Socio-cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India

Biomedical, anthropological and psychiatric frameworks have been used to research different elements of men's sexual health - sexually transmitted infections, psychosexual concerns and psychological distress - but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic-based survey of 366 symptomatic men who presented at rural private provider clinics. Men's urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12- items). Results revealed that local and traditional notions of health influenced men's symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non-infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51-4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.     

Initiation of antiretroviral therapy leads to a rapid decline in cervical and vaginal HIV-1 shedding

BACKGROUND: Antiretroviral therapy (ART) may decrease HIV-1 infectivity in women by reducing genital HIV-1 shedding. OBJECTIVES: To evaluate the time course and magnitude of decay in cervical and vaginal HIV-1 shedding as women initiate ART. METHODS: This prospective, observational study of 20 antiretroviral-naive women initiating ART with stavudine, lamivudine, and nevirapine measured HIV-1 RNA in plasma, cervical secretions, and vaginal secretions. Qualitative polymerase chain reaction estimated HIV-1 DNA in cervical and vaginal samples. Perelson's two-phase viral decay model and non-linear random effects were used to compare RNA decay rates. Decreases in proviral DNA were evaluated using logistic regression and generalized estimating equations. RESULTS: Significant decreases in the quantity of HIV-1 RNA were observed by day 2 in plasma (P < 0.001), day 2 in cervical secretions (P = 0.001), and day 4 in vaginal secretions (P < 0.001). Modeled initial and subsequent RNA decay rates in plasma, cervical secretions, and vaginal secretions were 0.6, 0.8, and 1.2 log10 virions/day, and 0.04, 0.05, and 0.06 log10 virions/day, respectively. The initial decay rate for vaginal HIV-1 RNA was more rapid than for plasma RNA (P = 0.02). Detection of HIV-1 DNA decreased significantly in vaginal secretions during the first week (P < 0.001). At day 28, 10 women had detectable HIV-1 RNA or proviral DNA in genital secretions. CONCLUSIONS: Genital HIV-1 shedding decreased rapidly after ART initiation, consistent with a rapid decrease in infectivity. However, incomplete viral suppression in half of these women may indicate an ongoing risk of transmission.     

Gynaecological problems related to anatomical changes after conventional proctocolectomy and ileostomy

Seventy-one women who had a proctocolectomy for ulcerative colitis (n=41) or Crohn's disease (n=30) were interviewed in the follow-up clinic about gynaecological problems and fertility. All women were examined by an independent gynaecologist and abnormalities of the internal genital tract were registered. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% (6/71) before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion with-out any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilatated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within 5 years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 21 delivered by caesarean incision. In conclusion, conventional proctocolectomy in women will result in distressing vaginal discharge, and dyspareunia in a considerable proportion of the patients. The operation also seems to decrease their chances of becoming pregnant.     

妇科门诊就诊者生殖道感染调查

目的了解妇科门诊阴道分泌物异常就诊者生殖道感染状况,为制订妇女性病艾滋病干预计划提供基础信息。方法对2004年1~12月上海市闸北区妇幼保健所和宁波市海曙区马园卫生院妇科门诊,主诉阴道分泌物异常的1 565例初诊病例进行生殖道感染调查。结果上海、宁波本地户口病例753例,以无待业、工人居多;外地812例,以工人、服务员居多。3.9%的人近3个月有1个以上新性伴,8.1%的人经常使用安全套。60.2%(942例)有生殖道感染。12.6%(197例)合并2~4种感染,多为外地病例。检出率最高的是细菌性阴道病(23.2%),其次是衣原体感染(16.7%)。外地病例淋菌感染检出率(5.3%)、近3个月有1个以上新性伴的比例(6.8%)、初中以下文化的比例(87.2%),均高于当地病例(43.6%)。经常使用安全套的比例(3.2%)低于当地病例(13.3%)。结论妇科门诊就诊者以常见生殖道感染居多。法定报告的性病(淋菌和衣原体感染)占一定比例,应引起足够重视。外地病例合并生殖道感染较多,安全套使用率低,存在较多传播性病艾滋病的危险因素。应针对她们文化程度较低的特点和对生殖健康的需求,加强有关性病艾滋病防治的宣传和咨询,积极开展生殖道感染预防、性病诊疗、安全套促进和行为干预工作。     

