Urethritis in women attending an STD clinic.

Of an unselected group of 159 women attending a sexually transmitted diseases (STD) clinic 20% (32) had symptoms of urethritis. A positive correlation existed between the finding of more than 10 polymorphonuclear leucocytes (PMNL) per high-power field in the Gram-stained urethral smear and the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Conversely, these organisms were rarely isolated if no PMNL were present. Fewer cultures gave positive results for these organisms if micturition had occurred less than four hours before examination. C trachomatis was recovered from the urethra or endocervix in 29/150 (19 . 3%) and from the urethra alone in six women. In contrast, N gonorrhoea was never recovered from the urethra in the absence of endocervical infection. Of the 159 women 10% had bacteriuria due to non-sexually transmissible agents; 50% had asymptomatic bacteriuria. All, however, had other urethral pathogens isolated as well. Thus, sexually transmitted disease agents are highly prevalent in women attending an STD clinic who have signs and symptoms of urethritis. As in non-gonococcal urethritis in men, C trachomatis may be an important cause of urethritis in women.     

Predicting pregnancy risk in women attending an STD clinic

BACKGROUND: Although sexually transmitted disease (STD) clinics focus mainly on STD treatment and prevention, women attending these clinics are also at high risk for pregnancy. GOAL: To evaluate the relationship between certain demographic and behavioral characteristics and the probability of pregnancy in women attending an urban STD clinic. STUDY DESIGN: Non-contraceptive-using women in an STD clinic-initiated randomized controlled contraception study (n = 877) were interviewed at baseline, and incident pregnancies within 1 year of enrollment were measured. Association between baseline demographic and behavioral characteristics with incident pregnancy was assessed by chi-square analysis, and logistic regression was used to assess factors associated with an incident pregnancy. RESULTS: Among the 673 women (76.7%) for whom follow-up pregnancy information was available, 220 (32.7%) incident pregnancies occurred within 1 year. By logistic regression controlling for study assignment, incident pregnancy was associated with age < or =19 years (odds ratio [OR], 2.8; 95% CI: 1.5-5.2), previous abortion (OR, 3.1; 95% CI: 1.7-5.4), frequency of sexual encounters of at least once a week (OR, 1.8; 95% CI: 1.2-2.6), and having a chlamydial infection at the time of enrollment (OR, 1.8; 95% CI: 1.0-3.2). With a combination of demographic and behavioral characteristics correlated by univariate analysis with incident pregnancy (i.e., age < or =19 years, nonwhite race, high school/general equivalency diploma or less education, previous pregnancy, no use of birth control with last intercourse, sex at least once a week, previous abortion, > or =3 partners within the past month, and <17 years of age at first pregnancy), the cumulative risk of pregnancy with 6 or more of the 9 characteristics was 51%, compared with 25.6% for women with < or =5 characteristics. CONCLUSION: For this STD clinic population, a combination of demographic and behavioral characteristics was useful when combined for identifying a subgroup of women at higher risk for subsequent pregnancy. Targeted intervention by STD care providers should include the provision for both pregnancy and STD prevention counseling.     

Prevalence of Mobiluncus spp among women with and without bacterial vaginosis as detected by polymerase chain reaction

BACKGROUND: Mobiluncus spp are highly associated with bacterial vaginosis, but their role in its pathogenesis is unknown. The authors used polymerase chain reaction (PCR) to compare the prevalence of Mobiluncus in women with and without bacterial vaginosis. GOAL: To compare the prevalence of Mobiluncus spp among women with and without bacterial vaginosis and to compare the sensitivities of PCR and Gram stain for detection. STUDY DESIGN: Vaginal specimens from 74 women were analyzed by PCR and Gram stain for the presence of Mobiluncus spp. Comparisons were made between the prevalence of this organism between the two cohorts and between the Gram stain and PCR detection methods. RESULTS: Mobiluncus was detected by PCR in 84.5% of women with bacterial vaginosis and in 38% of women without infection. M curtisii was rarely detected in the latter group, though it was found in 65.3% of women with bacterial vaginosis. The sensitivity and specificity of Gram stain compared with PCR were 46.9% and 100%, respectively. CONCLUSIONS: Mobiluncus is more common in healthy women than previously suspected, with M mulieris as the predominant species. The significant difference in the prevalence of M curtisii between women with bacterial vaginosis and uninfected women suggests that this species could be involved in the pathogenesis of bacterial vaginosis.     

