A population-based study of syphilis and sexually transmitted disease syndromes in north-western Tanzania. 2. Risk factors and health seeking behaviour.

OBJECTIVE--To determine risk factors for syphilis and sexually transmitted disease (STD) syndromes, and to study health seeking behaviour among those with STD syndromes, in the population of Mwanza Region, North-Western Tanzania. METHODS--A population-based random cluster sample survey, stratified by rural, roadside or urban residence, of 4173 individuals aged 15-54 years was performed in 1990-91. The seroprevalence of syphilis and the prevalence and incidence of self-reported genital ulcer syndrome (GUS) and genital discharge syndrome (GDS) are reported in the accompanying paper. This paper reports on risk factors for these conditions and on health seeking behaviour among those reporting them. RESULTS--In both sexes, the risk of STDs increased with the reported number of sexual partners in the previous five years. Men who were separated, divorced or widowed were at increased risk of STDs, but this was not the case among women. Higher educational status was associated with an increased risk of urethral discharge in males but with a decreased prevalence of syphilis in females. Male circumcision was associated with an increased risk of urethral discharge but a reduced prevalence of syphilis. Nearly all men, and 90% of women, reporting symptoms of genital discharge or ulceration had sought treatment. Of these, approximately 70% of males and 60% of females had sought treatment in the official health sector. CONCLUSIONS--Targetted health education concerning risk reduction for HIV infection and other STDs should be a high priority in this population. Improved case management of STDs in health centres and dispensaries may have a substantial impact on the incidence of these infections.     

Associations between sexually transmitted disease diagnosis and subsequent sexual risk and sexually transmitted disease incidence among adolescents

BACKGROUND: Empiric evidence is lacking in regard to the subsequent sexually transmitted disease (STD)-associated risk behaviors of adolescents diagnosed and treated for an STD. GOAL: The goal of this study was to prospectively identify associations between STD diagnosis and subsequent sexual risk and STD incidence among a sample of U.S. adolescents. STUDY DESIGN: A cohort of 455 adolescents (age 15-21 years) was followed for 3 months. Adolescents were recruited from primary care clinics and through outreach activities. RESULTS: A total of 10.8% were initially diagnosed with at least one STD. After adjusting for observed covariates, these adolescents (compared with those testing negative) were 2.8 times (P = 0.0001) more likely to be abstinent from sex and 2.2 times more likely to report always using condoms (P = 0.04). However, during the ensuing 3 months, they were approximately 2.4 times more likely to report having sex with multiple partners (P = 0.01), 8.9 times more likely to test positive for trichomonas (P = 0.009), and 3.0 times more likely to test positive for chlamydia (P = 0.04). CONCLUSIONS: Compared with those testing negative, adolescents diagnosed with an STD may subsequently adopt safer sex behaviors, including abstinence. However, perhaps in part as a result of having sex with multiple partners, they might fail to practice safer sex behaviors stringently enough to avoid subsequent STD acquisition.     

Prevalence of sexually transmitted disease infection in women alleging rape.

During a 2-year period ending in October, 1989, 110 women who claimed to have been raped were treated at the sexually transmitted disease clinic at Birmingham General Hospital. A total of 22 sexually transmitted infections were found in 14 (13%) women, of which Chlamydia trachomatis (in 8%) and Trichomonas vaginalis (in 6%) were the most frequently found pathogens. In none of these patients was it possible to determine whether infection resulted from rape or from voluntary intercourse with another person. The high prevalence of infection found in this study and in previous studies indicates that all women alleging rape should be investigated at a sexually transmitted disease clinic.     

Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea.

