Herpes simplex virus seroprevalence and risk factors in 2 Canadian sexually transmitted disease clinics

OBJECTIVES: The objectives of this study were to determine the seroprevalence and risk factors for herpes simplex virus (HSV) types 1 and 2 in patients attending 2 Canadian sexually transmitted disease (STD) clinics. STUDY: Stored sera were tested for the presence of IgG class antibodies to HSV-1 and HSV-2 and results linked to that obtained from a risk behavior questionnaire. RESULTS: Overall prevalences for HSV-1 and -2 were 56% and 19%, respectively. HSV-1 and -2 seropositivity was associated with increasing age, female gender, nonwhite ethnicity, and a history of STD. HSV-2 seropositivity was also associated with a history of genital herpes, presence of genital sores, and coinfection with either human immunodeficiency virus (HIV) or hepatitis C (HCV). CONCLUSIONS: Herpes simplex infection is common in this high-risk Canadian population. Our finding that HCV seropositivity was a significant predictor for HSV-2 seropositivity emphasizes the overlap between pathogens that are primarily thought to be bloodborne pathogens and sexually transmitted infections and the need to target prevention in these areas concurrently.     

High-risk sexual behaviour in men attending a sexually transmitted infection clinic in Durban, South Africa

Objectives

A study of men with genital ulcer disease (GUD) in Durban, South Africa, at the start of the local HIV epidemic in 1988/1989 found that 36% of men with GUD continued with sexual intercourse despite symptoms. The aim of this study was to determine whether this high‐risk behaviour was still prevalent and to enquire about similar risk behaviours with other sexually transmitted infection (STI)‐related problems.

Methods

650 Men attending the main Durban STI clinic with a new complaint were enrolled. A standard questionnaire was administered. Polymerase chain reaction (PCR) tests were performed to diagnose genital herpes from ulcer specimens and gonorrhoea and chlamydia from those with urethral discharge and/or dysuria. Serology tests were performed for HIV, herpes simplex virus type 2 (HSV‐2) and syphilis.

Results

Sex since the start of symptoms was reported by between 33.3% and 43.9% of men with GUD, herpetic ulcers, gonorrhoea and/or chlamydia or dysuria. The incidence of condom use was very low in all groups having sex despite symptoms. In 87 men with genital ulcers confirmed positive for genital herpes by PCR testing, 30 (34.4%) had had sex since the start of symptoms, 28 (93.3%) of whom had had unprotected sex.

Conclusions

There is a high level of risk behaviour in this group of men in whom genital herpes is the most common cause of GUD. This risky sexual behaviour could reflect disinhibition, possibly because so many have already been infected with HSV‐2, lack of education or other unknown factors. Syndromic STI management should be strengthened with intensive health education to promote community awareness of both genital ulceration and genital herpes and their role in facilitating HIV transmission. The low level of condom use indicates that condom promotion programmes still have much to achieve.Very high rates of genital ulceration have been reported from countries worst affected by HIV.¹ The reasons for this are uncertain but could reflect low rates of male circumcision or some other behavioural factors not yet identified. At the start of the HIV epidemic in Durban, South Africa, a study of men and women with genital ulcer disease (GUD) in 1988/1989 found that 36% of men and 36% of women with GUD continued with sexual intercourse despite symptoms.² Syphilis and chancroid were the most common causes of GUD then, but subsequent studies have shown that the incidence of both these conditions has declined whereas genital herpes has increased significantly.^3,4 Moreover, in a systematic review and meta‐analysis, prevalent herpes simplex virus type 2 (HSV‐2) infection was associated with a threefold increased risk of HIV acquisition among men and women in the general population, suggesting that in areas of high HIV‐2 prevalence a high proportion of HIV is attributable to HSV‐2.⁵After the onset of the local HIV epidemic in the early 1990s in Durban, sexually transmitted infection (STI) treatment and care was decentralised so that primary care would deal with all but the most complicated or resistant STI cases. Although this strategy was expected to improve delays in treatment, it was uncertain whether staff in primary healthcare settings would be motivated to provide health education for the very high‐risk practices outlined above and to counsel patients diagnosed with genital herpes.The primary objectives of this study were to determine whether there were differences in the sociodemographic profile and sexual behaviour of men with and without genital ulcers and selected aspects of healthcare seeking and sexual behaviour in men with genital ulcers, genital herpes, gonorrhoea and/or chlamydia or dysuria.     

