was 19.1 per 100 person years (95% CI: 15.1-22.1) for the treatment group and 18.5 per 100 person-years (95% CI: 15.1-22.8) for the observation arm, a difference that was not statistically significant. Conclusions: Young women were very amenable to home screening for BV, gonorrhea, and chlamydia. Treatment of asymptomatic BV with one week of oral metronidazole did not result in a decreased incidence of gonorrhea and/or or chlamydia.
    Clinical Infectious Diseases 11/2015; DOI:10.1093/cid/civ975 · 8.89 Impact Factor
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    ABSTRACT: Background: Chlamydia trachomatis genital tract infection is a major cause of female reproductive morbidity. Risk factors for ascending infection are unknown and the role for antibody in protection is not well established. Methods: We recruited 225 women from urban outpatient clinics and followed them for a median of 12 months. We performed a cross-sectional analysis of serum anti-chlamydial IgG, behavioral, and microbiological factors associated with endometrial infection at enrollment, and a longitudinal analysis of factors associated with incident infection. Results: Oral contraceptives (RRadj=2.02 [95% C.I. 1.38-2.97]) and gonorrhea (RRadj=1.66 [95% C.I. 1.07-2.60]) were associated with endometrial infection. Gonorrhea (HRadj=3.09 [95% C.I. 1.41-6.78]), cervical infection at enrollment (HRadj=2.33 [95% C.I. 1.07-5.11]), and exposure to uncircumcised (HRadj=2.65 [95% C.I. 1.21-5.82]) or infected partners (HRadj=4.99 [95% C.I. 2.66-9.39]) significantly increased risk of incident infection. Seropositivity was associated with reduced cervical burden (P<0.05), but no differences in ascending (RRadj=1.24 [95% C.I. 0.71-2.19]) or incident (HRadj=0.94 [95% C.I. 0.52-1.69]) infection rates. Conclusions: Serum anti-chlamydial IgG is not associated with a lowered rate of ascending or repeat infection. Identification of factors associated with ascending infection and increased risk of incident infection provide guidance for targeted screening of women at increased risk for sequelae.
    The Journal of Infectious Diseases 09/2015; DOI:10.1093/infdis/jiv438 · 6.00 Impact Factor
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    ABSTRACT: The US system for gonococcal antimicrobial susceptibility surveillance monitors trends exclusively among men with urethral infection, the population from whom the yield of gonococcal culture is highest. Little is known about the susceptibility of female urogenital isolates, and it is unclear whether gonococcal susceptibility among men who report sex exclusively with women (MSW) is representative of susceptibility among women. Using isolates collected during a recent treatment trial in 5 US cities, we performed a secondary analysis to compare antimicrobial susceptibilities of Neisseria gonorrhoeae urogenital isolates obtained from women, MSW, and men who have sex with men (MSM). Pretreatment isolates were collected from trial participants; minimum inhibitory concentrations (MICs) were determined by agar dilution. Geometric mean MICs were adjusted for geographic location using general linear models. Susceptibility data for urogenital isolates from 56 women, 252 MSW, and 170 MSM were studied. The adjusted geometric mean ceftriaxone MIC was similar among women (0.0067 μg/mL; 95% confidence interval [CI], 0.0049-0.0092 μg/mL) and MSW (0.0060 μg/mL; 95% CI, 0.0053-0.0066 μg/mL). In contrast, the adjusted geometric mean ceftriaxone MIC was higher among MSM (0.0098 μg/mL; 95% CI, 0.0082-0.0119 μg/mL) than among MSW. This same pattern was observed for other antimicrobials, including cefixime and azithromycin Ceftriaxone, cefixime, and azithromycin MICs were higher among MSM than among MSW, but were similar among women and MSW. These findings suggest that gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSW may adequately represent susceptibility of urogenital N. gonorrhoeae in women.
    Sexually transmitted diseases 08/2015; 42(8):434-9. DOI:10.1097/OLQ.0000000000000312 · 2.84 Impact Factor
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    ABSTRACT: To compare the pharmacokinetics of 2g and 3g doses of cefazolin when used for peri-operative prophylaxis in obese gravidae undergoing cesarean delivery. We performed a double-blinded randomized controlled trial from August 2013 to April 2014. Twenty-six obese women were randomized to receive either 2g or 3g IV cefazolin within 30min of skin incision. Serial maternal plasma samples were obtained at specific time points up to 8hrs after drug administration. Umbilical cord blood was obtained after placental delivery. Maternal adipose samples were obtained prior to fascial entry, after closure of the hysterotomy and subsequent to fascial closure. Pharmacokinetic parameters were determined via non-compartmental analysis. The median area under the plasma concentration vs. time curve was significantly greater in the 3g group than in the 2g group (27204 μg/mL/min vs. 14058 μg/mL/min: p=0.001). Maternal plasma concentrations were impacted by body mass index. For every 1 kg/m(2) increase in body mass index at time of cesarean delivery, there was an associated 13.77μg/mL lower plasma concentration of cefazolin across all time points (p=0.01). By the completion of cesarean delivery, cefazolin concentrations in maternal adipose were consistently above the minimal inhibitory concentration for both gram-positive and gram-negative bacteria with both the 2g and 3g doses. The median umbilical cord blood concentrations were significantly higher in the 3g vs. the 2g group (34.5 μg/mL and 21.4 μg/mL: p=.003). Cefazolin concentrations in maternal adipose both at time of hysterotomy closure and fascial closure were above the minimal inhibitory concentration for both gram-positive and gram-negative bacteria when either 2g or 3g cefazolin was administered as perioperative surgical prophylaxis. Maternal cefazolin concentrations in plasma and maternal adipose tissue are related to both dose and body mass index. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 06/2015; 213(4). DOI:10.1016/j.ajog.2015.06.034 · 4.70 Impact Factor