Reproductive health and STDs among clients of a women's health mobile clinic in rural Bali, Indonesia

Recent studies in Indonesia have reported significant levels of STDs in low-risk urban groups. To gather data on rural women, a prevalence study was undertaken in Bali utilizing a women's health mobile clinic. Rural (n=312) women were tested for vaginal reproductive tract infections (RTIs) by on-site wet mount, for Neisseria gonorrhoeae and Chlamydia trachomatis by unamplified DNA (Gen-Probe) test, and for syphilis by rapid plasma reagin (RPR). Results were: candidiasis 5.8%; bacterial vaginosis (BV) 37.2%; trichomoniasis 15.1%; gonorrhoea 0.7%; chlamydial infection 5.6%; syphilis 0%. Overall 55.1% had at least one RTI and 19.2% had at least one STD. Reported non-monogamy, pain with urination and genital lesions, observed cervical friability and cervical motion tenderness were associated with cervical STD infection (P<0.05). We conclude that there is a need for improved services for STD prevention and RTI/STD management in rural Bali, and for condom promotion.     

STD病征诊治流程图的探索研究

目的探索STD的病征处理流程图.方法对1027例初诊病人临床表现(症状、体征)和实验检查结果进行统计分析,总结出8个病征和流程图.结果临床表现为尿道分泌物按淋病和NGU方案治疗使92.94%的病人得到规范治疗;尿痛和尿道痒按NGU方案治疗,可使50%的病例获益;生殖器赘生物按尖锐湿疣方案治疗68.73%病人获益,醋酸白试验阴性者对症处理;生殖器溃疡按生殖器疱疹治疗,对60.27%的病人是恰当的;阴道分泌物多,按淋病和NGU方案治疗,只有43.13%病人是正确的;阴部瘙痒对症处理;阴囊肿痛66.67%要对症处理;主动要求检查应进行健康咨询和必要检查.结论 8个病征图中,以尿道分泌物流程图的准确率最高,依次为生殖器赘生物、生殖器溃疡和阴道分泌物流程图,其余病征图需由经验丰富的医师来处理,方能避免过大的误诊和误治.阴道分泌物流程图若以淋病、NGU和厌氧菌感染方案(甲哨唑)治疗,准确率可达67.97%,甲哨唑的药价便宜,副反应小,利大于弊.     

Use of modern and traditional products to self-treat symptoms of sexually transmitted infections in South African women

The objective of the study is to investigate products used by women self-treating symptoms of reproductive tract infections (RTIs), including sexually transmitted infections (STIs), and their methods of administration. A household survey using a multi-stage cluster sample design was undertaken in KwaZulu-Natal, South Africa. Women aged 18-60 years were interviewed (n = 867) and information was collected on demographics, reproductive health and sexual behaviours. A fifth of women reported having RTI/STI symptoms (20.5%), of whom 41.9% were treating these symptoms (mostly discharge [79.1%], ulcers [6.8%] and itching [7.7%]). Only three women were using medication prescribed by a health provider, while the remainder were self-treating using traditional medicines and modern products, including antiseptics, soaps, petroleum jelly, menthol creams and alum. Products were administered in various ways. Although RTI/STI treatment is widely available and free in public health facilities, many women are still self-treating. Potential harm of products for self-treatment requires further investigation and efforts should be made to improve STI service uptake.     