Aetiology of sexually transmitted infections and response to syndromic treatment in southwest Uganda

OBJECTIVE: To determine the aetiology of genital ulcers and discharges in rural south western Uganda and to assess response to syndromic treatment. METHOD: A longitudinal, prospective study using laboratory testing and questionnaires to evaluate 561 adult men and women presenting with clinically verified genital ulcers, urethral, or vaginal discharge at a general outpatient clinic and two health centres between December 1999 and July 2001. RESULTS: One third of patients had genital ulcers and two thirds discharges. There was good response to treatment in 461/508 patients (90.7%). Herpes simplex virus type 2 was found in 95/217 (43.8%) genital ulcers. In 24.1% of ulcer cases there was also a genital discharge. HIV seropositivity was high in ulcer cases (63.2%), with significantly more HSV2 and secondary bacterial infection than in seronegative cases. Neisseria gonorrhoeae was found in 135/204 (66.2%) male genital discharges. Female genital discharges were mostly associated with bacterial vaginosis (36.1%), Trichomonas vaginalis (18.9%), and candidiasis (18.6%). CONCLUSIONS: The aetiological pattern of STI syndromes reported will help inform revision of national STI guidelines. The importance of herpes simplex virus type 2, the variation in causes of genital ulcers according to HIV serostatus, the high frequency of multiple infections and secondary bacterial contamination of genital ulcers are notable. These results help explain the lack of effect of an STI intervention on HIV incidence in a recent trial in this area.     

Sexually transmitted and reproductive tract infections in symptomatic clients of pharmacies in Lima, Peru

OBJECTIVE: To determine prevalences and predictors of sexually transmitted and reproductive tract infections among men and women seeking care at pharmacies. METHODS: Men and women with urethral discharge or dysuria and vaginal discharge were enrolled at 12 central and 52 smaller pharmacies in Lima, Peru. All participants answered a questionnaire. Men provided urine for polymerase chain reaction (PCR) testing for Neisseria gonorrhoeae and Chlamydia trachomatis, and for leucocyte esterase testing. Women provided self-obtained vaginal swabs for PCR testing for N gonorrhoeae and C trachomatis, Trichomonas vaginalis culture and bacterial vaginosis and Candida. RESULTS: Among 106 symptomatic men, N gonorrhoeae and C trachomatis were detected in 34% and were associated with urethral discharge compared with dysuria only (odds ratio (OR) 4.3, p = 0.003), positive urine leucocyte esterase testing (OR 7.4, p = 0.009), less education (OR 5.5, p = 0.03), and with symptoms for <5 days (OR 2.5, p = 0.03). Among 121 symptomatic women, 39% had bacterial vaginosis or T vaginalis, and 7.7% had candidiasis. N gonorrhoeae and C trachomatis were detected in 12.4% of the women. Overall, 48.8% had one or more of these infections. No factors were associated with vaginal infection, and only symptoms of vaginal discharge for <5 days were associated with N gonorrhoeae and C trachomatis (OR 4.0, p = 0.02). The main reason reported for seeking advice at pharmacies by both men and women was trust in pharmacy workers. CONCLUSIONS: Among men and women presenting to pharmacies with urethral and vaginal symptoms, rates of urethral and vaginal infections were comparable to those found in other clinical settings. Pharmacies can contribute to the care and prevention of sexually transmitted infection in developing countries.     

Herpes simplex virus type 2 (HSV-2) Western blot confirmatory testing among men testing positive for HSV-2 using the focus enzyme-linked immunosorbent assay in a sexually transmitted disease clinic

