HIV and other sexually transmitted diseases among female prostitutes in Kinshasa

In 1988, 1233 prostitutes from different geographic areas of Kinshasa participated in a cross-sectional survey on HIV infection and other sexually transmitted diseases (STDs). Despite relatively good knowledge about AIDS and STDs, the reported preventive behaviour was poor. Only 12% of the women reported regular use of condoms, while greater than 50% of the women reported regular use of antibiotics and 38% reported doing nothing specific to prevent STDs. Thirty-five per cent of the women were HIV-positive compared with 27% in a similar survey in Kinshasa in 1986. The prevalence of other STDs was very high, ranging from 5% for genital ulcer disease (GUD) to 23% for gonococcal infection. HIV-positive women were older than HIV-negative women (26.9 versus 25.4 years; P less than 0.001), had a significantly lower level of reported condom use (9 versus 14%, P = 0.009), and reported more frequent use of antibiotics to prevent STDs (55 versus 42%, P = less than 0.001). The prevalence of syphilis, gonorrhoea, chlamydial infection and trichomoniasis was not higher in HIV-positive women compared with HIV-negative women. However, HIV-positive women had a higher prevalence of GUD (9 versus 3%, P less than 0.001), antibodies against Haemophilus ducreyi (82 versus 57%, P less than 0.001), antibodies against herpes simplex virus type 2 (96 versus 76%, P less than 0.001), condylomata accuminata (5 versus 1%, P = 0.003) and cytologic evidence of human papilloma virus on Papaniclaou cervical smear (11 versus 5%, P = 0.006). This study confirms the high incidence of HIV and other STDs among prostitutes in Africa.(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors associated with sexually transmitted diseases among prostitutes in Singapore.

From June to December 1990, 806 prostitutes registered with the STD programme in Singapore for regular screening for sexually transmitted diseases (STD) were investigated for factors associated with STD incidence in the preceding year. The majority were foreigners (92.7% Malaysians and 3.1% Thais). Anal sex (0.4%) and intravenous drug use (0.9%) were rare. The overall STD incidence rate was 47.7 per 100. None was human immunodeficiency virus (HIV) positive. The crude and age-adjusted risk of STD was found to increase significantly with client load. An inverse relationship between condom use and STD risk was also observed. Mean condom use among clients was reported as 56.1% for spontaneous use and estimated as 75.4% following negotiation for condom use by prostitutes. Although the prostitutes negotiated for condom use with majority of the clients (85.5%) who did not use condoms spontaneously, they were successful with only about half of them (54.4%). Health education should be targeted at clients on the protective effects of condom use and at the prostitutes on skills in negotiating condom use.     

暗娼行为学及主要STD的感染状况调查

目的　了解强制状态下暗娼的行为学特征及主要性传播疾病 (STD)的感染状况 ,为实施有效的干预措施提供信息。方法　对劳教所内 30 4名暗娼进行匿名问卷调查和血标本采集 ,对入所 <1个月的 5 0名暗娼另取宫颈分泌物。结果　 (1)调查对象平均年龄 2 9 7± 7 3岁 ,卖淫 <1年占 73 9% ;卖淫时从不使用安全套的占 34 8% ,最后一次性交对象 85 3%来自丈夫 /男友、情人和固定性伴侣 ,而最后一次安全套使用率仅 4 6 7%。 (2 )淋球菌、梅毒螺旋体、沙眼衣原体的感染率分别是 4 0 %、31 1%、18 0 % ,未发现艾滋病病毒 (HIV)感染者。结论　暗娼存在高危性行为 ,应尽快推广针对娱乐场所小姐的STD/艾滋病 (AIDS)干预项目 ,以阻断AIDS/STD经性途径传播。     

518名卖淫妇女STD感染状况调查分析

目的调查了解珠海市在强制状态下的518例卖淫妇女主要性传播疾病（STD）的感染状况，并为制定该人群性病防治及干预措施提供依据。方法由专业医师对518名卖淫妇女进行调查，取血标本和宫颈分泌物，用相应的方法检测。结果沙眼衣原体、解脲支原体、梅毒螺旋体、淋球菌、念珠菌、尖锐湿疣、生殖器疱疹、HIV等的感染率分别是21．04％、44．59％、4．83％、0．58％、2．51％、4．63％、0．19％、0．77％。结论卖淫妇女存在高危性行为，应针对高危人群早期进行检查、诊断、治疗，并广泛开展性教育，改变不良性行为，以降低性病和艾滋病的危害。     

Adolescents and sexually transmitted diseases

This paper presents a brief overview of sexually transmitted diseases (STDs), including acquired immunodeficiency syndrome (AIDS), in adolescent populations. Using the framework of a mathematical model (which considers how, why, and whether an infection spreads within a population), the epidemic of STDs among adolescent populations is considered. The unique aspects of adolescent behavior, adolescent biology, and the social context of adolescents' lives are highlighted.     

