Observations on syphilis in Addis Ababa. 2. Prevalence and natural history

Sera from various groups were tested for syphilis by cardiolipin, fluorescent treponemal antibody-absorbed (FTA-ABS), and treponemal haemagglutination (TPHA) tests. The proportion of positive results, 12.7%, obtained from an unselected urban population suggested that the prevalence of the disease had declined since 1953. The probable explanation is the widespread use of penicillin. Late manifestations of syphilis are much rarer in Ethiopia than would be predicted from the high incidence at the infectious stage and, if present, they affect the cardiovascular system. These findings confirm old observations. Llymphocytes from Ethiopians with early syphilis did not proliferate when cultured with Treponema pallidum in vitro, in contrast with cells from patients with cardiovascular syphilis. These findings differed from observations made previously on patients in England with early syphilis.     

Observations on syphilis in Addis Ababa. 1. General considerations

The socioeconomic picture of Addis Ababa, the capital of Ethiopia, is briefly described and the provision of general medical care is outlined. Control of venereal disease is centred on one clinic. Here two doctors attend to nearly 1000 outpatients daily. It is perhaps not surprising that self-diagnosis and self-medication are common and follow-up attendance is erratic.     

Observations on syphilis in Addis Ababa. 1. General considerations.

The socioeconomic picture of Addis Ababa, the capital of Ethiopia, is briefly described and the provision of general medical care is outlined. Control of venereal disease is centred on one clinic. Here two doctors attend to nearly 1000 outpatients daily. It is perhaps not surprising that self-diagnosis and self-medication are common and follow-up attendance is erratic.     

Prevalence of gonococcal and chlamydial infections and sexual risk behavior among youth in Addis Ababa,Ethiopia

BACKGROUND: No community-based study on the magnitude of sexually transmitted diseases (STDs) has ever been conducted among young people in Ethiopia. GOAL: To assess the magnitude of Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among youths (15-24 years old) in Addis Ababa, Ethiopia. STUDY DESIGN: Youths in or out of school residing in two (of the six) administrative zones in Addis Ababa served as the study population. Participants filled out a self-administered questionnaire related to sexuality and its sociocultural determinants. First-void urine (FVU) was analyzed for gonorrhea and chlamydial infection by polymerase chain reaction (PCR). RESULTS: A total of 561 youths took part in the study. Urine PCR was performed for 522 of them. Nine subjects (1.7%) were found to have and N gonorrhoeae and C trachomatis infections. There were five cases (1.0%) involving each agent. Double infection was noted in one female subject. All but one of the infections were detected among the out-of-school youths (chi-square = 4.5; < 0.05). None of these subjects complained of symptoms suggestive of an active STD. One-third (188/561) reported having had sexual intercourse. The prevalence among sexually active youths was thus 4.8% (9/188) for both infections combined (2.7% for each agent). While 7/52 (13.5%) of the sexually active females were found to also have STDs, only 2/136 (1.5%) of the males had an STD (chi-square = 8.0; < 0.01). Report of sexual activity was significantly associated with being male, an age of >/=20 years, out-of-school status, and report of alcohol/khat (amphetamine-like substance) consumption. Females reported less condom use, whether they were in or out of school and independent of age. CONCLUSIONS: Out-of-school youths, especially females, took more sexual risk and were exceedingly susceptible to STDs. This calls for alternative group-targeted strategies for sex education, disease prevention, and STD screening and management.     

Chlamydial genital infection in Addis Ababa, Ethiopia. A seroepidemiological survey.

A seroepidemiological survey was undertaken in Addis Ababa to assess the prevalence of chlamydial genital infections among patients attending a sexually transmitted diseases (STD) clinic and patients with no overt genital symptoms. In the STD clinic patients antibodies to Chlamydia trachomatis serotypes D to K (genital types) were detected in 68 of 210 (32.4%) men and in 72 of 159 (45.3%) women, a rate of exposure as high or higher than that found in Europe. Serological evidence of active chlamydial infection was present in 26.7% of men and 28.9% of women. Women were at risk of contracting STD, including chlamydial infections, at the age of 14 years or earlier. The titres of antichlamydial IgG were extremely high in some patients attending the STD clinic, with titres of between 1/512 and 1/8192 in 9.5% of men and 13.2% of women. This suggests that some patients had severe or disseminated chlamydial disease. The prevalence of exposure to chlamydial genital infections among 148 patients with no overt genital disease was 14.2%, which is significantly higher than that found in the United Kingdom. Among the total of 517 patients tested the prevalence of exposure to trachoma, lymphogranuloma venereum, and Chlamydia psittaci agents was very low.     

