Wednesday, December 05, 2007
Breaking the silence
There was a time when my best friend, Sarah, was the "sex lady." Out of college, one of her first jobs was as a sex educator. Sarah was passionate about it. Often, she would bring work home and, like many of us, dump it by the front door. On more than one occasion, I walked into Sarah's apartment and was greeted by a poster sized picture of full-blown chlamydia. I guess when you talk about sex all day, you don't think twice about what you leave in the hallway.

I thought about Sarah and her days as the "sex lady" recently when I took my dog, Bella, to our local dog park. I ran into "Apoo's Mom." (At the dog park, humans don't go by their real names. It's kinda like being in the CIA.) Apoo's mom is a pathologist. She works in women's health. She spends most of her days looking at slides. We got to talking about, you guessed it, STDs. Apoo's mom went to medical school in Europe and then came to the United States to do her residency. She says she is shocked by the STD problem we have in the U.S. "Almost every slide I see has trichomoniasis," sighed my dog park friend as we watched our "children" chase squirrels. "It is really alarming."

Just a few weeks ago, the Centers for Disease Control put out its annual STD report. The CDC estimates that 19 million infections occur each year - that's more infections than the total number of people who live in New York. According to the CDC, the big three STDs are chlamydia, gonorrhea and syphilis. Left untreated, these STDs can lead to infertility and in the case of syphilis, kill you. Nearly half of all infections happen among people ages 15 to 24.

Intrigued, I called Dr. Claire Brindis, professor of pediatrics at the University of California at San Francisco. "It is a silent topic," says Dr. Brindis. She says a number of factors contribute to the high numbers. First, young people tend to have "serial relationships" and when the relationship becomes "serious," the rules change and condoms come off. "The condom becomes a symbol of trust," says Brindis. But over the course of time, if someone has a series of monogamous relationships (and has a fling here or there), their risk and their partner's risk increases.

Dr. Brindis also points out that some groups have higher rates than others. According to the CDC report, the rate of chlamydia among African Americans was more than eight times higher than the rate among whites. Dr. Brindis says scientists are still trying to figure out why. She says it could be that African American teens tend to have sex earlier and that they don't have the access to condoms other groups do. Another possibility is that the health care community is just doing a better job screening for STDs. "We have better and less invasive tests," says Brindis.

She says we need to get creative when it comes to educating young people about STDs. She mentioned a program in San Francisco that sends "safe sex" messages to teen's cell phones.

