d care that includes assessment of individuals' needs for immediate medical attention. They go into some detail about steps health care providers should take to address the risk of sexually transmitted diseases, including encouraging individuals to accept prophylactic treatment when appropriate. As regards pregnancy, however, they are less comprehensive: The guidelines recommend that providers discuss the risk of pregnancy and encourage women of reproductive age to undergo pregnancy testing. They also suggest discussing "treatment options . . . , including reproductive health services," but nowhere mention the provision of emergency contraception. Predictably, the omission is seen as a major flaw by victims' advocates and many medical professionals, but has won praise from some conservative groups.2
1. Office on Violence Against Women, A National Protocol for Sexual Assault Medical Forensic Examinations: Adults/Adolescents, Washington, DC: Department of Justice, 2004.
2. McCullough M, Sex-assault treatment guidelines omit pill, Philadelphia Inquirer, Dec. 31, 2004, <www.philly. com/mld/inquirer/1053638.htm?1c>, accessed Jan. 10, 2005.
WATCH YOUR MOUTH
Fourteen percent of men and women with primary or secondary syphilis interviewed in Chicago in 2000-2002 reported that the only type of sexual contact they had had during the period in which they likely acquired the infection was oral sex.1 Among men who have had sex with men, the proportion of infections attributable to oral sex was above the average—20%. By contrast, only 6-7% of women and of men reporting exclusively heterosexual behavior appear to have become infected through oral sex. The total number of syphilis cases in Chicago has been stable since the 1990s, but the population affected has shifted dramatically: In the 1990s, infections were almost exclusively among heterosexual men and women; in 2001 and 2002, nearly three in five were among men who have sex with men. Some of the men interviewed believed that oral sex carries no risks and had been surprised to learn that they were infected. The researchers stress that "persons who are not in a long-term monogamous relationship and who engage in oral sex should use barrier protection."
1. Ciesielski C, Tabidze I and Brown C, Transmission of primary and secondary syphilis by oral sex—Chicago, Illinois, 1998-2002, Morbidity and Mortality Weekly Report, 2004, 53(41): 966-968.
COST OF NO CONFIDENTIALITY
Laws that restrict the confidentiality of Texas teenagers who wish to obtain reproductive health services could exact substantial health and economic costs.1 Using data from the state health department and publicly funded family planning clinics, analysts projected the effects of teenagers' loss of confidentiality resulting from two laws implemented since 2001, one of which requires those younger than 18 to get parental consent to obtain prescription contraceptives. Assuming that 37% of clinic clients younger than 18 would forgo reproductive health care if they had to tell their parents, the analysts estimate that each year, an additional 5,372 births and 1,654 abortions would occur in this population; medical costs associated with these outcomes would exceed $44 million. Teenagers' failure to seek care also would result in increases in untreated cases of chlamydia (2,243), gonorrhea (521) and pelvic inflammatory disease (501); treating the consequences of these diseases would cost $708,000. A reduction in visits owing to the loss of confidentiality would somewhat offset these costs; still, the state's tab would run $43.6 million.
1. Franzini L et al., Projected economic costs due to health consequences of teenagers' loss of confidentiality in obtaining reproductive health care services in Texas, Archives of Pediatrics and Adolescent Medicine, 2004, 158(12):1140- 1146.
INFANT DEATHS IN THE 'HOOD
Infant mortality varies more by neighborhood in New York City than it does in Paris, London or Tokyo.1 In 1988-1992, the infant mortality rate in high-income neighborhoods of Manhattan was 56% lower than the rate in low-income ne