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.     

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.     

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.     

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.     

The gay report on sexually transmitted diseases.

Most studies of sexually transmitted diseases in homosexual men have examined prevalence in clinic populations; for comparative purposes, we analyzed data from a survey of 4,329 gay men conducted in 1977. Among 4,212 respondents to the self-administered questionnaire, 66.8 per cent reported previous infection with pediculosis; 38.4 per cent, gonorrhea; 24.1 per cent, nonspecific urethritis; 18.1 per cent, venereal warts; 13.5 per cent, syphilis; 9.7 per cent, hepatitis; and 9.4 per cent, herpes. Number of different lifetime sexual partners best predicted histories of symphilis (r = .249), gonorrhea (r = .402), and the other diseases; frequency of checkups, years as a practicing homosexual, and furtive sexual activities were among the many other significant correlates of venereal infections. Respondents most often sought examinations from private physicians (39.4 per cent); those who visited gay clinics were examined most often and felt most positive about their medical care. Gay men who participated in the survey reported frequent infections with many of the same sexually transmitted diseases often seen in private medical practices, public VD clinics, and gay health centers. Since high rates of disease are related to large numbers of different partners, frequent exposures with anonymous contacts, and anal intercourse, we recommend frequent examinations for those whose life-styles include these characteristics.     

Chlamydiae as agents of sexually transmitted diseases.

Chlamydiae are being increasingly recognized as an important cause of human disease. The known geographical distribution of lymphogranuloma venereum and the role of chlamydiae as agents of sexually transmitted diseases are reviewed. The presence of chlamydiae in the urethra and the cervix, and their etiological relationship to genital infections, first recognized in connexion with ocular infections, have been proved in a number of studies in selected populations in a few countries. Chlamydiae appear to be the most important agent of nongonococcal urethritis, which in some cases appears now to be more frequent than gonococcal urethritis. In addition to their association with cervicitis, chlamydiae appear also to be fairly frequent in the cervix of apparently normal, asymptomatic, and sexually active women. The role of chlamydiae as agents of other human diseases still requires to be clarified. The organisms have been found in association with pelvic inflammatory disease, neonatal pneumonia, pharyngitis, and otitis. There is need for additional studies in view of the fact that effective chemotherapy is available. An outline is given of laboratory methods that may be useful for the diagnosis of chlamydial infections.     

2018年8月全国艾滋病性病疫情

  目的  了解广西壮族自治区中越边境市性病门诊男性就诊者艾滋病病毒（HIV）感染情况并探讨其影响因素,为制定干预策略提供参考依据。  方法  于2010 — 2016年在广西壮族自治区中越边境凭祥市某性病门诊监测哨点对性病门诊男性就诊者9 221人进行问卷调查,同时进行HIV、梅毒和丙肝血清学检测。  结果  2010 — 2016年广西壮族自治区中越边境市共监测9 221人,年龄为15～95岁,84.50 % 就诊者年龄为20～59岁。2010 — 2016年共检测出HIV抗体阳性感染者136人,检出率为1.47 %,HIV感染率呈下降趋势（趋势χ² = 18.673,P = 0.005）;梅毒患者检出223人,检出率为2.24 %;丙肝阳性患者66人,检出率为0.72 %;艾滋病知识答对6条及以上知晓率为92.51 % （8 488/9 221）;最近3个月与暗娼发生过性行为的比例占29.4 % （2 715/9 221）;最近3个月与临时性伴发生性行为的比例占22.24 % （2 051/9 221）;注射过毒品的比例占0.74 % （68/9 221）;与同性发生过肛交性行为的比例占0.17 % （16/9 221）;最近1年接受过干预服务的比例为62.6 % （5 776/9 221）。多因素logistic回归分析结果显示,年龄处于60～79岁（aOR = 1.144,95 % CI = 0.327～4.002）、注射过毒品（aOR = 6.439,95 % CI = 1.874～22.128）、与同性发生过肛交性行为（aOR = 7.362,95 % CI = 1.281～ 42.329）和最近1年患过性病（aOR = 1.922,95 % CI = 1.137～3.248）为性病门诊就诊者感染HIV的危险因素,知晓艾滋病知识为保护因素（aOR = 0.054,95 % CI = 0.037～0.075）。  结论  2010 — 2016年广西壮族自治区中越边境市性病门诊就诊者HIV感染率虽有所下降但情况依然不容乐观,仍需加大力度坚持宣传艾滋病相关知识,并从行为上加强预防干预。     

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.     

Techniques of testing for sexually transmitted diseases

Adolescent and young adult women are the highest-risk group for nearly all sexually transmitted infections. This article reviews diagnostic methods for the most common bacterial and viral sexually transmitted infections, with special attention to the use of nucleic acid amplification methods, as well as the utilization of nontraditional clinical specimens. These new modalities should help the care provider identify and manage the large asymptomatic pool of infected patients, and further lower the prevalence and burden of infection.     

Female adolescent communication about sexually transmitted diseases

Health researchers acknowledge a limited understanding of the social context of adolescents regarding their communication and decision making about sexually transmitted diseases (STDs). Using in-depth interviews, this study examines 18-year-old women regarding their self-concepts about STD communication, including their perceived and actual knowledge levels. Fifteen first-year college students from a Western university showed strong self-concepts and high perceived knowledge relative to sexual decision making and communication. The women's actual knowledge holding, however, was low. They demonstrated difficulty finding information from mediated sources with either high regard or mistrust of new information technologies for such information and limited use of interpersonal communication sources.     

Prevention and management of sexually transmitted diseases in adolescents

This review focuses on the diagnosis and treatment of common sexually transmitted diseases (STDs) encountered among adolescents in the U.S. and other developed countries. Included are new recommendations for the treatment of primary and recurrent genital herpes, management of pelvic inflammatory disease, and a revised approach to the care of adolescent victims of sexual assault. Diagnosis begins with a classification based on major clinical findings: genital ulcers with lymphadenitis, urethritis, vaginal discharge, pelvic inflammatory disease, and male STD syndromes. Appropriate laboratory evaluation for each of these clinical presentations is detailed and treatment options are summarized. Preventive interventions along with suggestions for an approach to the preadolescent well care visit, generally scheduled at age 11?12 years, are offered. Routine preventive therapy after a sexual assault takes into account difficulty in follow-up and the need to reassure adolescents and their families that all prophylaxis for possible infection has been provided.