I am curious to hear what you think. Why do you think the STD rates are so high? What do you think needs to be done to lower it?
I have been working in STD prevention and intervention for 3 months. While I am very new to the field I have seen enough to pin down a few problems that I have seen. One is the insane lack of knowledge regarding safe sex techniques (many people have never heard of lubrication). Another is the lack of knowledge by doctors (I'm still training for my job but I have to tell doctors about the complexities of syphilis). Solutions? Open, honest, comprehensive sexual education. If we continue to think that kids are too dumb or immature to handle sexual education, they won't be too dumb to have sex, they'll just be too dumb to do it safely.
I've worked in HIV and STD prevention for about 6 years now. The biggest issue I've seen is that there is an empathetic attitude regarding STDs and HIV in the community, especially among youth populations. They don't believe anything is going to happen to them. Secondly, we need more comprehensive education in schools. Federal funding has been reduced for the last 5 years and abstinence programs are being pushed and funed, rather than comprehensive education. Teens are not being the education they need to make healthy sexual decisions, which includes safer sex methods...they are just being taught about abstinence. We need to be honest about what's happening in this country regarding STDs and HIV!!
I think one major thing is a lack of free, comfortable arenas within which people can have discussions about this topic. The stigma - while it seems to be getting less bad - leads people to think that STDs only occur to those who are very promiscuous...which is just not true. I got herpes from my very first sexual partner - and not only did he not know that he had it, it was transmitted from a cold sore on his mouth to my genitals, AND it was after we dated for a year! No one wants to stand up and say "look at the bad thing that happened to me" however, I have made it a point to tell my closest friends because I don't want it to happen to them. People need to know that just because your friends or your new significant other says they don't and never had an STD doesn't necessarily mean it is the truth. People lie, and even when they're not lying, people can have it and honestly not know at all. To anyone considering going into a new sexual relationship, PLEASE talk, PLEASE ask, and PLEASE be honest. It is not easy in the beginning, but really, if you can't be frank with each other, is this really the sort of person for whom you might risk your freedom, your health, your fertility, even your life? Think about it.
People have a tendency to believe that it wouldn't happen to them so the use of condoms is limited. Maybe that's why teenage pregnancy rates are back up again. The practice of serial monogamy doesn't help matters either.
I work with a lot of teenage girls. Part of the problem is that no one is really telling these girls what is expected of them. No one is telling the boys either. If kids don't learn what they should know from parents, they will certainly get the information (wrong) from their friends. I can't tell you the kind of questions I am asked because I am a "younger" adult to them. I am frank about what can happen as far as STDs and pregnancy. I am also frank that 90% of guys will lie in any way they can to get what they want sexually. Most certainly don't know that and I don't want them to find out the hard way! I actually think more kids would think twice about having sex if they knew how predominant STDs really are. When they hear it, I usually hear how gross it is. And it is gross! They also don't understand the implications about how it can affect their fertility later. It comes as a shock when I tell them that and believe it or not, most girls DO care about that. There are enough couples with problems that they have seen this firsthand. Being open has the opposite affect that a lot of people feel that it has.
I have worked in Infectious Diseases for over 20 years. The verdict is in. It is a medically known fact that condoms will reduce the risk(not prevent)those STD's that are transmitted by body fluid but do not work for many of the others that are transmitted skin to skin or sore to skin such as herpes, HPV or syphilis. This was reported in 2001 after a workshop was conducted by the CDC, National Institute for Health and the FDA. None of this information has appeared in comprehensive sex education, to the detriment of children's health. Face it, sex education has been around for decades now and STD's continue to rise, so one of two things are happening. Either the adolescents are hearing the condom message and the condoms are not working the way they say they should, or despite all the education, young people are not buying into the message. Either way, sex education has been a failure. In the health care profession, there is a constant evaluation of policy and procedure. If something is not working, that procedure is scrapped for something that will. Why, then, do we lower the standards of care for the children of our society? Could it be that political ideology has crowded out scientific objectivity?
I believe that education is the best way to give knowledge to our kids regarding sex. We as parents need to be open and honest with them. The lack of communication and education about sex help some kids to direct their curiosity to their peers, television, and magazines. I believe that our education institution and parents need to accept that education is the best way to give them knowledge of sex and the best way to protect themselves from STD.
Personally, I believe that sex is for marriage and marriage only. If we would do things the way that our creator says, then things would go better. If we start to educate our children on values such as "saving themselves", they will think twice about having sex at the age they thinks its appropiate.Parents give teens the message that if you are ready for sex, then you should do it and also they send the message that you can do it as long as you dont get pregnant.This is food for thought.
I don't really remember receiving anything but kind of surface-level education about STDs in high school and even college. I think kids as young as 14, 15 need to be exposed to slides like the one the author saw, perhaps on a yearly or semi-yearly basis, to remind them how visually horrific many STDs are--those images are going to have a lot more impact than simply reading about HPV, HSV, etc. The only thing that's going to bring down STD rates is behavioral changes where people are acting more conservatively, sleeping with less partners, using protection more, etc.

But I do believe that kids and adults need to be exposed to harsh realities--otherwise the negative effects of the behaviors are being brushed under the carpet. One of the most effective anti-drunk-driving adds I've seen was of a horrificly disfigured girl that sad "Not all victims of drunk driving die." Sad, but true... actions and consequences.
Jen:

I think the big problem is lack of education everywhere and at every age.

Some of the young people are into oral sex because they don't think they can get any from it. Others are into rimming and don't think anything of it.

Also, I think the health business is moving fast too. How many heps are there now and who can keep up with that?

