Harold C Wiesenfeld

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (88)418.73 Total impact

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    ABSTRACT: Background: Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men who have sex with men is risk based. Despite high frequencies of oral and receptive anal intercourse (RAI) among women, extragenital screening is not recommended. Methods: Women (n = 175) and men who have sex with men (n = 224) primarily recruited from a sexually transmitted infection clinic reporting a lifetime history of RAI completed a structured questionnaire and clinician-collected swab samples from the rectum, pharynx, vagina (women), and urine (men). CT and GC were detected using 2 commercial nucleic acid amplification tests (Aptima Combo 2; Hologic, Inc, Bedford, MA; Xpert CT/NG, Cepheid Innovation, Sunnyvale, CA). Results: The median age of the population was 26 years, 62% were white, and 88% were enrolled from a sexually transmitted disease clinic. Men were more likely than women to have GC (22.8% vs. 3.4%) and CT (21.9% vs. 12.6%). In men versus women, GC was detected in 16.5% versus 2.3% of pharyngeal swabs, 11.6% versus 2.3% of rectal swabs, and 5.4% versus 2.9% of urine samples or vaginal swabs. C. trachomatis was detected in 2.2% versus 1.7% of pharyngeal swabs, 17.4% versus 11.4% of rectal swabs, and 4.5% versus 10.3% for urogenital sites in men versus women. Overall 79.6% of CT and 76.5% of GC in men and 18.2% of CT and 16.7% of GC in women were detected only in the pharynx or rectum. Conclusion: Reliance on urogenital screening alone misses most of GC and CT in men and more than 15% of infections in women reporting RAI.
    No preview · Article · Jan 2016 · Sexually transmitted diseases

  • No preview · Article · Dec 2015
  • L.K. Rabe · M. Petrina · L.A. Meyn · H. Wiesenfeld · S.L. Hillier

    No preview · Article · Dec 2015

  • No preview · Article · Dec 2015
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    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.
    No preview · Article · Nov 2015 · Clinical Infectious Diseases
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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.
    No preview · Article · Sep 2015 · The Journal of Infectious Diseases
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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.
    Full-text · Article · Aug 2015 · Sexually transmitted diseases
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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.
    No preview · Article · Jun 2015 · American journal of obstetrics and gynecology

  • No preview · Article · Jan 2015 · American Journal of Obstetrics and Gynecology
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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.
    No preview · Article · Dec 2014 · Anaerobe