  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S339-S340. DOI:10.1016/j.ajog.2014.10.900 · 4.70 Impact Factor
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    ABSTRACT: Three isolates of a bacterium recovered from human endometrium using conventional culture methods were characterized biochemically and subjected to 16S rRNA gene sequencing and phylogenetic analysis. Isolates were non-motile, obligately anaerobic, non-spore forming, asaccharolytic, non-cellulolytic, indole positive, Gram positive rods. Cell wall fatty acid profiling revealed C14:0, C16:0, C18:2ω6, 9c, C18:1ω9c and C18:0 to be the major fatty acid composition. The DNA mol % G+C was determined to be 44.2%. 16S rRNA gene sequence analysis revealed only 91% sequence similarity with the closest cultivated bacterial isolate, Saccharofermentans acetigenes. Based on genotypic and phenotypic data, all three isolates are considered to be members of the same species and data suggest it represents a novel genus and species in the order Clostridiales with an association with Clostridium rRNA cluster III within the family Ruminococcaceae. We propose the name, Mageeibacillus indolicus gen. nov., sp. nov. The type strain is BAA-2120(T) and CCUG 59143(T). Copyright © 2014. Published by Elsevier Ltd.
    Anaerobe 12/2014; 32. DOI:10.1016/j.anaerobe.2014.12.003 · 2.48 Impact Factor
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    ABSTRACT: Background: Ceftriaxone is the foundation of currently recommended gonorrhea treatment. There is an urgent need for backup treatment options for patients with cephalosporin allergy or infections due to suspected cephalosporin-resistant Neisseria gonorrhoeae. We evaluated the efficacy and tolerability of 2 combinations of existing noncephalosporin antimicrobials for treatment of patients with urogenital gonorrhea. Methods: We conducted a randomized, multisite, open-label, noncomparative trial in 5 outpatient sexually transmitted disease clinic sites in Alabama, California, Maryland, and Pennsylvania. Patients aged 15-60 years diagnosed with uncomplicated urogenital gonorrhea were randomly assigned to either gentamicin 240 mg intramuscularly plus azithromycin 2 g orally, or gemifloxacin 320 mg orally plus azithromycin 2 g orally. The primary outcome was microbiological cure of urogenital infections (negative follow-up culture) at 10-17 days after treatment among 401 participants in the per protocol population. Results: Microbiological cure was achieved by 100% (lower 1-sided exact 95% confidence interval [CI] bound, 98.5%) of 202 evaluable participants receiving gentamicin/azithromycin, and 99.5% (lower 1-sided exact 95% CI bound, 97.6%) of 199 evaluable participants receiving gemifloxacin/azithromycin. Gentamicin/azithromycin cured 10 of 10 pharyngeal infections and 1 of 1 rectal infection; gemifloxacin/azithromycin cured 15 of 15 pharyngeal and 5 of 5 rectal infections. Gastrointestinal adverse events were common in both arms. Conclusions: Gentamicin/azithromycin and gemifloxacin/azithromycin were highly effective for treatment of urogenital gonorrhea. Gastrointestinal adverse events may limit routine use. These non-cephalosporin-based regimens may be useful alternative options for patients who cannot be treated with cephalosporin antimicrobials. Additional treatment options for gonorrhea are needed. Clinical Trials Registration. NCT00926796.
    Clinical Infectious Diseases 07/2014; 59(8). DOI:10.1093/cid/ciu521 · 8.89 Impact Factor