An unlinked seroprevalence survey of human immunodeficiency virus (HIV) antibody was conducted using stored sera from all patients who attended the sexually transmitted disease (STD) clinic in Halifax, Nova Scotia between 1980 and 1986. None of the sera collected from 584 patients during 1980 were HIV positive. Of the 2867 patients who visited the clinic between 1981 and 1986, 27 (0.9%; 95% CI 0.6% to 1.2%) had the antibody. None of the 784 female patients were HIV seropositive. Of the 1,884 heterosexual men in the study, 5 (0.3%; 95% CI 0.1% to 0.5%) were HIV seropositive, and 22 (11.1%; 95% CI 6.7% to 15.5%) of the 199 homosexual men were HIV seropositive. There was a strong association between a history of syphilis and HIV antibody among heterosexual men (OR = 76.8; 95% CI 12.0 to 491.3; P = 0.001). Among homosexual men younger than 30 years of age, HIV infection was associated with a history of syphilis (OR = 18.2; 95% CI 5.1 to 64.7; P = 0.035) and a history of gonorrhea (OR = 8.2; 95% CI 4.2 to 16.0; P = 0.001). The association between a history of gonorrhea and HIV infection was strongest among homosexual men who had three or more sexual partners in the last month. These findings supplement existing evidence that STDs increase the likelihood of HIV transmission.     

Prevalence of sexually transmitted infections and high-risk sexual behaviors in heterosexual couples attending sexually transmitted disease clinics in Peru

OBJECTIVES: The objectives of this study were to determine the prevalence of sexually transmitted infection (STIs) in heterosexual couples and the sexual behaviors associated with their acquisition. GOAL: The goal of this study was to better direct educational efforts to decrease STI among heterosexual couples in Lima, Peru. STUDY DESIGN: We conducted a case-control study in 195 heterosexual couples without HIV infection who attended 2 sexually transmitted disease clinics in Lima, Peru. A case was defined as an individual with one or more newly diagnosed STIs such as gonorrhea, chlamydia, trichomoniasis, herpes simplex, syphilis, mycoplasma, or ureaplasma. RESULTS: Thirty-three percent of individuals (41 men and 89 women) had at least one STI and 26 couples (13%) had the same STI detected. Men who have sex with men (MSM) accounted for 13% of all men, had higher rate of STIs and higher risk behaviors than non-MSM. Ureaplasma infection was the most prevalent STI found in both men and women and was associated with oral sexual contact. In heterosexual pairs, condom use during anal sex occurred less than 10% of the time. CONCLUSIONS: The heterosexual couples in sexually transmitted disease clinics have high-risk behaviors and STIs are frequent. The educational effort concerning prevention of STIs requires higher effort.     

A survey of sexually transmitted disease centres in Australia.

In a nationwide survey carried out in 1981 centres offering free treatment for sexually transmitted diseases (STD) were located and the facilities available to the public were assessed. At least one special centre was located in each of the eight states and territories of Australia, but not in all cases did the clinics meet the basic requirements recommended by the Australian National Health and Medical Research Council. The STD clinics were almost exclusively found in capital cities, leaving large populations with no locally available specialist advice. The major centres, with one or two notable exceptions, were open only during routine office hours. In several centres staffing levels were barely adequate to cope with patient loads let alone deal with other important work required of reference centres--the training of health care workers, education of high risk groups, and institution of STD control programmes. In several respects the sexually transmitted diseases services in Australia were found to be inadequate to meet the needs of the population.     

Using sexually transmitted disease incidence as a surrogate marker for HIV incidence in prevention trials: a modeling study

BACKGROUND: Because many of the sexual behaviors that place individuals at risk of acquiring HIV are the same as those that place them at risk for other sexually transmitted diseases (STDs), researchers and policymakers have called for the use of non-HIV STDs as surrogate markers for HIV infection. GOALS: This study examined the epidemiologic conditions under which changes in STD incidence are associated with changes in HIV incidence. STUDY DESIGN: A mathematical model of HIV/STD transmission was applied to empirical data from a large HIV prevention intervention. The association between participants' HIV infection risk reduction scores and their STD risk reduction scores was measured with use of the Pearson product-moment correlation. The authors examined how the strength of association varied across different epidemiologic parameters and heterosexual behaviors. RESULTS: Moderate to strong associations were noted when the infectivity of the STD was similar to the infectivity of HIV. The association was attenuated for larger STD infectivity values. The prevalence of STD infection was a less important determinant of the strength of association. Stronger associations were obtained when the number of sex partners was large or the number of sex acts was small. CONCLUSIONS: Easily transmitted STDs, such as gonorrhea, are unsuitable for general use as surrogate markers for HIV infection. Hepatitis B, syphilis, and chlamydial infection have more promising epidemiologic profiles. Careful studies of STD infectivity are needed to aid in the identification of potential marker STDs.     

