Prevalence of Hepatitis C virus antibody in patients with sexually transmitted diseases attending a Harrisburg, PA, STD clinic

Objective: The prevalence of hepatitis B and hepatitis C in a sexually transmitted disease (STD) clinic population was studied, along with the prevalence of various STD agents, in an attempt to identify possible STD markers for the hepatitis C virus and help delineate the role of hepatitis C as an STD. The hepatitis C antibody rates found in the STD clinic were also compared with those found among patients attending a local OB/GYN clinic and those enrolled in a blood donor program, all from the same geographical area.Methods: A total of 150 women attending an STD clinc were examined for each of the following agents: Chlamyadia trachomatis, Neisseria gonorrhoeae, syphilis, hepatitis B surface antigen, hepatitis B core antibody, hepatitis B surface antibody, and hepatitis C virus antibody. Additionally, several patients who signed informed consent to be evaluated for human immunodeficiency virus (HIV) antibody were tested by an enzyme immunoassay (EIA) screen method. The prevalence of each agent was then compared with the other agents.Results: The overall prevalence rates detected were as follows: hepatitis B 16%, hepatitis C 4%, chlamydia 18.7%, gonorrhea 7.4%, syphilis 0.7%, and HIV 0%. Hepatitis C antibody was detected in 4% of patients in the STD clinic, 0.76% of volunteer blood donors from central Pennsylvania, and 0% of patiants studied from the Harrisburg Hospital (Harrisburg, PA) prentatal population.Conclusions: This screening study reveals an association between attending a Harrisburg, PA, area STD clinic and having an increased prevalence of hepatitis C antibody, but larger matched control studies will be needed to help clarify sexual transmission as a mode of transmission for the hepatitis C virus.     

Vaginitis in sexually active women: relationship to nine sexually transmitted organisms

Women seen for symptoms suggestive of vulvovaginitis were studied for the detection of Mycoplasma hominis. Ureaplasma urealyticum, yeast, Neisseria gonorrhoeae, Chlamydia trachomatis, Gardnerella vaginalis, herpes simplex virus, group B beta-hemolytic streptococci, aerobes, anaerobes, and Trichomonas vaginalis. Asymptomatic women who reported to be sexually active and agreed to undergo comprehensive genital cultures were used as controls. There was a significant association of vulvovaginitis with the recovery of sexually transmitted organisms. However, all organisms were also recovered from asymptomatic patients. A total of 468 sexually transmitted organisms were recovered from 253 symptomatic patients (1.85 organisms per patient), while 125 were recovered from 130 asymptomatic patients (0.96 organisms per patient). The difference in prevalence between symptomatic and asymptomatic women for Chlamydia trachomatis, group B streptococcus, and the mycoplasmas was not statistically significant. Factors that predispose patients to the manifestations of symptoms are not clearly understood.     

Oral contraceptive use and prevalence of infection with Chlamydia trachomatis in women (author's transl)

1080 nonpregnant women ages 16-34 years, presenting for the 1st time at a clinic for sexually transmitted diseases (STD), were examined and screened for infection with Chlamydia trachomatis, Neisseria gonorrheae, Trichomonas vaginalis, and Candida species. The respective prevalence rates were 21.1%, 20.7%, 13.4%, and 27.8%. Isolation rates for Chlamydia trachomatis, either occurring alone or in association with other genital infections, were significantly greater in women using oral contraceptives (OCs). This was not because OC users were more promiscuous. The findings strengthen the case for providing a routine chlamydial culture service for women attending STD clinics. They also indicate that the likelihood of chlamydial infection in women taking OCs is greater. (author's)     

Self-collected vaginal swabs for the detection of multiple sexually transmitted infections in adolescent girls

