Sexually transmitted diseases reported by STD services in The Netherlands, 1984-1990.

OBJECTIVE--To present general trends in sexually transmitted disease (STD) in the Netherlands during the period 1984-1990 and to describe characteristics of the patients in order to get insight into possible factors underlying these trends. METHODS--Since 1984 patients diagnosed with STD visiting STD clinics and local public health services in the Netherlands are reported by the nursing staffs. In addition to diagnosis and gender of the patient epidemiological background information is registered. The reported annual cases of gonorrhoea, syphilis and Chlamydia trachomatis infections are presented. Further, the epidemiological features of over 25,000 patients with infections due to Chlamydia trachomatis, gonorrhoea or syphilis infections were compared. RESULTS--During the period 1984-1990 an overall decrease in the total number of gonorrhoea infections was reported; among homosexual males; however, an increase in gonorrhoea rates and an increasing number of sexual partners after 1989 was reported. Furthermore, the percentage of gonorrhoea infections caused by penicillinase-producing Neisseria gonorrhoeae was found to be on the increase in various subgroups but not in homosexual males. Syphilis rates among females declined from 1984 to 1987 after which an increase was reported reaching a peak in 1989; syphilis rates among males peaked during 1989. After 1988 Chlamydia trachomatis infections increased which, however, is largely due to the introduction of screening among all visitors of the Amsterdam STD service resulting in improved case-detection. Finally, it appeared that STDs are not randomly distributed over the population but are associated with certain patient characteristics. CONCLUSION--The data provided by STD services reveal an epidemiological pattern for STDs in the Netherlands. The increase in the reported number of gonorrhoea infections among homosexuals together with the increasing number of sexual partners among homosexual males suggest that a group of highly sexually active individuals switch or return to higher risk behaviours. Further research is needed to determine the causes of the described trends and behavioural changes in order to undertake preventive activities.     

Detection of the gonococcal antigen with an enzyme immunoassay (Gonozyme). Results of the original and modified test procedure

Urogenital specimens of 2,485 patients were examined by an enzymeimmunoassay for the detection of Neisseria gonorrhoeae antigen (Gonozyme, Abbott). The results of the original test (Gonozyme A) and a modified version (Gonozyme B) were compared to bacterial culture. Three different groups were examined by Gonozyme A: 526 men and 464 women from the clinic for sexually transmitted diseases (STD) and 548 registered prostitutes. Sensitivity in men was 98%, in women from the STD clinic 89%, and in prostitutes 81%. Specificity in men was 99.5%, in women from the STD clinic 94%, and in prostitutes 88%. One of the reasons for the decreased specificity in women could be cross reacting bacteria from the genital secretions of the women. The assay was modified by optimizing the antigonococcal antibody and increased incubation times. These modifications improved the specificity of Gonozyme B by reducing the number of cross reactions with other bacterial antigens. Four different groups were examined by Gonozyme B: 261 men and 220 women from the STD clinic, 121 women from an infertility clinic, and 345 registered prostitutes. Sensitivity in men was 100%, in women from the infertility clinic 100%, in women from the STD clinic 94%, and in prostitutes 77%. Specificity in men was 99%, in women from the infertility clinic 100%, in women from the STD clinic 99%, and in prostitutes 96.5%. Analysis of the Gonozyme-positive/culture-negative test results suggested that most patients (85%) did not have gonorrhoea. In 15% of these specimens it is possible that patients had pretreated gonorrhoea which was only detected by Gonozyme.(ABSTRACT TRUNCATED AT 250 WORDS)     

Syphilis incidence in West Saxony (Germany) between 1983 and 1992

Background Classical sexually transmitted diseases, such as syphilis and gonorrhoea, have shown a marked reduction in incidence over the past decade in industrialised countries. A contrary trend was observed for syphilis in West Saxony. Methods Data compiled on the incidence of syphilis in West Saxony (1.4 Mill, population) from 1983 to 1992. Results The total number of patients notified with syphilis was 1509. The incidence increased between 1984 and 1984 by a factor of 7.7. Seventy one percent were clinically active, whereas 29% were in the latent stages. Conclusion Despite a relatively high level of the health care and strict reporting system, syphilis incidence increased. Reasons are discussed.     