An eye on sexually transmitted diseases: sexually transmitted diseases and their ocular manifestations

Ocular examination should be a part of the routine assessment of the patients seen at sexually transmitted diseases (STD) clinics due to the importance of these organs in the general wellbeing of patients. It is essential to keep an open eye on ocular signs and symptoms of patients with a history of exposure to common STD pathogens, to ensure prompt investigation and management of ocular complications of the STDs, which, if left unnoticed, otherwise could subject the patients to a great deal of anxiety and distress.     

International travel and sexually transmitted diseases

Despite concerted efforts to control sexually transmitted diseases (STDs) worldwide, they still remain a major public health problem. Out of the 25 organisms known to be transmitted sexually, travelers are at greater risk of acquiring HIV and other STDs in developing countries in view of the high prevalence rates in these countries, particularly after sexual exposure to local commercial sex workers (CSWs). Some of the STDs acquired during international travel are more likely to be resistant to standard antimicrobial regimens for the STDs. HIV, gonorrhoea, syphilis, non-specific urethritis, hepatitis B, hepatitis C, and other STDs are a significant risk for travelers who engage in unprotected sex, especially with overseas CSWs. It is recognized that barrier contraceptives provide considerable protection against STDs, but they are not regarded as 100% protective. Sexual abstinence and sexual monogamy with a 'known' partner carry a much lower risk than the safest of 'safer sex' practices. However, in the event of a sexual exposure to a new partner in the country being visited, prior hepatitis B immunization and the consistent and proper use of a latex condom are strongly advised, followed by proper medical investigations and physical examination on returning home, before sexual activity is resumed.     

An overview of sexually transmitted diseases

Brief summaries of the rate of infection and symptoms are provided for the following major sexually transmitted diseases (STDs): herpes simplex virus type 2, human papilloma viruses, trichomoniasis, chlamydia, gonorrhea, hepatitis B, and syphilis. Because STDs increase susceptibility to HIV and other serious complications, HIV educators are advised to counsel patients on the risks of STD exposure and infection. The rates by which some STDs increase the risk of infection with HIV are also provided.     

Progress in vaccines for sexually transmitted diseases

The development pipeline for vaccines to control sexually transmitted infections holds greater promise than ever before. Preclinical studies are encouraging in the development of chlamydia and gonococcal vaccines, and for the first time, recent clinical trials have shown the feasibility of creating vaccines to control genital herpes and cervical human papillomavirus infections. Behavioral research suggests that these vaccines will likely find acceptance among health care providers and consumers.     

Rapid tests for sexually transmitted diseases

Many molecular diagnostic tests for sexually transmitted diseases (STD_s) have been described recently but are not often accessible to clinicians in practice. There is a need for rapid, easy-to-perform, and accurate diagnostic tests for clinicians, especially for use in developing countries, where sophisticated laboratory support is often unavailable. Rapid tests, often termed “point-of-care” (POC) tests, can be performed in less than an hour in the doctor’s office, clinic, or in a field setting. If simple laboratory equipment is available, a health care worker or clinician can make an immediate diagnosis of a STD. Progress has been made in the development of POC tests for HIV, syphilis, trichomonas, and bacterial vaginosis, but more work is needed for chlamydia and gonorrhea. Improvements in POC_s will allow for faster treatment or provision of interventions in infected persons, in order to prevent transmission to partners or infants, thereby enabling effective control efforts for STDs.     

HIV testing and sexually transmitted infection care among sexually active youth in the Balkans

In light of the imminent threat of a growing HIV epidemic in east and southeast Europe, optimal accessibility of primary and secondary HIV preventative interventions, including HIV testing and sexually transmitted infection (STI) care, are fast becoming public health priorities. We surveyed 2150 high school students in Bosnia and Herzegovina, FYR of Macedonia, Serbia, and Montenegro to examine the uptake of HIV testing and associated predictors. Among sexually active youth (n = 651), 5.9% had already been tested for HIV. In marginal logistic regression, country of origin, type of high school, knowing a friend or relative with HIV, poor self-assessed health status, suspicion of having had an STI, and not having used a condom at first sex were independently associated with HIV testing. Fear of the diagnosis, fear of violation of confidentiality, and not knowing where to go for HIV testing were reported as barriers to HIV testing. Of sexually active adolescents who thought they might have contracted an STI, only 42% had subsequently visited a doctor or health facility. The main reasons for not doing so were spontaneous disappearance of the complaints, fear of the diagnosis and being ashamed of discussing the problem. In conclusion, the uptake of HIV testing among this population of sexually active, urban high school students was found to be low, although a higher prevalence of HIV testing history was observed among students showing evidence of risky sexual behavior. Practical and psychological factors seem to challenge the accessibility of facilities for HIV testing and STI care.     

