Comparative rates of sexually transmitted diseases among heterosexual men, homosexual men, and heterosexual women

The prevalences of several sexually transmitted diseases (STD) among patients attending a public STD clinic were determined in a prospective study. Rates of gonorrhea, syphilis, genital herpes, trichomoniasis, nongonococcal urethritis, pediculosis pubis, scabies, and venereal warts were ascertained according to sex, sexual preference, and race. Numbers of cases of diseases not routinely reported to most public health agencies exceeded numbers of cases of diseases that are routinely reported. Rates of gonorrhea were higher among men than among women and higher among blacks than among whites. Syphilis was most common among homosexual men. Trichomoniasis was three times more frequent among blacks than among whites. Rates of nongonococcal urethritis among heterosexual men were almost twice those among homosexual men. Whites were more likely than blacks to have pediculosis pubis, scabies, and venereal warts. STD not routinely reported to most public health agencies are commonly seen in public clinics, and rates vary according to sex, sexual preference, and race.     

Socio-medical characteristics of patients attending a V.D. clinic and the circumstances of infection

A study to examine the social characteristics of 1753 patients attending a venereal disease (VD) clinic in Belfast in 1969 was undertaken. Information was also sought on the circumstances in which infection took place. Only 24% of the patients were diagnosed as having statutory VD (syphilis, gonorrhea, or chancroid). The peak incidence of cases was found in the 20-34 year age group, approximately 2/3 of the patients. Men were more likely to be single than the women. 2/3 of the men and 3/4 of the women lived with their parents or their spouse. The high proportion of married women reflects that many came to the clinic as secondary contacts. Sailors constituted an important group of male patients. Diagnosis varied with social class: men in social classes I and II were more likely to have nongonococcal urethritis (NGU) (the most common condition found in all male patients) than men in social classes III, IV, and V, who were more likely to have syphilis, gonorrhea, and "other conditions". Women in social classes I and II were more likely to be free of infection than their counterparts in other classes. For patients with gonorrhea, both married and single men were more likely to acquire the infection from a casual contact than their married and single female counterparts. 14 or 1.2% of the male patients admitted to possible homosexual source of infection. The public house and dance hall were the most common meeting places and therefore it is suggested that information about VD be displayed in these places. A majority of men reported consuming alcohol before intercourse. For men, intercourse took place most frequently in the residence of the woman, in cars, or on the street; for women, their residence, residence of the man, or cars were most frequently mentioned. Of the patients to whom the question was applicable, 16.9% of the men and .8% of the women indicated that a cash payment had been made. Diagnosis varied with the use of a sheath. Men who used a sheath were less likely to be diagnosed with syphilis or gonorrhea and more likely to not have an infection or have NGU. From the 119 men with gonorrhea who could identify the source of contact, 45 women sought treatment from the clinic. The study results suggest that there is a pool of promiscuous infected women who do not seek treatment, probably because they are unaware they have an infection, as suggested by results from other studies. Persuading these women to come for treatment is an important step in controlling the spread of infection.     

Epidemiological importance of concealed nongonococcal urethritis.

Of the 229 806 new male patients attending venereal disease clinics in England in 1976, 31.9% had recognisable non-specific genital infection (NSGI), which was easily the most common diagnostic category of the sexually transmitted diseases (STDs) and one which had increased more markedly than all the others in the previous 25 years. Many more cases of nongonococcal urethritis (NGU) are concealed under the diagnosis of gonorrhoea, as is clear from the high incidence of post-gonococcal infection following treatment with penicillin. From 44% to 56% of male patients with gonorrhoea can also have non-specific genital infection during the same year. A practical treatment schedule for gonorrhoea which is also effective against simultaneously acquired non-gonococcal urethritis would be of great value.     

Pattern of STDs at Davangere

The distribution of sexually transmitted diseases (STDs) among 450 patients attending the Department of Skin, STD and Leprosy of JJM Medical College, Davangere, India, from May 1984-December 1988, is discussed. All patients had clinical exam, wet and stained smears of discharge and lesions, dark microscopy, culture and histopathology. The patients were 87.3% male, predominantly aged 21-30 years, and 54.5% middle-income, reflecting the fact that this is an urban, for-profit hospital. The distribution of STDs in order of prevalence was: balanoposthitis 19.3%, donovanosis 15.3%, gonorrhea 10.7%, syphilis 12.2%, lymphogranuloma venereum 10.1%, vulvo-vaginitis 6.9%, non-gonococcal urethritis 6.22%, herpes genitalis 4.89%, venereal warts 4.00%, and chancroid 1.33%. The vulvo-vaginitis was accounted for by bacterial, candidal and trichomonal infections, and 16.1% labeled nonspecific. The high incidence of donovanosis was noted in the discussion.     