OBJECTIVE: The objective of this study was to define the positive predictive value (PPV) of the Focus herpes simplex virus type 2 (HSV-2) enzyme-linked immunosorbent assay (ELISA) in a low HSV-2 prevalence population and to develop a new test interpretation algorithm. METHODS: HSV-2 Western blots were performed on sera from male sexually transmitted disease clinic patients testing HSV-2 ELISA-positive and used to define a new class of indeterminate HSV-2 ELISA result. HSV-2 Western blots were then prospectively performed on sequential sera with indeterminate HSV-2 ELISAs. RESULTS: Ninety-one (84%) of 108 HSV-2 ELISA-positive sera tested HSV-2 Western blot-positive. Western blot positivity was more common in men without herpes simplex virus type 1 (HSV-1) antibody than in those with HSV-1 antibody (93% vs 76%, P = 0.02) and in men with a history or clinical evidence of genital lesions (88% vs 80%, P = 0.30). Selectively raising the ELISA index value defining HSV-2 positivity from >1.1 to >or=3.0 either among HSV-1-positive men or among those without a history or clinical evidence of genital lesions increased the PPV to >or=93%. Prospective evaluation of an algorithm incorporating HSV-1 serostatus found that 11 of 70 persons with indeterminate HSV-2 ELISAs were Western blot-positive. CONCLUSIONS: Clinicians should consider selectively using a higher index value to define Focus ELISA HSV-2 positivity based on either HSV-1 serostatus or clinical circumstances.     

Trends in herpes simplex virus type 1 and 2 infections among patients diagnosed with genital herpes in a Finnish sexually transmitted disease clinic, 1994-2002

OBJECTIVE: The objective of this study was to analyze the proportion of herpes simplex virus types 1 and 2 (HSV-1 and -2) in genital infections during a 9-year period (1994-2002) in a Finnish sexually transmitted disease (STD) clinic population. STUDY DESIGN: We analyzed prospectively the proportion of HSV-1- or -2-positive culture samples from our STD clinic patients with genital herpes during years 1994-2002 and compared the proportions of HSV-1 and HSV-2 findings with the age and gender of the patients. RESULTS: The proportion of HSV-1 infections increased from 18.7% (39 of 209) in 1994-1996 to 25.9% (52 of 201) in 2000-2002 (P = 0.032). Female patients with genital herpes and laboratory isolation of HSV-1 were 35.9% of the cohort from 1994-1996 and 67.3% of the cohort from 2000-2002. The mean age of male patients with HSV-1 decreased from 29.3 years in 1994-1996 to 24.1 years in 2000-2002 (P = 0.023). CONCLUSIONS: An increase in the proportion of genital infections caused by HSV-1 was found. The increase was mainly the result of the increase in the number of female patients with HSV-1. Male patients acquire genital HSV-1 infection at a younger age than 10 years ago.     

Herpes simplex virus type 2 seroepidemiology in Spain: prevalence and seroconversion rate among sexually transmitted disease clinic attendees

BACKGROUND: Only limited data on the seroprevalence of herpes simplex virus type 2 (HSV-2) are available from European countries. Until recently, serologic tests for HSV-2 serotyping have been hampered by cross-reactivity to type-common antigens. The present study aims at providing data on the prevalence of HSV-2 infection in a group of STD clinic attendees using a reliable type-specific immunoassay. GOAL: To evaluate the seroprevalence of HSV-2 and the accumulated incidence of clinical genital herpes infection in a sample of Spanish sexually transmitted disease (STD) clinic attendees. STUDY DESIGN: The study consisted of two parts. First, a cross-sectional study of HSV-2 seroprevalence was conducted in patients with STDs. Second, a prospective cohort study was undertaken to evaluate the accumulated incidence of infection by HSV-2 and of clinical episodes of genital herpes in HSV-2-negative patients included in the first study during a follow-up period of 6 to 18 months. RESULTS: Of the 374 patients (129 men, 245 women) studied, 25% were seropositive for HSV-2 (12% of men, 30% of women). Antibodies to HSV-2 were related to female gender (odds ratio, 2.7; P < 0.001) and to the number of sexual partners (odds ratio, 4.1; P < 0.001). Fifty-two percent of patients (145 of 281 patients) who were initially seronegative returned to the clinic for a second serologic testing, of whom 1% (2 of 145 patients) had seroconverted. None of the patients developed genital herpes during the follow-up period. CONCLUSION: The relatively high seroprevalence (25%) and the low rate (4%) of HSV-2 previously reported in the general population in Spain suggest that the virus circulation may be restricted to certain risk groups. Therefore, future healthcare measures may target specific groups, such as patients with STDs.     

