Sexually transmitted diseases in a general practice

A pilot study of the occurrence of latent sexually transmitted diseases in a sexually active sample was carried out in a general practice. The conclusions confirm that a reliable diagnosis of a sexually transmitted disease cannot be made in general practice when based only on the opinion of the patient. Full venereological history, examination and microbiological backup are essential. The microbiological investigations should be broad-based and should not rely on one specimen or method.     

Sexually transmitted diseases in victims of rape

The risk of acquiring a sexually transmitted disease as a result of rape is not known, in part because it is difficult to ascertain whether infections were present before the assault or acquired during it. To investigate this question, we examined female victims of rape within 72 hours of the assault and again at least one week after the assault. Of the 204 girls and women initially examined within 72 hours of the rape, 88 (43 percent) were found to have at least one sexually transmitted disease. These diseases included infections caused by Neisseria gonorrhoeae (6 percent of those tested), cytomegalovirus (8 percent), Chlamydia trachomatis (10 percent), Trichomonas vaginalis (15 percent), herpes simplex virus (2 percent), Treponema pallidum (1 percent), and the human immunodeficiency virus type 1 (HIV-1; 1 percent) and bacterial vaginosis (34 percent). Among the 109 patients (53 percent) who returned for at least one follow-up visit (excluding those who were found to be infected at the first visit or who were treated prophylactically), the incidence of new disease was as follows: gonorrhea, 4 percent (3 of 71); chlamydial infection, 2 percent (1 of 65); trichomoniasis, 12 percent (10 of 81); and bacterial vaginosis, 19 percent (15 of 77). There were no new infections with herpes simplex virus, cytomegalovirus, Trep. pallidum, or HIV-1, but follow-up serologic testing was performed in only 26 percent of the patients. On the basis of our assumptions that most venereal infections present within 72 hours of a rape were preexisting and that new infections identified 1 to 20 weeks later were acquired during the assault, we conclude that the prevalence of preexisting sexually transmitted diseases is high in victims of rape and that they have a lower but substantial additional risk of acquiring such diseases as a result of the assault.     

Sexually transmitted diseases in the History of Medicine

Classic sexually transmitted diseases (syphilis, gonorrhea, condyloma acuminatum, venereal ulcera) were known since ancient times. Being considered as a "divine punishment" for impure intercourses, they were generally mistaken one for another (except for condylomatosis) until the different pathogenic agents were identified in the course of 19th Century. It was only with the introduction of antibiotics that their incidence drastically fell, at least up to this last decade, as a number of factors determined their fresh outbreak.     

Sexually transmitted infections in primary care: a need for education.

General practitioners and practice nurses require the clinical skills that will enable them to detect sexually transmitted infections in the context of a shift to having no, or insidious symptoms. They need to be able to confirm the diagnosis and have clear models for management and referral. Primary care and genitourinary medicine need to work more closely together to increase mutual understanding and clarify the issues which surround referral and attendance. Sexual health risk assessment through the investigation of sexual history is a helpful way forward in both differential diagnosis and in targeting sexual health promotion and care. Many aspects of these clinical skills are specific to the primary care context. There is a need for improved undergraduate, postgraduate, and in-service training. Multidisciplinary educational approaches are ideal for the subject of sexual health. Primary care groups offer a potential way forward to help develop quality in primary care and some are developing health improvement programmes that aim to address sexual health issues.     

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.     

Individual and community risk factors and sexually transmitted diseases among arrested youths: a two level analysis

High rates of infection for chlamydia and gonorrhea have been noted among youths involved in the juvenile justice system. Although both individual and community-level factors have been found to be associated with sexually transmitted disease (STD) risk, their relative importance has not been tested in this population. A two-level logistic regression analysis was completed to assess the influence of individual-level and community-level predictors on STD test results among arrested youths processed at a centralized intake facility. Results from weighted two level logistic regression analyses (n = 1,368) indicated individual-level factors of gender (being female), age, race (being African American), and criminal history predicted the youths’ positive STD status. For the community-level predictors, concentrated disadvantage significantly and positively predicted the youths’ STD status. Implications of these findings for future research and public health policy are discussed.     

Sexually transmitted diseases and the increased risk for HIV transmission: implications for cost-effectiveness analyses of sexually transmitted disease prevention interventions

We estimated the annual number and cost of new HIV infections in the United States attributable to other sexually transmitted diseases (STDs). We used a mathematical model of HIV transmission to estimate the probability that a given STD infection would facilitate HIV transmission from an HIV-infected person to his or her partner and to calculate the number of HIV infections due to these facilitative effects. In 1996, an estimated 5,052 new HIV cases were attributable to the four STDs considered here: chlamydia (3,249 cases), syphilis (1,002 cases), gonorrhea (430 cases), and genital herpes (371 cases). These new HIV cases account for approximately $985 million U.S. in direct HIV treatment costs. The model suggested that syphilis is far more likely than the other STDs (on a per-case basis) to facilitate HIV transmission. This analysis provides a framework for incorporating STD-attributable HIV treatment costs into cost-effectiveness analyses of STD prevention programs.     