Is there immunity to chlamydial infections of the human genital tract?

Chlamydia trachomatis is commonly found in the urethra of men with gonococcal urethritis. Studies report a 20%-40% rate of double infection. A two-year study of men attending a venereal disease clinic in California showed that only 4% (4/99) or 7% (10/147) of men with gonorrhea had concomitant chlamydial infection, whereas 25-31% of the men with nongonococcal urethritis (NGU) had chlamydial infection. Men with gonorrhea seemed to have substantial recent exposure to chlamydial infection, since C. trachomatis was isolated from the cervix of 20% (36/180) of female contacts. Microimmunofluorescence (micro IF) tests showed that 93.6% (131/141) of the men with gonorrhea had IgG antibodies to Chlamydia and 36% (51/141) had IgM antibodies. IgG antibody rates were higher than those found among men who had NGU or no urethritis (83% and 65%, respectively), a fact which suggests that in this clinic setting the men with gonorrhea had very high antecedent exposure to C. trachomatis and may have been resistant to reinfection.     

Epidemiological importance of concealed nongonococcal urethritis.

Of the 229 806 new male patients attending venereal disease clinics in England in 1976, 31.9% had recognisable non-specific genital infection (NSGI), which was easily the most common diagnostic category of the sexually transmitted diseases (STDs) and one which had increased more markedly than all the others in the previous 25 years. Many more cases of nongonococcal urethritis (NGU) are concealed under the diagnosis of gonorrhoea, as is clear from the high incidence of post-gonococcal infection following treatment with penicillin. From 44% to 56% of male patients with gonorrhoea can also have non-specific genital infection during the same year. A practical treatment schedule for gonorrhoea which is also effective against simultaneously acquired non-gonococcal urethritis would be of great value.     

Value and feasibility of screening women attending STD clinics for cervical chlamydial infections.

A chlamydial screening service was provided in Bristol over a three-month period for women attending the sexually transmitted disease (STD) clinic either for the first time or with a new complaint. Isolation of Chlamydia trachomatis was attempted in cytochalasin-treated McCoy cells. Of 919 specimens, valid results were obtained in 796. Chlamydial infections were identified and treated in 154 (19%) of these 796 women. Chlamydia were isolated from 52 (37%) of 152 female partners of men with nongonococcal urethritis (NGU); these patients already routinely receive treatment with tetracylcines in this clinic. The remaining 102 infections (34 (48%) of 71 women with gonorrhoea and 68 (12%) of the other 573 women) would have been unrecognised and usually untreated without chlamydial isolation studies. These figures confirm the need to provide chlamydial diagnostic services for selected STD clinic attenders.     

Study of STDs in patients attending venereal disease clinics in Khartoum, Sudan.

During the period October 1976 to January 1978, 290 patients were examined for sexually transmitted diseases in three venereal clinics in Khartoum Providence. Clinical and laboratory findings showed that nongonococcal urethritis was the commonest STD in men (35.1%), with gonorrhoea the second commonest (25.9%). Most of the patients with STDs were aged between 20 and 30 years. Of the infected men, 49.3% had acquired their infections from prostitutes.     

Relative and seasonal incidences of the sexually transmitted diseases. A two-year statistical review.

In the United States statistics on sexually transmitted diseases (STDs), other than gonorrhoea and syphilis, are meagre. In this study the relative and seasonal incidences of most STDs in an American clinic where 34,938 patient visits were recorded over a two-year period (1975-76) are assessed. Gonorrhoea was the most common STD in male and female patients combined (18%), while nongonococcal urethritis (NGU) was most common in men (23%), and vaginitis (trichomonal 7.5%, yeast 7.1%, and non-specific 7.1%) was the most common in women. A significantly higher incidence of NGU occurred in Caucasian (63%) than in black (42%) men (P less than 0.005). No other STD was diagnosed in more than 5% of patients, and 31% had normal findings on clinical examination and investigation, and could be described as the 'worried well'. Two or more STDs co-existed in 4.2% of patients. In 1976 the incidence of genital herpes and scabies decreased in contrast to other STDs and total patient visits, which increased. A seasonal peak in late summer and early autumn was observed for most STDs. These observations indicate the importance of a comprehensive approach when attempting to compile accurate statistics on selected epidemiological aspects of sexually transmitted diseases.     