OBJECTIVE: To evaluate the use of self-collected vaginal swabs to test for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis, and to describe the acceptability of this technique to adolescents. DESIGN: Comparison of a new protocol for sexually transmitted infection (STI) testing with the current standard of care, using the same subjects. Survey of attitudes regarding the self-collection technique. SETTING: A juvenile correctional facility in western Pennsylvania. PARTICIPANTS: Convenience sample of 133 detainees, 12-17 years of age. INTERVENTION: Girls were invited to undergo STI screening using a self-collected vaginal swab. Polymerase chain reaction was used to test this specimen for each of the above three infections. Pelvic exams and endocervical testing were performed at the discretion of the physician performing the intake physical, independent of the study. MAIN OUTCOME MEASURES: The number of infections diagnosed using the self-testing protocol, compared to the number diagnosed using standard practices; acceptability of the self-collection technique.RESULTS: Twenty-four percent of sexually active subjects had one or more infections diagnosed by self-testing: 11.3% had C. trachomatis, 8.5% had N. gonorrhoeae, and 11.7% had T. vaginalis. Only 30% of subjects with infections had pelvic exams while detained; therefore 70% of girls with infections would have been missed in the absence of the self-testing option. The self-collection technique was acceptable to 95% of subjects. CONCLUSIONS: STI testing using self-collected vaginal specimens is highly acceptable to adolescent girls, and can dramatically increase the detection rate for these three treatable infections when pelvic exams are not performed.     

Prevalence of HIV, syphilis, Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis and candidiasis among pregnant women attending an antenatal clinic in Khartoum, Sudan.

Antenatal screening and treatment for sexually transmitted infections (STIs) has shown some benefits in countries where the practice is adopted. To date the prevalence of STIs in the Sudan is unknown. Our aims were to establish the prevalence of STIs among pregnant women in Khartoum (Sudan), to identify any risk factors and to suggest management. One hundred and fifty-one pregnant women were recruited for the study in an antenatal clinic in Khartoum in 1999. The prevalence of Chlamydia trachomatis, HIV, Trichomonas vaginalis, syphilis, Neisseria gonorrhoea and vulvo-vaginal candidiasis among the study population was established; 7.3% of patients suffered multiple infections. No risk factors for acquiring an STI were identified apart from genital ulcer disease. These findings suggest that a syndromic approach for treating STIs during pregnancy might not be possible. We conclude that STIs have a high prevalence among pregnant Sudanese women in Khartoum. The providers of health care in the Sudan need to revise their priority list.     

Bacterial vaginosis and lower genital tract infections in women attending out-patient clinics at a tertiary institution serving a developing community.

The prevalence of bacterial vaginosis and other lower genital tract infections were determined in women from a developing community. Patients were recruited from four out-patient clinics of a large urban tertiary referral hospital serving the indigent Black population of KwaZulu/Natal, South Africa. A total of 208 women attending the sexually transmitted diseases (STD) (n = 51), colposcopy (n =50), family planning (n = 52) and antenatal (n = 55) clinics were investigated. Endocervical and vaginal specimens were collected for microbiological investigation of recognised sexually transmitted pathogens. Estimation of vaginal pH, amine test and wet smear microscopy were performed at the bedside. Peripheral venous blood was obtained for serological tests for syphilis, hepatitis B surface antigen and antibody to the human immunodeficiency virus (HIV). Vaginal infections were detected in a total of 50% (104) of women, endocervical infections alone in 9% (18) and concurrent vagino-endocervical infections in 20% (41). Bacterial vaginosis (BV) was diagnosed in 35% (73) and its prevalence amongst different clinic populations ranged from 25% to 41% with no significant differences between any groups. Trichomoniasis was detected significantly more often in women attending the STD and antenatal clinics. Endocervical infections were found mainly in women attending the STD clinic, though the prevalence of Chlamydia trachomatis amongst the other clinic attenders ranged from 13% to 20%. Micro-organisms such as Gardnerella vaginalis, Mycoplasma hominis, anaerobes and curved Gram-negative rods were found in significantly higher number of women with BV. This study confirms the high prevalence of vaginal, endocervical and mixed vagino-endocervical infections in women from developing communities. The high prevalence of bacterial vaginosis as a single infection and its association with other recognised sexually transmitted pathogens in a large proportion of women, is of significance since such infections not only predispose to ascending upper genital tract infections but are also associated with complications in pregnancy such as premature rupture of membranes, preterm labour and endometritis.     