Personality types of women attending an STD clinic: correlation with keeping first review appointments.

One hundred and eighty new women patients attending a sexually transmitted disease (STD) clinic answered the Eysenck personality questionnaire (EPQ) which measures psychoticism, extraversion, neuroticism, and a tendency to "fake good". These personality scores were correlated with the patients' attendance or non-attendance for their first review appointments. The results showed that the mean psychoticism scale scores of the 41 non-attenders was significantly higher than that of the 139 who kept their first appointment. This relation was confirmed using point biserial correlations. The mean scores of non-attenders on the other three EPQ scales were not significantly different from those of attenders, and none of the correlations between the other EPQ scales and this behavioural criterion was significant. The psychoticism scale is tentatively recommended for identifying women patients who may need special counselling about the importance of keeping their first review appointment.     

Bacterial vaginosis in lesbians and bisexual women

OBJECTIVE: To determine whether bacterial vaginosis (BV) is associated with sexual activity between women. STUDY DESIGN: Cross-sectional survey of 708 new patients attending 2 sexual health clinics for lesbians and bisexual women in London, U.K. Questionnaire for demographic, sexual history, and sexual practice data linked with the results of genitourinary examination. RESULTS: BV was common (31.4%). The odds of BV was significantly associated with larger numbers of female sexual partners (odds ratio [OR], 1.6; confidence interval [CI], 1.05-2.44 for > or = 11 compared with 1-5 partners) and with smoking (OR, 1.43; CI, 1.01-2.03), but not with sex with men or vaginal douching. CONCLUSIONS: BV is common in women who have sex with women (WSW). The increasing odds of BV with larger numbers of female sexual partners suggest that BV may be sexually transmitted between women.     

Genital human papillomavirus infection among patients attending an STD clinic.

OBJECTIVES--To determine the prevalence of human papillomavirus (HPV) infection in patients, male and female, attending a clinic for sexually transmitted diseases (STDs). DESIGN--A randomly selected group of patients representative of the population studied and first-time visitors to the STD clinic, were asked to participate in the study. Samples from the skin and mucous membranes of the lower genital region were taken for cytological analysis by the polymerase chain reaction (PCR) method for HPV DNA. The patients then underwent colposcopy or peniscopy after acetic acid application. SETTING--Department of Dermatology and Venereology, University Hospital, Uppsala, Sweden. SUBJECTS--A total of 131 patients, 66 women and 65 men, attending the clinic for various reasons. RESULTS--At colposcopy/peniscopy, 18 patients (10 men and 8 women) had lesions typical of, and 24 (12 men and 12 women) suspicious of HPV infection. With the PCR technique HPV DNA was detected in 72% of the patients with typical lesions and in 54% of those with suspicious lesions. CONCLUSION--Nearly one-third or 30.5% of these randomly selected patients in a Swedish STD clinic were infected by HPV. The diagnosis was made by clinical inspection and/or by HPV DNA analysis with PCR.     

Genital human papillomavirus infections in patients attending an inner-city STD clinic.

