Sexually transmitted infections and their diagnoses: Bapedi experience

Background

The global burden of sexually transmitted infections (STIs) is a major concern to the World Health Organization (WHO).

Objective

To document STIs treated by Bapedi traditional healers and their methods of diagnoses in the Limpopo Province, South Africa.

Methods

A semi-structured questionnaire with closed and open-ended questions was used to collect data from 34 traditional healers, during a face-to-face interview.

Results

Five seemingly dissimilar STIs; gonorrhoea, chlamydia, HIV/AIDS, nta (Bapedi-terminology) and syphilis were identified as being treated by Bapedi traditional healers. With the exclusion of HIV/AIDS, all STIs are known by healers via their vernacular names. Not all of the recorded STIs are treated by all the questioned traditional healers. Generally, diagnosis of these infections was based primarily on the presentation of symptoms and certain behavioural traits; mostly unprotected sexual intercourse with multiple partners.

Conclusion

The current study concludes that Bapedi traditional healers play an important role in the treatment STIs in the Limpopo Province. Of concern is their diagnosis which is based primarily on the presentation of symptoms and behavioural traits, which are not always accurate indicators. Thus, to make their contribution to the treatment and management of STIs beneficial, they have to receive elementary training in diagnostic methods particularly for HIV/AIDS.     

Exotic and indigenous problem plants species used,by the Bapedi,to treat sexually transmitted infections in Limpopo Province,South Africa

Background

The ethnic usage of exotics and indigenous problem plants is a highly debated topic, as legislative requirements over-shadow their potential medicinal value, particularly to treat sexually transmitted infections (STIs). Limited information exists regarding their medicinal value among the Bapedi.

Objectives

To ascertain the importance of exotics and indigenous problem plants in the treatment of STIs, a major global primary health care challenge.

Methods

A field observation and semi-structured questionnaire focussing on species diversity, types of STIs treated and medicinal preparation as well as application was used to collect data from 34 traditional healers.

Results

Seven exotics and three indigenous problem species were identified. These species were used to treat four STIs; with Catharanthus roseus illustrating its dominance in the treatment of gonorrhoea. Some medicinal species used by Bapedi traditional healers have been validated through scientific research or through their extensive use by various cultures in South Africa and other parts of Africa. To the best of our knowledge Alternanthera pungens, Caesalpinia decapetala, Cinnamomum verum, and Citrullus lanatus are reported for the first time in the treatment of the investigated STIs.

Conclusions

Exotic and indigenous problem species constitute an important component of the STIs treatment protocol. Their utilization by Bapedi cautions against the narrow-minded approach of indiscriminate eradication, as these species can play a significant role in the primary health care needs of socio-economic vulnerable people.     

Medicinal Plants Used for the Treatment of Tuberculosis by Bapedi Traditional Healers in Three Districts of the Limpopo Province,South Africa

The present study was aimed at documenting medicinal plants used for the treatment of tuberculosis (TB) by the Bapedi traditional healers in three districts of the Limpopo Province, South Africa. Fifty two traditional healers from 17 municipalities covering Capricorn, Sekhukhune and Waterberg districts were interviewed between January and July 2011. Twenty one medicinal plant species belonging to 20 genera and 18 families were documented. The majority (61.9%) are indigenous and the rest are exotics, found near homes as weeds or cultivated in home gardens as ornamentals or food plants. Hyacinthaceae, Moraceae and Rutaceae families were the most represented families in terms of species numbers (9.5% each). Herbs and trees (38% each) constituted the largest proportion of the growth forms of the medicinal plants used. Tuberculosis remedies were mostly prepared from leaves (34%) followed by roots (21%). The therapeutic claims made on medicinal plants used to treat TB by the Bapedi traditional healers are well supported by literature, with 71.4% of the species having antimicrobial properties or have similar ethno medicinal uses in other countries. This study therefore, illustrates the importance of medicinal plants in the treatment and management of TB in the Limpopo Province, South Africa.     

