The prevalence of sexually transmitted diseases among prostitutes in Malaysia.

The prevalence of sexually transmitted diseases was determined among 370 prostitutes in Kuala Lumpur, Malaysia. Chlamydial cervicitis (26.5%) was detected more frequently than gonorrhoea (14.25%) and was associated more often with pelvic inflammatory disease. Concurrent infections and asymptomatic infections were common. Seropositivity to hepatitis B and syphilis were 66.3% and 13.6% respectively. Women under 20 years of age had significantly higher rates of infection with Chlamydia trachomatis and hepatitis B virus than older women.     

Characteristics and sexually transmitted diseases of male rural migrants in a metropolitan area of Eastern China

GOAL: The goal of this study was to identify the correlates and determine the prevalence of sexually transmitted diseases (STDs) among male rural migrants in Shanghai, China. STUDY: The authors conducted a community-based cross-sectional study with an anonymous questionnaire interview and collection of blood and first-void urine samples for STD screening. RESULTS: One thousand eighty-six (85.3%) of 1273 male rural migrants approached were interviewed. Among the 986 sexually active migrants, the prevalence of chlamydia, gonorrhea, and syphilis was 3.5%, 0.5%, and 1.0%, respectively. None were infected with HIV. The prevalence of STDs was 3.2% for construction workers, 5.6% for market vendors, and 5.6% for factory workers. Risk factors for STDs were longer duration in Shanghai, frequent hometown visits, having multiple sex partners, and the desire to have multiple sex partners. CONCLUSIONS: The prevalence of STDs among male rural migrants is relatively low. Maintaining the current low prevalence can reduce the risk of an HIV epidemic among Shanghai migrants, but prevention messages need to be tailored to the low level of literacy in many migrants.     

HIV and other sexually transmitted diseases at a rural hospital in Zimbabwe.

OBJECTIVE--To define the epidemiological characteristics of STD patients attending an outpatient clinic in rural Zimbabwe, to examine the aetiologic agents causing infection and to determine their relationship with HIV infection. SUBJECTS--319 men and 146 women, making a sample of about 7% all patients attending an STD clinic during the 3 month study period. Microbiological data were collected from 104 men and 72 women selected randomly from these. Pregnant women were excluded and patients who had received antibiotics within the previous 14 days were excluded from the microbiology sub-sample. SETTING--An outpatient STD clinic at a District Hospital on a major truck route about 300 km north of the capital, Harare. METHODS--All new patients attending the clinic during a 3 month period were enrolled for clinical and epidemiological investigations using a standard procedure. Specimens for microbiological investigation were taken from every second patient seen on the first three days of each week. RESULTS--The typical patient was male (m:f ratio 2.2) aged 20-29 years (68% patients), not married (56% men) and in paid employment (66% men vs. 27% for the district). In men the most common presenting feature was genital ulceration, while in women, discharges were more common. Genital warts were noted frequently in both sexes. In the sub-sample examined microbiologically, H ducreyi was isolated from 46% ulcers clinically diagnosed as chancroid, and motile spirochaetes were detected in 25% painless ulcers. Neither of these were detected in ulcers in women, but HSV antigen was found as frequently in ulcers from men (19%) as from women (17%). In patients with genital discharges, gonococcal infection occurred in 64% men and 17% women, while T vaginalis was isolated from 39% women and only 8% men. Over 60% gonococcal isolates were PPNG, and 18% showed in vitro resistance to tetracycline. Yeasts, mainly C albicans were isolated from 42% women with a discharge and 25% women with ulcers. In men the presence of yeasts was associated with superficial ulceration and itchiness of the glans. Positive HIV-1 serology was found in 64% patients. There was no statistical association with current genital ulcers, though there was an association with previous STD episodes and particularly with serological evidence of syphilis. Apart from yeasts, there was no association between positive HIV-1 serology and the presence of pathogens in the genital tract. CONCLUSIONS--The high prevalence of HIV-1 antibodies in STD patients in Karoi suggests integration of STD and AIDS control programmes to be a necessity. Since paid employment was a common feature of both STD clinic attendance and HIV-1 seropositivity, these programmes may be effectively directed through the work place.     

Perceived social cohesion and prevalence of sexually transmitted diseases

BACKGROUND: Although physical attributes have been shown to be associated with sexually transmitted disease (SD) rates, there is little information about the association between social attributes and STD rates. GOAL: The objective of this study was to determine the association between gonorrhea prevalence and perceptions of social cohesion in impoverished, urban neighborhoods. STUDY DESIGN: We conducted a street-based survey of 18- to 24-year-olds residing in selected census block groups in Baltimore City, Maryland. Census block groups eligible for selection were defined as impoverished (greater than 20% in poverty) and unstable (lowest 25th percentile for stability). From the eligible census block groups, 5 from high gonorrhea rate (greater than the 75th percentile) census block groups and 5 from the lower gonorrhea rate (lowest 25th percentile to equal or greater than the 75th percentile) census block groups were randomly selected. Participants within the 10 selected census block groups were recruited using a street-intercept method. Participants were asked about perceived social cohesion and control. RESULTS: Results showed that for young adults 18 to 24 years of age residing in high gonorrhea census block groups, the mean social cohesion index scores were 1.7 points lower than mean social cohesion index scores of the participants residing in the low gonorrhea census block groups (P <0.01). CONCLUSION: Future research needs to be conducted to determine the temporal association between gonorrhea prevalence and local social cohesion dynamics.     