One hundred and sixteen consecutive women attending a Baltimore City STD clinic were studied for the prevalence of human papillomavirus (HPV) infection of the genital tract using three criteria: presence of clinically recognized (visible) genital warts, cytopathologic evidence suggestive of HPV infection in a Papanicolaou smear, and analysis of cervical scrapes for genital tract HPV genomic sequences by Southern hybridization. The women were young (median age: 22 years) and more than 80% had a history of one or more STDs. The prevalences were 17% for visible warts, 41% for cytologic findings suggestive of HPV infection, and 12% for HPV DNA in cervical scrapes. Comparing the results of the three techniques, HPV DNA was found significantly more often in cytopathology-positive women than in cytopathology-negative women (18% vs. 5%, P = 0.05) and in women with visible warts than in women without visible warts (29% vs. 6%, P = 0.01). Visible warts were more common in women with HPV-DNA-positive cervical scrapes than in HPV-negative women (50% vs. 14%, P = .01). Although 52% of women were judged as infected by at least one of the three criteria, only 4% were infected by using all three criteria. The prevalence of infection was 23% if cytopathology alone was excluded as evidence of HPV infection. These results indicate the difficulty in an accurate estimation of the prevalence of HPV infections, even in a high-risk population.     

Antibodies to cytomegalovirus in homosexual and heterosexual men attending an STD clinic.

We studied the prevalence of antibody to cytomegalovirus (CMV) in 262 men (132 homosexual, 20 bisexual, and 108 heterosexual) attending the sexually transmitted diseases (STD) clinic at this hospital. Antibody to CMV at a titre of 1/4 or more was found in 92% of the homosexuals, 80% of the bisexuals, and 56% of the heterosexuals (p less than 0.0001). Among heterosexuals, but not homosexuals, nationality and social class showed a significant association with antibody to CMV. In both heterosexuals and homosexuals a history of gonorrhoea was more common in patients with antibody to CMV than in those without it. A similar finding was seen in heterosexual men with a history of non-specific urethritis (NSU). Using a series of log linear models, sexual orientation was shown to be the most important determinant of antibody to CMV in this population.     

Antibodies to gonococcal pili in women with asymptomatic gonorrhoea. Diagnostic value of the ELISA for testing women attending an STD clinic.

The diagnostic efficacy of an enzyme-linked immunosorbent assay (ELISA) using gonococcal pili 6650 as antigen was studied in asymptomatic women attending an STD clinic. Of the 182 women studied, gonorrhoea was diagnosed in 29%. The value of the ELISA was calculated on the basis of four arbitrary cut-off points in the test. The best predictive values for a positive result (PV(+)) were obtained at an absorbance value of A greater than or equal to 1.15 and A greater than or equal to 1.30 and that for a negative result at A greater than or equal to 0.85. When patients with a history of gonorrhoea were excluded, the PV(+) rose only at A greater than or equal to 1.15 (not at A greater than or equal to 1.30) and the PV(-) rose slightly. To be of use in the diagnosis of gonorrhoea in asymptomatic patients the ELISA should be used as follows: the result is positive at A greater than or equal to 1.15 and negative at A less than 0.85, the PV(+) then being 0.52 and the PV(-) 0.85. Whenever sera give a result between A = 0.85 and A = 1.15, the test should be repeated.     

Recognising covert disease in women with chronic vulval symptoms attending an STD clinic: value of detailed examination including colposcopy.

A vulval colposcopy clinic was established in the sexually transmitted diseases (STD) clinic of St Mary's Hospital, London, to investigate patients with chronic symptoms (mean duration 3 1/2 years). Fifty patients with a mean age of 33 were studied for 12 months, and a specific diagnosis was established for many of them. Forty complained of pruritus vulvae, 33 of dyspareunia, and 30 of vulvodynia. One or more macroscopic abnormality was seen in 29 of the women, the most common being erythema, papules, plaques, and fissures. Colposcopic abnormalities, however, were identified in 45 of the women, the most common being acetowhite epithelium in a flat, papillary, or cobblestone pattern. Biopsy specimens were obtained from 33 of the patients, and all had abnormal histological features. Those of human papillomavirus (HPV) infection were the most common, and were found in 27 specimens; evidence of vulval intraepithelial neoplasia was seen in seven and that of dermatoses in 10. Further work is required, however, before concluding that HPV was necessarily responsible for the chronic symptoms.     