Gonorrhoea diagnostics: An update

Diagnosis of gonorrhoea is an ongoing challenge. The organism is fastidious requiring meticulous collection and transport for successful cultivation. Asymptomatic infections are common which go undetected by conventional methods thereby leading to continued transmission and the risk of complications. The nucleic acid amplification tests, now increasingly used in developed countries, offer improved sensitivity compared to bacterial culture. However, these continue to suffer sequence related problems leading to false positive and false negative results. Further, these cannot be used for generation of data on antibiotic susceptibility because genetic markers of antibiotic resistance to recommended therapies have not been fully characterised. They are unaffordable in a setting like ours where reliance is placed on syndromic approach for sexually transmitted infection (STI) management. The use of syndromic approach has resulted in a considerable decline in the number of Neisseria gonorrhoeae isolates that have been cultured for diagnostic purposes. Many laboratories formerly doing so are no longer performing culture for gonococci, and the basic skills have been lost. There is a need to not only revive this skill but also adopt newer technologies that can aid in accurate diagnosis in a cost-effective manner. There is room for innovation that can facilitate the development of a point-of-care test for this bacterial STI.     

Hepatitis B virus infection in a group of heterosexuals with multiple partners in Amsterdam,The Netherlands: Implications for vaccination?

The aim of the study was to assess prevalence and incidence of hepatitis B virus (HBV) infection among heterosexual men and women with multiple partners attending a sexually transmitted disease (STD) clinic and to establish risk factors of HBV infection in order to consider immunisation for those subjects. A prospective study of heterosexual men and women selected on having multiple partners and presenting to an STD clinic as new patients was carried out from October 1987 through December 1989. Follow-up continued until December 1990 at the STD clinic of the Municipal Health Service of Amsterdam. Five hundred ninety-eight men and women entered the study. More than 70% of both women and men had had commercial sexual partners in the last 5 years. Three hundred eighty-one participants were born in HBV low endemic countries, 205 came from HBV intermediate endemicity regions. The prevalence of HBV markers in both men and women from low endemic regions was 10%, and for men and women from middle endemic regions 42% and 19%, respectively. Logistic regression analysis showed that number of years involved in commercial sex was an independent risk factor in male participants from HBV low endemic regions (odds ratio [OR] 1.10 per year) and for women sexual contact with men at high risk of HBV infection (OR 2.59). In people from middle endemic regions more men than women had HBV markers, HBV-positive men were older than HBV-negatives (OR 1.05 per year), and for HBV-positive women the number of years involved in commercial sex was an independent predictor (OR 1.23 per year). No new cases of HBV infection were found in both groups (upper 95% limit of confidence 7.1 per 1,000 and 35.8 per 1,000 for the participants from low and middle endemic countries, respectively). The duration of follow-up was 419.9 person-years at risk for the group from low endemic regions and 83.7 person-years for the people from middle endemic regions. The participants must be considered to have been at continuous high risk of heterosexual transmission. The incidence of HBV was so tow that we decided for the moment not to offer hepatitis B vaccination to all heterosexual men and women attending our STD clinic. © 1994 Wiley-Liss, Inc.     

Herpes simplex virus type 2 among mobile pastoralists in northwestern Namibia

Background: Although herpes simplex virus type 2 (HSV-2) epidemiology has been described for many western and/or urban populations, disease burden has not been characterized for remote, non-western, under treated populations, where patterns of risk and vulnerability may be very different.

Aims: To understand demographic, behavioural and geographic influences on risk for HSV-2 in a population of mobile, rural pastoralists in northwestern Namibia.

Subjects and methods: The authors conducted a cross-sectional survey of reproductively aged adults (n?=?445) across 28 villages in Kaokoveld, Namibia. All participants completed a questionnaire of demographic data, ecological interactions and sexual behaviour, and a rapid test specific for HSV-2.

Results: HSV-2 status was significantly associated with being female (OR?=?3.1, 95% CI?=?2.00, 4.71), increasing age (men: OR?=?7.5, 95% CI?=?2.67, 20.85; women: OR?=?6.2, 95% CI?=?2.48, 15.50) and with higher wealth among men (OR?=?5.1, 95% CI?=?1.98, 13.09).

Conclusions: Higher risk among women can be explained, in part, by local hygiene practices and a preference for “dry” sex. There was considerable variation in prevalence by region, which appears to be linked to geographic remoteness. Culturally contextualized epidemiologic studies of remote, vulnerable populations can provide essential information for limiting the introduction and spread of new infections.     