Recurrent genital herpes in a population attending a clinic for sexually transmitted diseases.

Patients with recurrent genital herpes attending a sexually transmitted disease clinic were studied and transmission of the infection was elucidated by evaluating serostatus in their partners. Of 84 patients attending for recurrent genital herpes, 94% had a herpes simplex virus type 2 (HSV-2) infection and only 6% (5 patients) a type 1 infection. The mean age of the patients was 36 years and the duration of their infection was up to 37 years (median 4 years). In most patients the number of recurrences had not decreased between the first year and the last year. About half had experienced a more severe first episode infection. Of the patients, 64% were not aware of asymptomatic shedding and the risk of sexual transmission without clinical symptoms. Of 67 steady partners of patients with genital HSV-2, 15% had a history of genital herpes. By HSV serology, HSV-2 antibodies (indicating subclinical genital herpes) were demonstrated in more than half of the partners. The duration of the relationship or condom use did not seem to influence the frequency of transmission to the partner, which may indicate an individual susceptibility for acquiring a genital HSV-2 infection. Eleven per cent of the patients were on suppressive antiviral therapy, while 39% had no experience of antiviral therapy. Type-specific HSV serology was found to be of value in counselling partners of patients with genital herpes.     

Prevalence of asymptomatic sexually transmitted infections among high-risk patients attending a free anonymous HIV-screening center

INTRODUCTION: The aim of this study was to assess the prevalence of sexually transmitted infections among patients attending an anonymous HIV Screening Center. PATIENTS AND METHODS: This prospective study was performed in the HIV Screening Center of University hospital in Reims (France) from May 1997 to December 1997. The inclusion criteria were the asymptomatic clinical presentation and the presence of risk factors for sexually transmitted infections referring to WHO criteria. The methods included clinical examination after application of acetic acid and urethral and endocervical swabs to identify:Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, Trichomonas vaginalis in specific culture. Treponema pallidum and HIV-1 infection were both detected by Enzym Linked Immuno Sorbent Assay (ELISA). RESULTS: One hundred and one patients (62 men and 39 women) were included in the study. Their mean age was 27 +/- 4 Years. Risk factors for sexually transmitted infections were: multiple sexual partners 81 p. 100; homo or bisexuality 16 p. 100; intravenous drug use 3 p. 100. The sexually transmitted infections were: HIV-1 infection 1 p. 100;Ureaplasma urealyticum 25 p. 100; genital warts 5 p. 100;Chlamydia trachomatis 3 p. 100; Gardnerella vaginalis 3 p. 100; Mycoplasma hominis 2 p. 100; Treponema pallidum 0 p. 100; Neisseria gonorrhoeae 0 p. 100; Trichomonas vaginalis 0 p. 100. The prevalence of sexually transmitted infections was significantly higher among women (p<0.05). DISCUSSION: Classical sexually transmitted infections and HIV infection were rarely detected in this study; but prevalence of other sexually transmitted infections (genital warts, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum) was high. Ureaplasma urealyticum is considered as a possible pathogenic agent in pregnant women (preterm delivery, decrease of birth weight, chorioamniotitis). These results suggest that other than sexually transmitted infections in high risk patients attending a HIV Screening Center other sexually transmitted infections should also be systematically screened for.     

Sentinel surveillance of sexually transmitted infections in South Africa: a review

OBJECTIVES: To review studies of sexually transmitted infection (STI) prevalence in South Africa between 1985 and 2003 in selected sentinel populations. To examine how STI prevalence varies between populations and to identify the limitations of the existing data. METHODS: Studies of the prevalence of syphilis, chancroid, granuloma inguinale, lymphogranuloma venereum, gonorrhoea, chlamydia, trichomoniasis, bacterial vaginosis, candidiasis, and herpes simplex virus type 2 (HSV-2) were considered. Results were included if they related to women attending antenatal clinics or family planning clinics, commercial sex workers, individuals in the general population (household surveys), patients with STIs, patients with genital ulcer disease (GUD), or men with urethritis. RESULTS: High STI prevalence rates have been measured, particularly in the case of HSV-2, trichomoniasis, bacterial vaginosis and candidiasis. The aetiological profile of GUD appears to be changing, with more GUD caused by HSV-2 and less caused by chancroid. The prevalence of gonorrhoea and syphilis is highest in "high risk" groups such as sex workers and attenders of STI clinics, but chlamydia and trichomoniasis prevalence levels are not significantly higher in these groups than in women attending antenatal clinics. CONCLUSIONS: The prevalence of STIs in South Africa is high, although there is extensive variability between regions. There is a need for STI prevalence data that are more nationally representative and that can be used to monitor prevalence trends more reliably.     

