High prevalence of sexually transmitted diseases in a rural area in Mozambique.

OBJECTIVE--To assess the extent of the sexually transmitted diseases (STDs) problem in a rural area of Mozambique. METHODS--A cross sectional study among pregnant women and patients presenting with genital complaints. Laboratory confirmation was done for gonorrhoea, chlamydial infection, active syphilis, trichomoniasis and HIV infection. SETTING--A primary health care setting in Vilanculos, Inhambane province, Mozambique. RESULTS--Evidence of one or more of the above STDs was found in 51% of 201 pregnant women, 56% of 85 women and 62% of 77 men with genital complaints. Neisseria gonorrhoea or Chlamydia trachomatis were found in 16% of pregnant women, 23% of female patients and 28% of male patients; genital ulcer disease was present in 6%, 28% and 36%, of respectively pregnant women, female and male patients. The prevalence of active syphilis was about the same in the three groups of study subjects, that is 15%. HIV infection was found in 4% of the male patients; no HIV infection could be detected in the female groups. CONCLUSION--STDs were a major health problem in this rural area in Mozambique. Though HIV infection was still low, the high prevalence of STDs indicates that the potential is there for an explosive spread of the HIV/AIDS epidemic.     

Overview of incidence of sexually transmitted diseases in Kuwait

Sexually transmitted diseases (STDs) are the most common infections afflicting mankind. According to the World Health Organization (WHO) estimates, the global incidence in 1995 of new cases of selected curable STDs, (gonorrhea, chlamydial infection, syphilis, and trichomoniasis) was 333 million. They are now the most common group of notifiable infectious diseases in most countries, particularly in the age group of 15-50 years, and in infants. They assume significance in view of the high incidence of acute infections, complications and sequelae, socioeconomic impact, role in increasing transmission of the human immunodeficiency virus (HIV). STDs are hyperendemic in many developing countries. In the industrialized world, diseases due to Chlamydia trachomatis, genital herpes virus, human papillomaviruses, and human immunodeficiency virus are now more important than the classical bacterial ones; whereas both groups remain major health problems in most developing countries. Their contribution to the spread of the HIV pandemic due to similar routes of transmission has brought attention to STDs in a forceful manner.     

2004-2005年肇庆市桑拿按摩女性服务人群性病及相关高危因素调查分析

目的:掌握肇庆市桑拿娱乐场所服务人群的性病与艾滋病的感染水平、性病防治相关健康知识和健康行为状况,为遏制性病和艾滋病的传播提供科学依据。方法:对桑拿按摩女性服务从业人员进行性病筛查和性病与艾滋病防治相关知识和行为问卷调查。结果:在651名女性服务从业人员中发现性病168例,性病感染率为25.81%,其中有1例HIV阳性;服务从业人员对性病与艾滋病防治知识的知晓率和健康行为形成率偏低。结论:对桑拿按摩女性服务从业人员必须加强健康宣教,大力推广使用安全套等行为干预措施。     

STD vaccines--an overview.

OBJECTIVES: To describe the role and current status of vaccine research against sexually transmitted diseases (STDs). METHODS: The available literature was reviewed with particular emphasis on bacterial STDs. RESULTS: Strategic approaches to possible implementation of STD vaccine programmes were analysed. The status of vaccines against bacterial STDs (syphilis, chancroid, gonorrhoea, and chlamydia) is described in detail. CONCLUSIONS: The development of safe and effective STD vaccines offers a potent tool for the control of STDs, including direct and indirect prevention of HIV infection. Future priorities should be in the development of vaccines against gonorrhoea, chlamydia, and syphilis. When such vaccines become available, caution should be exercised to ensure that they do not interfere with the effectiveness of other prevention programmes.     

Incidence of sexually transmitted diseases and HIV infection in men who have sex with men related to knowledge, perceived susceptibility, and perceived severity of sexually transmitted diseases and HIV infection: Dutch MSM-Cohort Study

