Narrowing sexual behavioural differences between Chinese and non-Chinese populations in Hong Kong: implications for sexually transmitted infection (STI) transmission

Information on sexual networking between different ethnic groups, in particular between Chinese and non-Chinese, is scarce. This study compared patterns of sexual behaviour and determinants of unsafe sexual behaviours amongst the Chinese and non-Chinese residents of Hong Kong. Of the 2,060 respondents (2060/4157; 50% response rate), 73% identified themselves as being ethnic Chinese. Overall, having a non-regular partner was more common amongst the non-Chinese (36%) than the Chinese (17%) respondents. Chinese people who were at increased risk of having had sex with a non-regular partner included social hygiene clinic attendees and airport travellers, males and ever smokers. For non-Chinese this was inconsistent condom use and being aged 18-45. Predictors of inconsistent condom use for Chinese included being aged 18-45, never having been married, and having had sex with non-regular partners; for non-Chinese the predictors were being aged 18-45, having had sex with non-regular partners and being unafraid of AIDS. We conclude that there are similarities and differences in sexual risk-taking behaviours between Chinese and non-Chinese residents in Hong Kong. To maximize potential public health benefits, behavioural interventions should be designed to address the different risk profiles of Chinese and non-Chinese populations separately.     

Adolescents in The Netherlands underestimate risk for sexually transmitted infections and deny the need for sexually transmitted infection testing

Worldwide, adolescents are at risk for sexually transmitted infections (STI). In The Netherlands, test rates among young heterosexual people are low and knowledge on the behavioral determinants of testing is scarce. In this study, we investigated STI testing in more detail with two independent samples of 16-25 year old vocational school students (n?=?756/n?=?1302). The aim of this study was to examine risk perceptions in relation to STI testing among lower educated adolescents in order to inform the development of an intervention promoting STI testing. We compared multiple measures of risk perception, fear of testing, self-efficacy for testing, and risk knowledge between groups of adolescents engaging and not engaging in risk behavior. The results show that at least half of the participating students with sexual experience underestimated their susceptibility for STI and showed an optimistic bias. Students with sexual experience also considered STI very severe but lacked self-efficacy for testing. This combination can yield a defensive reaction to the threat of STI that, in turn, results in the underestimation of personal risks. However, self-efficacy did not mediate the relationship between intention to test and perceived relative risk. In conclusion, our findings show underestimation of personal risks by vocational school students, a high perceived severity of STI and low self-efficacy for testing. A low level of knowledge regarding sexual risks and symptoms of STI might have contributed to low risk perceptions. Self-efficacy did not change the relation of intention-to-test to perceived risk.     

HIV infection and sexually transmitted infections in Lithuania

Lithuania is a small country with a population of 3.7 million. It has recently been released from the yoke of Soviet rule. HIV infection was first identified in 1988 and while the numbers of cases are small, the incidence is beginning to rise precipitously. A National AIDS Centre has been established in the capital, Vilnius, and a nationwide epidemiological survey is underway. Efforts are being made to prevent HIV infection. Sixty one per cent of notified cases of HIV infection are in Klaipéda, a port city adjacent to the Kaliningrad region and the predominant mode of transmission is by intravenous drug use. The majority of cases of AIDS, however, are seen in Vilnius. Sexually transmitted infections (STIs) are poorly controlled and there is no national control strategy. While the incidence of gonorrhoea is declining, new cases of syphilis have been on the increase, reaching 101.4 cases per 100,000 of the population. Cases of congenital syphilis are still seen.     

The relationship between condom use,sexually transmitted diseases,and location of commercial sex transaction among male Hong Kong clients

OBJECTIVE: This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions. DESIGN AND METHODS: Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information. RESULTS: Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05). CONCLUSION: The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.     

Prevalence and associated factors of mental health problems among monogamous Chinese female patients with sexually transmitted diseases in Hong Kong

Sexually transmitted disease (STD) increases risk of HIV infection and has profound psychological consequences. The present study examined the mental health problems (poor emotional well-being, insomnia, probable depression) and their associated factors among monogamous Chinese female STD patients. A total of 537 Chinese female STD patients who self-reported having had only one male sex partner in the last 12 months were recruited from a STD clinic in Hong Kong. They completed a survey including measures of mental health, STD-related history, perceptions, feelings related to STD infection, and perceptions toward condom use. Results showed that 22% had poor emotional well-being, 25.7% had insomnia, and 43% were probable cases of depression. Unemployment, worsened relationship with partners after STD diagnosis, STD history in last three months, finding STD examinations embarrassing, and feelings of helplessness were significant risk factors for poor emotional well-being and insomnia. Also, unemployment, worsened relationships with partners after STD diagnosis, and perceived high chance of STD in the coming six months were significant risk factors for probable depression. Perceived efficacy of condom use for STD prevention was a significant protective factor against poor emotional well-being and probable depression. Findings suggest that interventions are warranted to improve the mental health among this population.     