AIDS related changes in pattern of sexually transmitted disease (STD) in an STD clinic in Copenhagen.

Testing for antibodies against human immunodeficiency virus (HIV) was introduced in 1984 in this major sexually transmitted disease (STD) clinic in Copenhagen, which is attended by about 10,000 new patients each year. From 1984 to 1987 the proportion of patients examined for antibodies to HIV rose from 6% to 32%. The overall incidence of HIV antibody positivity decreased from 30% in 1984 to 3% in 1987, the combined result of decreased positivity in high risk patients tested and increased screening in low risk patients. HIV antibody positivity has been confined largely to homosexual men and drug addicts. Since 1985, however, 21 out of 2623 (0.8%) heterosexuals who were not drug addicts were found to be HIV antibody positive. During 1984-6 the incidence of STDs most often encountered in high risk groups (syphilis and gonorrhoea) decreased by 64% and 41% respectively, whereas the incidence of diseases most often diagnosed in low risk groups (condylomata acuminata and genital herpes) increased by 70% and 34% respectively in the same period. The addition of HIV infection to the list of STDs requires the allocation of more resources to the STD clinics to enable these clinics to handle this new problem. Screening for all patients attending an STD clinic for antibodies to HIV must be considered, and in our area it would be cost effective.     

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.     

A study on the present scenario of STD management in an urban clinic in Kolkata

A total of 4129 patients attended the STD clinic from 1996 to 1999. Of those 25.75% were STD cases. Male and female cases comprised 86% and 14% respectively. Majority were in the age group between 18 to 38 years. Chancroid was the commonest STD (37.7%). Other STDs in order were syphilis (30.66%), NGU (15.71%), gonorrhoea (7%), venereal wart (3.57%), candidiasis (2.53%), trichomonal vaginitis (1.6%), herpes genitalis (0.65%) and LGV (0.47%). No case of Donovanosis or HIV was detected. 13.7% of STD cases were reactive for VDRL test and 8% of the antenatal attendants were strongly VDRL test reactive. The urethral discharge on gram staining was positive for gonococcus, in 29%. 68% of the clinic attendants were given safer sex education and served condom.     

Imported penicillinase producing Neisseria gonorrhoeae becomes endemic in London.

We review all cases of gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae (PPNG) seen between 1976 and 1983 at the sexually transmitted disease (STD) clinic of this hospital, which accounted for 11% of all such cases reported in that period in the United Kingdom. While the overall incidence of gonorrhoea remained relatively stable in this clinic, that of PPNG rose to 4.4% of all such cases by 1982. Until last year, 75% of these cases were imported, mainly from Nigeria and Ghana, but a marked change was seen in the second half of 1982, when 71% of cases were indigenous in origin. Casual partners and prostitutes in London were mentioned as the source of infection by 34% of patients, a much higher percentage than that seen previously. Such sources are notoriously difficult to trace and these figures show a very disturbing trend. Although rectal infection tends to be asymptomatic, PPNG was isolated in rectal cultures from two of five homosexuals and 19 of 26 women. There is therefore a risk that PPNG could spread rapidly through the homosexual population. We suggest that spectinomycin should no longer be the first drug of choice in the treatment of gonorrhoea caused by PPNG but should be replaced by the newer cephalosporins.     

Determinants of penicillinase producing Neisseria gonorrhoeae infections in heterosexuals in Amsterdam.