Sexual behaviour of women attending an inner-city STD clinic before and after a general campaign for safer sex in Denmark.

OBJECTIVES--To examine the sexual behaviour and the prevalence of sexually transmitted diseases (STD) among females attending an inner-city STD clinic before and after safer sex campaigns. SUBJECTS--In 1984 981 women and in 1988 684 women were interviewed immediately after the venerological examination. SETTING--Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark. METHODS--In a face to face interview, details of symptoms, age at coitarche, number of sexual partners (lifetime and during the last year), obstetric history, and contraceptive methods were recorded. RESULTS--A substantially higher proportion of women used condoms in 1988 than in 1984. A dramatic decrease in the prevalence of gonorrhoea occurred (from 22% in 1984 to 6% in 1988, p < 0.01), whereas an increase in the number of patients with genital warts was observed (from 4% in 1984 to 10% in 1988, p < 0.05). The prevalence of chlamydia, genital herpes, and cervical dysplasia remained unchanged. No significant changes in the number of sexual partners, or the frequency of sexual intercourse or unplanned pregnancy could be detected from 1984 to 1988. CONCLUSIONS--The safer sex campaigns have only been partly successful, as a general reduction in all sexually transmitted diseases should be expected as a result of the increased use of condoms. Future campaigns should focus on the correct use of condoms, and encourage a lifestyle with stable sexual relationship.     

Bacterial vaginosis: prevalence in outpatients, association with some micro-organisms and laboratory indices.

Seven hundred and ninety three women were investigated, aged between 16 and 78 years, to evaluate the prevalence of bacterial vaginosis (BV) and some associated micro-organisms, and to discuss the significance of laboratory indices correlated to this pathology. BV was diagnosed on the basis of four distinct criteria: a positive result of the test for amines with 10% KOH (odour-test), the presence of clue cells on fresh microscopic examination, a pH greater than 4.5 and direct Gram stain positive (the presence of more than 40 Gram negative or Gram variable coccobacilli per microscopic field by 1000 magnifications under oil immersion). The total prevalence of BV was 20.5% (163); similar percentages were found in both fertile and pregnant women, whereas a lower percentage (12.7%) was found in menopausal women. Gardnerella vaginalis was present in 235 (29.6%) of the 793 women, in 144 (88.3%) of the 163 with BV and in 91 (14.4%) of the 630 women without BV. Mobiluncus species was present in 8.2% (65) of the total population, in 38.6% (63) of the women with BV and only in two (0.3%) of the women without BV. In the women with BV lower percentages were found for Trichomonas vaginalis, yeasts, Chlamydia trachomatis and Neisseria gonorrhoeae. The absence of a definite relationship between BV and cultural isolation of G vaginalis is confirmed whereas the role played by Mobiluncus spp still has to be clarified. It is concluded that it is not necessary to screen with all four laboratory indices. Two positive indices from a panel of three (excluding pH greater than 4.5 and direct Gram stain positive in the same panel) allows the correct diagnosis of BV in almost all cases.     

Disease prevalence among women attending a sexually transmitted disease clinic varies with reason for visit.

Prevalence of sexually transmitted diseases (STD) and selected behavioral and demographic variables were evaluated in 279 women attending a Baltimore STD clinic, using a standardized questionnaire and cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Stratified by reason for clinic visit, 102 (37%) of 279 women attending the clinic stated that they were recent contacts to men with STDs with the majority (59 out of 102, or 58%) reporting gonorrhea contact as their reason for visit. Another 124 women (44%) came to the clinic for symptom evaluation, and 53 (19%) for other reasons. Prevalence of STDs was higher among those attending as contacts than among noncontacts: 35% versus 15% for N. gonorrhoeae; 26% versus 16% for C. trachomatis; and 27% versus 15% for T. vaginalis (P less than 0.05 for each). Furthermore, multiple infections were found in 23% of those attending as contacts but only in 10% of noncontacts (P less than 0.001). In general, patients reporting contact with an infected person were also less likely to report symptoms (43% versus 34%, P less than 0.001), despite increased disease prevalence. These data suggest that multiple STDs are often present in women attending STD clinics, irrespective of reason for visit. Merely treating women for reported exposure without further evaluation will fail to identify a substantial number of women coinfected with other organisms.     