Prevalence of mental distress in the outpatient clinic of a specialized leprosy hospital. Addis Ababa, Ethiopia, 2002

Leprosy is a chronic disease that leads to physical disability as a result of nerve damage. Stigma and associated psychosocial problems are common and may increase the risk of mental disorders. This study was conducted to estimate the prevalence of mental distress amongst people attending a Specialized Leprosy and Dermatology Hospital, ALERT, Addis Ababa. Alternate patients from the daily register of outpatients were interviewed for symptoms of mental distress using the Self Reporting Questionnaire (SRQ). This questionnaire was administered by two specially trained nurses. The study population consisted of 786 people. Of these, 60% had leprosy and the remainder had other skin diseases. The sex distribution of the study population was approximately equal. The overall prevalence of mental distress was found to be 34.6%. Among people with leprosy the prevalence was 52.4%, compared with 7.9% in those with other skin conditions. This represented a 7-fold increased risk of mental distress in people with leprosy, adjusted OR = 7.14 (95% CI; 4.15, 12.35). Physical disability was also strongly associated with mental distress. This study showed that the 1-month prevalence of mental distress was significantly higher in patients with leprosy compared to patients with other dermatological conditions. Such a study allows identification of non-specific mental distress. Thus, future work should be directed at further characterizing the nature and severity of mental disorder in this group. However, our study has indicated a need for the integration of psychosocial care into our current medical treatment of patients with leprosy.     

Prevalence of liver abnormality in early syphilis.

Hepatic structure and function of 22 unselected patients with early syphilis was assessed. In 20 (91%) routine hepatic tests or bromsulphalein retention showed mild non-specific abnormalities. Minor changes in hepatic structure were present in 12 (55%), in three of whom intrahepatic spirochaetes were found. The only patient who had hepatomegaly also had splenomegaly. Observed changes in hepatic structure correlated with neither physical signs nor results of biochemical tests. Hepatic changes in early syphilis are common but frequently subclinical.     

Herpes simplex virus type 2 seropositivity among urban adults in Africa: results from two cross-sectional surveys in Addis Ababa, Ethiopia

BACKGROUND: Although several surveys investigating the epidemiology of herpes simplex virus type 2 (HSV-2) infection using type-specific immunologic assays have been carried out in Africa, none has examined the risk factors for HSV-2 infection in a representative sample from an urban adult population. GOALS: To estimate the prevalence of HSV-2 infection in the adult population of Addis Ababa, Ethiopia, and to identify risk factors for HSV-2 infection. STUDY DESIGN: Two cross-sectional surveys, one community-based (June to September 1996, n = 506) and one factory-based (February to November 1997, n = 657), were conducted. Samples were tested for HSV-2 immunoglobulin G antibodies using type-specific enzyme-linked immunoassays (ELISA). RESULTS: In the community-based survey, HSV-2 prevalence increased with age until 25 years, then leveled off at 50% in both genders. The same independent predictors of HSV-2 infection were identified in both genders: older age, higher lifetime number of sexual partners, positive HIV serology, and positive Treponema pallidum hemagglutination serology. CONCLUSIONS: This study confirmed the high prevalence of HSV-2 infection among adults in an African urban population and its association with HIV infection. Prevention of HSV-2 and other sexually transmitted infections through partner reduction and condom use should be encouraged.     

Fluctuations in natural killer cell activity in early syphilis.

The natural killer cell activity was studied in 25 patients with primary, secondary, or latent syphilis before and after treatment. In primary syphilis natural killer cell activity was increased, especially in patients lacking circulating lipoidal antibodies. In patients who had become seroreactive in the lipoidal tests it was depressed in those with secondary and latent syphilis. The natural killer cell activity thus becomes activated by the syphilitic infection but is significantly reduced during progression of the disease. The importance of the natural killer cell activity in controlling syphilitic infection is questionable.     

Prevalence of syphilis and hepatitis B among homosexual men in two saunas in Amsterdam.

In a pilot study by field-screening in two different sauna baths, a day-sauna and a night-sauna, 318 homosexual men were investigated for syphilis and hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs). Of the 134 visitors to the day-sauna 35.1% were seroreactive for syphilis, four (3%) carried HBsAg, and 95 (70.9%) anti-HBs. Of the 184 visitors to the night-sauna 33.2% were seroreactive for syphilis, 16 (8.7%), carried HBsAg, and 97 (52.7%) anti-HBs. The correlation between seroreactivity for syphilis and the presence of HBsAg amd anti-HBs was statistically significant.     