BACKGROUND AND OBJECTIVES--At the STD clinic of the Municipal Health Service in Amsterdam, the annual number of infections with penicillinase-producing Neisseria gonorrhoeae (PPNG) strains remained relatively stable from 1983 until 1990, while the number of non-PPNG infections declined dramatically. To investigate the PPNG and non-PPNG epidemic, a cross sectional study was conducted in 1989 and 1990. The purpose of this study was to assess determinants of PPNG infections among heterosexuals diagnosed with gonorrhoeae. METHODS--In addition to routinely collected data in new consultations for STDs, information on alcohol use, drug use and sexual behaviour was obtained from patients diagnosed with gonorrhoea. The diagnosis of gonorrhoea was based on a positive culture and isolates were screened for PPNG. Logistic regression analysis was used to assess independent predictors of PPNG infection. RESULTS--Additional information was available of 328 women and 995 heterosexual men diagnosed with gonorrhoea. PPNG was diagnosed in 86/328 (26%) women and in 329/995 (33%) men. Logistic regression analysis identified a Central/South American nationality (odds ratio(OR) = 2.46) and older age (OR = 1.04 per year) as positively associated with PPNG infection in female patients. An inverse relation was found with use of hard drugs (OR = 0.29). Among men diagnosed with gonorrhoea, sexual contacts with window prostitutes (mainly women from Central/South America) (OR = 1.98) and a foreign nationality (OR = 1.78) were positively associated with PPNG infection, and sexual contact with drug using prostitutes (OR = 0.47) inversely. CONCLUSIONS--PPNG infections were especially common among Central and South American window prostitutes and their clients, but not among hard-drug addicted prostitutes and their clients. Since window prostitutes originating from Central and South American countries are transient in Amsterdam, prevention activities targeted at these prostitutes and their clients should be continued to limit the spread of PPNG and other STDs within these groups.     

HLA and sexually transmitted diseases in prostitutes.

The HLA profile of 148 unrelated, Chinese prostitutes (56 with repeated gonococcal infection, 31 with syphilis, 31 with gonorrhoea and syphilis, and 30 with no evidence of infection) was compared with that of 238 unrelated, healthy, Chinese control subjects. The joint occurrence of AW19 B17 was observed in 25.8% of prostitutes with double infections compared with 6.7% of control subjects, while that of A11 B15, on the other hand, was associated with a resistance to syphilis and gonorrhoea. The latter profile was observed in 46.7% of prostitutes in business for more than two years who were resistant to disease, in 30% of prostitutes with an overall disease resistance, in 13.4% of control subjects, and in only 3.2% of prostitutes with combined syphilis and gonorrhoea. Because of the statistical uncertainty when multiple variables are being analysed these studies should be repeated in other groups of prostitutes of the same and different ethnic origins.     

HLA and sexually transmitted diseases in prostitutes

The HLA profile of 148 unrelated, Chinese prostitutes (56 with repeated gonococcal infection, 31 with syphilis, 31 with gonorrhoea and syphilis, and 30 with no evidence of infection) was compared with that of 238 unrelated, healthy, Chinese control subjects. The joint occurrence of AW19 B17 was observed in 25.8% of prostitutes with double infections compared with 6.7% of control subjects, while that of A11 B15, on the other hand, was associated with a resistance to syphilis and gonorrhoea. The latter profile was observed in 46.7% of prostitutes in business for more than two years who were resistant to disease, in 30% of prostitutes with an overall disease resistance, in 13.4% of control subjects, and in only 3.2% of prostitutes with combined syphilis and gonorrhoea. Because of the statistical uncertainty when multiple variables are being analysed these studies should be repeated in other groups of prostitutes of the same and different ethnic origins.     

Sexually transmitted diseases in northern Nigeria. Five years'' experience in a university teaching hospital clinic.

Between 1977 and 1981, 3089 patients attended the sexually transmitted diseases (STD) clinic in Zaria, northern Nigeria. The male-to-female ratio of attenders was 6:1. Postpubertal gonorrhoea accounted for 28.1% of cases, non-specific genital infections for 22.4%, and syphilis for 1.2%. Illiteracy, polygamy, the purdah system, widespread prostitution, and inadequate facilities are factors aiding the spread of these diseases in northern Nigeria.     