Sexual behaviour in women attending a genitourinary medicine clinic.

In 1025 women attending a genitourinary medicine (GUM) clinic, sexual experience had started at an increasingly early age during the past 30 years, from a mode of 19 in the early 1950s to 16 in the early 1980s. Up to the age of 40, sexually active older women had as many recent sexual partners as younger women. Oral intercourse (fellatio) was practised by 714 (70%) women, and 378 (37%) experienced ejaculation in the mouth. Anal intercourse was practised by 200 (20%) women and 90 (9%) experienced ejaculation in the anorectum. The prevalence of all these practices increased with age. Women attending a Family Planning Association (FPA) clinic reported a similar prevalence of these practices, and differed from GUM clinic women only in the number of sexual partners in the preceding year. In the GUM group, black women reported significantly fewer recent sexual partners than did white women, and significantly fewer black women practised oral intercourse or permitted anal penetration. Full anal intercourse with ejaculation into the anorectum was practised at least occasionally by 9% (80/873) of white and 8% (10/131) of black women.     

Pattern of sexually transmitted diseases and risk factors among women attending an STD referral clinic in Nairobi, Kenya

BACKGROUND: In Kenya, sexually transmitted disease (STD) clinics care for large numbers of patients with STD-related signs and symptoms. Yet, the etiologic fraction of the different STD pathogens remains to be determined, particularly in women. GOAL: The aim of the study was to determine the prevalence of STDs and of cervical dysplasia and their risk markers among women attending the STD clinic in Nairobi. STUDY DESIGN: A cross-section of women were interviewed and examined; samples were taken. RESULTS: The mean age of 520 women was 26 years, 54% had a stable relationship, 38% were pregnant, 47% had ever used condoms (1% as a method of contraception), 11% reported multiple partners in the previous 3 months, and 32% had a history of STDs. The prevalence of STDs was 29% for HIV type 1, 35% for candidiasis, 25% for trichomoniasis, 16% for bacterial vaginosis, 6% for gonorrhea, 4% for chlamydia, 6% for a positive syphilis serology, 6% for genital warts, 12% for genital ulcers, and 13% for cervical dysplasia. Factors related to sexual behavior, especially the number of sex partners, were associated with several STDs. Gonorrhea, bacterial vaginosis, cervical dysplasia, and genital warts or ulcers were independently associated with HIV infection. Partners of circumcised men had less-prevalent HIV infection. CONCLUSION: Most women reported low-risk sexual behavior and were likely to be infected by their regular partner. HIV and STD prevention campaigns will not have a significant impact if the transmission between partners is not addressed.     

Sexual behaviour and HIV prevalence in patients with sexually transmitted disease attending an STD clinic in north eastern state of India

The study was done to determine the sexual risk behaviour and to monitor HIV seroprevalence among STD patients attending a STD clinic as a part of sentinel surveillance programme in North Eastern State of India. Face to face interviews, clinical and epidemiological investigations were carried out in all new patients. The frequency of condom use, and the number of sexual partners during the preceding 6 months were recorded. Out of 680 males, majority (66.4%) were aged 20-29 years. 89.2% men reported to have had sexual contacts with prostitutes. Being younger, single and staying away from home were independent risk factors for having sexual contact. 34.7% men used condom at all times, 27.2% reported inconsistent use and 38.1% did not use condoms. Eleven (1.6%) of the 680 STD patients tested were found to be HIV positive, did not use condom and had genitoulcerative disease.