Detection of Kaposi's sarcoma-associated herpesvirus in oral and genital secretions of Zimbabwean women

Kaposi's sarcoma-associated herpesvirus (KSHV) in oral and genital secretions of women may be involved in horizontal and vertical transmission in endemic regions. Nested polymerase chain reaction assays were used to detect KSHV DNA sequences in one-third of oral, vaginal, and cervical specimens and in 42% of peripheral blood mononuclear cell (PBMC) specimens collected from 41 women infected with human immunodeficiency virus type 1 who had Kaposi's sarcoma (KS). KSHV DNA was not detected in specimens from 100 women without KS, 9 of whom were seropositive for KSHV. A positive association was observed between KSHV DNA detection in oral and genital mucosa, neither of which was associated with KSHV DNA detection in PBMC. These data suggest that KSHV replicates in preferred anatomic sites at levels independent of PBMC viremia. Detection of genital-tract KSHV only among relatively immunosuppressed women may provide an explanation for infrequent perinatal transmission of KSHV.     

Cellular replication of human immunodeficiency virus type 1 occurs in vaginal secretions

Most human immunodeficiency virus type 1 (HIV-1) transmission worldwide is the result of exposure to infectious virus in genital secretions. However, current vaccine candidates are based on virus isolates from blood. In this study, vaginal secretions from HIV-1-infected women were examined for evidence of cellular viral replication that produced virus with properties different from that in blood. Multiply spliced HIV-1 messenger RNA, which is found only in cells replicating virus, was detected in all vaginal lavage samples tested. There was a strong correlation between the amounts of multiply spliced HIV-1 messenger RNA and of cell-free HIV-1 RNA in the lavage samples. In addition, significant genotypic differences were found in cell-free virus from matched blood plasma and vaginal secretions. Moreover, drug resistance-associated mutations appeared in plasma virus several months before appearing in vaginal virus. These findings indicate that cellular replication of HIV-1 occurs in vaginal secretions and can result in a virus population with important differences from that in blood.     

Sex during genital bleeding and risks for HIV infection: preliminary study of sexually transmitted infection clinic patients in Cape Town,South Africa

Practicing sexual intercourse in the presence of blood is a potentially important factor in facilitating HIV transmission. In the current study 149 men and 78 women receiving diagnostic and treatment services for repeated sexually transmitted infections (STI) in Cape Town, South Africa, provided behavioural data on sexual exposure to blood. Results showed that 46% of women and 12% of men reported lifetime prevalence of engaging in sexual intercourse while their genitals were bleeding and 7% of women and 40% of men reported sexual intercourse with a partner whose genitals were bleeding; 27% of men and 22% of women had engaged in sexual intercourse with blood present within the previous month. Individuals who had engaged in sexual intercourse involving blood had significantly greater numbers of sex partners in the previous month, engaged in higher rates of unprotected vaginal intercourse and total anal intercourse occasions during that time period. Engaging in sex during genital bleeding was also related to greater lifetime prevalence of sexually transmitted infections and unexplained genital discharge. These findings add to the growing evidence that exposure to blood during vaginal intercourse may be prevalent and may be an important contributing factor to the rapid spread of HIV in Southern Africa.     

Is routine vaginal examination necessary for asymptomatic women attending sexual health services?

The aim of this study was to determine whether our sexual health service could be streamlined by dispensing with routine vaginal examination of asymptomatic women, without missing important diagnoses. This was an audit of asymptomatic women presenting to the centre who had had a Papanicolaou (PAP) smear in the previous two years. Of the 421 women who were eligible, no abnormalities were found on genital inspection in 392 (93%) individuals. Abnormalities detected on clinical examination included one case (0.2%) with mucopurulent cervicitis that tested positive for Chlamydia trachomatis, four (1%) with warts or molluscum contagiosum, and one with an asymptomatic genital ulcer of unknown cause. Dispensing with the vaginal examination in asymptomatic women who have had a speculum examination as part of biennial cervical screening may be appropriate in settings where sensitive non-invasive testing for sexually transmitted infections (STI) is in use and STI prevalence is low.     