The focus at all ages should be education.
I am a 50+ white, heterosexual grandmother diagnosed with HIV earlier this year. While the focus seems to be on young adults, blacks, and AIDS in Africa, I would like to call attention to the growing number HIV/AIDS cases in the U.S. among older women. Many women past childbearing age do not use protection and lack current education about STDs. They do not perceive their partner as a member of a high risk group (either gay, or a needle user). Doctors in suburbia do not recognize the symptoms and do not counsel their sexually active patients to get STD/HIV tests. I was in a long term, supposedly monogamous relationship, but did not know the man was bi-sexual, had a criminal history, and was a walking petri dish of STDs. Neither did the scores of other women (of all ages) he has also infected. With benefit of hindsight here is my advice: Ask and share your STD status openly with your partners - Use protection, no matter what they say!!! Get tested for STD's every year as part of your annual exam (even if you THINK you are in a monogomous relationship). Get a criminal check on your partners - no kidding - many guys get HIV who have been in jail more than 6 months! Early detection of HIV may extend your life and the quality of time you have left -- but sadly it will not save you. Be careful out there.
OK, what I don't understand is why is a 'responsible sexual decision' be whether you're going to use a condom or not? Why can't responsible sexual decision making be if you are going to have sex or not? Why does that not seem to be an option?
In 2005, the Washington Post wrote an article on how depression has become the new STD. In fact, some mental health workers are recommending that if a teen is sexually active, a mental health screening should occur. Suicide attempts are 3x more likely in a sexually active teen girl than in those who are not sexually active. What condom is going to prevent that?
Notice that not one of the professionals mentioned in Jen's article mentioned that we need to find a way to get kids to stop having sex or to have them not start in the first place. Do we think so little of our teens that we don't think they're capable of self-control? What an awful message we are sending our kids.
While a lot of the comments above tackle the social stigma of STD's, I think it's specifically more related to the taboo that surrounds sex and nudity in our country. The U.S uses sexuality as a means of marketing and a foundation for making money, yet it's regarded as a terrible thing. A woman can show as much skin on television as she would like as long as she doesn't expose the few "naughty bits." Parents don't talk to their kids seriously enough about sex and puberty enough and by having abstinence only education, teenagers and children have no one else to look up to for this kind of information besides peers who only myths, and older adults whom, a percentage of the time, are sexual predators and use it to their advantage.

It's about time someone took a stand and said "look, teenagers are NOT going to stop having sex so it's about time we tell how they SHOULD be handling themselves so they don't SCREW UP.

I'm a 19 year-old in college filled with hormones and promiscuous activities. Yet, I have a respect for my sexuality and others as well due to my private progressive education and my mother who has taught me anything and everything I would want to know about sex.