Prevalence and patterns of condom use among patients attending a sexually transmitted disease clinic.

The purpose of this study is to evaluate prevalence and patterns of condom use among patients attending a sexually transmitted disease (STD) clinic, who are at increased risk of developing STDs. Interviews of 800 patients attending a Baltimore STD clinic were conducted. The prevalence of condom use was dependent on the measure of use employed. For example, 9 out of 10 patients reported ever having used condoms, slightly less than one-third of the patients reported having used condoms in the past 30 days, and only 17% of the patients reported using a condom at last sex. Use also varied somewhat by type of sexual partner, and within any given relationship, from first to last sexual encounter. The most significant factor corresponding to condom use in the 30 days prior to the interview was number of sexual partners (lifetime and in the last month). Multivariate analyses revealed number of lifetime partners to be the most significant predictor of condom use for men, whereas age was the most significant variable for women. These findings suggest that interventions should focus not only on the individual, but the couple.     

The sexually transmitted diseases laboratory in a framework of population-based diagnostics.

Laboratory support for the diagnosis and treatment of sexually transmitted diseases has traditionally been within a patient-based diagnostic paradigm. Tests and interpretative criteria developed within this paradigm may not be appropriate for laboratories supporting population-based STD control programs. As STD control strategies expand to population-based levels, the present patient-based laboratory models will have to be modified to meet these increased demands.     

A case-control study of beliefs and behaviors associated with sexually transmitted disease occurrence in Estonia.

BACKGROUND: Epidemiologic data document rapidly increasing sexually transmitted disease (STD) rates throughout Eastern Europe. GOAL: This case-control study was designed to delineate factors contributing to the STD epidemic in Estonia. STUDY DESIGN: For this study, 189 study participants and 112 control subjects completed a behavioral questionnaire and underwent testing for Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum. RESULTS: The prevalence of STDs among the control subjects was 32%. Although the participants believed that condoms prevent STDs, only 17% reported consistent use. Methods believed to prevent transmission included washing the genitals (65%), urinating (26%), douching (35%), and using oral contraceptives (19%). An interaction between sex and travel outside Estonia (odds ratio, 0.1; 95% CI, 0-0.7) reflects the fact that males with STDs were more likely to report travel (46% of participants and 45.5% of control subjects with STD) than were those without STD (16.1% of controls without STD). CONCLUSIONS: STD rates are related to high-risk sexual behavior among males traveling outside of Estonia. Intervention is needed to promote understanding of disease transmission dynamics in this area, and to decrease sexual risk behavior, particularly in the context of travel.     

Overview of incidence of sexually transmitted diseases in Kuwait

Sexually transmitted diseases (STDs) are the most common infections afflicting mankind. According to the World Health Organization (WHO) estimates, the global incidence in 1995 of new cases of selected curable STDs, (gonorrhea, chlamydial infection, syphilis, and trichomoniasis) was 333 million. They are now the most common group of notifiable infectious diseases in most countries, particularly in the age group of 15-50 years, and in infants. They assume significance in view of the high incidence of acute infections, complications and sequelae, socioeconomic impact, role in increasing transmission of the human immunodeficiency virus (HIV). STDs are hyperendemic in many developing countries. In the industrialized world, diseases due to Chlamydia trachomatis, genital herpes virus, human papillomaviruses, and human immunodeficiency virus are now more important than the classical bacterial ones; whereas both groups remain major health problems in most developing countries. Their contribution to the spread of the HIV pandemic due to similar routes of transmission has brought attention to STDs in a forceful manner.     

Some aspects of sexually transmitted disease in Swaziland.

A survey of sexually transmitted diseases was attempted in Swaziland. Time and the terms of reference limited its scope, but much interesting information was gathered. Neither the prevalence nor the relative frequency of the different diseases in the community could be ascertained, but there was evidence to support the local impression that the sexually transmitted diseases present an increasing problem in Swaziland. An important problem was that of case finding and two aspects of this are stressed: (1) A general lack of knowledge concerning the venereal diseases; (2) The large number of men infected by 'casual' girl friends who cannot easily be traced, and who form a reservoir of infection in the community.     