Sexual behaviour and Chlamydia trachomatis infections in German female urban adolescents, 2004

This ad-hoc observational study, conducted in the metropolitan area of Berlin during 2004, revealed that the prevalence of Chlamydia trachomatis (CT) infections in female urban adolescents self-presenting at their gynaecologist without (n=397) or with (n=124) symptoms of CT infection was 5.5% (95% CI 3.7-8.2%) and 9.7% (95% CI 5.6-16.2%), respectively. The prevalence of CT infection was significantly dependent on the number of lifetime sexual partners. Condom use was inconsistent, and lack of knowledge about CT infections and associated health risks predominated in this cohort. The data indicated a need for health education concerning CT to be targeted at female adolescents.     

Herpes simplex virus detection by ELISA: effect of enzyme amplification, nature of lesion sampled and specimen treatment

The relative sensitivity of two enzyme detection procedures was investigated in a simultaneous "monoclonal" ELISA for herpes simplex virus (HSV). A cyclical enzyme amplified detection system with alkaline phosphatase, rather than horse-radish peroxidase and a conventional chromogenic substrate, gave an increase in absolute sensitivity and a 20 to 30% increase in the detection of HSV in routine isolation-positive genital specimens collected in transport medium. The HSV detection rate, with both procedures, was shown to vary with the site and clinical stage of lesion sampled; it was highest with penile vesicular lesions. Direct extraction of the swab specimen in a small volume of diluent further increased the sensitivity of antigen detection giving positive and negative predictive values of 100 and 96% respectively. The overall sensitivity of HSV detection was equivalent to that obtained by isolation in cell culture. The amplified ELISA offers an alternative, rapid, simple, non-culture technique for routine HSV diagnosis that does not rely upon retention of virus viability.     

Prevalence,evolution, and features of infection with human papillomavirus: A 15‐year longitudinal study of routine screening of a women population in the north of Spain

Determination of the prevalence of type‐specific human papillomavirus (HPV) is important for the development of new vaccines and to prevent malignancy. The objective of this study was to determine HPV infection in two areas in the north of Spain, and their evolution in the last 15 years. Between 1991 and 2007, 7,930 fresh cervical swabs were obtained from 5,554 women (37.8 ± 11.8 years old). From them, 425 have been followed‐up for an average of 3.7 ± 2.08 years after sampling (range 2–14.6), and 71 for 7.7 ± 2.2 years (range 5–14). Methods based on polymerase chain reaction (PCR) were carried out. Samples from 1,598 (28.8%) women were positive for HPV: 40.9% were under 25 years of age, 34.2% in the 25–35 year age group, 27.2% in the 36–45 year age group, and 19.6% older than 45 years (P < 0.001). HPV was found in 34.4% of the women with cytological alterations versus 23% of women without cervical changes (P < 0.0001). HPV‐16 was present in 25.8% of the women, although the study identified 26 different HPV genotypes. After 3 years of follow‐up, HPV remained or became undetectable in 87% of the cases, and in 5 years 70.3%. The prevalence of HPV is associated with younger women and women with cytological changes in the cervix. Although HPV‐16 is more prevalent, HPV types not included in available vaccines were found the most commonly. The low 3‐year (even 5‐year) cumulative incidence rate of HPV infection suggests that cervical screening every 3 (or even 5) years is safe and effective. J. Med. Virol. 82:597–604, 2010. © 2010 Wiley‐Liss, Inc.     

Chlamydia trachomatis: time for screening?

Genital Chlamydia trachomatis infection is the leading cause of bacterial sexually transmitted disease in industrialised countries, particularly among young people. The consequences of chlamydial infection may involve urethritis, cervicitis, pelvic inflammatory disease, ectopic pregnancy, tubal factor infertility, epididymitis and prostatitis. In addition, chlamydial infection increases the risk of acquisition of human immunodeficiency virus and has been associated with cervical cancer. Although screening programmes exist in a number of countries, the continuously increasing prevalence of chlamydial infections demonstrates the necessity for health authorities to establish effective screening policies, and the importance of defining a comprehensive European screening policy is emerging.     

Herpes simplex virus 2 infection rate and necessity of screening during pregnancy: a clinical and seroepidemiologic study

Purpose

This study determined the seroprevalence of herpes virus 2 in gravidas and the differences between herpes virus 2-infected and healthy gravidas. The need to screen gravidas for herpes virus 2 was also evaluated.