Epidemiology of sexually transmitted diseases in rape victims

Rape is a violent crime that is increasing rapidly in incidence. Victims can include male and female adults and children. These victims may be at risk for the acquisition of many sexually transmitted conditions. The risk will vary with the sex and socioeconomic status of the assailant as well as with the nature of the sexual contact. Infections with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus, human papillomavirus, and Treponema pallidum have all been found to occur following sexual assault of female adults or children. Although data are lacking, male victims of homosexual rape are presumably at risk for the acquisition of the above infections as well as hepatitis B, the acquired immunodeficiency syndrome, and other infections prevalent among homosexual men. All victims of sexual assault should undergo a comprehensive physical examination with a complete history. Baseline and follow-up laboratory tests should be performed. In some instances, prophylactic administration of antimicrobial agents may be warranted.     

Spreading of sexually transmitted diseases in heterosexual populations

The spread of sexually transmitted diseases (e.g., chlamydia, syphilis, gonorrhea, HIV, etc.) across populations is a major concern for scientists and health agencies. In this context, both the data collection on sexual contact networks and the modeling of disease spreading are intensive contributions to the search for effective immunization policies. Here, the spreading of sexually transmitted diseases on bipartite scale-free graphs, representing heterosexual contact networks, is considered. We analytically derive the expression for the epidemic threshold and its dependence with the system size in finite populations. We show that the epidemic outbreak in bipartite populations, with number of sexual partners distributed as in empirical observations from national sex surveys, takes place for larger spreading rates than for the case in which the bipartite nature of the network is not taken into account. Numerical simulations confirm the validity of the theoretical results. Our findings indicate that the restriction to crossed infections between the two classes of individuals (males and females) has to be taken into account in the design of efficient immunization strategies for sexually transmitted diseases.     

Sentinel surveillance of sexually transmitted diseases in Italy

Statutory notifications suggest that the incidence of gonorrhoea and syphilis have fallen in the past 30 years in Italy, as in other developed countries. Nevertheless, during the 1980s, the annual notification rates in Italy were from 15 to 50 times lower     

Syphilis and other sexually transmitted diseases in HIV infection

An ongoing resurgence of syphilis and continued transmission of other common sexually transmitted diseases (STDs) in HIV-infected patients is fueled by a number of factors, including "prevention burnout" resulting from fatigue with long-term, safer-sex behavior, use of recretional drugs (notably methamphetamine), and false sense of security associated with HIV serosorting and elevated CD4+ cell count. Annual screening for common STDs is recommended for HIV-infected patients. Issues in syphilis and herpes simplex virus-2 (HSV-2) diagnosis and treatment are discussed. New problems are briefly reviewed, which include the increased reporting of lymphogranuloma venereum and the increased frequency of fluoroquinolone-resistant gonorrhea. The recently revised Centers for Disease Control and Prevention guidelines for treatment of syphilis, HSV-2 infection, chlamydial infection, and gonorrhea are summarized. This article summarizes a presentation on syphilis and other STDs made by Jeanne Marrazzo, MD, MPH, at the International AIDS Society-USA Continuing Medical Education course in New York, in October 2006. The original presentation is available as a Webcast at www.iasusa.org.     

Sexually transmitted diseases in prostitutes in Moshi and Arusha, Northern Tanzania.

Sexually transmitted diseases are thought to be important in facilitating transmission of HIV in sub-Saharan Africa. This study reports the prevalence of several sexually transmitted diseases in 106 prostitutes in Arusha and Moshi Northern Tanzania. The seroprevalence of HIV was 73% compared with 3% for local blood donors. Over half (51%) of the subjects had evidence of N. gonorrhoeae infection. Seventy-four per cent had a positive TPHA and 27% a positive RPR. Of 47 subjects tested 12 (25%) had Chlamydia trachomatis antigen detected in endocervical swabs. No significant statistical association was found between the presence of any of the STDs investigated and HIV seropositivity.