Syndromic management of sexually transmitted diseases at primary care level, Mozambique

Methods: In 26 health facilities in selected sites, we observed management of all STD patients presenting in the adult general or STD clinic. We assessed the referral system by analysing patient registers.

Results: 408 STD patients (65% in STD and 35% in general clinics) were observed. 70% were women. Women were examined less (26% against 75%, p<0.0001), had laboratory tests ordered more (74% against 45%, p=0.0002), were more often diagnosed syndromically (57% against 38%, p=0.008), and received less advice on condom use (19% against 87%, p<0.001) and contact treatment (47% against 81%, p=0.04). Examination, laboratory requests, diagnosis, and treatment were not significantly different in the STD and general clinic. Health education was better in the STD clinic (condom advice 47% against 8%, p <0.001). Only 41% of referred patients presented to the STD clinic.

Conclusions: The better performance of STD clinics in health education was offset by high referral losses. A proposed integration of STD treatment into general outpatient clinics and better implementation of syndromic management and health education should improve STD case management at primary level in Mozambique.

     

HLA and sexually transmitted diseases in prostitutes.

The HLA profile of 148 unrelated, Chinese prostitutes (56 with repeated gonococcal infection, 31 with syphilis, 31 with gonorrhoea and syphilis, and 30 with no evidence of infection) was compared with that of 238 unrelated, healthy, Chinese control subjects. The joint occurrence of AW19 B17 was observed in 25.8% of prostitutes with double infections compared with 6.7% of control subjects, while that of A11 B15, on the other hand, was associated with a resistance to syphilis and gonorrhoea. The latter profile was observed in 46.7% of prostitutes in business for more than two years who were resistant to disease, in 30% of prostitutes with an overall disease resistance, in 13.4% of control subjects, and in only 3.2% of prostitutes with combined syphilis and gonorrhoea. Because of the statistical uncertainty when multiple variables are being analysed these studies should be repeated in other groups of prostitutes of the same and different ethnic origins.     

Screening for sexually transmitted diseases in an HIV testing clinic; uptake and prevalence.

OBJECTIVE: To estimate the prevalence of sexually transmitted diseases (STDs) and the acceptability of STD screening among people seeking an HIV antibody test in an established free standing HIV testing clinic. DESIGN: A 9 month period prevalence study conducted between August 1993 and April 1994. SETTING: The Same Day Testing Clinic (SDTC) for HIV antibodies at the Royal Free Hampstead NHS Trust Hospital, London. SUBJECTS: 242 males and 160 females attending the Same Day Testing Clinic. OUTCOME MEASURES: The prevalence of STDs including gonorrhoea, chlamydia, syphilis and hepatitis B and the percentage of clinic attenders accepting an STD screen. RESULTS: Of those invited to take part in the study 69% of the males (242/350) and 59% (160/269) of the females agreed to be screened although for a variety of reasons not everyone agreed to a full screen. Two cases of untreated syphilis, no cases of gonorrhoea and six cases of chlamydia were detected. Four people had active, previously undiagnosed herpes while three had genital warts. Evidence of previously unknown hepatitis B infection was found in 26 people. Despite a high level of previous contact with genitourinary medicine services, uptake of hepatitis B vaccination among those homosexual men eligible for immunisation was low (28%; 23/83). Nine (4%) of the males, but none of the females screened for STD were found to be HIV antibody positive. CONCLUSION: Among people seeking an HIV antibody test in an established free standing HIV testing clinic, the prevalence of acute STDs was low. However, evidence of previously undiagnosed hepatitis B infection was found in a number of subjects and uptake of vaccination among those most at risk had been low. While opportunistic screening for STD was acceptable to almost two thirds of HIV testing clinic attenders, a substantial minority nonetheless declined this offer. Selective STD screening could be offered to those people seeking an HIV test who report never having been screened before, as both cases of positive syphilis serology and all those of chlamydia were in people who had not previously been screened. All those at risk for hepatitis B infection should be encouraged to establish their infection status and be immunised where appropriate.     

High prevalence of sexually transmitted diseases in young women seeking HIV testing in Rio de Janeiro, Brazil

BACKGROUND AND OBJECTIVES: Few data are available on the prevalence of and risk factors for sexually transmitted diseases (STDs) other than HIV in Brazil. GOAL: The goal of this study was to determine the prevalence of HIV infection and other STDs in Brazilian women who seek HIV testing, investigate risk factors for these infections, and assess feasibility of screening in HIV test clinic settings. STUDY DESIGN: We conducted a cross-sectional study of 200 women, aged 14 to 29 years, who attended an HIV testing site in central Rio de Janeiro. Participants completed a questionnaire and received testing for HIV, syphilis, chlamydia, and gonorrhea. RESULTS: HIV and other STDs were common (HIV 8%, syphilis 6.5%, chlamydial infection 8%, and gonorrhea 9.5%). HIV was significantly associated with lower education and with having an HIV-infected partner. Other STDs were significantly associated with younger age at first intercourse, heavy alcohol consumption, and marijuana use. CONCLUSION: STDs appear to be substantial health problems among young Brazilian women seeking HIV testing. HIV testing sites in Brazil should consider offering screening and treatment for STDs and substance abuse as part of their HIV prevention services.     