A survey of sexually transmitted disease centres in Australia

In a nationwide survey carried out in 1981 centres offering free treatment for sexually transmitted diseases (STD) were located and the facilities available to the public were assessed. At least one special centre was located in each of the eight states and territories of Australia, but not in all cases did the clinics meet the basic requirements recommended by the Australian National Health and Medical Research Council. The STD clinics were almost exclusively found in capital cities, leaving large populations with no locally available specialist advice. The major centres, with one or two notable exceptions, were open only during routine office hours. In several centres staffing levels were barely adequate to cope with patient loads let alone deal with other important work required of reference centres--the training of health care workers, education of high risk groups, and institution of STD control programmes. In several respects the sexually transmitted diseases services in Australia were found to be inadequate to meet the needs of the population.     

Some aspects of sexually transmitted disease in Swaziland.

A survey of sexually transmitted diseases was attempted in Swaziland. Time and the terms of reference limited its scope, but much interesting information was gathered. Neither the prevalence nor the relative frequency of the different diseases in the community could be ascertained, but there was evidence to support the local impression that the sexually transmitted diseases present an increasing problem in Swaziland. An important problem was that of case finding and two aspects of this are stressed: (1) A general lack of knowledge concerning the venereal diseases; (2) The large number of men infected by 'casual' girl friends who cannot easily be traced, and who form a reservoir of infection in the community.     

Seroepidemiologic study of hepatitis C virus in sexually transmitted disease risk groups.

To identify the importance of heterosexual activity as a possible route for the transmission of the hepatitis C virus (HCV), a screening of antibodies against HCV (anti-HCV) was performed in 200 sexually transmitted disease patients with different risks for incurring genital infections as well as in 100 registered prostitutes. Out of all 300 persons tested, 14 cases of HCV infection were detected. Anti-HCV was present in 3 of the prostitutes and in 11 of the STD patients. Evaluating known risk factors, such as intravenous drug use or blood transfusion, 6 out of the 11 STD patients and all of the prostitutes in whom anti-HCV was present were intravenous drug users and exhibited highly promiscuous behavior. Intravenous drug use was the probable means of acquisition in 9 of the 14 subjects in whom anti-HCV was present, and homosexual promiscuous behavior was assumed to be the means of acquisition in another 2 subjects. In heterosexual patients engaging in high-risk behavior (high number of sexual partners and genital infections), the exclusion of intravenous drug use decreased the prevalence of anti-HCV from 12.1% to 4.1%, demonstrating no significant increase from the prevalence among low-risk persons. Most of the patients were screened for STDs, such as syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, human immunodeficiency virus (HIV), hepatitis B virus (HBV), trichomoniasis, and yeast infections. The highest rate of coinfection with anti-HCV was found in patients with serologic evidence of an HIV infection (50%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Analysis of the incidence of sexually transmitted diseases in 1987

In 1987 the number of cases of early symptomatic syphilis increased by 1.5% to 1211 cases (3.2 per 100 thousand). Early asymptomatic syphilis was diagnosed in 2.5 per 100 thousand of the population, that is 5% less than in the preceding year. In all, 2136 cases of early syphilis were recorded, that is 1% less than in the preceding year, and the incidence was 5.7 per 100 thousand. The incidence of gonorrhoea decreased by 23% to 7665 cases, that is 20.3 per 100 thousand, the lo-west incidence after World War II. The male/female sex ratio was 3.4:1. The incidence of non-gonococcal urethritis was 16% lower in men, that is 26.6 per 100 thousand of men. The ratio of NGU to gonorrhoea was 82:100. Anti-HIV antibodies were detected in 1987 in another 32 Polish citizens (since 1985 they were found in 52 Polish citizens) and 7 foreigners, 3 of whom left Poland. Homosexual and bisexual males prevailed (23), 14 were haemophiliacs, 9 were women (5 prostitutes). Two new cases of AIDS were found (three in all), all three patients died.