CQMTRACEPTPVE USE BY INAER CITY AWLESCEPlT WILES. Efstratios 0.. Stacy Harris. I.P.H.. Vasiliki Siooris. ngione. Ph.D. Boston Cfty Hospital and i&pa

bF Padlatrfcs, Boston University School of Medicine. &ton, MA. Little is known about the contrdcmtive behavior of adotes-

ler. Ua studied factors that uay distinguish'coadom usws from nonusers. niencc sauplc of 203 sexually experienced subjects 13 to 19 years old ng m innar city adolzscant clink wara given an inter-kwer adiwinis-

tend quertlonnalre based on the Health ifalief Adel. Tboaa who used condofps at lsast 50% of tha tiw wera considered users. Respondents were a @aan of 1?.3+1.5 years old; 94L wre black, 49X Pmtastant. 26% Ca dfg@ik Only 1% wuld be unhaupy if their girlfriend bee felt a pregnancy would chanr marital plans. 433 educational plans. and 21X .iob Hans. &n average of 7.2 of 12 resmductiwe knowledge items ware answered iorrketly. TRe.effe&ve!uss of only 3.3 of 9 contraceptive u&hods uere COP' rectly identified. am age off first intercourse was 12.7+2.7 years; 362 had i~raanatad a ~a~tnar and 293 uere fathers. 128, had used candons at soue t&a;-611 usecdcondous 50% or more of the tiw. Reesonu for nonuse included decreased pleasun (21). unavdllability (178). and parlnar’s use of birth contra1 (14la) or objection (Ill). Univariata analysis indicated users w-a likely to be fn school (p=.IM). desire to caapleta college (p=.O3), have araatnr ranroductivc tnowlcdae fo=.Ul). have a oartncr who used birth contw! &:I%). have thought they biid &tton’i pdrtnu; uregnant (g=.OZ). cite fewer physical (p=.WZ), attitudinal (p=.UlW). and c nlcatlon barriers (p=.OMM! and 1808 attitudinal benefits (p=.glWUl to condow USE, have higher self COR- caps (pz.MKhl). and a wore internal locus of contrul (p=.M11). Users were lass 1G~ly to ha l,ivIng with their father n.039, and have ewei- inpregnated a partner (p=.O2). Logistic regression a sis found that only fewer phys- ical lo=.031 attibdiN,al (u=.UUO3). and c nlcation barrfers (p=.OUOl), and mre bitituulnal hsvaElts~~p=.U4~&-a associated with use (uadel chi-square- U6.28, 13 d.f.. p~.tWX). Interventions that reduce barriers and reinfarce benefits may increase condon use ng inner city adolescent orates.

TIE CHANGING PIDMIOUX;IC SECTRUM OF SYiWILP.5 18 URBAN AUUt&CEfE. Janic Cow. M.D.. Lavrence D’Anrelu. M.D.. M.P.H.. and Toaes Silber. M.D. .Children’s Hosp. Nat: Heed. Cc+.. Waahingtoa, D.C.

The incidence of svshilis continues LO increcse. In an __ eEfort to evaluate the epidemiologic charecteristirs of adolescents seen in as wban clinic. we studied 31 paiients identified with syphilis between 19a5 and 1938. Only 8 of our oatients (26%) were wale and 23 (74%) were fee&s. Complete dka were sv~ilsble on 2gmpetients. The wau age vas 16 years. Chief casplaists (182 rash, 162 genital lesion. 11% adeno&xthyl or phgsichl findin@ (14% rash, 14% chancre, 21% adempathy) suggestive of syphilis were present in 54%. AL least one of these physrcal findings was present iru 83X af males but in only.32Z of felleles. Stages of syphfiis uere as fa~llavs: 142 prisary, 432 secondary, 392 latent, and 42 undetermined. The diagnosis ves made in only 252 of patients at the initial visit. A ses+stch.ud case control cm~periscm revealed no differences in age. presence of an eaeo~iated aexoally trenswitted dieease( previous STD. or pregnancy history. Chi squers tests shwed thst cesee were store likely to have prescntcd for a specific complaint (pc.05). to bsve abused drugs (p(D21 and to b-e nOn-cOntCaCeptiY@ users lpe.051.

This stodv sumests that the coideaioloav of syphilis way be chenoinn in urban ad&&t;;: The high pare&age of-k&ekes is in @arked-cvksst to e previous atody ot this iz?ttitution (1’5’77-81) in uhicb only 393 of casts wets fess&z. That 39% of our cases dste latent and only 2% of caoes were initially disgnosed underscores the Esct that my sexually active adolescent should have routine serologic screening for syphilis. Finally. sexually setlve adolescents who abuse drugs. do net use contraceptives. ur present for s specific cseplaint blsrrant extra vigilance.

