Sexually transmitted diseases among psychiatric patients in Brazil

Sexually transmitted diseases are still highly prevalent worldwide and represent an important public health problem. Psychiatric patients are at increased risk of sexually transmitted diseases but there are scarce published studies with representative data of this population. We sought to estimate the prevalence and correlates of self-reported sexually transmitted diseases among patients with mental illnesses under care in a national representative sample in Brazil (n = 2145). More than one quarter of the sample (25.8%) reported a lifetime history of sexually transmitted disease. Multivariate analyses showed that patients with a lifetime sexually transmitted disease history were older, had history of homelessness, used more alcohol and illicit drugs, suffered violence, perceived themselves to be at greater risk for HIV and had high risk sexual behavioral: practised unprotected sex, started sexual life earlier, had more than ten sexual partners, exchanged money and/or drugs for sex and had a partner that refused to use condom. Our findings indicate a high prevalence of self-reported sexually transmitted diseases among psychiatric patients in Brazil, and emphasize the need for implementing sexually transmitted diseases prevention programs in psychiatric settings, including screening, treatment, and behavioral modification interventions.     

Sexually transmitted diseases

Traditionally, STD is considered a disease of younger adults, and older adults continue to present a challenge to health care providers. Geriatric health care professionals must offer older adults adequate information relating to sexuality and aging. In addition, sexual health must be evaluated as a standard domain in routine comprehensive geriatric evaluation and management. Large-scale community education programs are helpful in encouraging cultural and societal acceptance of the sexuality of older adults. Finally, as baby-boomers age, health care professionals will face increasing pressure from their patients to address sexual health problems in geriatric clinical practice. The current dearth of relevant evidence-based information highlights the urgent need for prioritized research in this area.     

Sexually transmitted infections and infectiousness beliefs among people living with HIV/AIDS: implications for HIV treatment as prevention

Objectives

Sexually transmitted infections (STIs) significantly impact the health of people living with HIV/AIDS, increasing HIV infectiousness and therefore transmissibility. The current study examined STIs in a community sample of 490 HIV‐positive men and women.

Methods

Assessments were performed using confidential computerized interviews in a community research setting.

Results

Fourteen per cent of the people living with HIV/AIDS in this study had been diagnosed with a new STI in a 6‐month period. Individuals with a new STI had significantly more sexual partners in that time period, including non‐HIV‐positive partners. Participants who had contracted an STI were significantly more likely to have detectable viral loads and were less likely to know their viral load than participants who did not contract an STI. Multivariate analysis showed that believing an undetectable viral load leads to lower infectiousness was associated with contracting a new STI.

Conclusions

Individuals who believed that having an undetectable viral load reduces HIV transmission risks were more likely to be infectious because of STI coinfection. Programmes that aim to use HIV treatment for HIV prevention must address infectiousness beliefs and aggressively control STIs among people living with HIV/AIDS.     

Sexually transmitted infections and HIV among travellers: a review

Sexually transmitted infections are often acquired during travel. Infections are most often seen in young adults, travelling without a regular partner and among those who have higher numbers of partners while at home. Alcohol and recreational drug use may increase risk. The risks are highest from having unprotected sex with local partners in developing countries where the prevalence of infection can be many times higher than at home. The risks of acquiring HIV are highest in Africa, followed by South Asia. Special precautions are required by those going to work in health-care settings in high HIV prevalence countries. Travellers may benefit from advice about safer sex, condom use, emergency contraception and vaccination against hepatitis B. In special circumstances a starter pack for HIV post-exposure prophylaxis should be considered. Following return travellers should consider attending specialist services for a screen for sexually transmitted infections and HIV if they are concerned about exposure whilst travelling. A number of reports suggest that travel clinics need to pay more attention to the sexual health of travellers.     