  • No preview · Article · Oct 2014 · Open Forum Infectious Diseases
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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.
    Full-text · Article · Jul 2014 · Clinical Infectious Diseases
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    ABSTRACT: Background PID is a polymicrobial infectious condition of the female upper genital tract. Neisseria gonorrhoeae (GC) and Chlamydia trachomatis(CT), long considered the predominant organisms involved in the pathogenesis of PID, are identified in fewer than half of U.S women diagnosed with acute PID. Mycoplasma genitalium (MG) is associated with male urethritis and some evidence suggests an association with other STD syndromes including cervicitis and PID. Our objective was to examine the association between MG and acute PID. Methods The ACE Trial is a randomised double-blind study evaluating the value of anaerobic therapy for acute PID. At enrollment, specimens were collected from the cervix and endometrium for testing for GC, CT and MG by transcription-mediated amplification. Histology was performed on endometrial tissue. Identification of cervical and endometrial organisms was correlated with endometritis. Results Among the 125 women diagnosed with acute PID, twenty two percent (n = 27) tested positive for M. genitalium, while CT, GC and bacterial vaginosis were present in 14%, 7% and 54%, respectively. Forty six women (37%) had histologic endometritis. Histologic endometritis was more common among those having cervical infections with GC, CT or MG than uninfected women (66% vs. 24%, p < 0.001). Among women with endometritis, GC, CT and MG were present in 17%, 30% and 36%, respectively. Endometritis was present in 71% (20/28) of women with endometrial GC, CT or MG. Endometrial identification of GC (100% vs. 34%, p < 0.05), CT (77% vs. 32%, p < 0.01) and MG (64% vs. 33%, p < 0.05) were each independently associated with endometritis. Conclusion Mycoplasma genitalium is identified in 22% of women diagnosed with acute PID. Similar to CT and GC ,the presence of MG in the endometrium is highly associated with endometritis among women diagnosed with PID. This study suggests that M. genitalium may play an important role in the pathogenesis of PID.
    Preview · Article · Jul 2013 · Sexually Transmitted Infections
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    ABSTRACT: Background The BRAVO trial is an ongoing study designed to determine whether bi-monthly home-screening and treatment for asymptomatic bacterial vaginosis (BV) reduces risk of urogenital chlamydia and gonorrhoea infections in young women. Return rate of self-collected swabs is a critical element of home testing interventions. We conducted this preliminary analysis to determine the swab return rate and to assess its association with age, race, or recruitment setting. Methods Participants, recruited from 10 clinics in 5 cities, were asked to mail self-collected vaginal swabs to the research team every 2 months for one year. For each evaluable participant, we determined the number of kits returned (of 6 total) and compared the proportion of women that returned all 6 kits according to age, race, and recruitment setting. Results Data were available for 756 participants who were primarily non-Hispanic Blacks (76%), with median age 21 (range: 17–25 years), and mostly recruited from STD clinics (82%). Nearly all women (89%) returned at least one swab; 59% returned all 6 kits; 14% returned 5, 16% returned 1–4, and 11% returned none. Complete swab return rate (all 6) was greater among women aged 23–25 than those aged 17–22 (67% vs. 56%, p < 0.01) and varied among the 5 recruitment cities (range 42%–66%, p = 0.02). Return rates were not significantly associated with race and Hispanic ethnicity, or with recruitment from STD clinics vs. other settings (58% vs. 66%, p = 0.10). Conclusions The majority of study participants collected and submitted all six home-screening kits, and 73% completed at least five. Adolescent women aged 22 and younger had a lower return rate than women aged 23–25, although the complete return rate was still over 50%. Therefore, frequent home-screening for BV and STIs is feasible in clinical trial settings and could likely be implemented as part of clinical care and STD prevention programmes.
    No preview · Article · Jul 2013 · Sexually Transmitted Infections
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    ABSTRACT: Objective While Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are known to cause PID, many women with clinical signs and symptoms of PID and histologic evidence of endometritis have neither of these pathogens. Our objective was to describe microorganisms in the upper genital tract of women with PID, and to evaluate their association with histologic endometritis. Methods Women presenting with symptoms and meeting the CDC diagnosis of PID had an endometrial biopsy obtained by Pipelle, and the tissue was split for microbiological and histological assessment. Cultivated microorganisms were identified using phenotypic and genotypic characteristics. Fisher’s exact tests were used to assess the association between microorganisms and endometritis (plasma cells ± neutrophils). Results Of 136 women with clinical PID, 55 (40%) had histologic evidence of endometritis, and endometrial GC and/or CT was associated with endometritis (29% vs. 6%, P < 0.001). In addition to STIs, a broad range of bacteria representing 63 different species were recovered from 53 (39%) of the endometrial biopsy samples, including 8 novel species. The recovery of any non-GC/non-CT organisms from the endometrium was associated with histologic endometritis (53% vs. 30%, P = 0.008). Both G. vaginalis(35% vs. 16%, P = 0.01) and A. vaginae (22% vs. 3%, P < 0.001) were associated with histologic endometritis. Other anaerobic bacteria associated with bacterial vaginosis including Prevotella timonensis, P. amnii and Peptoniphilus harei were also more frequent in the endometrium of women having endometritis (11% vs. 3%, P = 0.06) but this did not reach statistical significance. After excluding women having GC and/or CT, A. vaginaewas still independently associated with endometritis (17% vs. 3%, P = 0.03). Conclusions The recovery of non STIs from the endometrium is associated with histologic endometritis among women with clinically diagnosed PID. A. vaginae may play an etiologic role in PID and merits further evaluation for its role in nongonococcal/nonchlamydial PID.
    No preview · Article · Jul 2013 · Sexually Transmitted Infections
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    ABSTRACT: Objective Most women with Chlamydia trachomatis (CT) infection are asymptomatic, while ∼3% progress to pelvic inflammatory disease (PID) within two weeks of untreated infection. The identification of biomarkers that predict development of PID would aid in identification of women at risk for complications of infertility and ectopic pregnancy. The specific aim of this study was to identify a whole blood transcript signature for acute PID due to chlamydial infection. Methods We performed gene expression microarrays using whole blood from 79 women who had a gynecologic exam, and cervical and endometrial microbiologic testing. Samples were divided into five groups: Group 1, women with acute PID who were CT+ at endometrium (PID+, CT+, and E+); Group 2, asymptomatic women who were CT+ at endometrium (PID-, CT+, E+); Group 3, asymptomatic women who were CT+ at cervix (PID-, CT+, E-); Group 4, asymptomatic women who were CT- at cervix and endometrium (PID-, CT-, E-); Group 5, women with symptoms of PID who were negative for CT or other sexually transmitted pathogens (PID+, STI-, E-). Results We identified a transcript signature that discriminated women with chlamydial PID from all other groups. Pathway analysis revealed that the chlamydial PID signature contained genes from interferon response pathways. Gene transcription in a subset of women with chlamydial endometrial infection clustered with women with chlamydial PID. Conclusions Our study raises the possibility that transcriptional biomarkers with potential as diagnostic and prognostic tools can be identified to combat chlamydial reproductive tract disease in women.
    No preview · Article · Jul 2013 · Sexually Transmitted Infections
  • Harold C Wiesenfeld

    No preview · Article · Jul 2013 · Obstetrics and Gynecology
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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.
    No preview · Article · May 2013 · Journal of Adolescent Health
  • Harold C Wiesenfeld

    No preview · Article · May 2013 · Sexually transmitted diseases
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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.
    Preview · Article · Feb 2013 · Infectious Diseases in Obstetrics and Gynecology

Publication Stats

2k Citations
418.73 Total Impact Points

Institutions

  • 1994-2015
    • University of Pittsburgh
      • • Department of Obstetrics, Gynecology and Reproductive Sciences
      • • Department of Medicine
      Pittsburgh, Pennsylvania, United States
  • 1993-2015
    • Magee-Womens Hospital
      • • Department of Pathology
      • • Magee-Womens Research Institute
      • • Department of Obstetrics
      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