上海市金山区卖淫嫖娼人员892人性病状况分析

目的了解上海市金山区2005～2007年公安强制送检的892名卖淫嫖娼人员的性病状况及其特点,为制订防病政策提供依据。方法对892名金山区各派出所强制送检的卖淫嫖娼人员的一般资料进行分析,对采集的标本进行淋病奈瑟菌(NG)的分离培养、解脲脲原体(UU)培养、沙眼衣原体(CT)检测、梅毒甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体抗体凝集试验(TPPA)及人类免疫缺陷病毒(HIV)1+2型抗体(ELISA)的检测。结果892名卖淫嫖娼人员中以外省人员居多(880人),文化程度初中及以下最多(771人);该3年平均阳性检出率:448名卖淫人员中NG感染为10.49%,UU感染为74.33%,CT为感染7.14%,梅毒12.28%,HIV为0;444名嫖娼人员依次分别为2.25%,45.27%,1.35%,2.93%,0人;同时患两种性病的卖淫人员17.41%,多于嫖娼人员的2.93%,同时患3种性病的卖淫人员4.02%,多于嫖娼人员的0.68%,同时患4种性病的0.22%,多于嫖娼人员的0人。结论卖淫嫖娼人员性病感染率较高,尤其UU感染和梅毒,是艾滋病性病的重要传染源。加强对卖淫嫖娼人员的主动监测和规范治疗,提倡安全性行为,是预防与控制艾滋病性病的有效措施。     

Sexually transmitted diseases in northern Nigeria. Five years' experience in a university teaching hospital clinic

Between 1977 and 1981, 3089 patients attended the sexually transmitted diseases (STD) clinic in Zaria, northern Nigeria. The male-to-female ratio of attenders was 6:1. Postpubertal gonorrhoea accounted for 28.1% of cases, non-specific genital infections for 22.4%, and syphilis for 1.2%. Illiteracy, polygamy, the purdah system, widespread prostitution, and inadequate facilities are factors aiding the spread of these diseases in northern Nigeria.     

Surveillance report: disease trends at New Zealand sexually transmitted disease clinics 1977-1993.

AIM--To document trends in sexually transmitted diseases (STDs) recorded by New Zealand STD Clinics from 1977-1993. METHODS--Clinic disease figures have been recorded since clinics commenced in the 1920s and were recorded in a comprehensive format from the 1970s. The New Zealand Venereological Society has collated these data since 1986. RESULTS--The most common STDs in New Zealand clinics are genital warts, non-specific genital infections, chlamydia and genital herpes. Genital Wart infection has been the commonest STD diagnosed in clinics since 1988 and occurred in 17.9% of new patients in 1993. Non Specific Genital Infections were the commonest diagnosis from 1977 to 1988 affecting 17.5% of new patients in 1993. Chlamydia has shown a fall since the mid 1980s diagnosed in 5.4% of new patients in 1993 compared with 14.6% in 1986. Gonorrhoea incidence has fallen steadily since 1975 affecting only 1.1% new patients in 1993. Genital Herpes numbers tripled from 1977 to 1993 and 54% are primary cases. HIV Disease has increased clinic workload greatly with screening and counselling conducted in 25% of new patients in 1993. HIV disease was diagnosed or managed in 0.2% new clinic patients (49 cases). Syphilis has remained at a low incidence in New Zealand diagnosed in 0.3% new patients in 1993. CONCLUSION--Attendance for the viral diseases, HIV disease, genital warts and genital herpes is increasing while for the bacterial diseases, gonorrhoea and chlamydia is decreasing. The rise in disease numbers since 1990 may be due to meeting service needs rather than a true rise in disease incidence. STD surveillance in New Zealand is improving with new reporting systems being developed.     