Sexually transmitted diseases in travelers

International travelers engaging in casual sex are at risk for acquiring sexually transmitted diseases (STDs), including HIV. The frequency of international travel emphasizes the need for a travel sexual activity history to be included in the clinical assessment of any returned traveler. When formulating a differential diagnosis, the STD prevalence rates at the travel destination and the risk profile of the traveler and the sexual partner need to be considered. Casual sex with host country nationals residing in tropical and subtropical areas of the developing world increases the traveler’s risk for acquiring STDs rarely seen in industrialized countries, particularly bacterial genital ulcer diseases. Pretravel counseling needs to include education on STD prevention. A post-travel STD diagnostic evaluation is indicated when casual sexual activity has occurred during travel, regardless of whether symptoms are present.     

Sexually transmitted diseases in lesbians

The limited published data support the assumption that lesbians are a low risk group for sexually transmitted diseases (STDs). However, there are virtually no contemporary data and the older papers do not take into account genital wart virus infection, now the third most prevalent STD in Britain. One of the dangers in assuming that lesbians are a 'safe group' for STD and allied disorders is that patients may not attend for regular cervical cytology and could be at risk of developing cervical cancer. In an unselected series of 27 lesbians attending a genitourinary medicine clinic, the most important findings were a relatively high prevalence of the viral STDs, herpes simplex and human papillomavirus. Additionally, 10 patients had abnormal cytology ranging from inflammation to dyskaryosis. There is a need for more information about the true prevalence of STDs in this group and evaluation of the risk factors for female-to-female transmission of infections. Lesbians should continue to have regular cervical smears, especially as many have had earlier heterosexual intercourse.     

Sexually transmitted diseases in Germany

In the former West Germany, in specific venereal diseases legislation passed in 1953, only syphilis, gonorrhoea, ulcus molle, and lymphogranuloma venereum were defined as venereal diseases and subject to mandatory notification. The proportion of unreported cases was as high as 75% for syphilis and up to 90% for gonorrhoea. Epidemiological data for the past 10 years exist only on selected populations from research studies and are summarized in this article. In the former East Germany reporting of sexually transmitted infections (STIs) was mandatory and, due to the centralized organization, underreporting was considered to be low, although no specific studies have examined this. After the unification in 1990 of the two German states the West German laws were adopted in East Germany. Since 1982 - when the first AIDS case was reported in Germany - information on AIDS cases has voluntarily been collected at the national register at the AIDS Centre of the Robert Koch Institute in Berlin. The law governing the reporting of infectious diseases has recently been revised. Under the new Protection against Infection Act, which became effective on 1 January 2001, clinical diagnoses of STIs (with the exception of hepatitis B) are no longer notifiable diseases. Laboratory reporting of positive test results for Treponema pallidum has been introduced. With T. pallidum and HIV notifications, additional disaggregated data are collected. Since T. pallidum and HIV remain the only notifiable STIs, all other STIs have to be monitored through sentinel surveillance systems. These surveillance systems are currently being established. Under the new legislation, local health authorities have to provide adequate counselling and testing services for STIs, which may be provided free of charge if necessary.     

Sexually transmitted diseases in pregnancy

Sexually transmitted diseases may have a significant impact on the pregnant woman and her fetus and neonate. Infection at various stages of pregnancy may result in severe maternal disease, congenital defects, premature delivery, or neonatal infection. The clinician caring for pregnant women must be aware of the multitude of sexually transmitted diseases and their potential risks during pregnancy.     

