Renal manifestations of sexually transmitted diseases: sexually transmitted diseases and the kidney

The adolescent population is particularly vulnerable to STDs. Those that cause significant kidney disease are of viral origin. The primary VVD are HIV-1, HBV, and HCV. Screening of high-risk populations should include quantitation of proteinuria, including total protein and microalbumin, to assess severity of renal damage and potential for progression. Renal biopsy is indicated for diagnosis and for planning important treatment interventions if there is significant proteinuria or decreased renal function. Causes of acute renal failure are frequently reversible and should be treated aggressively. These include HUS, vaso-motor or ischemic acute tubular necrosis, and drug toxicities. The spectrum of chronic kidney disease associated with VVD is broad and may include systemic manifestations of vasculitis. HIV-associated nephropathy is the prototype, with the most prevalent lesion remaining FSGS. Progression occurs in up to 15% of the patients, who are overwhelmingly of African lineage. Significant advances in management include ongoing development of HAART, angiotensin antagonists to control proteinuria, and novel immune-modulating drugs such as MMF, CsA, and rituximab. Dialysis therapies have offered improved survival, especially in pediatric patients. Moreover, transplantation is no longer considered experimental and should be offered to select patients.     

Spread of sexually transmitted diseases

The World Health Organization has stressed the importance of preventing and controlling sexually transmitted diseases (STD) at the global level, also in light of the high costs represented by sequaele and complications for both children and adults. In industrialised countries, STD represent the most commonly notified infectious disease. Moreover, in non-industrialised, especially in Africa, STD represent the major reason for which adults seek health care. In Italy, data based on statutory notifications suggest that the incidence of gonorrhoea and syphilis has decreased in the past 20 years, though annual rates are underestimated. This report presents the data collected by the Italian System for the Surveillance of STD.     

International travel and sexually transmitted diseases

Sexually transmitted diseases (STDs) are a group of communicable diseases transferred mainly by sexual contact. Population movements are undoubtedly a major contributing factor in the spread of STDs. Owing to the ease of modern travel, larger numbers of people are moving around than ever before in peacetime. Travellers may both import and export infection, and the importance of their role in the transmission of STDs is demonstrated by the rapid worldwide spread of penicillinase-producing strains of N. gonorrhoeae (PPNG) and AIDS. While in most industrialized countries the incidence of the classic STDs (syphilis, gonorrhoea, chancroid) has decreased during the last decade, they remain hyperendemic in many developing countries due to poorly developed STD services. In many industrialized countries, the incidence of genital C. trachomatis infection now exceeds that of gonococcal infection. Chlamydial infections were previously thought to be infrequent in developing countries, but recent research has made it clear that this infection is at least as frequent as gonorrhoea. Incidence of genital herpes and genital human papilloma-virus infections (HPV) has increased dramatically during the last 20 years. Now that international travel takes place increasingly by air, it is more likely than previously for a traveller to return home within the incubation period of many STDs. Moreover, people behave differently when they travel. Tourists travel to seek adventure and new experiences, including sex. In countries where a good notification system exists, up to 30% of new cases of syphilis were found to be acquired abroad. Since PPNG appeared in 1976, these strains have spread to almost all areas of the world. During the first five years of the epidemic, most cases in Europe and the United States of America were imported. Measures for preventing STDs are the same whether the individual is travelling or not. Abstinence or sexual intercourse between two mutually-faithful uninfected partners exclusively are the only totally effective prevention strategies. The risk of infection can also be significantly reduced by adopting safe sexual practices such as the use of condoms. Prophylactic use of an antibiotic is not recommended, however.     

Women and sexually transmitted diseases.

This paper presents a brief review of historical developments in women's health care. It describes the current campaign against sexually transmitted diseases (STDs) and assesses the campaign's success in light of its history and the reality of women's lives. The authors suggest that women are forced into a double-bind in which they are expected to take responsibility for the prevention of STDs although they may not have the ability to do so. Modifications are suggested which take into account gender-role socialization and social group norms.     

Circumcision and sexually transmitted diseases.

OBJECTIVES. New evidence linking lack of circumcision with sexually transmitted human immunodeficiency virus revives concerns about circumcision and other sexually transmitted diseases. This study was undertaken to assess the relationship between circumcision and syphilis, gonorrhea, chlamydial infection, genital herpes, nongonococcal urethritis, and exophytic genital warts. METHODS. A cross-sectional study of 2776 heterosexual men attending a sexually transmitted disease clinic in 1988 was used to investigate the relationship between circumcision and sexually transmitted diseases. Subjects with specific sexually transmitted diseases and those without such diseases were compared after adjustment for age, race, zip code of residence, other sexually transmitted diseases, and number of sexual partners. RESULTS. A positive relationship was observed between uncircumcised status and both syphilis and gonorrhea. A negative relationship was found between warts and lack of circumcision. No apparent relationship was noted between uncircumcised status and genital herpes, chlamydial infection, or nongonococcal urethritis. CONCLUSIONS. Uncircumcised men were more likely than circumcised men to have syphilis and gonorrhea and were less likely to have visible warts.     

Control of sexually transmitted diseases in Senegal

STD are an important public health problem in numerous developing countries. Although satisfactory diagnostic and therapeutic means are available, the incidence of STD is increasing. Among the causes for this are sociological factors, like the weakening of customs and the family unit, and the development of tourism, which stimulates prostitution. There is a marked ignorance of the population in respect to STD. The Senegalese Government, WHO, and the Geneva-based Sandoz Institute launched in 1976 a joint programme of service, training and sesearch. The research aims at developing a preventive approach, especially through health education. While the three centers set up have accomplished good work locally, results are still disappointing from a public health point of view. Weak spots are in particular: - inadequacy of the social and contact-tracing services; -lack of action at the periphery and of integration with primary health care; -lack of coordination with other sectors (including police), and with professionals of various disciplines who should contribute to the socio-economic investigation of the problem. Several groups have recently been created in Senegal to support the project. An evaluation will soon be carried out. Such programmes should be implemented in other countries of the region.     

育龄妇女性病病原体感染分析

目的了解有生殖道感染症状与体征的已婚育龄妇女中5种性病病原体的感染情况。方法用PCR法对浙江省950例有生殖道感染症状与体征已婚育龄妇女的宫颈分泌物进行人乳头瘤病毒(HPV)16.18、HPV6.11、沙眼衣原体(CT)、解脲支原体(UU)、淋病奈瑟菌(NG)检测。结果该组人群的5种性病病原体总阳性率为69.05%(656/950),其中HPV6.11阳性率最高(45.47%),UU阳性率次之(42.95%),CT阳性率为8.50%,HPV16.18阳性率为2.20%,NG阳性率最低(0.32%),单一病原体感染率42%,混合感染率26.94%,性病病原体感染与受教育程度呈正相关(P<0.05),年龄差异与性病病原体感染无统计学意义(P>0.05)。结论本地区已婚育龄妇女存在不同程度5种性病病原体感染,应高度重视感染的控制问题。