BACKGROUND: This longitudinal study was conducted to investigate whether knowledge, perceived susceptibility, and perceived severity of HIV infection and sexually transmitted diseases (STDs) are associated with the incidence of STDs and new HIV infections among men who have sex with men (MSM). METHODS: A 3-year cohort study was conducted among 190 HIV-negative MSM. Data were collected on the incidence of STDs and new HIV infections, as well as on knowledge and perceived susceptibility to and perceived severity of HIV infection and STDs. Knowledge and perceptions were assessed in self-administered questionnaires. RESULTS: In the course of the 3-year study, six MSM (3.2%) HIV-seroconverted and 78 (41.1%) participants were diagnosed with at least one STD. MSM seemed to be better informed about HIV infection compared with STDs, and HIV infection was perceived as more severe than other STDs. In multivariable analyses, low perceived severity of HIV infection significantly (P = 0.025) predicted increased likelihood of infection with STDs or HIV, and the practice of anal intercourse was (marginally) associated with an increased risk of acquiring STDs or HIV (P = 0.052). CONCLUSIONS: A high perceived severity of HIV infection seems to induce sexual behavior that protects against STDs and HIV infection. More research is needed to establish the specific behaviors by which perceived severity of STDs/HIV influences the incidence of STDs and HIV.     

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.     

STD control in drug users and street youth.

OBJECTIVE: To review the relation between drug use, sexual risk behaviour, and STDs including HIV in two marginalised populations--drug users and street youth. METHODS: A review of recent medical and behavioural literature focusing on illustrative examples from industrialised countries. FINDINGS: Injecting and other illicit drug users and street youth are both sexually active populations with a high rate of partner turnover and frequently exchange sex for money or drugs. Both STDs and HIV are prevalent among injecting and crack using individuals. Drug use may lead drug users to be less aware of or concerned about STD symptoms than others with STDs and thus increase the threshold for attending clinical services. CONCLUSIONS: Given that STDs facilitate the transmission of HIV and that standard STD control programmes in general do not reach these populations, it is argued that drug users and street youth require targeted special outreach STD control programmes.     

威海市某医院498例性传播疾病临床分析

目的了解威海市性传播疾病(简称性病)的发病情况,为制定防控策略提供科学依据。方法对威海市某医院2006-2010年报告的498例性病疫情资料进行临床分析。结果 5年间报告梅毒、淋病、非淋菌性尿道炎、生殖器疱疹及尖锐湿疣共498例,男356例,女142例,33例患两种以上性病;发病构成比先增高后降低,由2006年的14.26/万,先上升至2009年的28.11/万,后降至2010年的21.08/万。梅毒和非淋菌性尿道炎、生殖器疱疹发病比例逐年增高,尖锐湿疣最高,平均为32.60%,淋病逐年下降;21～29岁年龄组为高发人群(44.18%),50岁以上年龄组构成比逐年增高;职业以待业者为主。结论梅毒等发病比例呈上升趋势,高年龄组性病发病比例逐年增高,因此性病的预防与控制工作应有针对性的加大力度。     

The role of epidemiology and surveillance systems in the control of sexually transmitted diseases.

Surveillance and epidemiological studies are essential components of effective control programmes for sexually transmitted diseases. While other forms of basic biomedical research may add to our understanding of why an exposure or behaviour causes or prevents disease, only epidemiology allows the quantification of the magnitude of the exposure-disease relationship in humans. It is this measure of the association between risk and disease that is needed to inform rational policy on altering risk through intervention. Surveillance data are used both to determine the need for public health action and to assess the effectiveness of programmes: they are required for the setting of priorities, for planning and resource allocation, for the definition of population subgroups and risky behaviours for targeted interventions, for the development of disease prevention programmes, and for the evaluation of interventions. Data from surveillance systems and epidemiological studies can also inform diagnostic and therapeutic practice, and indicate areas for further research. Over the last 20 years chlamydia infections and viral agents have emerged as the major cause of STD in developed countries, and with this change in the aetiological mix of STD cases the focus of prevention and control of STDs has shifted from treatment and partner notification towards health education. In developing countries there is an urgent need for appropriate surveillance infrastructures, particularly now that there is evidence that STD control programmes, informed by surveillance data, can reduce HIV transmission at the population level. The importance of surveillance and epidemiology in the control of STDs is set to increase in the face of the changing pattern of sexually transmitted pathogens. The challenge to clinicians and epidemiologists is to work together in developing systems that will inform new approaches to control and prevention.     

Contact tracing for human immunodeficiency virus (HIV) infection

Contact tracing--or partner notification--is a generally accepted method for the control of sexually transmitted diseases (STDs), but its use as an epidemiological tool against the spread of acquired immunodeficiency syndrome (AIDS) has been questioned. The authors find contact tracing for infection with human immunodeficiency virus (HIV) quite feasible; it makes it possible for health care providers to reach people at high risk for infection in order to offer them counseling and testing. Contact tracing must be performed by someone directly engaged in caring for the HIV infected patient, as well as in giving support and aiding the patient through possible crisis reactions. Through this approach the authors were able to identify 188 contacts to 91 index patients. Thirty-eight of the contacts were seropositive for HIV infection, and 21 of these were previously unaware of their infection.     

Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases.

Understanding the role of other sexually transmitted diseases (STDs) in the transmission of human immunodeficiency virus (HIV), the role of STDs in progression of HIV disease, and the role of HIV infection in alterations of natural history, diagnosis, or response to therapy of STDs is critical to the development of optimal strategies for HIV control. One hundred sixty-three studies on the interrelationships between HIV infection and other STDs were examined. Of 75 studies on the role of STDs in HIV transmission, the 15 analyses of examination or laboratory evidence of STDs adjusted for sexual behavior showed that both ulcerative and nonulcerative STDs increase the risk of HIV transmission approximately 3- to 5-fold. Due to limited data, the role of STDs in progression of disease remains unclear. Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community level, HIV infection may increase the prevalence of some STDs (e.g., genital ulcers). If coinfection with HIV prolongs or augments the infectiousness of individuals with STDs, and if the same STDs facilitate transmission of HIV, these infections may greatly amplify one another. This "epidemiological synergy" may be responsible for the explosive growth of the HIV pandemic in some populations. Effective STD control programs will be essential to HIV prevention in these communities.     

From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection

OBJECTIVES: To review the scientific data on the role of sexually transmitted diseases (STDs) in sexual transmission of HIV infection and discuss the implications of these findings for HIV and STD prevention policy and practice. METHODS: Articles were selected from a review of Medline, accessed with the OVID search engine. The search covered articles from January 1987 to September 1998 and yielded 2101 articles. Methods used to uncover articles which might have been missed included searching for related articles by author, and combing literature reviews. In addition, all abstracts under the category "sexually transmitted diseases" from the XI and XII International Conferences on AIDS (Vancouver 1996 and Geneva 1998) and other relevant scientific meetings were reviewed. Efforts were made to locate journal articles which resulted from the research reported in the identified abstracts. All original journal articles and abstracts which met one of the following criteria were included: (1) studies of the biological plausibility or mechanism of facilitation of HIV infectiousness or susceptibility by STDs, (2) prospective cohort studies (longitudinal or nested case-control) which estimate the risk of HIV infection associated with specific STDs or STD syndromes, or (3) intervention studies which quantitate the effect which STD treatment can have on HIV incidence. RESULTS: Strong evidence indicates that both ulcerative and non-ulcerative STDs promote HIV transmission by augmenting HIV infectiousness and HIV susceptibility via a variety of biological mechanisms. These effects are reflected in the risk estimates found in numerous prospective studies from four continents which range from 2.0 to 23.5, with most clustering between 2 and 5. The relative importance of ulcerative and non-ulcerative STDs appears to be complex. Owing to the greater frequency of non-ulcerative STDs in many populations, these infections may be responsible for more HIV transmission than genital ulcers. However, the limited reciprocal impact of HIV infection on non-ulcerative STDs and the evidence that non-ulcerative STDs may increase risk primarily for the receptive partner (rather than bidirectionally) may modulate the impact of these diseases. The results of two community level randomised, controlled intervention trials conducted in Africa suggest that timely provision of STD services can substantially reduce HIV incidence, but raise additional questions about the optimal way to target and implement these services to achieve the greatest effect on HIV transmission. CONCLUSIONS: Available data leave little doubt that other STDs facilitate HIV transmission through direct, biological mechanisms and that early STD treatment should be part of a high quality, comprehensive HIV prevention strategy. Policy makers, HIV prevention programme managers, and providers should focus initial implementation efforts on three key areas: (i) improving access to and quality of STD clinical services; (ii) promoting early and effective STD related healthcare behaviours; and (iii) establishing surveillance systems to monitor STD and HIV trends and their interrelations.


     

The effect of treating sexually transmitted diseases on the transmission of HIV in dually infected persons: a clinic-based estimate. Ad Hoc STD/HIV Transmission Group