Three years'' experience of sexually transmitted diseases in Seville, Spain.

At present there are no reliable statistics on the relative prevalences of sexually transmitted diseases (STDs) in Spain. In a report of the first three years' experience in an STD diagnostic centre between 1977 and 1979 a total of 879 patients (534 men adn 345 women) were seen. They mainly consisted of university students and the mean age was 22 years in 1977 and 23 years in the following two years. All the patients were examined for syphilis and all women for gonorrhoea and trichomoniasis. Investigations for Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Candida albicans, and Herpesvirus hominis infections were carried out according to the presenting symptoms. Non-specific genital infections occurred most commonly (25.7%); chlamydia were isolated from 30% of the patients with non-gonococcal urethritis (NGU). The second commonest infection was candidosis (13.5%). Gonorrhoea, which was found in 10.6% of the patients, was diagnosed more frequently in men (13.5%) than in women (6%). No strains of beta-lactamase-producing Neisseria gonorrhoeae were detected and all were sensitive to penicillin. Syphilis was diagnosed in 4.4% of patients (2% women and 5% men). Condylomata acuminata were diagnosed in 2.8% of patients and more frequently in men (4%). Herpes genitalis and venereophobia were uncommon (1.9% and 1.2% respectively) and were diagnosed only in men.     

Comparison of sexually transmitted disease prevalence by reported condom use: errors among consistent condom users seen at an urban sexually transmitted disease clinic

BACKGROUND: The protective effect of condom use is controversial as a result of limited data. GOAL: The goal of this study was to assess the association between condom use errors in consistent condom users and the prevalence of various sexually transmitted diseases (STDs). STUDY: We conducted a cross-sectional study of visits to an urban STD clinic between January 2001 and January 2003, by women, men who have sex with women (MSW), and men who have sex with men (MSM) by consistent condom users with or without a condom use error. METHODS: Prevalence rates were calculated for gonorrhea, chlamydia, trichomonas, nongonococcal urethritis (NGU), and pelvic inflammatory disease. Rates were stratified by reported errors in condom use over the past 4 months for consistent users with adjusted odds ratios calculated by logistic regression. RESULTS: Among 1973 consistent condom users with error information available, any condom use error was reported more commonly among women (57%) than MSW (48%), or MSM (P <0.001 for each comparison), with breakage being the most frequently reported error. Among MSW, having a condom use error was associated with gonorrhea (adjusted odds ratio [AOR], 5.53; 95% confidence interval [CI], 2.48-12.35), chlamydia (AOR, 3.19; 95% CI, 1.80-5.65), and NGU (AOR, 2.09; 95% CI, 1.45-3.01), whereas, for women and MSM, no associations were seen for any STD. CONCLUSIONS: Condom use errors were common among subjects reporting consistent condom use and for MSW, condom error was associated with a significant increased risk of STD. These data support the premise that correctness of condom use is an important methodologic issue in studies assessing condom effectiveness.     

Sexual and treatment behaviour of STD patients

Many individuals infected with STDs have their infections/diseases misdiagnosed and mistreated by people who are not qualified to practice medicine. This paper looks at HIV infection and treatment behavior in India. All STD patients attending the private clinic of a senior dermatologist and venereologist in Varanasi during a 6-month period were interviewed. There were 54 men and 6 women of mean age 27.5 years in the range of 18-52. 40 of the men were younger than age 30 years, while most patients had contracted infection from prostitutes. A fair number of more casual contacts were also reported. Infections among males came from known prostitutes in 22 cases, girlfriends in 13, relatives in 10, and a neighbor in 9. 69% of the men were married, with 40.6% of these men living with their wives at the time of exposure. Viral STDs such as herpes genitalis were common. 20 of the men consulted a qualified venereologist after the first exposure to infection. Indigenous "gupt rog" specialists in sexual medicine attracted the second largest number of patients after first exposure. On subsequent visit, however, none of the men returned to a gupt rog specialist. Good compliance as in the case of primary syphilis, gonorrhea, and non-gonococcal urethritis was probably due to good symptomatic response. Poor compliance in the case of herpes genitalis was probably the result of recurrence and inconvenient treatment regimens.     