Recent developments in sexually transmitted diseases: is Kaposi's sarcoma a sexually transmitted disease?

Kaposi's sarcoma (KS), a major complication of AIDS, is found more frequently in the Western hemisphere among homosexual and bisexual male AIDS patients than among other patients with AIDS. Theory and arguments for the possibility of infectious cofactors playing a role in the cause and transmission of the sarcoma are reviewed. While cytomegalovirus, Epstein-Barr, and human herpesvirus have been explored as potential cofactors in AIDS-related KS, the focus here is on the suggestion that Kaposi's sarcoma in a person with AIDS may be caused by an unidentified infectious agent spread through sexual contact. The 1st of 4 arguments supporting this theory is that patients acquiring HIV via sexual contact instead of through parenteral or vertical means experience a much greater risk of KS. 2nd, women acquiring HIV heterosexually from bisexual men experienced a 4 times greater risk of KS than those having other sexual partners. The identification of benign and localized KS in 6 homosexual or bisexual men from New York City without HIV antibodies suggests that the KS causal agent is the same regardless of the presence or absence of HIV infection. There is some evidence that circumstances permitting the heterosexual spread of AIDS in Africa also facilitate the transmission of the KS causal agent. Laboratory and epidemiologic investigations are needed to identify the sexually transmitted cofactor or cause of KS. KS in its classic and endemic African forms is described, followed by discussion of KS and immunodeficiency. 2 sections are then devoted to exploration of AIDS-associated KS in the US and the AIDS-related KS epidemic in Africa, respectively.     

High prevalence of sexually transmitted diseases among men who have sex with men in Jiangsu Province, China

OBJECTIVE:: The objective of this study was to investigate the prevalence of sexually transmitted diseases (STDs), including HIV infection, and sexual risk behaviors among men who have sex with men (MSM) in Jiangsu Province, China. DESIGN:: The authors conducted a cross-sectional study. METHODS:: From February to July 2003, men who attended 10 participating gay bars in five cities in Jiangsu Province were asked to complete a self-administered questionnaire, including measures of alcohol use and sexual risk behaviors. Blood samples and urethral swabs were taken to examine the presence of STDs, including HIV infection. RESULTS:: A total of 144 men were recruited in the study. Forty-six percent of men reported unprotected anal intercourse with their male sexual partners in the past 3 months. No one was found to be HIV-infected, but the prevalence of STDs was high: gonorrhea 2.7%, chlamydial infection 8.0%, nonchlamydial nongonococcal urethritis 27.7%, active syphilis 6.9%, hepatitis B virus infection 9.1%, herpes simplex virus-2 infection 7.8%, and genital warts 13.2%. CONCLUSIONS:: Given that HIV prevalence among MSM in some other parts of China has been as high as 3%, STDs facilitate the transmission of HIV, and high prevalence of STDs and sexual risk behaviors among MSM exist in Jiangsu Province, the potential for the future spread of HIV is of concern, and it is urgent to provide MSMs with STD healthcare services and HIV/AIDS/STD prevention education and intervention.     

性传播疾病中的支原体感染

对８７２例性病门诊患者的尿道（宫颈）拭子标本进行了解脲支原体和人型支原体的培养，其中部分标本还做了淋球菌和沙眼衣原体的培养。结果表明，支原体培养阳性者共２５８例（２９．６％），其中ＵＵ感染为１８８例（１２．６％），显著高于ＭＨ感染（１７例，１．９％）和ＭＨ与ＵＵ混合感染（５３例，６．１％）（Ｐ〈０．０１）。在１７３例支原体培养阳性的患者中有５３例（３０．５％）合并ＣＴ和（或）ＮＧ感染。作者对上述病     

Pathogen-host relations in sexually transmitted diseases

The host-parasite relationship between the major causative agents of sexually transmitted diseases, e.g. Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis, and their target cells in the urogenital tract can generally be studied in suitable cell and organ cultures. Experience with N. gonorrhoeae predominantly gained from fallopian-tube organ cultures shows that there are several prerequisites for adherence as the first step of pathogenesis. They range from the type of bacterial pili to the type of epithelial cell. Later the function of these cells is damaged by subcellular toxins of a lipopolysaccharide nature. The cocci are phagocytosed, which eventually leads to definite (ultra-) structural alterations. These processes are not only described in detail but also compared with those found with other bacterial species and target cells. Possible predisposing factors in the host are also taken into account. Finally the need for investigating the effect of antibiotics on the host-parasite relationship is stressed.