Genital syndromes and syndromic management of vaginal discharge in a community setting

The objective of the study was to determine the community prevalence of genital syndromes in women and evaluate the syndromic management of vaginal discharge in this setting. A representative sample for the state of Tamilnadu was chosen using probability proportional to size cluster technique. Thirty clusters were selected from three districts. Demographic, sexual behaviour, risk factors, clinical and laboratory data were collected from the selected population using a structured questionnaire. Direct smear examination for Trichomonas vaginalis, culture for Neisseria gonorrhoeae and Haemophilus ducreyi, serological tests for syphilis (RPR and TPHA), hepatitis B (Hbs Ag ELISA), IgM and IgG antibodies to HSV2 (Novum diagnostics, Germany) and PCR test for detection of C. trachomatis from urine were done. There were 1157 women in the selected population. On examination, vaginal discharge was the most common genital syndrome (38.4%). The sensitivity, specificity, positive and negative predictive value of vaginal discharge as a marker for STD in women was found to be 43.3%, 61.6%, 10.7% and 91.1%, respectively. We concluded that treatment on the basis of syndromic management would result in over-treatment of 90% of women with vaginal discharge.     

Female genital cutting in Kilimanjaro,Tanzania: changing attitudes?

OBJECTIVES: To study the prevalence, type, social correlates and attitudes towards female genital cutting (FGC) among urban women in Kilimanjaro, Tanzania; and to examine the association between FGC and gynaecological problems, reproductive tract infections (RTIs) and HIV. METHODS: In 1999, 379 women attending reproductive health care clinics were interviewed and underwent pelvic examination. Specimens for RTI/HIV diagnosis were taken. RESULTS: Seventeen per cent had undergone FGC, mostly clitoridectomy (97%). Female genital cutting prevalence was significantly lower among educated, Christian and Chagga women. Women aged >or=35 were twice as likely to be cut as those < 25 years. Seventy-six per cent of those who had undergone FGC intend not to perform the procedure on their daughters. Age < 25 years (P < 0.0001) and low parity (P < 0.01) were predictors of that intention. There was no association between RTIs, HIV or hepatitis B and FGC. CONCLUSION: FGC is still fairly common but there is evidence of a change of attitude towards the practice, especially among young women. The opportunity to educate women who attend reproductive health care facilities on FGC should be taken.     

Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa

Sexual violence is associated with women's risks for HIV infection. The current study investigated factors related to risks for sexually transmitted infections (STIs), including HIV, among South African women with a history of sexual assault. An anonymous street intercept survey of women (N = 272) living in an African township in the Western Cape, South Africa assessed demographic characteristics, history of sexual assault, HIV risk behaviours, substance use and non-sexual relationship abuse. Surveys were completed by 90% of women approached. Forty-four per cent (N = 119) of women reported a history of sexual assault. Multiple logistic regressions, controlling for participant age, education, marital status and survey venue, showed that women who had been sexually assaulted were significantly more likely to have shared injection drug equipment, exchanged sex to meet survival needs, and used alcohol compared to women who had not been sexually assaulted. Women with a history of sexual assault were also significantly more likely to have multiple male sex partners, greater rates of unprotected vaginal intercourse, lower rates of condom protected anal intercourse, more sexual contacts involving blood, more STIs and genital ulcers. Finally, women who had been sexually assaulted were more likely to have been non-sexually abused by relationship partners and were more likely to fear asking partners to use condoms. There is a close connection between sexual assault and women's risks for STIs and HIV. Structural and behavioural interventions are needed to simultaneously reduce the prevalence of sexual assault against women and prevent the transmission of HIV.     

The epidemiology of neonatal herpes simplex virus infections in California from 1985 to 1995.