BACKGROUND: The effect of sexually transmitted disease (STD) treatment on HIV transmission is a topic of considerable current interest and controversy. GOAL: To assess the potential effect of STD treatment on HIV transmission in persons who are dually infected with STD and HIV. STUDY DESIGN: Using data from eight STD clinic sites in the United States, the authors estimate the actual achievable reduction in HIV transmission by multiplying the prevented fraction associated with treatment of STDs (set at an average of 0.8) by the maximum potential reduction in HIV transmission achieved by treating STDs (using an average relative risk of 3.0 for increased HIV transmission in the presence of STDs). Subgroup analysis assessed infection proportions for genital ulcer disease, nonulcerative STDs, and any STD by sex, ethnicity, age, and sexual orientation. RESULTS: The maximum achievable reduction in HIV transmission from dually infected persons to their partners is approximately 33%. The actual achievable reduction is approximately 27% (range, 10.0-38.1%) at the eight clinic sites. If each of the 4,516 dually infected persons in this cohort experienced a single sexual exposure with an uninfected person, 28 HIV infections would occur in the absence of STD treatment whereas 16 infections would occur with STD treatment. CONCLUSIONS: The estimate of a 27% reduction provides a qualitative assessment of the potential impact of STD treatment on HIV transmission in the absence of any other behavioral intervention. Identification of dually infected persons in STD clinics is an important mechanism for targeting interventions to a social milieu with high risk for HIV infection and other STDs.     

Community understanding and prevention of sexually transmitted diseases

In spite of the various attempts by health care workers to reduce the morbidity and mortality of sexually transmitted diseases (STDs), more than 15 million persons acquire STDs each year in the United States. The situation is more serious in developing countries and, in particular, Africa and Southeast Asia. The causes of the increase in STDs are many, but we believe that alterations in family structures, drug and alcohol addiction, wars and mobilization of armies and movement of populations, in addition to change in sexual behaviors and lax morality are the main ones. Education, counseling, and community understanding of the risks of STDs are very essential factors in prevention and control. Physicians need to recognize the manifestations of STDSs and start the treatment as early as possible, but at the same time, more efforts are needed for prevention.     

AIDS related changes in pattern of sexually transmitted disease (STD) in an STD clinic in Copenhagen.

Testing for antibodies against human immunodeficiency virus (HIV) was introduced in 1984 in this major sexually transmitted disease (STD) clinic in Copenhagen, which is attended by about 10,000 new patients each year. From 1984 to 1987 the proportion of patients examined for antibodies to HIV rose from 6% to 32%. The overall incidence of HIV antibody positivity decreased from 30% in 1984 to 3% in 1987, the combined result of decreased positivity in high risk patients tested and increased screening in low risk patients. HIV antibody positivity has been confined largely to homosexual men and drug addicts. Since 1985, however, 21 out of 2623 (0.8%) heterosexuals who were not drug addicts were found to be HIV antibody positive. During 1984-6 the incidence of STDs most often encountered in high risk groups (syphilis and gonorrhoea) decreased by 64% and 41% respectively, whereas the incidence of diseases most often diagnosed in low risk groups (condylomata acuminata and genital herpes) increased by 70% and 34% respectively in the same period. The addition of HIV infection to the list of STDs requires the allocation of more resources to the STD clinics to enable these clinics to handle this new problem. Screening for all patients attending an STD clinic for antibodies to HIV must be considered, and in our area it would be cost effective.     

Using sexually transmitted disease incidence as a surrogate marker for HIV incidence in prevention trials: a modeling study

BACKGROUND: Because many of the sexual behaviors that place individuals at risk of acquiring HIV are the same as those that place them at risk for other sexually transmitted diseases (STDs), researchers and policymakers have called for the use of non-HIV STDs as surrogate markers for HIV infection. GOALS: This study examined the epidemiologic conditions under which changes in STD incidence are associated with changes in HIV incidence. STUDY DESIGN: A mathematical model of HIV/STD transmission was applied to empirical data from a large HIV prevention intervention. The association between participants' HIV infection risk reduction scores and their STD risk reduction scores was measured with use of the Pearson product-moment correlation. The authors examined how the strength of association varied across different epidemiologic parameters and heterosexual behaviors. RESULTS: Moderate to strong associations were noted when the infectivity of the STD was similar to the infectivity of HIV. The association was attenuated for larger STD infectivity values. The prevalence of STD infection was a less important determinant of the strength of association. Stronger associations were obtained when the number of sex partners was large or the number of sex acts was small. CONCLUSIONS: Easily transmitted STDs, such as gonorrhea, are unsuitable for general use as surrogate markers for HIV infection. Hepatitis B, syphilis, and chlamydial infection have more promising epidemiologic profiles. Careful studies of STD infectivity are needed to aid in the identification of potential marker STDs.     