Use of a glycoprotein G-based type-specific assay to detect antibodies to herpes simplex virus type 2 among persons attending sexually transmitted disease clinics

BACKGROUND: Most genital herpes simplex virus type 2 (HSV-2) infections are unrecognized, thus, strategies to reduce the sexual transmission of HSV-2 are partly dependent on serologic screening. GOAL: To define performance characteristics of the Gull/ Meridian glycoprotein G-based HSV-2 enzyme-linked immunosorbent assay among sexually transmitted disease clinic attendees and correlates of test acceptance. STUDY DESIGN: The cross-sectional study was conducted during two periods. Serologic testing was offered at a US $15 charge during the first period and at no charge during the second period. Sera were tested by a type-specific glycoprotein G enzyme-linked immunosorbent assay and Western blot analysis, with the latter test used as the reference standard. RESULTS: Acceptance of HSV-2 testing was associated with free testing (odds ratio, 7.5; 95% CI, 6.0-9.9), older age, and white race. Sensitivity of the HSV-2 assay was 80.5% and specificity was 98.5%. The HSV-2 positive and negative predictive values were 95.8% (95% CI, 91.6-98.0%) and 92.2% (95 % CI, 89.6 -94.2%), respectively. Antibodies to HSV-2 were detected in 25.9% of 606 persons with no history of genital herpes. CONCLUSION: Acceptance of HSV-2 serologic testing was cost sensitive. In this high-prevalence population, the positive predictive value of the enzyme-linked immunosorbent assay was sufficient to warrant its use without a confirmatory test. This assay could be useful in the screening of sexually active adults to detect unrecognized HSV-2 infection.     

Baseline survey of sexually transmitted infections in a cohort of female bar workers in Mbeya Region, Tanzania

OBJECTIVES: To determine baseline prevalence of sexually transmitted infections (STI) and other reproductive tract infections (RTI) and their association with HIV as well as sociodemographic and behavioural characteristics in a newly recruited cohort of female bar workers in Mbeya Region, Tanzania. METHODS: 600 female bar workers were recruited from 17 different communities during September to November 2000 and underwent gynaecological examination, laboratory testing for HIV/STI, and interviews using structured questionnaires. RESULTS: HIV-1 seroprevalence was 68%. Prevalences of STI/RTI were high titre syphilis (TPPA/RPR >/=1/8), 9%; herpes simplex virus 2 antibodies, 87%; chlamydia, 12%; gonorrhoea, 22%; trichomoniasis, 24%; and bacterial vaginosis, 40%. HIV infection was associated with TPPA and HSV-2 seropositivity, bacterial vaginosis and clinically diagnosed genital ulcers, blisters, and warts. Reported high risk sexual behaviour during the past year (having multiple casual partners) was associated with prevalent STI. CONCLUSION: Female bar workers in Mbeya are at high risk of STI and HIV infection. Targeted STI/HIV prevention interventions for these women and their sexual partners need to be reinforced. Methods should be sought to improve healthcare seeking and to provide easily accessible and affordable STI care services.     

Prevalence of sexually transmitted infections and high-risk sexual behaviors in heterosexual couples attending sexually transmitted disease clinics in Peru

OBJECTIVES: The objectives of this study were to determine the prevalence of sexually transmitted infection (STIs) in heterosexual couples and the sexual behaviors associated with their acquisition. GOAL: The goal of this study was to better direct educational efforts to decrease STI among heterosexual couples in Lima, Peru. STUDY DESIGN: We conducted a case-control study in 195 heterosexual couples without HIV infection who attended 2 sexually transmitted disease clinics in Lima, Peru. A case was defined as an individual with one or more newly diagnosed STIs such as gonorrhea, chlamydia, trichomoniasis, herpes simplex, syphilis, mycoplasma, or ureaplasma. RESULTS: Thirty-three percent of individuals (41 men and 89 women) had at least one STI and 26 couples (13%) had the same STI detected. Men who have sex with men (MSM) accounted for 13% of all men, had higher rate of STIs and higher risk behaviors than non-MSM. Ureaplasma infection was the most prevalent STI found in both men and women and was associated with oral sexual contact. In heterosexual pairs, condom use during anal sex occurred less than 10% of the time. CONCLUSIONS: The heterosexual couples in sexually transmitted disease clinics have high-risk behaviors and STIs are frequent. The educational effort concerning prevention of STIs requires higher effort.     