  • Sexually Transmitted Infections 07/2013; 89(Suppl 1):A34-A34. DOI:10.1136/sextrans-2013-051184.0106 · 3.40 Impact Factor

  • Sexually Transmitted Infections 07/2013; 89(Suppl 1):A132-A132. DOI:10.1136/sextrans-2013-051184.0409 · 3.40 Impact Factor
  • S. L. Hillier · L. K. Rabe · L. Meyn · I. Macio · G. Trucco · A. Amortegui · T. Darville · H. C. Wiesenfeld ·

    Sexually Transmitted Infections 07/2013; 89(Suppl 1):A36-A36. DOI:10.1136/sextrans-2013-051184.0112 · 3.40 Impact Factor
  • T. Darville · X. Zheng · C. O'Connell · U. Nagarajan · I. Macio · H. Wiesenfeld · L. Rabe · S. Hillier ·

    Sexually Transmitted Infections 07/2013; 89(Suppl 1):A27-A27. DOI:10.1136/sextrans-2013-051184.0086 · 3.40 Impact Factor
  • Harold C Wiesenfeld ·

    Obstetrics and Gynecology 07/2013; 122(1):156. DOI:10.1097/AOG.0b013e3182989ba3 · 5.18 Impact Factor
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    ABSTRACT: Purpose: To pilot test a text message (SMS) sex risk reduction program among at-risk young adult female patients discharged from an emergency department (ED). Methods: A convenience sample of 52 female patients with hazardous drinking behavior and recent risky sexual encounters were recruited from an urban ED and randomized to the SMS program (n = 23) or a control group (n = 29). All participants completed a web-based questionnaire in the ED and at 3-month follow-up. For 12 weeks, SMS participants were asked to report whether they had a risky sexual encounter in the past week, received theory-based feedback, and were asked if they were willing set a goal to refrain from having another risky encounter. Results: Thirty-nine percent of SMS participants completed all weeks of SMS reports, and noncompletion increasing from 12% on week 1 to a 33% by week 12. Three-month follow-up was completed in 56% of participants. In the intervention group, there was an increase in the proportion with condom use with last vaginal sex from 20% (95% CI 4%-48%) to 53% (95% CI 27%-79%) and an increase in always condom use over the past 28 days from 0% (95% CI 0%-22%) to 33% (95% CI 12%-62%). These changes were not statistically different from control participants. Conclusions: SMS programs may be useful to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED. Future trials should examine ways to improve adherence to SMS dialog over time and measure objective outcomes in a larger sample.
    Journal of Adolescent Health 05/2013; 53(3). DOI:10.1016/j.jadohealth.2013.04.006 · 3.61 Impact Factor
  • Harold C Wiesenfeld ·