Chlamydia trachomatis infection in sexually active teenagers

BACKGROUND: The prevalence of Chlamydia trachomatis infections among Polish teenagers remains unknown. Sexually active teenagers are exposed at sexually transmitted infections, including Chlamydia trachomatis (CT). Most infections are asymptomatic and, therefore, untreated. Early detection and treatment of cervical chlamydial infections may prevent pelvic inflammatory diseases and prevent later infertility. AIM: to determine the prevalance and risk factors of Chlamydia trachomatis infections among sexually active female teenager. MATERIALS AND METHODS: 243 sexually active girls, 16-19 year-olds, attending the outpatient clinic were enrolled in this study between 2005-2007. The participants filled in a questionnaire containing such information as age, purpose of visit, level of education, age at the first intercourse, number of sexual partners, number of current partners (in the past 3 months), contraceptive methods, use of condoms, past history of STD and obstetric history at the first visit. Pelvic examination was performed to check the following: vaginal discharge, presence of abnormalites of the cervix (ectopy, erythema, tenderness of uterine and adnexal) and to take a Pap smear and a cervical swab for Chlamydia trachomatis. Cervical swabs for Chlamydia trachomatis were tested by polymerase chain reaction (PCR). RESULTS: The prevalence of CT genital infection in the studied group was 2,9%. Adolescent females infected by CT less frequently admitted to the use of condom and more often did not use any contraception at all, in comparison with the girls without CT genital infections (29% and 57% vs. 37% and 19%). There were statistically significant differences in the results of the abnormal Pap smears (ASCUS, LGSIL) between the two groups.     

Epidemiology of reproductive tract infections in a symptomatic population of North-East of Italy

AIM: Reproductive tract infections (RTIs) are one of the main causes of morbidity in the world and sexually transmitted infections (STIs) can give rise to severe sequels (inflammatory pelvic disease, etc.). The epidemiology of these infections is changeable and depends on geographical and economical factors, migratory flows and social and sexual habits. This variability, along with the lack of sufficient data in literature, is a serious problem in the development of screening, prevention and therapy strategies centered on local needs. The aim of our study was to evaluate the epidemiology of reproductive tract infections in a symptomatic population of the Nord-East of Italy. METHODS: In the period January-June 2006, we investigated 207 subjects at the Microbiology and Virology Service of Padua's Hospital, 18-65 years old, males and women, Italian and foreigners. All had symptoms or personal history pointing to a possible reproductive tract infection. For female we collected vaginal and cervical swabs, and for male urethral swabs, for microscopy, the culture for Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma spp., other bacteria and yeasts, and for molecular assay for Chlamydia trachomatis. RESULTS: Among our population, the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were respectively 6.28%, 1.93% and 3.86%. STIs were more frequent in males, among foreigners, and in patients aged 18-30 years. CONCLUSION: From the results obtained, ideas have emerged in order to arrange a qualitative and quantitative optimization of the diagnosis of RTIs, implementing diagnostic paths based on the different typologies of patients and on the local epidemiology.     

Sexual experience, abortion and sexually transmitted diseases among young women at a contraceptive clinic.

All visitors who during one year visited a contraceptive clinic in the Solna district of Stockholm County and were below the age of 26 were asked to fill in a questionnaire and offered a test for C. trachomatis. Three hundred and six women (97%) participated. Ninety percent had at some time used oral contraceptives and 91% had experience of condom use. One-fifth of the whole group had undergone one or more legal abortions, and one fourth had experience of a sexually transmitted disease (STD). The most common STD experienced was chlamydia, followed by condyloma. The actual prevalence of chlamydia in the group was 6%. Sexual contacts were often made early in on-going steady relations. Forty-two percent admitted casual sex, but the number of life-time partners was five or less among the majority.     