Syphilis and other sexually transmitted diseases in HIV infection

An ongoing resurgence of syphilis and continued transmission of other common sexually transmitted diseases (STDs) in HIV-infected patients is fueled by a number of factors, including "prevention burnout" resulting from fatigue with long-term, safer-sex behavior, use of recretional drugs (notably methamphetamine), and false sense of security associated with HIV serosorting and elevated CD4+ cell count. Annual screening for common STDs is recommended for HIV-infected patients. Issues in syphilis and herpes simplex virus-2 (HSV-2) diagnosis and treatment are discussed. New problems are briefly reviewed, which include the increased reporting of lymphogranuloma venereum and the increased frequency of fluoroquinolone-resistant gonorrhea. The recently revised Centers for Disease Control and Prevention guidelines for treatment of syphilis, HSV-2 infection, chlamydial infection, and gonorrhea are summarized. This article summarizes a presentation on syphilis and other STDs made by Jeanne Marrazzo, MD, MPH, at the International AIDS Society-USA Continuing Medical Education course in New York, in October 2006. The original presentation is available as a Webcast at www.iasusa.org.     

Verocytotoxin-producing Escherichia coli infection: The Hong Kong experience

Abstract Infection by verocytotoxin-producing Escherichia coli (VTEC) is prevalent in many parts of the world but relatively uncommon in Asia, except Japan. A territory wide screening for VTEC (April to August 1996) in diarrhoeal stool samples sent to six hospital microbiology laboratories in Hong Kong revealed only four isolates of VTEC and one isolate of E. coli O157:NM in 1003 specimens (incidence 0.5%). Two isolates carrying the verocytotoxin (VT) genes belonged to the O157:H7 serotype while the other two were non-O157. One non-toxigenic E. coli O157:NM was also isolated. All isolates positive for VT genes by polymerase chain reaction (PCR) were also positive for the Vero toxin assayed by the Vero cell culture. The 97 kDa eaeA outer membrane protein gene and 60 MDa fimbrial plasmid pcVD419 were present only in the two O157:H7 isolates. All patients presented with uncomplicated watery diarrhoea; no one suffered from haemorrhagic colitis or the haemolytic uraemic syndrome. All patients recovered uneventfully without antibiotic treatment. Although VTEC infection is still uncommon in Hong Kong, continued surveillance is essential to prevent future outbreaks.     

The epidemiology of cytomegaloviral infection in women attending a sexually transmitted disease clinic

To test the hypothesis that cytomegalovirus (CMV) is sexually transmitted, we examined the association of CMV infection with indices of sexual activity in 347 women attending a sexually transmitted disease (STD) clinic. Stepwise multivariate logistic regression analysis showed that seropositivity to CMV (complement-fixation antibody titer, greater than or equal to 1:8) was most closely associated with number of sex partners in the subjects' lifetime (P less than .0001), young age at first sexual intercourse (P = .0002), and nonwhite race (P = .0007). Among seropositive women, cervical shedding of CMV was most strongly associated with younger age (P = .0001) and the presence of cervical chlamydial infection (P = .016). Among 84 seronegative women followed up for a mean of 18.4 weeks, 11 (13%) developed primary CMV infections, an annual incidence of 37%. Sexual contact seems to be an important mode of acquisition of CMV in some young women.     

Prevalence of hepatitis C infection in Hong Kong

A study of a cross-section of the Hong Kong Chinese population was done to investigate the seroprevalence of hepatitis C. Healthy subjects were random visitors of a health exhibition, while clinical subjects were recruited from an outpatient liver disease clinic, sexually transmitted disease clinics, dialysis centres and drug rehabilitation centres. A total of 910 subjects were tested. The assay kits were from Abbott and Ortho laboratories. Of the general population, 0.5% was found to be positive for antibody to hepatitis C (anti-HCV). Suspected chronic non-A non-B patients, parenteral drug abusers and haemophiliacs shared a common high (up to 70%) prevalence of anti-HCV. Sexual partners of index patients, homosexuals and female prostitutes as well as hepatitis B carriers had 0% prevalence. It was concluded that parenteral and blood product exposures were the two main risk factors for hepatitis C.     