Prevalence and risk factors for herpes simplex infection among patients at high risk for HIV infection in Brazil

Background Herpes simplex infection is responsible for substantial morbidity in patients with HIV infection. Data from less‐developed countries analyzing risk factors within this population are largely unavailable. Aims Investigate the incidence and seroprevalence of HSV‐1 and HSV‐2 infection in populations at high and low risk for HIV infection. Materials and methods A prospective cohort study was performed in a population at high risk for STDs composed of 170 HIV seronegative male homosexuals and bisexuals (group A). The population at low risk for STDs was composed of 155 volunteer male blood donors (group B). All blood samples were screened using a type specific ELISA to HSV‐1 and HSV‐2 glycoprotein G (gG). Results The prevalence of HSV‐1 and HSV‐2 infection among all the 325 patients was 83.5% and 63.4%, respectively. Annual incidence of HSV‐1 and 2 among group A were 0.053% and 0.08%, respectively. Among group B, the incidence for HSV‐1 was 0.04% and for HSV‐2 was 0.02%. Educational parameters (P<0.001), irregular use of condoms (P<0.001), and percentage of previous receptive anal intercourse (P<0,012) were significantly associated with seropositivity to HSV‐2. About 8.4% of the HSV‐1 seronegative subjects presented recurrence episodes of herpes labialis as well as 7.6% of the HSV‐2 seronegative patients had genital herpes in the past. Discussion The high seroprevalence detected suggests that routine screening for HSV should be performed in populations at high risk for STDs, especially in HIV‐infected patients. Conclusion Educational campaigns, with particular focus on the transmission of HSV, and the regular use of condoms are important measures to reduce the HSV dissemination among patients with less advanced educations and at high risk for STDs.     

Attitudes to HIV and HIV testing in high prevalence areas of China: informing the introduction of voluntary counselling and testing programmes

OBJECTIVES: To assess knowledge and attitudes towards HIV and its testing among pregnant women and health professionals in Yunnan Province, south west China, to inform the introduction of voluntary counselling and testing (VCT) programmes. METHODS: The study design was a cross sectional survey using self completion questionnaires. It was carried out in 12 hospitals in four high prevalence areas of Yunnan Province. Questionnaires were completed under examination conditions by health professionals, and at the routine antenatal examination by pregnant women. RESULTS: Completed questionnaires were obtained from 840 pregnant women and 780 health professionals. Knowledge of HIV and its modes of transmission were good in health professionals but patchy in pregnant women. The weakest area in both groups was knowledge of maternal to child transmission. There was strong support for compulsory testing in pregnancy and at the premarital examination. But attitudes towards HIV/AIDS were negative: 23% of health professionals and 45% of pregnant women thought HIV was a disease of "low class and illegal" people, 48% of health professionals and 59% of pregnant women thought that HIV positive individuals should not be allowed to get married, and 30% of the health professionals were not willing to treat an HIV positive individual. Levels of knowledge were higher and attitudes more positive in younger health professionals and better educated pregnant women. CONCLUSIONS: Community education programmes and intensive training of health workers must precede or accompany VCT programmes. They must particularly address negative attitudes towards people with HIV. Pilot VCT programmes are now under way in two of the areas studied.     

健康教育对性病患者健康知识水平的影响

目的 :探讨健康教育干预对性病门诊患者健康知识水平的影响 ,为控制性病流行提供较为科学的干预措施。方法 :对在 2 0 0 1年 3月～ 9月性病门诊中确诊的初发病人 ,随机分为对照组和干预组 ,采取自填性病、艾滋病和安全套相关健康知识问卷后 ,对干预组进行健康教育 ,对照组则不作任何千预 ,3个月后两组进行第 2次问卷凋查 ,利用SPSS 1 0 1统计软件包进行卡方检验及相关分析进行项目评估。结果 :3个月后干预组、对照组的性病患者的艾滋病、性病、安全套相关知识水平都有不同程度地提高 ,但干预组明显高于对照组 (P <0 0 5 )。结论 :应加强对性病患者进行性病、艾滋病和安全套相关知识的健康教育 ,可减少或避免其再感染性病或传染他人 ,进而减少性病、艾滋病的进一步流行。     

Traveling through skin manifestations of HIV in 2001.

There are currently over 34 million people worldwide infected with human immunodeficiency virus (HIV) with 15,000 new patients infected each day. The acquired immunodefiency syndrome (AIDS) pandemic has particularly affected the third world and currently over 70% of those infected reside in sub-Saharan Africa. The epicenter of the pandemic is shifting to Asia as HIV infection increases in the densely populated countries of India, China, and SE Asia. Patients with HIV infection develop a variety of mucocutaneous diseases and often present to dermatologists.