Prevalence of human papillomavirus, Chlamydia trachomatis, and Neisseria gonorrhoeae in commercial sex workers in Japan

OBJECTIVE: We used the hybrid capture assays to investigate the prevalence of human papillomavirus (HPV), Chlamydia trachomatis and Neisseria gonorrhoeae among commercial sex workers in Tokyo. METHODS: Five hundred forty-six consecutive commercial sex workers (CSW) who visited an STD clinic for STD checkup in 1998 and 1999 were studied. A control group consisted of 233 consecutive women who visited a general gynecological clinic for annual checkup. A cervical sample was obtained for hybrid capture assays for HPV-A (low-oncogenic-risk types), HPV-B (intermediate- and high-oncogenic-risk types), C. trachomatis, and N. gonorrhoeae. Fisher's exact test was used for statistical analyses. RESULTS: The positive rate for HPV-B among the CSW was 48.4%, significantly higher than the 6.0% among the control subjects. The positive rates for HPV-A, C. trachomatis, and N. gonorrhoeae were also significantly higher among the CSW than among the control subjects. Among the microorganisms tested, the positive rate for HPV-B was the highest in both the STD and control groups. CONCLUSIONS: The high prevalence of HPV, C. trachomatis, and N. gonorrhoeae infection in CSW poses a risk of further transmission of STD to the general public, suggesting the need for further education and screening for CSW and the general public. We found high- and intermediate-oncogenic-type HPV to be the most prevalent infection among both CSW and control subjects. Screening for HPV may be necessary in STD and general clinics to predict the risk of cervical malignancy. Hybrid capture assays, which permit simultaneous detection of HPV and other STD with high sensitivity, may be a useful diagnostic method.     

Strategies for partner management when treating sexually transmitted infection

Chlamydia trachomatis and Neisseria gonorrhea are the most commonly reported bacterial sexually transmitted infections (STIs) in the United States, and reinfection accounts for 14% to 30% of all reported cases of these STIs. Treatment of both the woman and her partner is imperative to prevent long-term sequelae. This report examines the clinical course of a woman diagnosed with Chlamydia during pregnancy, and reviews various approaches to treating partners, including patient referral, provider referral, patient-delivered partner therapy, and accelerated partner therapy.     

Increased prevalence of sexually transmitted viral infections in women: the role of female sex hormones in regulating susceptibility and immune responses

Sexually transmitted infections (STIs) caused by viruses, including HSV-2, HIV-1, HPV, are among the most prevalent infectious diseases worldwide and a major cause of morbidity and mortality. Despite decades of effort, the attempts to develop efficacious vaccines against viral STIs have failed repeatedly, with the exception of the recent HPV vaccine. Given the higher prevalence rates of STIs in women, it is becoming clear that a better understanding of gender-specific differences in STIs may be critical for the development of preventative strategies for these diseases. In order to gain this insight, it is important to examine the distinct microenvironment of the female reproductive tract, the site of primary infection, since it can significantly influence the outcome of infection. An important biological factor in the female reproductive tract is the presence of female sex hormones, estrogen and progesterone, which are produced endogenously primarily by the ovaries and commonly provided exogenously via the use of hormonal contraceptives. Here we review our current knowledge of the role played by the female sex hormones in regulating susceptibility and immune responses to viral sexually transmitted infections and whether this could contribute to higher prevalence of STIs in women. Manipulating the microenvironment of the female genital tract with sex hormones may contribute to the development of improved immunization strategies against sexually transmitted infections.     

Sexual behaviors after universal screening of sexually transmitted infections in healthy young women

OBJECTIVE: To prospectively study the relationship between diagnosis of sexually transmitted infections (STIs) at entry to U.S. Marines recruit training and subsequent sexual behaviors during vacation. METHODS: Of all women entering recruit training (June 1999-June 2000), 2,157 (94%) voluntarily enrolled. At baseline, women received universal screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis and treatment and counseling for positive STIs. Recruit training (13 weeks) precluded any social activities. Unrestricted vacation followed (median 10 days). After training resumed (3 weeks), questionnaires and repeat STI screening were administered. Multivariable logistic regression examined STI diagnosis at baseline as a predictor for risky sexual behaviors at vacation and STI-positive diagnosis after vacation. RESULTS: The study was completed by 1,712 (79%) women (median age 18 years); 1,038 reported sexual activity during vacation; 71% used condoms inconsistently; 19% had casual partners. At baseline, 152 (15%) tested STI-positive. Baseline STI diagnosis was unrelated to inconsistent condom use, nonmonogamous partnerships, or multiple partnerships. However, women testing STI-positive at baseline were more likely to test STI-positive after vacation (adjusted odds ratio 3.74, 95% confidence interval 2.10-6.65). Baseline STI diagnosis predicted casual partnerships among women aged 19-21 years (adjusted odds ratio 2.48, 95% confidence interval 1.12-5.50). CONCLUSION: Substantial numbers of women engaged in risky sexual behaviors after universal STI screening and counseling. Compared with STI-negative women, STI-positive women were at increased risk for subsequent STI acquisition regardless of their similar behaviors. As universal STI screening is increasingly implemented, follow-up care will likely be required to further reduce risky behaviors and address network-level factors. LEVEL OF EVIDENCE: II.     