Sexually transmitted infection services as a component of HIV care: findings of a demonstration project among HIV-infected women in Thailand

OBJECTIVES: As Thailand scales up its antiretroviral treatment program, the role of sexually transmitted infection (STI) services to prevent HIV transmission has not been addressed. We provided STI services for HIV-infected women as a component of HIV care and assessed STI prevalence and risk behaviors. METHODS: HIV-infected women attending an infectious disease clinic and an STI clinic in Bangkok were screened for the presence of genital ulcers by visual inspection, for gonorrhea and chlamydial infection by polymerase chain reaction, for trichomoniasis by wet mount, and for syphilis by serology. Women were asked about sexual risk behavior and use of antiretroviral treatment. Risk-reduction counseling, condoms, and STI treatment were provided. RESULTS: Two-hundred ten HIV-infected women at an infectious disease clinic (n = 150) and an STI clinic (n = 60) received STI services from July 2003 through February 2004. The prevalence for any STI was 8.0% at the infectious disease clinic and 30.0% at the STI clinic (P < 0.01). Of the 116 (55.2%) sexually active women, 42 (36.2%) reported sex without a condom during the last 3 months. Women receiving antiretroviral treatment reported condom use during last sex more often compared with those not receiving antiretroviral treatment (82.2% vs. 58.8%; P = 0.03). CONCLUSION: STIs and sexual risk behavior were common among these HIV-infected women, and STI services for HIV-infected persons have been expanded to more clinics in Thailand. Further analysis of HIV transmission risk is necessary for developing a national strategy for prevention of HIV transmission among HIV-infected persons.     

Factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe; 2007

Background

Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases.

Objective

To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane.

Methods

A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities for other ailments. We interviewed 77 cases and 154 controls.

Results

Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42–20.85), relationships less than one year, OR= 9.33 (95% CI 3.53–24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64–16.25) and paying for sex OR= 23.65 (95% CI 6.23–89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02–6.04) and relationships less than one year OR=3.19 (95% CI 1.41–7.23).Significant differences in attitudes were evident among cases and controls.

Conclusion

Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women.     

Sexually transmitted disease among women with HIV infection: a missed opportunity for intervention

Women with HIV disease face not only the same barriers to safe sexual and drug use behaviors that placed them at risk for infection but also problems unique to their serostatus. The high incidence of sexually transmitted disease among some subgroups of women with HIV infection, particularly among those who engage in illicit drug use, demands that the scope of their HIV care encompass identification and treatment of both drug addiction and sexually transmitted disease.     

Attachment and health care relationships in low-income women with trauma histories: a qualitative study

Few studies have examined the relationship between low-income, traumatized women and their health care providers. In this study we interviewed 23 women from primary care and social service settings for the underserved about trauma, attachment, psychiatric symptoms, and reports of their interactions with primary care providers. Nearly all reported trauma exposure, and 17% had current posttraumatic stress disorder. About half were categorized as Unresolved with regard to attachment state of mind. Analyses of a health experiences interview showed that women with Unresolved attachment reported significantly more negative interactions with providers. Attachment may play a role in the relationship between trauma and health care interactions with providers, indicating the need for further study of this relationship and suggesting intervention strategies to help both parties contribute to a more collaborative process.     

The value of choice: a qualitative study

BACKGROUND: Providing choice in health care is part of an ongoing policy initiative. AIM: To explore how people understand choice in healthcare provision. DESIGN OF STUDY: A qualitative study using semi-structured interviews. SETTING: South East England. METHOD: Twenty-two people were interviewed about the issue of choice in general, and choice in healthcare in particular. Data were analysed using template analysis. RESULTS: Participants discussed choice in the NHS within the context of the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. Participants valued choice in principle, and having choice was seen as positive. However, the provision of choice options was not always associated with the possibility of meaningful choice. Participants expressed that in some instances they were given the appearance rather than the substance of choice. Making - as opposed to having - choice was often unwanted and considered as indicative of erosion in trust in the GP. Information was seen as a necessary, but not sufficient, prerequisite of informed choice. CONCLUSION: People value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine, rather than promote, the doctor-patient relationship.     

Improvement of health care for patients with upper respiratory tract diseases associated with chlamydia infection

At present the issues in regard to Chlamydia infection are not only limited by urogenital system. By the way optimal organization and non-urogenital chlamydiosis treatment strategy (with respiratory tract involvement in particular) have not been worked out yet and require immediate solutions. Due to new knowledge on respiratory chlamidiosis the authors discuss scientific background for future development of complex measures and main directions of health care support strategy for patients with upper respiratory associated with Chlamydia infection.