Sexually transmitted diseases in incarcerated adolescents

PURPOSE OF REVIEW: The objectives of this review are to summarize recent developments in the epidemiology of sexually transmitted disease in incarcerated adolescents and to review screening and treatment recommendations for sexually transmitted disease in juvenile corrections facilities. RECENT FINDINGS: The introduction of non-invasive, urine-based nucleic acid-amplification tests for chlamydia and gonorrhea has led to a dramatic increase in the ability to screen for chlamydia and gonorrhea in non-traditional settings, including corrections facilities. The prevalence of chlamydia and gonorrhea has been uniformly high in incarcerated adolescents. The prevalences of chlamydia and gonorrhea in adolescents aged 18-19 years incarcerated in adult corrections facilities were higher than those incarcerated in juvenile facilities. The prevalence was higher in incarcerated adolescent women than adolescent men and in black adolescents than non-black adolescents. Screening for chlamydia in incarcerated adolescents has been shown to be a cost-effective strategy for preventing adverse health consequences. Syphilis prevalence in incarcerated adolescents is relatively low. Hepatitis B is relatively common among incarcerated adolescents. SUMMARY: The high prevalence of chlamydia in incarcerated adolescents and gonorrhea in incarcerated adolescent women suggests that screening of these populations should be a priority. The reasons for the higher prevalence of chlamydia and gonorrhea in young adults aged 18-19 years incarcerated in selected adult corrections facilities compared with those incarcerated in juvenile facilities should be investigated. Hepatitis B virus vaccination in juvenile correction facilities is recommended to prevent and control the transmission of this disease.     

Sexually transmitted diseases in older adults

Health professionals are frequently reluctant to recognize or investigate the sexuality of their older patients. Thus, sexual health may never be addressed, even among older adults who come into frequent contact with health care professionals. As the dominant culture continues to shift toward a more realistic view of aging that supports the expression of sexuality among older adults, evaluation of sexual health will become a critical component of comprehensive assessment of the geriatric patient. This article reviews the clinical features and management of common sexually transmitted diseases in the older adult.     

Sexually transmitted diseases in travelers.

Prevention of sexually transmitted diseases (STDs) is a low priority among travel clinic services, despite increasing evidence that travelers have an increased risk of acquiring such infections. A proportion of 5%-50% of short-term travelers engage in casual sex while abroad, and this rate is even higher among long-term travelers. Few publications are available on STD preventive interventions among travelers. Education and counseling are recognized as key components of risk reduction. New efforts should be put forth with regard to identifying effective tools to promote safer sexual behaviors and to reduce the spread of infection by promoting condom use. Travelers at increased risk should be identified for targeted interventions; research to validate proposed markers of increased risk is prospectively needed. Hepatitis B infection is the only STD that is preventable by vaccination. The feasibility and cost-effectiveness of STD screening in travelers after exposure is a virtually unexplored field, though it may represent an important component of STD control strategies in developed countries.     

Sexually transmitted infections among women living with HIV in a Brazilian city

BackgroundClinical improvements following highly active antiretroviral therapy (HAART) may increase high-risk behaviors resulting in sexually transmitted infections (STI). Optimism related to the success of HAART in slowing disease progression, reducing viral load, and improving health status might be important factors for increasing sexual risk behaviors such as less use of condoms.ObjectiveTo determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, hepatitis B and C, high-risk HPV, and cervical cytological abnormalities among women living with HIV (WLHIV) who attended a Reference Center for STI/AIDS in Brazil.MethodsA cross-sectional study was conducted among 151 WLHIV attending an STI Clinic in Vitória city, Brazil. A structured questionnaire, including demographic, behavioral, and clinical information, was used for data collection. Serological tests for HIV, syphilis, hepatitis C and B, CD4 counts, and viral load determination were performed. Cervical samples were collected for cytology and real-time PCR for HPV,Chlamydia, and Neisseria gonorrhoeae.ResultsIn this study, 59% of women had at least one diagnosed STI at the time of the first clinic visit; 31% had clinical forms of anogenital HPV, 10% syphilis, 8%Neisseria gonorrhoeae, 5.0% trichomoniasis, 3% Chlamydia trachomatis, 1% hepatitis B, and 1% hepatitis C; 6.7% of the women presented with cervical cytological abnormalities. Furthermore, 46.3% of women had HR-HPV, and 17.6% had HPV 16/18. Only 5% of the women had a CD4 count <200 cells/mm³, 61.6% had undetectable HIV viral load, and 81.3% were currently on HAART.ConclusionA high prevalence of STI and HR-HPV infections were observed among HIV-infected women in this investigation. Prevention programs need to focus on counseling WLHIV and their regular partners with focused interventions such as couples counseling and education programs.     