    Sexually transmitted diseases 05/2013; 40(5):386-7. DOI:10.1097/OLQ.0b013e3182917baa · 2.84 Impact Factor
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    Kimberly A Paccione · Harold C Wiesenfeld ·
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    ABSTRACT: Objective: To investigate adherence to the 2002 Centers for Disease Control and Prevention (CDC) guidelines for perinatal group B streptococci (GBS) prevention in penicillin-allergic obstetric patients. Methods: This is a retrospective cohort study of penicillin-allergic obstetric patients who tested positive for GBS and delivered at our institution in 2010. Electronic medical records were reviewed for the nature of the penicillin allergy, documentation of having previously tolerated cephalosporins, gestational age at delivery, type of delivery, antimicrobial sensitivity testing, and antibiotics administered. Antimicrobial sensitivity testing and "appropriate" antibiotic choice, which was determined using 2002 CDC guidelines, were analyzed. Results: Intrapartum antibiotic prophylaxis was administered in 97.8% (95% confidence interval [CI] 93.5-99.5%) of patients, but it was considered appropriate in only 62.2% (95% CI 53.8-70.0%) of patients. Clindamycin was the most commonly used antibiotic, but 26.4% (95% CI 16.3-39.7%) of patients who received clindamycin did not have confirmation of susceptibility via antimicrobial sensitivity testing. Overall, the sensitivity testing was performed in only 65.5% (95% CI 56.2-73.7%) of patients in whom it was indicated. Conclusion: Compliance with CDC guidelines for performing antimicrobial sensitivity testing and choosing an appropriate antibiotic in GBS-positive penicillin-allergic women continues to be suboptimal. Institution of measures to increase adherence is necessary.
    Infectious Diseases in Obstetrics and Gynecology 02/2013; 2013(1):917304. DOI:10.1155/2013/917304
  • Catherine A Chappell · Harold C Wiesenfeld ·
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    ABSTRACT: Severe pelvic inflammatory disease and tuboovarian abscesses (TOAs) are common pelvic infections requiring inpatient admission. There are few large randomized trials guiding appropriate clinical management of TOA, including antibiotic selection and timing of surgical management and drainage. The pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and TOA are summarized and reviewed from the most current literature.
    Clinical obstetrics and gynecology 12/2012; 55(4):893-903. DOI:10.1097/GRF.0b013e3182714681 · 1.77 Impact Factor
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    ABSTRACT: Development of safe and effective Chlamydia trachomatis vaccines requires better understanding of the host immune responses elicited by natural infection. Peripheral blood mononuclear cells isolated from women with or without history of genital tract chlamydial infection were stimulated with inactivated C. trachomatis elementary bodies (EB) in ELISPOT assays that enumerated frequencies of cells producing interferon (IFN)-γ or interleukin (IL)-17. IFN-γ-positive cells were highest among women sampled 30–60 days after diagnosis of C. trachomatis infection and treatment initiation, while the numbers of IFN-γ-positive cells were equally low among uninfected women and women sampled <30 or >60 days after diagnosis of infection. Conversely, IL-17-positive cell numbers were uniformly low among all participants. Dramatically reduced numbers of Chlamydia-specific Th1 memory cells in the peripheral circulation of study participants sampled more than 2 months after diagnosis, and initiation of treatment provides new insight into the results from C. trachomatis vaccine trials, in which immunization with EB provided only short-lived protection. Our results also suggest that an effective vaccine against this weakly antigenic intracellular pathogen will need to generate immunological memory more durable than that elicited by natural infection.
    American Journal Of Reproductive Immunology 08/2012; 68(6). DOI:10.1111/aji.12008 · 2.44 Impact Factor
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    ABSTRACT: The reported incidence of acute pelvic inflammatory disease (PID) has decreased but rates of tubal infertility have not, suggesting that a large proportion of PID leading to infertility may be undetected. Subclinical PID is common in women with uncomplicated chlamydial or gonococcal cervicitis or with bacterial vaginosis. We assessed whether women with subclinical PID are at an increased risk for infertility. A prospective observational cohort of 418 women with or at risk for gonorrhea or chlamydia or with bacterial vaginosis was recruited. Women with acute PID were excluded. An endometrial biopsy was performed to identify endometritis (subclinical PID). After provision of therapy for gonorrhea, chlamydia and bacterial vaginosis participants were followed-up for fertility outcomes. There were 146 incident pregnancies during follow-up, 50 pregnancies in 120 (42%) women with subclinical PID and 96 in 187 (51%) women without subclinical PID. Women with subclinical PID diagnosed at enrollment had a 40% reduced incidence of pregnancy compared with women without subclinical PID (hazard ratio 0.6, 95% confidence interval 0.4-0.8). Women with Neisseria gonorrhoeae or Chlamydia trachomatis, in the absence of subclinical PID, were not at increased risk for infertility. Subclinical PID decreases subsequent fertility despite provision of treatment for sexually transmitted diseases. These findings suggest that a proportion of female infertility is attributable to subclinical PID and indicate that current therapies for sexually transmitted diseases are inadequate for prevention of infertility.