Risk factors associated with failure of syndromic treatment of sexually transmitted diseases among women seeking primary care in Addis Ababa

OBJECTIVE: To determine risk factors associated with the failure of syndromic management of sexually transmitted diseases (STDs) among women seeking treatment in primary healthcare centre in Addis Ababa, Ethiopia. METHODS: Women with symptomatic STDs seeking care in a health centre were prospectively enrolled. A total of 259 women were interviewed and underwent clinical examination; 106 were enrolled and received syndromic STD treatment and 91% returned for follow up. Logistic regression analysis was used to identify risk factors associated with treatment failure. RESULTS: Of the 106 women enrolled and presenting with symptomatic STDs 67% were HIV seropositive. Syndromic STD treatment did not result in clinical improvement in 30% of the women. Having genital ulcer disease, genital ulcer disease with genital discharge, genital warts, bacterial vaginosis and plasma HIV-1 load >10,000 copies RNA/ml or being HIV seropositive were all significantly associated with treatment failure. In multivariate analysis, however, only genital ulcer disease was significantly associated with treatment failure. CONCLUSION: In our setting, the association between HIV and genital ulcer disease caused by herpes may, therefore, be the reason for the failure of treatment.     

A population-based study of syphilis and sexually transmitted disease syndromes in north-western Tanzania. 1. Prevalence and incidence.

OBJECTIVE--To determine the prevalence of syphilis and the prevalence and incidence of self-reported STD syndromes in the population of Mwanza Region, North-Western Tanzania. METHODS--A population-based random cluster sample survey, stratified by rural, roadside or urban residence, of 4173 individuals aged 15-54 years was performed in 1990-91. The seroprevalence of syphilis (using TPHA and RPR) and the prevalence and incidence of self-reported genital ulcer syndrome (GUS) and genital discharge syndrome (GDS) were determined. RESULTS--Active syphilis was detected in 9% of the adult population, while 15% had serological evidence of past or current infection. Seroprevalence was significantly lower in the rural than in the roadside and urban populations, but there was little difference between men and women. Amongst men, a history of GDS was reported by 28%, and a history of GUS by 14%, with point prevalences of 2.3% and 1.3% respectively. Annual incidence among men were 6.8% for GDS and 3.6% for GUS. Women reported these conditions less frequently. There was little difference between the strata in the prevalence or incidence of reported STD syndromes. CONCLUSION--Sexually transmitted diseases represent a major public health problem in both the rural and urban populations of Mwanza Region.     

Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community

OBJECTIVES: To estimate prevalence and risk factors for herpes simplex 2 (HSV2) positivity, syphilis and Chlamydia trachomatis infection among rural people aged 15-34 in the Gambia. METHODS: Questionnaires and serum samples were collected from 1076 men and women aged 15-34 during a cross sectional prevalence survey in a rural area of the Gambia. Sera were screened for antibodies to herpes simplex virus type 2 (HSV2), and for syphilis using Treponema pallidum haemagglutination assay (TPHA) and rapid plasma reagin (RPR) tests. Urine was tested by polymerase chain reaction (PCR) for C trachomatis infection. RESULTS: 28% of women and 5% of men were HSV2 ELISA positive; 10% of women and 2% of men were TPHA positive; and 7% of women and 1% of men were both RPR and TPHA positive. Out of 1030 urine sample tested only six were positive for C trachomatis. 7% of those who reported never having sex were positive for one or other of these tests. Prevalences of all STIs increased with age and were higher in women than men. Women were much less likely than men to seek treatment for STI symptoms at a health centre. Married people were at increased risk of an STI compared with single people. Jola and Fula women had a higher prevalence of HSV2 than women from other ethnic groups, and Fulas also had a higher prevalence of RPR/TPHA positivity. The limited number of sexual behaviour questions were not significantly associated with STIs after adjustment for age, marital status, and ethnic group. CONCLUSIONS: The prevalences of the ulcerative infections HSV2 and syphilis in this population are a cause for concern. In a setting where HIV1 prevalence remains low this indicates an urgent need for STI control and behaviour change programmes to prevent an HIV epidemic. Concerns about the validity of reported sexual behaviour data high light the necessity of biological markers in the evaluation of behaviour change programmes.