Sexually transmitted diseases. Urethritis in men

Gonococcal and nongonococcal urethritis (NGU) are among the most common syndromes afflicting men. NGU is caused primarily by Chlamydia trachomatis and Ureaplasma urealyticum, but the cause is unknown in approximately 20 to 30 percent of cases. Evaluation of a gram-stained urethral smear is generally sufficient to distinguish between gonococcal and nongonococcal urethritis. Owing to the frequent coexistence of Neisseria gonorrhoeae and C. trachomatis in heterosexual men, treatment regimens for gonococcal urethritis should generally include an effective antichlamydial regimen. Complications of urethritis are uncommon, but the causative pathogens produce serious morbidity in women. Prevention of urethritis is based on identification of asymptomatically infected persons who serve as the major reservoir of infection with both N. gonorrhoeae and C. trachomatis.     

Sexually transmitted diseases in injection drug users

The recommended work up for diagnosis of STDs in injection drug users is presented in the box. Diagnostic work up for sexually transmitted disease in injection drug users Asymptomatic patients-screening work up Serology VDRL, HIV antibody, hepatitis B surface antigen, hepatitis C antibodies AND Endocervical specimen Gonococcal culture, gonococcal DNA detection (probe) OR Amplification (PCR), chlamydial DNA detection or amplification OR Urine specimen-gonococcal and chlamydial DNA amplification (PCR) AND Vaginal specimen pH, clue cells, Trichomonas Endourethral specimen Gonococcal DNA amplification, chlamydial DNA amplification OR Urine specimen-gonococcal and chlamydial amplification Symptomatic patients-diagnostic work up All the above AND Genital ulcers Dark-field microscopy, Herpes simplex virus-DNA detection or culture, and, depending on geographic risk factors, Gram's stain for Hemophilus duceryl Exophytic lesions Clinical diagnosis of genital warts, skin biopsy if treatment fails VDRL, Venereal Disease Research Laboratory; PCR, polymerase chain reaction.     

Sexually transmitted diseases in children and adolescents

Sexually transmitted diseases have an impact on children's health at three times in their development: during pregnancy or delivery (through maternal-neonatal transmission), during prepubertal childhood (through sexual transmission), and during adolescence (through sexual transmission). These phases must be considered distinctly by the physician, since not only the type of infection but also the management and long-term implications of the disease vary with the time period in which it was acquired.     

Sexually transmitted diseases in leprosy patients in north and northeastern India. A futile search for human immunodeficiency virus antibody

Three-hundred-eighty-four leprosy patients were clinically examined for sexually transmitted diseases (STD) in north and northeastern India, revealing a high incidence (5.2%) of STD among them. Eighteen males, one female, and one eunuch were found to have chancroid ulcer, gonococcal urethritis, lymphogranuloma inguinale, and primary chancre. Of these patients, only 100, selected randomly, could be screened serologically for STD due to Treponema pallidum, herpes simplex (type 1 and 2), Entamoeba histolytica, hepatitis-associated virus, cytomegalovirus, Chlamydia trachomatis and human immunodeficiency virus (HIV); 100 control sera were included for comparison. In addition, sera from another 133 normal subjects and another 176 lepromatous patients were also screened for HIV antibody. Thus, a total of 233 normal sera and 276 leprosy sera were tested for HIV antibody. Although our leprosy patients have shown significantly high incidences of clinical STD and also high seropositivity against T. pallidum, herpes-simplex viruses types 1 and 2, hepatitis-associated virus, and cytomegalovirus, the search for antibody against HIV was negative. Our clinical and serological data suggest promiscuity in our patient population. The absence of HIV antibody in this high-risk population, however, seems to be an enigma.