Sexually transmitted diseases and risk of HIV infection in men attending a sexually transmitted diseases clinic in Dakar, Senegal

This cross-sectional study was carried out among male outpatients with symptoms of STDs at the STD reference centre at the Institute of Social Hygiene (IHS), Dakar, Senegal, from March 1989 through May 1991. This study was used to determine the prevalence of STDs and HIV among male patients attending an STD clinic and to identify their socio-demographic characteristics and risk factors. A total of 975 patients were enrolled in the study. The most common syndromes were urethritis (76%) and genital ulcers (22%). Considering single infections, the major STD agents were Neisseria gonorrheae (N.gonorrheae, 30%), Chlamydia trachomatis (C.trachomatis, 15%), Treponema pallidum (T.pallidum, 12%), and Haemophilus ducreyi (H.ducreyi, 7%). HIV prevalence was 2.6 percent (25/975). After multivariate analysis, the risk factors associated with HIV infection were a history of sex with prostitutes (odds ratio [OR] = 8.6, 95% confidence interval [CI] = 2.0-37.8), unprotected sexual contact (OR = 5.6, 95% CI = 1.2-25.0), a history of urethritis (OR = 3.4, 95% CI = 1.3-8.9), current STDs due to H.ducreyi or T.pallidum (OR = 6.1, 95% CI = 2-18.8), and mixed STD infection (OR = 5.3, 95% CI = 1.3-21.8). HIV prevalence was quite low in this population compared to similar studies of STD patients from other sub-Saharan African countries. Neisseria gonorrheae and Chlamydia trachomatis were the leading causes of STDs. A history of risky sexual behaviour, previous STDs, current genital ulcers, and mixed STD infections were associated with HIV infection. Further studies are necessary to determine changes in the relationship of STDs and HIV infection in this population.     

A case-control study on the association between female genital mutilation and sexually transmitted infections in Sudan

OBJECTIVE: To assess whether the extent of female genital mutilation (FGM) influences the risk of acquiring sexually transmitted infections (STIs). DESIGN: Hospital-based case-control study. SETTING: Two obstetric/gynaecological outpatient clinics in Khartoum, Sudan, 2003-2004. POPULATION: A total of 222 women aged 17-35 years coming to antenatal and gynaecological clinics. METHODS: Women recruited for the study were divided into cases with seropositivity for Neisseria gonorrhoeae (gonococcal antibody test), Chlamydia trachomatis (enzyme immunoassay) or Treponema pallidum (Treponema pallidum haemagglutination assay) (n= 26) and controls without antibodies to these species (n= 196). Socio-demographic data were obtained and physical examination including genital examination was performed in order to classify the form of FGM. Cases and controls were compared using logistic regression to adjust for covariates. MAIN OUTCOME MEASURES: Extent of FGM and seropositivity for C. trachomatis, N. gonorrhoeae or T. pallidum. RESULTS: Of the cases, 85% had undergone the most severe form of FGM involving labia majora compared with 78% of controls (n.s.). Thus, there was no association between serological evidence of STIs and extent of FGM. The only factor that differed significantly between the groups was the education level, cases with STIs having significantly shorter education (P= 0.03) than controls. CONCLUSIONS: There is a little difference between cases and controls in regard to FGM. Having in mind the relatively small sample size, the results still indicate that FGM seems neither to be a risk factor for nor protective against acquiring STIs. This is important as argument against traditional beliefs that FGM protects against pre/extramarital sex.     