The fact is, I learned how to properly put on a condom and how sexual diseases are contracted before I graduated the sixth grade, yet, you don't see me running around attempting to fornicate at any moment's notice as the pro-abstinence supporters would have believe, but I have a knowledge that ultimately allows me to respect myself and others, and that keeps me safe.
"Self control" could handle every single health problem that has some forebearance on personal action. People CAN put the Oreo's down, but obesity is still a problem. People CAN stop climbing trees, but we still get broken arms. Are we so anti-sex as a culture that we have to tell people that they CAN'T have sex if they don't want an STD. Don't we teach people to limit cookie consumption and wear proper footwear so they don't fall out of the tree?
We need to hide sex from children rather than push it in their face. Maybe high school is time enough to have good, comprehensive sex education. All parents should be strongly advised to talk about sex with their children but not until they start asking questions. Why is it that sexual diseases are more prolific and teen pregnancies are on the rise?
Young children should not be told about so much sexuality.
In a society where every aspect of life is sexualized it is impossible to preach to young people the importance of abstinence. The pressures put on teenagers, especially boys to engage in sexual activity is very high. I am a 23 year male and I am surprised when I meet someone my age who is still a virgin. While I used to ridicule those who made that choice, it has become apparent to me in recent years that those people are exhibiting a great amount of self-control. I myself lost my virginity at, what I would consider, an early age, however I hear stories now of 7th and 8th graders engaging in the same type of activity that I was involved in at 17 and 18. Sex is a wonderful thing and I don't regret any of my decisions but I do think one must be mentally and emotionally prepared to take that step. Teresa is absolutely correct, today we are so concerned with the acts and the physical effects of teen sex that we overlook the physiological implications involved. Abstinence education is not a realistic way to reach our young people but open and honest discussion of the physical ramifications and emotional issues surrounding sex are.
"Young people should not be told about so much sexuality, All parents should be strongly advised to talk about sex with their children but not until they start asking questions" are you serious? do you really think that kids are that stupid? That if we tell them sex before marriage is wrong they will listen? I guarantee that 80 percent of high school students will have had sex by their senior year and most of them do not use condoms. Teens will have sex no matter what you teach them. Guarentee most parents who think their kids are saving themselves or are too good to be sexually active are completely in the dark about what is really going on. It angers me that there are still people who believe abstinence only ed. is the ONLY way to go.
I am a 26 year old female, and have just been diagnosed with HPV Cervical Cancer. I am still shocked and disgusted. I visit with my doctor regularly and until the day my PAP Smear results came back abnormal, was I asked regarding my knowlege on HPV. It was then that I was offered the HPV vaccine. How is this possible? Looking back, the only formal sex education I have received was in middle school when I was given a bag of tampons, pads and feminine wipes. I believe if magazines can publish pictures of Britney Spears flashing her va-jay-jay, why coudln't the CDC publish images in Star, Cosomopolitan, Shape and like magazines, these magazines fly off the shelf every day. Pictures sometimes speak louder than words and the military uses these images and more to educate their men and women. Why are we holding back? The more research I do the more it becomes evident that the message is not having a significant impact. Churches, City Councils, Schools, Public Library's and I would even venture to say HR Managers have a moral obligation to educate kids, teens, adolescents, adults, seniors and even employees. We are loosing the battle! We need to wake up and take action at the local community level. Ignorance is not bliss.
Why is anyone surprised by the fact that STDs/HIV/AIDS are so rampant? We live in a highly sexualized society where little girls, under 10, can buy thongs. What message is that sending our children? Sex sells. And unfortunately it's selling a lot of young people short on life. Abstinence-only programs clearly aren't going to work when society is cramming sexual images into our youth's brains at every given moment.
STDs are not going to go away until we stop teaching abstinence-only programs in schools. Teens are going to have sex whether we talk to them about it or not. If we don't teach them to be safe, and if we are not honest about sex and its consequences, the rates of STDs and teen pregnancy will continue to increase. When will this country wake up to the fact that silence will not solve the problem?
STD rates are high for one reason

stupid sick people having sex with others and not being honest enough to get checked out and treated if possible.

I am sorry this is harsh but the pure simple honest fact is there are a lot of stupid people out there and until the end of time there will never be a cure for this.

Does anyone really believe that any person over the age of 15 has not heard about AIDS in the USA?

Even when you have reports about AIDS in Africa a month or so ago doctors were going around teaching people and giving them medicine and telling them Yes all of your parents have died because they had AIDS and then they spread Aids by having sex.....

And yet in 5 years or 10 or even 100 years there will still be some problem some STD of the day where people die and where family members watch their whole town wiped out and they will still have unprotected sex and they will still lie to their partners and cheat with prostitutes or have bisexual relationships (which no one ever talks about) and hide their other partners from their spouses.

People are stupid.

We scorn heroin addicts but give Robitussin with dxm in it to our children.

We fight wars and then rearm our enemy or we fight the wrong enemy and leave our own borders and ports totally wide open for attack.

People are stupid

And this will never ever ever change never.

How else do you explain that the most expensive buildings in every major city is the sports complex... STUPID PEOPLE LIFT UP OTHER STUPID PEOPLE TO MAKE THEMSELVES FEEL MORE IMPORTANT TO THE WORLD.....

its sad
but it is so true

50% don't graduate high school
only 25% attend college
of that maybe 1% get a degree worth the work.
and
a degree only means you want to learn
because it takes the rest of your life to learn a career.

If you can't graduate from high school then YOU ARE STUPID.