Clinical profile of STD clinic patients seropositive for HIV antibodies

This article provides clinical profiles for HIV seropositive patients discovered at an STD clinic in Tirupati, India. Considering that sexual contact is the most common mode of transmission of HIV, researchers from the SV Medical College at Tirupati conducted a surveillance for HIV infection among patients attending an STD clinic. From January 1988 to April 1989, the researchers collected serum samples from 2320 patients. 11 people were found to be infected with HIV, 1 of whom exhibited the AIDS Related Complex (ARC). 9 out the HIV-infected patients were 20-30 year-old males categorized as heterosexually promiscuous; the remaining 2 seropositive patients were female prostitutes. The seropositivity rate among heterosexually promiscuous males was 0.58%, and 6.7% among female prostitutes (the total seropositivity rate was 0.47%). Among the HIV-infected patients, the most commonly associated STD was syphilis. 5 of the patients had syphilis alone, and 2 others had syphilis and another STD. One of the HIV-infected patients, a 50 year-old heterosexual male with a history of multiple partners, suffered from a nonhealing genital ulcer and inguinal buboes of 1 month duration. A biopsy of the genital ulcer revealed a pattern consistent with that of granuloma venereum. He also developed angular stomatitis which did not respond to B complex therapy. Furthermore, suffering from persistent lymphadenopathy, weight loss, slight thrombo-cytopenia, an opportunistic infection in the form of oral candidosis and persistent seropositivity for HIV antibodies, the patient was deemed to have the AIDS Related Complex. Tirupati's seropositivity rate of .47% was higher that noticed in other parts of the country, leading the authors call for a plan to investigate the problems of HIV-infected people.     

Increase in sexually transmitted infections among homosexual men in Amsterdam in relation to HAART

OBJECTIVES: We investigated if a rise in rectal gonorrhoea and early syphilis among men who have sex with men (MSM) in Amsterdam coincided with the introduction of highly active antiretroviral therapies (HAART) in July 1996 and determined risk factors for these sexually transmitted infections (STI). METHODS: Subjects were patients of the STI clinic of the municipal health service in Amsterdam. Surveillance data (1994-9) represented consultations (n=11 240) of MSM (n=6103). For analyses we used logistic regression. RESULTS: Comparing the periods before and after the introduction of HAART, the infection rate for rectal gonorrhoea increased from 4% to 5.4% (p=.001) and for syphilis, from 0.5% to 0.8% (p = 0.050). Independent risk factors for rectal gonorrhoea (younger age, western nationality, and concurrent infection with another STI) and for early syphilis (non-western nationality and concurrent infection with rectal gonorrhoea) did not change after HAART became available. For rectal gonorrhoea, however, the infection rate increased only among men who had exclusively homosexual contacts (OR 1.38, p<0.01), compared with bisexual men. For early syphilis, the infection rate increased only among men of western nationality (OR 3.38, p<0.01) compared to men of non-western nationality. CONCLUSIONS: Infection rates of rectal gonorrhoea and early syphilis increased, indicating a change in sexual behaviour, possibly as a result of the introduction of HAART. For now, it is important to find out how sexual behaviour is changing and to keep monitoring trends in STIs (including HIV) among MSM in Amsterdam.     

Screening for sexually transmitted diseases in an HIV testing clinic; uptake and prevalence.

OBJECTIVE: To estimate the prevalence of sexually transmitted diseases (STDs) and the acceptability of STD screening among people seeking an HIV antibody test in an established free standing HIV testing clinic. DESIGN: A 9 month period prevalence study conducted between August 1993 and April 1994. SETTING: The Same Day Testing Clinic (SDTC) for HIV antibodies at the Royal Free Hampstead NHS Trust Hospital, London. SUBJECTS: 242 males and 160 females attending the Same Day Testing Clinic. OUTCOME MEASURES: The prevalence of STDs including gonorrhoea, chlamydia, syphilis and hepatitis B and the percentage of clinic attenders accepting an STD screen. RESULTS: Of those invited to take part in the study 69% of the males (242/350) and 59% (160/269) of the females agreed to be screened although for a variety of reasons not everyone agreed to a full screen. Two cases of untreated syphilis, no cases of gonorrhoea and six cases of chlamydia were detected. Four people had active, previously undiagnosed herpes while three had genital warts. Evidence of previously unknown hepatitis B infection was found in 26 people. Despite a high level of previous contact with genitourinary medicine services, uptake of hepatitis B vaccination among those homosexual men eligible for immunisation was low (28%; 23/83). Nine (4%) of the males, but none of the females screened for STD were found to be HIV antibody positive. CONCLUSION: Among people seeking an HIV antibody test in an established free standing HIV testing clinic, the prevalence of acute STDs was low. However, evidence of previously undiagnosed hepatitis B infection was found in a number of subjects and uptake of vaccination among those most at risk had been low. While opportunistic screening for STD was acceptable to almost two thirds of HIV testing clinic attenders, a substantial minority nonetheless declined this offer. Selective STD screening could be offered to those people seeking an HIV test who report never having been screened before, as both cases of positive syphilis serology and all those of chlamydia were in people who had not previously been screened. All those at risk for hepatitis B infection should be encouraged to establish their infection status and be immunised where appropriate.     