Value and feasibility of screening women attending STD clinics for cervical chlamydial infections

A chlamydial screening service was provided in Bristol over a three-month period for women attending the sexually transmitted disease (STD) clinic either for the first time or with a new complaint. Isolation of Chlamydia trachomatis was attempted in cytochalasin-treated McCoy cells. Of 919 specimens, valid results were obtained in 796. Chlamydial infections were identified and treated in 154 (19%) of these 796 women. Chlamydia were isolated from 52 (37%) of 152 female partners of men with nongonococcal urethritis (NGU); these patients already routinely receive treatment with tetracylcines in this clinic. The remaining 102 infections (34 (48%) of 71 women with gonorrhoea and 68 (12%) of the other 573 women) would have been unrecognised and usually untreated without chlamydial isolation studies. These figures confirm the need to provide chlamydial diagnostic services for selected STD clinic attenders.     

Study of STDs in patients attending venereal disease clinics in Khartoum, Sudan

During the period October 1976 to January 1978, 290 patients were examined for sexually transmitted diseases in three venereal clinics in Khartoum Providence. Clinical and laboratory findings showed that nongonococcal urethritis was the commonest STD in men (35.1%), with gonorrhoea the second commonest (25.9%). Most of the patients with STDs were aged between 20 and 30 years. Of the infected men, 49.3% had acquired their infections from prostitutes.     

性传播疾病防治工作一些迫切需要解决的问题

In the past over ten years since the conrtrol of sexually transmitted diseasses(STD)was resuned in China,a great deal of efforts and achievements have been made.Many new problems,however,have meerged.This paper analyzes and discusses the pressing problems to be solved in the control of STD,which include the eight notifiable diseases stipulated by the Ministry of Health in 1991,i.e.gonorrhea,syphilis,condyloma acuminatum,non-gonococcal urethritis,chancroid,venereal lymphogranuloma,genital herpes and AIDS.     

No evidence for a sustained increase in sexually transmitted diseases among heterosexuals in Amsterdam, the Netherlands: a 12-year trend analysis at the sexually transmitted disease outpatient clinic, Amsterdam

OBJECTIVES: Sexually transmitted diseases (STDs) are on the rise, mainly among men having sex with men (MSM). GOAL: The goal of this study was to evaluate whether STD increases as seen in MSM are also visible among heterosexuals. STUDY DESIGN: Attendees of the STD clinic in Amsterdam, The Netherlands, are routinely tested for chlamydia, gonorrhea, and syphilis. Additionally, all women are tested for trichomoniasis. STD time trends of heterosexual attendees between 1994 and 2005 were analyzed by logistic regression and generalized linear models with a negative binomial distribution. RESULTS: The number of consultations doubled since 1994. However, no long-term increase was seen in the number of syphilis and gonorrhea infections. Additionally, the trichomonas prevalence declined. However, the number of chlamydia infections increased over time. CONCLUSIONS: Although the number of attendees increased, no evidence for increasing STD incidence was found among heterosexuals. The increase in chlamydia infections can probably be explained by increased screening resulting from increased numbers of attendees.     

A study on the present scenario of STD management in an urban clinic in Kolkata

A total of 4129 patients attended the STD clinic from 1996 to 1999. Of those 25.75% were STD cases. Male and female cases comprised 86% and 14% respectively. Majority were in the age group between 18 to 38 years. Chancroid was the commonest STD (37.7%). Other STDs in order were syphilis (30.66%), NGU (15.71%), gonorrhoea (7%), venereal wart (3.57%), candidiasis (2.53%), trichomonal vaginitis (1.6%), herpes genitalis (0.65%) and LGV (0.47%). No case of Donovanosis or HIV was detected. 13.7% of STD cases were reactive for VDRL test and 8% of the antenatal attendants were strongly VDRL test reactive. The urethral discharge on gram staining was positive for gonococcus, in 29%. 68% of the clinic attendants were given safer sex education and served condom.     

Chlamydial genital infection in Ibadan, Nigeria. A seroepidemiological survey.