Just wish them good luck and teach your family the best you can.
My friend Sarah sent this to me and being a "sex lady" myself, I have to comment. I agree with the bloggers that referenced abstinence-only until marriage education. Not only do these unresearched programs fail to provide young people with information about condoms and contraception, but these programs also give young people false information about the efficacy of condoms. I have heard many youth say, "Why use condoms, they don't work anyway?"
In fact, research shows that evidence-based comprehensive sexuality education that includes information about abstinence, contraception, and helps reduce risky sexual behavior in teens. Teens that have been given the tools, the skills, and the information to make responsible sexual decisions are much more likely to make them than those that are not.
In addition, I highly recommend that parents have age-appropriate discussions with their children starting at an early age. Research also shows that youth whose parents are open and honest with them about sex are much more likely to wait longer to have sex and use protection when they do.
If you would like more information on this topic, I highly recommend that you speak with the Education Department of your local Planned Parenthood.
May our youth have safe and healthy futures.
I really don't think that most people have any idea what an abstinence curriculum looks like. It is not "just say no" and leave them to their own devices. It is comprehensive in that it gives them a lot of info about communication skills, decision making, building friendships, refusal techniques, recognizing & neutralizing peer pressure, family & career decisions, reproductive anatomy, fetal development and HIV/STI education. It teaches them to value themselves. This would be a departure from the current 'comprehensive' sex education currently being taught in schools. This is also supported by a recent report coming out of Britain that shows that the sex education implemented in the last decade has resulted in a teen pregnancy rate that is the highest in Europe; six times that of Holland, four times that of Italy and three times higher than in France. The report goes on to say that the combination of sexual images in the media with explicit sex education had broken down the natural inhibitions of children about sex, while progressively easier availability of contraception meant that young girls could no longer use fear of pregnancy as a reason to reject sexual advances.
As for the previous comment about approaching Planned Parenthood for education, people should know that this organization is not about sexual health but about sexual empowerment. One Planned Parenthood website, that advertises itself as a new spin on sexual health for teens, gives instructions on how to share sex toys safely, how to perform oral sex, what 'fisting' is, and that it is legal for 11 year old children to have sex, as long as it is with other 11, 12 and 13 year old children.
No wonder our kids are getting sick.
I disagree with Dr. Brindis' comment that "African-American teens tend to have sex earlier." I find this line of reasoning offensive. Chlamydia is more prevalent among all groups than previously reported. "In Acta Paedriactica, researchers from Sweden found chlamydia bacteria in almost all the tonsils that were removed from children with chronic recurrent respiratory infections. Chlamydia pneumoniae is a common cause of respiratory infections in children and that bacteria remains in a child's throat forever until it is killed by the appropriate antibiotic." Many American males and unfortunately, children have Chlamydia. see:Chlamydia pneumoniae in children undergoing adenoidectomy. E Normann, J Gnarpe, J Naas, H Gnarpe, MG Karlsson, B Wettergren. Acta Paediatrica, 2001, Vol 90, Iss 2, pp 126-129. Address: Normann E, Gavle Cent Hosp, Dept Paediat, SE-80187 Gavle, SWEDEN
Google and 1) The modulation of chlamydial replication by HLA-B27 depends on the cytoplasmic domain of HLA-B27. JG Kuipers, A Bialowons, P Dollmann, MC Jendro, L Koehler, M Ikeda, DTY Yu, H Zeidler. Clinical and Experimental Rheumatology, 2001, Vol 19, Iss 1, pp 47-52Address Kuipers JG, Hannover Med Sch, Div Rheumatol, Dept Internal Med, D-30623 Hannover, GERMANY.

2) Adult Still's disease associated with Mycoplasma pneumoniae infection. C Perez, V Artola. Clinical Infectious Diseases, 2001, Vol 32, Iss 6, pp E105-E106.Address Perez C, Hosp Virgen del Camino, Dept Internal Med, Irunlarrea 4, Pamplona 31008, SPAIN

A recent issue of the American College of Cardiology lists 15 papers showing the overwhelming evidence that heart attacks are caused by infections as well as by certain dietary fats, obesity, smoking and lack of certain vitamins. Recent reports from Germany and Italy show that chlamydia is found in arterial plaques and at much higher than normal levels in blood of people who suffer heart attacks (16,17,18).