Detection of Chlamydia trachomatis using consecutive endocervical swabs. Prevalence in asymptomatic female adolescents and women attending a sexually transmitted disease clinic

Chlamydia trachomatis is an organism commonly transmitted through sexual intercourse. In women it is associated with cervicitis, salpingitis, perihepatitis and infertility. Neonates born to infected women may have inclusion conjunctivitis and pneumonia due to this organism. Screening in obstetrics and in gynecology clinics is not usually performed routinely because of the cost and time involved in culturing the organism. A rapid enzyme immunoassay (EIA) kit (Chlamydiazyme, Abbott Laboratories) that can detect C. trachomatis was developed recently. Women belonging to two different cohorts were studied to determine whether multiple endocervical samples increased the likelihood of a positive result from this EIA kit. One cohort consisted of 70 asymptomatic, sexually active female adolescents from a local family planning clinic. The second cohort included 80 women who were seen at a sexually transmitted disease (STD) clinic. Both groups were assayed for Chlamydia infections using the rapid EIA kit. Positive test results were found in 7 of the 70 asymptomatic teenagers (10%) and 12 of the 80 women from the STD clinic (15%). No significant differences were noted in the order of the positive swabs in either group, although more of the earlier swabs tended to be positive.     

HIV and sexually transmitted infections among women presenting at urban primary health care clinics in two cities of sub-Saharan Africa

In a cross-sectional study, 786 consenting women from two cities in Africa, Harare and Moshi, attending primary health care clinics were interviewed, examined and tested for HIV and other sexually transmitted infections (STIs). The aim of the study was to assess and compare differences in the characteristics that may affect the prevalence of HIV/STIs among women in the two cities. Multivariate analysis was used to generate odds ratio. STIs and behaviour characteristics among this low risk group of women could not fully explain the higher HIV prevalence in Zimbabwe, 29.3% compared to 11.5% in Tanzania (p < 0.01). Interventions should target identified risk factors with particular attention to youths.     

性传播疾病病原体在急性盆腔炎发病中的作用

目的 研究性传播疾病病原体在急性盆腔炎发病中的作用。方法 对130例急性盆腔炎患者的宫颈分泌物采用分离培养法进行细菌培养及性传播疾病系列检查。结果 130例急性盆腔炎患者中,有55例培养出性传播疾病病原体,其中淋病奈瑟菌检出率为6．9％（9／130）,约半数病例混有解脲支原体、沙眼衣原体及白色念珠菌感染;沙眼衣原体检出率为4．6％（6／130）,均为混合感染（淋病奈瑟菌、解脲支原体及厌氧菌）;解脲支原体检出率为37．7％（49／130）,三分之一病例存在混合感染。结论 性传播疾病病原体可为急性盆腔炎的发病因素,但也可能仅在急性盆腔炎发病中起协同作用。     

Randomized trial of presumptive sexually transmitted disease therapy during pregnancy in Rakai, Uganda.

OBJECTIVE: The purpose of this study was to assess presumptive sexually transmitted disease treatment on pregnancy outcome and HIV transmission. STUDY DESIGN: In a randomized trial in Rakai District, Uganda, 2070 pregnant women received presumptive sexually transmitted disease treatment 1 time during pregnancy at varying gestations, and 1963 control mothers received iron/folate and referral for syphilis. Maternal-infant sexually transmitted disease/HIV and infant outcomes were assessed. Intent-to-treat analyses estimated adjusted rate ratios and 95% confidence intervals. RESULTS: Sexually transmitted diseases were reduced: Trichomonas vaginalis (rate ratio, 0.28; 95% CI, 0.18%-0.49%), bacterial vaginosis (rate ratio, 0.78; 95% CI, 0.69-0.87), Neisseria gonorrhoeae /Chlamydia trachomatis (rate ratio, 0.43; 95% CI, 0.27-0.68), and infant ophthalmia (rate ratio, 0.37; 95% CI, 0.20-0.70). There were reduced rates of neonatal death (rate ratio, 0.83; 95% CI, 0.71-0.97), low birth weight (rate ratio, 0.68; 95% CI, 0.53-0.86), and preterm delivery (rate ratio, 0.77; 95% CI, 0.56-1.05); but there were no effects on maternal HIV acquisition or perinatal HIV transmission. CONCLUSION: Reductions of maternal sexually transmitted disease improved pregnancy outcome but not maternal HIV acquisition or perinatal HIV transmission.