Sera from patients attending a sexually transmitted diseases (STD) clinic, a family planning clinic, and an antenatal clinic in Ibadan, Nigeria, as well as from male blood donors from the same area were tested for the presence of type specific antichlamydial antibodies using a modified micro-immunofluorescence test. Among men and women attending the STD clinic the exposure rates to Chlamydia trachomatis serotypes D to K (genital pathogens) were 18.7% and 26.7% respectively. Antibody titres suggesting active disease in these men and women were found in 11.8% and 22.7% respectively. The highest rate of exposure (35%) was among women attending the family planning clinic; of these women 25% had antibody suggesting active disease. Titres of IgG antibody in this study were similar to those found among men and women with chlamydial genital infections in the United Kingdom. Antibodies to serotypes D to K were also detected in 10.3% of women attending an antenatal clinic and in 9.9% of male blood donors. The prevalence of antibodies to C trachomatis serotypes A to C and lymphogranuloma venereum serotypes was low. These results suggest that the prevalence of chlamydial genital infections in Ibadan, both among STD patients and especially among those individuals not seeking treatment (family planning and antenatal clinic patients), is high. Since serious sequelae can follow chlamydial genital infections it is imperative to carry out further investigations in this area.     

Epidemiology of urethritis in Ibadan

This paper explores the frequency of different etiological agents causing urethritis among cases in the University College Hospital, Ibadan; the prevalence of gonococcal infections among housewives and prostitutes, and the incidence of isolation of T-strain mycoplasmas in the urethra of patients with nongonococcal urethritis (NGU) and a control group of Nigerian males. 6 groups of patients were studied: 442 men with urethral discharge and/or urethritis; 228 women with heavy vaginal discharge or consorts of male patients with symptoms; 130 symptomless women aged 15-45; 19 local prostitutes; 93 men diagnosed as having NGU; and 65 men aged 15-44 presenting at the outpatient department of the hospital with no genitourinary symptoms or history of urethral discharge in the last 6 months. 69% of the 442 male and 62% of the 228 female cases were aged 25 and above. Among them, 147 of the males and 38 of the females had gonorrhea, 15 males and 44 females had Trichomonas vaginalis, 9 men and 63 women had Candida albicans, and 271 men had NGU. 47.1% of men were infected by casual consorts, 21% by prostitutes, and 20.4% by their wives. 11.4% of females were infected by casual consorts and 63.1% by their husbands. T-strain mycoplasmas were isolated from 18 (19.3%) of the 93 patients with NGU and from 13 (20%) of the 65 controls. Among the 130 symptomless women, 19 had Trichomonas vaginalis, 15 had Candida albicans, 7 had gonorrhea, and 89 had no abnormal findings. Among the 19 prostitutes, 3 each had gonorrhea and trichomonas vaginalis, none had Candida albicans, and there were no abnormal findings in 13. A likely reason for the prevailing patterns of infection is that self-treatment of symptomatic disease is widely practiced, broad spectrum antibiotics being freely available. All the prostitutes took regular prophylactic treatments.     

Disease prevalence among women attending a sexually transmitted disease clinic varies with reason for visit.

Prevalence of sexually transmitted diseases (STD) and selected behavioral and demographic variables were evaluated in 279 women attending a Baltimore STD clinic, using a standardized questionnaire and cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Stratified by reason for clinic visit, 102 (37%) of 279 women attending the clinic stated that they were recent contacts to men with STDs with the majority (59 out of 102, or 58%) reporting gonorrhea contact as their reason for visit. Another 124 women (44%) came to the clinic for symptom evaluation, and 53 (19%) for other reasons. Prevalence of STDs was higher among those attending as contacts than among noncontacts: 35% versus 15% for N. gonorrhoeae; 26% versus 16% for C. trachomatis; and 27% versus 15% for T. vaginalis (P less than 0.05 for each). Furthermore, multiple infections were found in 23% of those attending as contacts but only in 10% of noncontacts (P less than 0.001). In general, patients reporting contact with an infected person were also less likely to report symptoms (43% versus 34%, P less than 0.001), despite increased disease prevalence. These data suggest that multiple STDs are often present in women attending STD clinics, irrespective of reason for visit. Merely treating women for reported exposure without further evaluation will fail to identify a substantial number of women coinfected with other organisms.