Men with circulating chlamydia DNA are at high risk for heart attacks (1). Herpes virus causes arteriosclerosis in chickens (3). Cytomegalovirus causes arteriosclerotic heart disease in men who have had heart transplants (4). Chlamydia causes accumulation of foam cells and oxidation of cholesterol, two key changes that prevented the formation of arteriosclerotic plaques (5). The surface protein of chlamydia shares surface protein with blood vessels, so immune antibodies that attack. chlamydia may indeed damage blood vessels (6). Chlamydia is very common, causing 10% of pneumonias worldwide (7). Chlamydia damages cultured arteries removed from animals and placed in a test tube (9). Chlamydia causes the same damage in rats and chickens as it does in humans (10). People with dental infections are at increased risk for suffering heart attacks (11). Chlamydia pneumoniae, cytomegalovirus, herpes simplex virus, and periodontal disease caused by Porphyromonas gingivalis and Streptococcus sanguis are associated wit increased risk for heart attacks (12). Antibiotics that kill chlamydia prevent heart attacks (13). The recently completed WIZARD study shows that Zithromax prevents second heart attacks (14, 15).

1)YK Wong, KD Dawkins, ME Ward.Circulating Chlamydia pneumoniae DNA as a predictor of coronary artery disease. Journal of the American College of Cardiology, 1999, Vol 34, Iss 5, pp 1435-1439.

2) VV Valtonen.Role of infections in atherosclerosis.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S431-S433.

3) CG Fabricant, JFabricantle.Atherosclerosis induced by infection with Marek's disease herpesvirus in chickens.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S465-S468.

4) JD Hosenpud.Coronary artery disease after heart transplantation and its relation to cytomegalovirus.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S469-S472.

5) GI Byrne, MV Kalayoglu.Chlamydia pneumoniae and atherosclerosis: Links to the disease process.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S488-S490.

6) G Christiansen, T Boesen, K Hjerno, L Daugaard, P Mygind, AS Madsen, K Knudsen, E Falk, S Birkelund.Molecular biology of Chlamydia pneumoniae surface proteins and their role in immunopathogenicity.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S491-S495.

7) P Saikku.Epidemiology of Chlamydia pneumoniae in atherosclerosis.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S500-S503.

8) M Leinonen, P Saikku.Interaction of Chlamydia pneumoniae infection with other risk factors of atherosclerosis.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S504-S506.

9) TC Quinn, CA Gaydos.In vitro infection and pathogenesis of Chlamydia pneumoniae in endovascular cells.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S507-S511.

10) IW Fong.Value of animal models for Chlamydia pneumoniae-related atherosclerosis.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S512-S513. 11) JD Beck, J Pankow, HA Tyroler, S Offenbacher.Dental infections and atherosclerosis.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S528-S533.

12) B Chiu.Multiple infections in carotid atherosclerotic plaques. American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S534-S536.

13) EP Gurfinkel, G Bozovich.Trials of anti-chlamydial therapy - Emerging role of antibiotics in atherosclerosis.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S537-S538.

14) M Dunne.WIZARD and the design of trials for secondary prevention of atherosclerosis with antibiotics.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S542-S544.

15) JT Grayston, LA Jackson, WJ Kennedy, RA Kronmal.Secondary prevention trials for coronary artery disease with antibiotic treatment for Chlamydia pneumoniae: Design issues.American Heart Journal, 1999, Vol 138, Iss 5, Part 2, Suppl. S, pp S545-S549.

16) G Bauriedel, R Andrie, JA Likungu, A Welz, P Braun, U Welsch, B Luderitz Persistence of Chlamydia pneumoniae in coronary plaque tissue: a contribution to the infection and immune hypothesis concerning unstable angina. Deutsche Medizinische Wochenschrift, 1999, Vol 124, Iss 47, pp 1408-1413.

17) F Blasi, J Boman, G Esposito, G Melissano, R Chiesa, R Cosentini, P Tarsia, Y Tshomba, M Betti, M Alessi, N Morelli, L Allegra. Chlamydia pneumoniae DNA detection in peripheral blood mononuclear cells is predictive of vascular infection. Journal of Infectious Diseases, 1999, Vol 180, Iss 6, pp 2074-2076.

18) J Kahler, R Koster, JH Braser, P Schafer, W Terres, CW Hamm, T Meinertz. Role of Chlamydia pneumoniae in the pathogenesis of coronary artery disease. Zeitschrift Fur Kardiologie, 1999, Vol 88, Iss 11, pp 885-895.

Thank you, Azul Baltimore, Maryland
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