Comprehensive hospital discharge data completed by the California Office of Statewide Health Planning and Development was used to determine whether the proportion of infants 相似文献   

Clinical and microbiological characterization of patients with nonspecific vaginosis associated with motile, curved anaerobic rods

The vaginal secretions of 20 normal control subjects and 21 patients with motile, curved anaerobic rods were cultured for aerobic and anaerobic bacteria, Chlamydia trachomatis, herpes simplex virus, and Trichomonas vaginalis. Extensive histories and physical examinations of the patients and microscopic appearance and gas-liquid chromatography patterns of vaginal secretions were compared between the two groups. The patients who had motile rods in their vaginal secretions more frequently presented with a history of complaints about foul-smelling discharge (18 [86%] of 21); discharge noted during physical examination at their introitus (15 [71%] of 21); a vaginal pH greater than 4.5 (21 [100%] of 21); and a highly specific microscopic appearance of their secretions. The secretions were characterized by the absence of lactobacilli, the presence of highly motile, curved bacilli, and an increased number of background bacteria when compared with normal patients. Patients had more frequent anaerobic isolates than did controls (P less than .001), with increased numbers of Peptococcus, Peptostreptococcus, Propionibacterium, and Bacteroides species. All patients with motile bacteria in their secretions met the criteria of the syndrome of nonspecific vaginosis that has been previously described.     

Presence and Persistence of Putative Lytic and Temperate Bacteriophages in Vaginal Metagenomes from South African Adolescents

The interaction between gut bacterial and viral microbiota is thought to be important in human health. While fluctuations in female genital tract (FGT) bacterial microbiota similarly determine sexual health, little is known about the presence, persistence, and function of vaginal bacteriophages. We conducted shotgun metagenome sequencing of cervicovaginal samples from South African adolescents collected longitudinally, who received no antibiotics. We annotated viral reads and circular bacteriophages, identified CRISPR loci and putative prophages, and assessed their diversity, persistence, and associations with bacterial microbiota composition. Siphoviridae was the most prevalent bacteriophage family, followed by Myoviridae, Podoviridae, Herelleviridae, and Inoviridae. Full-length siphoviruses targeting bacterial vaginosis (BV)-associated bacteria were identified, suggesting their presence in vivo. CRISPR loci and prophage-like elements were common, and genomic analysis suggested higher diversity among Gardnerella than Lactobacillus prophages. We found that some prophages were highly persistent within participants, and identical prophages were present in cervicovaginal secretions of multiple participants, suggesting that prophages, and thus bacterial strains, are shared between adolescents. The number of CRISPR loci and prophages were associated with vaginal microbiota stability and absence of BV. Our analysis suggests that (pro)phages are common in the FGT and vaginal bacteria and (pro)phages may interact.     

Acceptability and feasibility of Micralax applicators and of methyl cellulose gel placebo for large-scale clinical trials of vaginal microbicides

OBJECTIVE(S): To evaluate the feasibility and acceptability of the Micralax applicator and of methyl cellulose placebo gel for use in vaginal microbicide clinical trials. DESIGN: A two-centre prospective study following women for 2 months. SETTING: Two primary health care clinics in South Africa. PATIENTS, PARTICIPANTS: Female volunteers (n = 28) 18 years or older who were HIV negative and had no clinically detectable genital tract abnormalities or reproductive tract infections. INTERVENTIONS: Participants used pre-filled Micralax applicators to apply methyl cellulose gel every other day, as well as up to 1 h before to every episode of vaginal sex. MAIN OUTCOME MEASURE(S): Consistency in the weight of gel dispensed per application; side-effects attributed to applicator or gel use; and acceptability of the applicator and of the gel. RESULTS: Over a 2 month follow-up period the 22 women completing the study reported no adverse events related to gel or applicator use. The Micralax applicator proved acceptable. The gel was not too messy and did not reduce sexual frequency or pleasure. On average, the applicator dispensed 4.7 ml per use (close to the 4 ml planned). CONCLUSIONS: The Micralax applicator performs well as a delivery system for potential vaginal microbicides; and methyl cellulose is an appropriate placebo for future microbicide trials.