    Obstetrics and Gynecology 06/2012; 120(1):37-43. DOI:10.1097/AOG.0b013e31825a6bc9 · 5.18 Impact Factor
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    ABSTRACT: While endometrial neutrophils and plasma cells are criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease (PID) research, plasma cell misidentification and nonspecificity may limit the accuracy of these criteria. Herein, we examined: (1) the identification of endometrial plasma cells with conventional methyl green pyronin-based methodology versus plasma cell-specific (CD138) immunostaining, (2) the prevalence of endometrial plasma cells among women at low risk for PID, and (3) endometrial leukocyte subpopulations among women diagnosed with acute or chronic histologic endometritis by conventional criteria. We observed an absence of CD138+ cells in 25% of endometrial biopsies in which plasma cells had been identified by conventional methodology, while additional immunohistochemical analyses revealed indistinguishable inflammatory infiltrates among women diagnosed with acute or chronic endometritis by conventional criteria. Among women considered at lower risk for PID development, flow cytometric analyses detected plasma cells in 30% of endometrial biopsy specimens, suggesting that these cells, even when accurately identified, only nonspecifically identify upper genital tract inflammatory processes. Combined, our findings underscore the limitations of the criteria used to diagnose histologic endometritis in PID-related research and suggest that satisfactory understanding of PID pathogenesis, treatment, and prevention is hindered by continued use of these criteria.
    Pathology - Research and Practice 11/2011; 207(11):680-5. DOI:10.1016/j.prp.2011.08.007 · 1.40 Impact Factor
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    Priya R Gursahaney · Kwonho Jeong · Bruce W Dixon · Harold C Wiesenfeld ·
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    ABSTRACT: Timely notification and treatment of sex partners exposed to a sexually transmitted disease (STD) is essential to reduce reinfection and transmission. Our objectives were to determine factors associated with patient-initiated notification of sex partners and preferences regarding standard partner referral versus expedited partner therapy (EPT). Participants diagnosed with gonorrhea, chlamydia, trichomoniasis, or nongonococcal urethritis within the previous year were administered a baseline survey asking about demographics, sexual history, and partner treatment preferences (standard partner referral vs. EPT). They identified up to 4 sex partners within the past 2 months, and answered questions on relationship characteristics, quality, and notification self-efficacy. At follow-up, participants with a current STD were asked whether they notified their partners. Generalized estimating equations were used to evaluate the associations between predictor variables and partner notification. Of the 201 subjects enrolled, 157 had a current STD diagnosis, and 289 sex partners were identified. The rate of successful partner notification was 77.3% (157/203 sex partners). Partner notification was increased if the subject had a long-term relationship with a sex partner (odds ratio: 3.07; 95% confidence interval: 1.43, 6.58), considered the partner to be a main partner (odds ratio: 2.53; 95% confidence interval: 1.43, 6.58), or had increased notification self-efficacy. Overall, participants did not prefer EPT over standard referral; however, females, those with higher education levels, and those with a prior STD preferred EPT. Patient-initiated partner referral is more successful in patients with increased self-efficacy who have stronger interpersonal relationships with their sex partners.
    Sexually transmitted diseases 09/2011; 38(9):821-7. DOI:10.1097/OLQ.0b013e31821c390b · 2.84 Impact Factor

Publication Stats

2k Citations
407.00 Total Impact Points


  • 1993-2015
    • Magee-Womens Hospital
      • • Department of Pathology
      • • Department of Obstetrics
      Pittsburgh, Pennsylvania, United States
  • 1998-2014
    • University of Pittsburgh
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Pittsburgh, Pennsylvania, United States
  • 2007
    • Allegheny County Health Department
      Pittsburgh, Pennsylvania, United States
  • 2006
    • University of Washington Seattle
      • Department of Medicine
      Seattle, WA, United States
  • 2002
    • Duke University Medical Center
      • Department of Obstetrics and Gynecology
      Durham, North Carolina, United States
  • 1999
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States