Immigration and sexually transmitted diseases: risk factors,prevention and health education

Assessment of behaviour at risk of HIV-infection and other Sexually Transmitted Diseases (STD) in high-risk subjects, such as illegal immigrants is the first step for successful prevention measures. In order to assess knowledge of AIDS, STDs, risk behaviour and condom use, a sexual behaviour questionnaire was administered to all illegal immigrants living in the Domitia area (north-west of naples) and coming to our ambulatory for several pathologies. The following risk markers identified were: low level of knowledge concerning HIV and STD transmission and prevention, multiple sexual partners, casual sex, low frequencies of condom use, drugs and alcohol use. Therefore prevention campaigns should include educational activities concerning AIDS and STD transmission and prevention, and condom promotion. Particular attention should be given to improve access to STD services that provide treatment and counselling. Moreover, commercial sex workers require counselling at each visit, screening and treatment.     

Adolescents in the age of AIDS: myths,misconceptions, and misunderstandings regarding sexually transmitted diseases

The purpose of this study is twofold: to evaluate the extent of knowledge possessed by young people residing in an urban sexually transmitted disease (STD) and AIDS epicenter about STDs, including AIDS; and to determine whether knowledge levels varied by age, gender, race/ ethnicity, and/or previous health instruction. A total of 867 adolescents (472 females and 395 males) attending a large public high school in New York City completed a self-administered survey. Levels of knowledge about AIDS transmission and prevention were high (mean percentage correct = 91.8%). Nonetheless, adolescent respondents locked awareness about the prevalence of common STDs, had limited understanding of the ways in which these diseases can be transmitted and prevented, and were unaware of potentially serious sequelae resulting from exposure to infectious agents (e.g., infertility from chlamydial infections). Young people who had taken a health education course in which STDs were discussed did slightly better on the knowledge survey than did their peers. While the prevention of HIV infection is, and should be, a national priority, more concerted efforts are needed to better educate young people about other STDs in the overall context of sexual health.     

Serologic detection of sexually transmitted diseases caused by Chlamydia trachomatis

163 patients were examined for the presence of C. trachomatis by cultivation and concurrently sera were examined by the ELISA method for the presence of antibodies against C. trachomatis. Significant titres of antibodies were detected in less than half the patients with infection proved by cultivation. Antibodies were found more frequently in patients with a complicated course of the disease. In approximately 3% of the patients, where the agent was not detected by cultivation, antibodies were found in high titres. The author evaluated also the possibility to use the complement fixation reaction with ornithose antigen for the diagnosis of sexually transmitted infections caused by C. trachomatis. According to the author's results this method cannot be used. Serological evidence of Chlamydia infection is not a method of first choice for the diagnosis of sexually transmitted infections caused by C. trachomatis, but is an important supplementary method for the diagnosis, mainly of complicated infections.     

Declining HIV incidence among patients attending sexually transmitted infection clinics in Pune, India

OBJECTIVE: A recent report suggesting declining HIV transmission rates in southern India has been based on HIV seroprevalence data to estimate HIV incidence. We analyzed HIV incidence rates among 3 cohorts (male, female non-sex worker, female sex worker [FSW]) presenting to sexually transmitted infection (STI) clinics in Pune, India over 10 years. METHODS: Between 1993 and 2002, consenting HIV-uninfected individuals were enrolled in a prospective study of the risks for HIV seroconversion. Standardized HIV incidence estimates were calculated separately for the 3 cohorts. RESULTS: HIV acquisition risk declined by more than 70% for FSWs (P = 0.02) and men (P < 0.001) attending the STI clinics. There was no significant reduction in HIV incidence among women attending STI clinics (P = 0.74). The decline in HIVacquisition risk among male patients with STIs was associated with an increase in reported condom use with recent FSW contact and a decrease in genital ulcer disease. CONCLUSIONS: We report the first direct evidence for a decline in HIV incidence rates in FSWs and male patients with STIs over time. The lack of change in HIV infection risk among non-sex worker women highlights the need for additional targeted HIV prevention interventions.     

Human immunodeficiency virus and other sexually transmitted diseases in Cuban women

A cross-sectional study was performed in 60 Cuban women of child-bearing age who were seropositive for human immunodeficiency virus (HIV) and 60 controls. Human papillomavirus (HPV) was identified most frequently, with oncogenic HPV serotypes 16, 33 and 58 detected in HIV-positive patients, and serotypes 11, 33 and 51 in the controls (relative risk 4.41; 95% CI 2.21-8.29). Syphilis and hepatitis B and C viruses were detected exclusively in HIV-seropositive women (p<0.05). Sexually transmitted diseases (STDs) appeared to pose a substantial health problem, especially for HIV-positive women. Clinics should consider screening and treatment for STDs as part of their HIV prevention programmes.     

Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women

BACKGROUND: This study sought to document the prevalence of recent gender-based violence (rGBV) among seropositive women and to determine the association between rGBV and pregnancy, sexually transmitted infections (STIs), condom use, and negotiation of sexual practices. METHODS: A total of 304 seropositive women recruited from HIV clinics in the southeastern United States who reported being sexually active in the previous 6 months with 1 partner were included in analyses. Gender-based violence during the previous 3 months, condom use, and negotiation of sexual practices were assessed. Biologic samples for pregnancy and STI testing were collected. RESULTS: A total of 10.2% of women reported a history of rGBV. rGBV was related to inconsistent condom use practices, pregnancy, and abuse stemming from requests for condom use. No associations were found between rGBV and negotiation of sexual practices and STIs. CONCLUSIONS: The prevalence of rGBV among HIV-positive women emphasizes the need for screening of abuse and highlights the need for the design and implementation of integrated intervention approaches necessary in addressing the needs of this population.     

High prevalence and incidence of sexually transmitted infections among women living in Kwazulu-Natal,South Africa

Background and objectives

Sexually transmitted infections (STIs) contribute largely to the burden of health in South Africa and are recognized as major contributors to the human immunodeficiency virus (HIV) epidemic. Young women are particularly vulnerable to STIs. The purpose of this secondary analysis was to examine the risk factors associated with prevalent and incident STIs among women who had participated in three clinical trials.

Methods

A total of 5,748 women were screened and 2293 sexually active, HIV negative, non-pregnant women were enrolled in three clinical trials in Kwazulu-Natal, South Africa. The prevalence of individual STIs Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), syphilis, and Trichomonas vaginalis (TV) was assessed at screening; and incident infections were evaluated over a 24 month period.

Results

Overall, the combined study population of all three trials had a median age of 28 years (inter-quartile range (IQR):22–37), and a median duration of follow-up of 12 months. Prevalence of STIs (CT, NG, TV, or syphilis) was 13% at screening. The STI incidence was estimated to be 20/100 women years. Younger women (<25 years, p?<?0.001), women who were unmarried (p?<?0.001) and non-cohabiting women (p?<?0.001) were shown to be at highest risk for incident STIs.

Conclusions

These results confirm the extremely high prevalence and incidence of STIs among women living in rural and urban communities of KwaZulu-Natal, South Africa, where the HIV epidemic is also particularly severe. These findings strongly suggest an urgent need to allocate resources for STI and HIV prevention that mainly target younger women.

Trial registration

Clinical Trials.gov, NCT00121459.

     

280例足月妊娠产妇性传播疾病调查分析

目的：调查围产期性传播疾病患病率,了解临床产妇女生殖健康状况。方法：1、用ELISA法检测产妇静脉血中艾滋病病毒（HIV）;2、悬滴法镜检阴道分泌物中霉菌和滴虫;3、革兰氏染色法镜检宫颈分泌物中淋球菌;4、肉眼观察外阴、阴道及宫戏是否性病疣。结论：HIV感染率为0;霉菌阳性率为21.78%;滴虫阳性率为0.7%;淋菌感染率为0;尖锐湿疣患病率1.78%。结论：280名产妇中感染性传播疾病以阴道炎患病率为首,达22.5%。其次为尖锐湿疣。淋病及艾滋病患病率为0。     

Epidemiology of sexually transmitted diseases in the mine area of Las Claritas, Bolivar State, Venezuela

The primordial objective of this study was to carry out an epidemiological analysis of sexually transmitted diseases (STD) in terms of sensed morbidity and real morbidity in the mining region of "Las Claritas", Bolivar State, Venezuela, during the third trimester of 1998. The epidemiological characteristics of time, people and place are interlaced, giving a relationship included within the Epidemiological Triad, that represents this work's conceptual framework; defining both, the determinant and the conditioning factors of the presence of STDs in the zone. The clinical interrogatory was partially steered towards the participant's sensed morbidity. A mostly feminine population is described (65%), with a low scholarly level in the general population and a high index of foreigners among the evaluated patients; with 48.72% of stable unions in the interviewees. From 166 evaluated patients, 27.70% referred to have had some STD episode, being syphilis and blenorrhagia the most frequently reported. In the survey, there was a general hush concerning the presence of STDs; but, key informants such as the medicine retailers, revealed a higher presence of these diseases, which are wrongly treated by automedication. These are important results, since they let opened a space for the epidemiological evaluation in the zone, in the various health, sanitary, environmental and social aspects and mainly, by the individual's quality of life expectations.     

Drug use and sexually transmitted diseases among female and male arrested youths

Knowledge of the rates and correlates of juvenile offenders’ sexually transmitted diseases (STD) has been limited to samples of incarcerated youths comprised mostly of males. Data collected on 442 female and 506 male youths processed at a centralized intake facility enabled us to study this important public health problem among a sample of juvenile offenders at the front end of the justice system. Female–male, multi-group latent class analyses identified two subgroups, High Risk and Lower Risk, of youths described by a latent construct of risk based on drug test results, STD test results, and a classification for the seriousness of arrest charge. The results found: (1) a similar classification distinguished High Risk and Lower Risk male and female youths, and (2) important gender group differences in sexual risk related factors (e.g., substance use during sexual encounters). Among the youths in this sample who tested positive for an STD, 66% of the girls and 57% of the boys were released back into the community after arrest. Overall, our findings raise serious public health and social welfare concerns, for both the youths and the community. Prevention and intervention implications of these findings are also discussed.