Increase of sexually transmitted infections, but not HIV, among young homosexual men in Amsterdam: are STIs still reliable markers for HIV transmission?

OBJECTIVES: The incidence of HIV and STIs increased among men who have sex with men (MSM) visiting our STI clinic in Amsterdam. Interestingly, HIV increased mainly among older (> or =35 years) MSM, whereas infection rates of rectal gonorrhoea increased mainly in younger men. To explore this discrepancy we compared trends in STIs and HIV in a cohort of young HIV negative homosexual men from 1984 until 2002. METHODS: The study population included 863 men enrolled at < or =30 years of age from 1984 onward in the Amsterdam Cohort Studies (ACS). They had attended at least one of the 6 monthly follow up ACS visits at which they completed a questionnaire (including self reported gonorrhoea and syphilis episodes) and were tested for syphilis and HIV. Yearly trends in HIV and STI incidence and risk factors were analysed using Poisson regression. RESULTS: Mean age at enrollment was 25 years. The median follow up time was 4 years. Until 1995 trends in HIV and STI incidence were concurrent, however since 1995 there was a significant (p<0.05) increase in syphilis (0 to 1.4/100 person years (PY)) and gonorrhoea incidence (1.1 to 6.0/100 PY), but no change in HIV incidence (1.1 and 1.3/100 PY). CONCLUSIONS: The incidence of syphilis and gonorrhoea has increased among young homosexual men since 1995, while HIV incidence has remained stable. Increasing STI incidence underscores the potential for HIV spread among young homosexual men. However, several years of increasing STIs without HIV, makes the relation between STI incidence and HIV transmission a subject for debate.     

Trends in sexually transmitted diseases and condom use patterns among commercial sex workers in Fukuoka City, Japan 1990-93.

OBJECTIVE: To investigate trends in sexually transmitted diseases (STDs) among female commercial sex workers and in their condom use patterns during the period from 1990 to 1993 in Fukuoka, Japan. METHODS: The study group consisted of a total of 824 commercial sex workers who attended an STD clinic to undergo screening for STDs including chlamydia, gonorrhoea, syphilis, hepatitis B and HIV-1 infection during the period from 1990 to 1993. For detection of Chlamydia trachomatis and Neisseria gonorrhoeae, endocervical smear specimens were taken from the women. Blood samples were obtained for serological diagnosis of syphilis, hepatitis B and HIV-1. Commercial sex workers who visited the clinic during the period from November to December of 1993 were interviewed concerning past (1990 and 1991) and recent (1992 and 1993) condom use patterns. RESULTS: The annual detection rates of C trachomatis and N gonorrhoeae declined significantly from 16.3% in 1990 to 12.2% in 1993 (P < 0.0001) and from 1.5% in 1990 to 0.8% in 1993 (P = 0.0096), respectively. There was a remarkable reduction in the annual syphilis infection rate, from 7.5% in 1990 to 0.5% in 1993 (P = 0.0011). The positive rate for the hepatitis B surface antigen in the women ranged from only 0.6% to 1.9% and none were found to be positive for HIV-1 during the 4-year period. During the same period, there was a significant increase in the proportion of commercial sex workers always using condoms from 6.3% in 1990-91 to 25.3% in 1992-93 (P = 0.0023). CONCLUSION: The prevalences of chlamydia, gonorrhoea, and syphilis infections decreased significantly among commercial sex workers in Fukuoka from 1990 through 1993, and no commercial sex workers were HIV-1 seropositive. The reductions in the prevalence of major STDs may be related to the increased use of condoms.