., Pelin Beeld. l&D. Wsrren Torgersrm. Ph.D.. Dept. of Ped.. Univ. of Maryland. and llsyt. of Beuee~~vgery, Johns Aspkins gasp., ~ltiners, Plarylend.

In adoleaeent fenalas vim dysurie. traditfwnnl aywpta infowaation end ganeral phyeical crarrloati-.n dsta do net raliebly distinguish between urinary fIRI) and genital tmr’~ infections (GTI). Our prior studiaa nua&asted that the two a of P.?fecrion wiAht be diatinguisheble on the basis of pain sevptity suted v&inS viseal snalopw xs1.s. In the prssent study. ee translated these findings into a strrlght-forward quueticn that gives a verbal reseeawant of dyenric pain intensity. Our abfactive was to deter&no if the

GTI. c&l %valuatti B3l”consecutive, f la adolescents kho presented with ..- dysuria to a Unl’rsraiy Wocpital Adolescent Clinic. In addition to the traditional quastlons cooeo a genito-urinary 5ympt , patients were a&ad

dfstely peior to urine n. during urinsry l&&on of urination. &ti.nts wra than classified as iRI

ev non-WI &f? or no disgnesis) based on data obtained fr.ze a full physical and pelvic exsninatiun. an3 a standsrdirod battery ef lebaratory tests. UnIv.%riate ms1v.m~ rrtvealed Mat 77.31 of aatienta with lJTI. coewared w+th 11.7X of those ktb nm-Si. described thei; @ain as maat se&c &n cenplstion of urinatioii (p c-0 C31:. Pain. reported as grrstast prior to win&ion or durlnS urlmry flew, did not distinguish between the two SrouP~, Further anslysscls usina la~istic re~rassion vevaalad that if a patient dsacribed he; poln an-grekost up& cowPletlon of urination, the odds were 20.3 : 1 that a UTI wan DrBSR,,t (95X CS 4.65 to 88.5. D <.OOOl). The addition

color. ewount, and odor of vaginal dischorAe to the wedel did not leprwe Its ability to pradict UTL Thasa data Buspast that Pain reparts ahauld be included in the clinical evaluatien of all adolescent fessla~ with dysurio.

BACK m WIGS: AlULDDl DDIlig IW BATIWC DIsOED3A PATI&Kps tbsartha FL Axden, M.D., Erie C. Weisslbs~g, W.D., Lauren Dlldew, H.Q., iMen Landers, D.N., DoUglOP w. guilnall. K.D.. Hiehaal P. Ilus~ba~~% M.D,. 1. Bonald Shankat, M.D.. Marc S. Jacobson, M.D. Scbnsidar Children’s Rospitsl. Long Island Jewish tfwlical Center. SUNY at Stony Breoob. &v Ayde P&zr NY.

After noting the uresencs of slhsline utlna in revere1 of our pa2ienta with atfng disorders (P), w dacidud to datarsdns if this ir 0 ohnractoriatlc P*tabe1io abnetwa1ity waa Pmapnctively aaoesaed by dip5tl le ED and nen-ID

patimta prwtinp to our zdoleecent psried. Physicisns and 29 pstirnts cc+spktsd qusPtlansair%r sbeut clinical uariahlss includir@ diagRosia. curmat prsif;ht. change in ueisht, the ptwanca af self-inducad vcaiting, and the uao of lonetivee or diuretica.

yatfwnto with D (n a 465 bed sl@ficently bigtor orine pll tko controls (n w 2nvr.P i 0.g vs 5.9 2 0.g. p < .ODl by StGdent’e t-tant).

was highly OpaCiflC for tlm gwmlcm of tan El (0.961, hot y wao low (0.37). Rte pQ5itivP pdfct~wa vrlva of an urina in our clinic pr’pul~tion (51% ED p*ti@nt.s) is 941x.

pationtr with anownia ns~.vsaa bed lwar urins pll b&n paPLant

sit3 ?m&!lp m?LTE9 (Q.7 ;f. F.8 WI 7.2 + 0.0), they at!?1 had eigoifkantly highem pmr tbBn controla (p < .ool). AfClinn ueino wao fawnd azorw often iu ~Limta ulth wnight Ioea than g5X idsal k’ < .o5) and whan the ptismt mprtad ud~~inducad malting within the past uonth (u C .OS by ehi w .

Alh~lina urine ia an raly and rapfdly d&%wlnad tabo1ic 1ity found in patianti witlh ii

IL way prove ueeful ss a