Beta-lactams in sexually transmitted diseases: Rationale for selection and dosing regimens

A review is given of the selection and rationale of optimal treatment regimens for patients with sexually transmitted pathogens, e.g. in cases of gonorrhea, chlamydial infections, chancroid, syphilis, pelvic inflammatory diseases and ophthalmia neonatorum. The scientific basis for the selection of a beta-lactam agent is discussed, including dose, MIC, the critical serum level and maintenance interval, and the duration of therapy. Except in the case of penicillinase-producingNeiserria gonorrhoeae, penicillin remained until recently the most effective agent available against many sexually transmitted diseases. However, ceftriaxone, a new third-generation cephalosporin, has been shown to have a long half-life (8 h) and excellent in vitro efficacy againstNeiserria gonorrhoeae (including penicillinase-producing strains) andHaemophilis ducreyi. In view of its exceptional clinical efficacy against both gonorrhea and chancroid, clinical studies of its efficacy against other sexually transmitted diseases appear warranted.     

应用FQ-PCR技术检测乌鲁木齐地区性病病原体的流行病学分析

目的掌握本地区性病病原体的现行感染水平及发展规律,为控制该疾病的传播和流行提供科学依据.方法采用实时荧光定量聚合酶链反应技术,定量测定病原体基因.结果连续4年对引起性病的5种主要病原体UU、HPV、HSV、NG及CT进行了检测,结果显示①阳性率分别为45.84%、29.68%、21.45%、9.09%和7.10%,与国内已有文献比较,本组UU感染率最高,而NG、CT却较低.②UU、NG及CT在女性中的阳性率高于男性,但HPV和HSV却低于男性,其性别差异与通常的认识既相一致(如UU、CT),也有不同(如HPV、HSV、NG).③4年间UU、HPV和NG感染逐年升高,CT感染逐年下降,流行趋势与国内外相关报道存在较大差异.结论乌鲁木齐性病病原体的感染现状显示明显的地区特点,深入研究并从流行病学角度分析该地性病病原体的发生、发展趋势,对加强性病防治工作具有重要意义.     

实时荧光定量PCR检测常见性传播疾病病原体基因

目的;用实时荧光定量聚合酶链反应(FQ-PCR)技术准确定量检测常见性病病原体基因,为临床治疗提供依据.方法采用实时FQ-PCR技术,检测了临床送检标本3641份.结果淋球菌(NGH)1416份、沙眼衣原体(CT)1165份、解脲支原体(UU)765份,人乳头瘤病毒(HPV6.11)214份、梅毒螺旋体(TP)81份,阳性率分别为26%(368/1416)、27%(315/1165)、36.5%(279/765)、77%(165/214)、21%(17/81).阳性率差异有高度显著性(P＜0.001).NGH、CT、UU、HPV6.11、TP阳性标本DNA平均拷贝数2.3×106、8.5×105、2.4×104、5.6×107、3.8×105.146例治疗后复查,其转阴率为NGH63.9%(39)、CT70%(33)、UU44.7%(17).治疗后复查转阴率差异有显著性(P＜0.05),其DNA拷贝平均数有明显下降.结论实时FQ-PCR技术检测常见性病病原体基因,具有简便、快捷、特异性高、定量准确等优点,对其诊断和治疗有指导意义.     

The value of screening for sexually transmitted diseases in an HIV clinic

Because bacterial sexually transmitted diseases (STDs) facilitate HIV transmission, screening for and treatment of STDs among HIV-infected persons should prevent HIV spread to partners. Before screening programs for gonorrhea and Chlamydia infection should be widely established in HIV clinics, it is useful to know the prevalence of these infections. This study analyzed the results of a urine-based screening program for gonorrhea and Chlamydia in a New Orleans HIV clinic and compared the positivity rates to the prevalence in the local community. Among persons screened in the HIV clinic, 1.7% (46/2629) had gonorrhea and 2.1% (56/2629) had Chlamydia infection. Among persons aged 18-29 years, the test positivity for gonorrhea was similar in the HIV clinic to that of persons in sociodemographically similar community samples (3.1 versus 2.4%, adjusted odds ratio 1.6, P = 0.11) and the test positivity for Chlamydia infection was lower (5.4% versus 10.5%, adjusted odds ratio 0.6, P < 0.01). Based on a previously published mathematical model, it was estimated that treatment of all 46 gonorrhea and 56 Chlamydia infections in the HIV clinic may have averted 9 HIV infections among sex partners and saved far more in future medical costs than the cost of the screening. Routine screening for gonorrhea and Chlamydia infection should be considered in HIV clinics.