Sexually transmitted infections in women who have sex with women

OBJECTIVES: To describe the prevalence of sexually transmitted infection (STIs) in a sample of women who have sex with women (WSW) and to identify risk factors for the acquisition of STI. METHOD: Cross sectional survey. Questionnaire for demographic, sexual history, and sexual practice data linked with the results of genitourinary examination. 708 new patients attending two sexual health clinics for lesbians and bisexual women in London were surveyed. RESULTS: A majority of WSW reported sexual histories with men (82%). Bacterial vaginosis and candida species were commonly diagnosed (31.4% and 18.4% respectively). Genital warts, genital herpes, and trichomoniasis were infrequently diagnosed (1.6%, 1.1%, and 1.3% respectively). Chlamydia, pelvic inflammatory disease, and gonorrhoea infections were rare (0.6%, 0.3%, and 0.3% respectively) and diagnosed only in women who had histories of sex with men. CONCLUSIONS: Although we have demonstrated a low prevalence of STI, WSW may have sexual histories with men as well as women or histories of injecting drug use, and are therefore vulnerable to sexually transmitted or blood borne infections. Diagnosis of trichomoniasis, genital herpes, and genital warts in three women who had no history of sex with men implies that sexual transmission between women is possible.     

Urethral syndrome in women attending a clinic for sexually transmitted diseases

Of 107 women investigated for frequency of micturition and dysuria, 21 had gonorrhoea, 14 chlamydial urethritis, eight an Escherichia coli urinary tract infection, 18 candidosis, 12 trichomoniasis, and four asymptomatic genital herpes. No organisms were isolated from 30 patients. Eighty nine women referred themselves and 18 were referred by the family practitioner. These findings suggest that Chlamydia trachomatis is frequently associated with the urethral syndrome among patients attending sexually transmitted disease clinics.     

Male circumcision and common sexually transmissible diseases in a developed nation setting.

OBJECTIVE--To determine whether the circumcision status of men affected their likelihood of acquiring sexually transmissible diseases (STDs). DESIGN--A cross-sectional study employing an anonymous questionnaire, clinical examination and type specific serology for herpes simplex virus type 2 (HSV-2). SETTING--A public STD clinic in Sydney, Australia. SUBJECTS--300 consecutive heterosexual male patients. MAIN OUTCOME MEASURES--Associations between circumcision status and past or present diagnoses of STDs including HSV-2 serology and clinical pattern of genital herpes. RESULTS--185 (62%) of the men were circumcised and they reported similar ages, education levels and lifetime partner numbers as men who were uncircumcised. There were no significant associations between the presence or absence of the male prepuce and the number diagnosed with genital herpes, genital warts and non-gonococcal urethritis. Men who were uncircumcised were no more likely to be seropositive for HSV-2 and reported symptomatic genital herpes outbreaks of the same frequency and severity as men who were circumcised. Gonorrhoea, syphilis and acute hepatitis B were reported too infrequently to reliably exclude any association with circumcision status. Human immunodeficiency virus infection (rare among heterosexual men in the clinic) was an exclusion criterion. CONCLUSIONS--From the findings of this study, circumcision of men has no significant effect on the incidence of common STDs in this developed nation setting. However, these findings may not necessarily extend to other setting where hygiene is poorer and the spectrum of common STDs is different.     

Urethral syndrome in women attending a clinic for sexually transmitted diseases.