Emerging issues in management of sexually transmitted diseases in HIV infection

Sexually transmitted diseases (STDs) occur often among sexually active persons with HIV infection. Incident STDs may complicate the course of HIV infection and potentiate HIV transmission in the coinfected individual by mucosal disruption and an increase in HIV concentration in ulcers and involved mucous membranes. Conducting ongoing periodic sexual risk assessments in HIV-positive patients in routine medical care is critical to identifying asymptomatic infections. HIV clinicians should be familiar with updated recommendations for screening, diagnosis, and treatment of bacterial and viral STDs, including those specific to HIV infection. This article addresses emerging issues in the management of STDs in HIV-infected persons and summarizes the latest evidence that can be applied to clinical decision-making in this population.     

Screening for sexually transmitted infection pathogens in semen samples.

The transmission of sexually transmitted infection (STI) pathogens from an infected donor to the recipient of a semen donation in assisted conception may result not only in acute infection but also in long-term reproductive complications or adverse outcomes of pregnancy, including infection of the offspring. Screening for bacterial STI pathogens, Chlamydia trachomatis and Neisseria gonorrhoeae is strongly recommended because these pathogens can cause serious reproductive complications in the recipients of semen donations and infection in their offspring. Screening for these pathogens should be performed using the most sensitive methods, such as nucleic acid amplified tests. False-negative results due to inhibitory substances in the semen sample should be monitored using amplification controls. Where specimen transport is not a problem and culture facilities are available, N gonorrhoeae can also be detected by culture. Laboratories performing screening should subscribe to proficiency programs and have strict quality controls. Although Trichomonas vaginalis, group B streptococcus and genital mycoplasmas have been associated with adverse outcomes of pregnancy, the frequent finding of these organisms in healthy individuals brings into question the validity of mandatory inclusion of these organisms in the screening panel. Although viral STI pathogens and Treponema pallidum - the causative agent of syphilis - may be detected in semen, their presence may be more sensitively detected through antibody testing of the donor. Screening donors for HIV, hepatitis B and syphilis by serology is uniformly recommended in all of the guidelines, but the value of screening either donors or semen samples for cytomegalovirus, herpes simplex viruses and human papilloma viruses is less clear.     

Cytomegalovirus infection in women attending a sexually transmitted disease clinic

To evaluate prospectively the relationship between current and past sexual practices and seroprevalence of cytomegalovirus (CMV) in adult women, 1481 women (1101 white, 301 black, 79 other) attending a sexually transmitted disease clinic underwent a standardized interview and genital examination. CMV seroprevalence was higher in black (78%) than in white (59%) women. In logistic regression models that adjusted for age and years of education, CMV seropositivity in white women was associated with younger sexual debut (P = .001), more lifetime sex partners (P = .025), recent new partner(s) (P = .003), and parity (P = .002), and was inversely associated with use of barrier contraception (P = .006). In black women, after adjustment for demographic characteristics, CMV antibody was associated with greater numbers of recent sex partners (P = .007), new sex partners (P = .04), and with cervical infection with Chlamydia trachomatis (P = .05). This study confirms that sexual activity is an important determinant of CMV infection in both white and black women; however, the relative contributions of sexual and nonsexual transmission of CMV apparently vary and require further investigation.     

Interactions between HIV infection and other sexually transmitted diseases

Mechanisms and implications of the interaction between HIV and other STDs such as syphilis, Herpes simplex, Chlamydia and Neisseria gonorrhoeae infection are presented and relevant case reports and trials described.     

HIV testing and sexually transmitted infection care among sexually active youth in the Balkans

In light of the imminent threat of a growing HIV epidemic in east and southeast Europe, optimal accessibility of primary and secondary HIV preventative interventions, including HIV testing and sexually transmitted infection (STI) care, are fast becoming public health priorities. We surveyed 2150 high school students in Bosnia and Herzegovina, FYR of Macedonia, Serbia, and Montenegro to examine the uptake of HIV testing and associated predictors. Among sexually active youth (n = 651), 5.9% had already been tested for HIV. In marginal logistic regression, country of origin, type of high school, knowing a friend or relative with HIV, poor self-assessed health status, suspicion of having had an STI, and not having used a condom at first sex were independently associated with HIV testing. Fear of the diagnosis, fear of violation of confidentiality, and not knowing where to go for HIV testing were reported as barriers to HIV testing. Of sexually active adolescents who thought they might have contracted an STI, only 42% had subsequently visited a doctor or health facility. The main reasons for not doing so were spontaneous disappearance of the complaints, fear of the diagnosis and being ashamed of discussing the problem. In conclusion, the uptake of HIV testing among this population of sexually active, urban high school students was found to be low, although a higher prevalence of HIV testing history was observed among students showing evidence of risky sexual behavior. Practical and psychological factors seem to challenge the accessibility of facilities for HIV testing and STI care.