Of 107 women investigated for frequency of micturition and dysuria, 21 had gonorrhoea, 14 chlamydial urethritis, eight an Escherichia coli urinary tract infection, 18 candidosis, 12 trichomoniasis, and four asymptomatic genital herpes. No organisms were isolated from 30 patients. Eighty nine women referred themselves and 18 were referred by the family practitioner. These findings suggest that Chlamydia trachomatis is frequently associated with the urethral syndrome among patients attending sexually transmitted disease clinics.     

Sex differences in the transmission, prevention, and disease manifestations of sexually transmitted diseases

BACKGROUND: Dermatological manifestations of sexually transmitted diseases (STDs) range from full body papulosquamous eruptions to genital ulcers and warts. The transmission, prevalence, and disease burden of STDs are not shared equally between the sexes. OBSERVATIONS: Women are more susceptible than men for the acquisition of the human immunodeficiency virus and other dangerous STDs because of economic, biological, and social factors, and often sustain more damage to their health from the disease.Conclusion This review article elucidates the differential effect of STDs on women vs men to better understand what is required to protect women from the morbidity and mortality of STDs.     

High prevalence of Mycoplasma genitalium in the lower genitourinary tract of women attending a sexually transmitted disease clinic in Paris,France

BACKGROUND: Previous studies have suggested that Mycoplasma genitalium is associated with cervicitis and may be a cause of pelvic inflammatory disease. This study attempted to investigate further the possible role of M genitalium in genital symptoms of women attending a sexually transmitted disease (STD) clinic. GOAL: To determine the prevalence of and the association of clinical and microbiologic features with M genitalium in women presenting with genital symptoms. STUDY DESIGN: Between April 1994 and June 1996 a prospective study of 170 consecutive women with abnormal vaginal discharge, with or without urethral itching, dysuria, or pelvic pain, was conducted at the STD clinic at Saint-Louis Hospital in Paris. Information was collected on each subject's characteristics, and a clinical vulvar, vaginal, and cervical examination was performed. Cervical, vaginal, and urethral samples were obtained to identify infecting organisms. RESULTS: DNA of M genitalium was identified by polymerase chain reaction (PCR) at one or more genital sites in 65 women (38%; 95% CI, 31-46%) and was statistically more frequently detected in the vagina (39%) than in the cervix (21%) or urethra (28%) (P = 0.001 and 0.048, respectively). PCR inhibitors were detected in 17 specimens (4%). M genitalium was found in 6/14 (43%) positive for Chlamydia trachomatis, but no significant association between M genitalium and any demographic, clinical, or microbiologic data was noted in univariable or multivariable analysis. CONCLUSION: This study indicates that M genitalium is frequently encountered in the female genital tract and is not associated with cervicitis or any particular clinical or microbiologic data.     

Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait

BACKGROUND: Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait. METHODS: All patients seen over a 1-year period (July 2003 to June 2004), who presented with signs and symptoms suggestive of STDs, were included. Sociodemographic details and clinical findings were recorded. The diagnosis of each STD was based mainly on standard World Health Organization (WHO) criteria and available data. Serologic tests for syphilis and human immunodeficiency virus (HIV) were offered to all patients. RESULTS: One thousand and ninety-six patients (1068 male, 28 female) with STDs constituted 2.84% of all new dermatology patients seen; most (866) were in the 21-40-year age group. The STDs were acquired from commercial sex workers in 844 patients (77%). Heterosexual encounter (99.3%) was the most common mode of acquiring STDs. Urethral discharge was noted in 54.1% of patients, followed by genital ulcers (17.8%), papules/growths (16.4%), and urethral/pubic pain without associated discharge/ulcers (5.9%); these were the four most common presenting complaints. Evaluation revealed gonorrhea in 31.5% of patients, nongonococcal urethritis in 23.6%, chlamydia in 4.1%, nonspecific urethritis in 19.5%, concomitant gonorrhea and chlamydia urethritis in 2.7%, genital warts in 13.7%, chancroid in 13.0%, genital herpes in 4.8%, molluscum contagiosum in 2.7%, and lymphogranuloma venereum in 1.4%. CONCLUSIONS: Urethral discharge, gonorrhea, and nonspecific urethritis (presenting with urethral discharge), followed by genital warts, chancroid, and genital herpes (ulcers), were the most common STDs among male patients in the Farwaniya region of Kuwait. Although no case of HIV or syphilis was detected, health authorities and physicians need to remain vigilant.