Materials and Methods

A retrospective analysis involving 500 gravidas who underwent herpes virus 2 serologic testing and delivery in our hospital between January 2009 and August 2010 was performed. All patients in the study group were classified as herpes simplex virus 2 (HSV2) positive, and all cases were analyzed with respect to the clinical course of the pregnancy, pregnancy outcome, obstetric complications, and neonatal outcomes. SPSS software (version 14.0) was used for statistical analysis. A chi-square test and Student''s t-test were used for statistical analysis.

Results

In the current study, the herpes virus 2 seroprevalence rate in gravidas was 17%. There was no significant difference in the rates of preterm delivery, premature rupture of membranes, preterm labor, and intrauterine growth restriction between the herpes virus 2-infected gravidas and the healthy control group. The rates of spontaneous abortion and sexually transmitted disease were higher in the herpes virus 2 infection group than the healthy control group.

Conclusion

After educating gravidas on genital herpes and, if gravidas thereafter consent to herpes virus 2 screening, the risk of neonatal herpes virus 2 infections can be reduced. In addition, examination of gravidas for sexually transmitted diseases would increase as would appropriate treatment.     

Using Chat and Text Technologies to Answer Sexual and Reproductive Health Questions: Planned Parenthood Pilot Study

Background

Teens and young adults in the United States are in need of sexual and reproductive health information, as evidenced by elevated rates of sexually transmitted infections (STIs), pregnancy, and births among this population. In-person sexuality education programs are helpful, but they are unlikely to rapidly accommodate teens and young adults in a moment of crisis. Evidence suggests that technologies such as instant messaging (IM) and text messaging may be effective ways to provide teens and young adults with sexual and reproductive health information. In September 2010, Planned Parenthood Federation of America launched a text and IM program designed to provide immediate answers to urgent sexual and reproductive health questions from a reliable and confidential source and to link young people to sexual and reproductive health services if needed.

Objective

To assess whether this program is successful in reaching the target population, whether user characteristics vary by mode (IM vs text), and whether mode is associated with reaching individuals with high levels of worry or reducing worry postchat.

Methods

Data were collected from prechat and postchat surveys for all IM and text message conversations between September 2010 and August 2011. A bivariate analysis was conducted using chi-square tests for differences in the main covariates by mode of conversation. In the multivariable analysis, logistic regression was used to identify factors that were independently associated with prechat levels of worry and changes in worry postchat.

Results

A total of 32,589 conversations occurred during the program’s first year. The odds of feeling very worried prechat were highest for IM users (adjusted odds ratio [AOR] 1.43, 95% CI 1.20-1.72), users 17 years and younger (AOR 1.62, 95% CI 1.50-1.74), Latino/Hispanic users (AOR 1.36, 95% CI 1.27-1.46), and black users (AOR 1.40, 95% CI 1.30-1.50). After controlling for the study covariates, there was no significant difference in the odds of feeling better (less worried) postchat between IM and text message users. Feeling better postchat was associated with being younger (≤17 years: AOR 1.42, 95% CI 1.17-1.72; 18-24 years: AOR 1.20, 95% CI 1.02-1.42), being Latino/Hispanic (AOR 1.31, 95% CI 1.10-1.55), reporting that the service was very helpful (AOR 3.47, 95% CI 3.24-4.32), and asking about emergency contraception (AOR 1.35, 95% CI 1.13-1.61). The odds of feeling better were lowest for users with questions about STIs (AOR 0.61, 95% CI 0.47-0.78).

Conclusions

The results from the process evaluation suggest that the program was able to provide informational support to vulnerable groups, such as teens and racial minorities, in moments of particular worry. Differences between the IM and text message users reveal that each mode appeals to a different population and that both are necessary to reach a diverse audience.     

The social context for risky sexual behavior among adolescents

This study supports a model of adolescents' risky sexual behavior in which this behavior is seen as a product of the same peer and family factors which influence a wide range of problem behaviors. The Pattersonet al. (1992) model of peer and parental factors associated with adolescents' sexual risk-taking behavior was tested on three independent samples of adolescents, ages 14 through 18. Adolescents whose peers were reported to engage in diverse problem behaviors were more likely to engage in risky sexual behavior. Poor parental monitoring and parent-child coercive interactions were associated having deviant peers, and poor parental monitoring also had a direct relationship to risky sexual behavior. Family involvement was associated with fewer parent-child coercive interactions. Less availability of parental figures in the family was directly associated with risky sexual behavior and was also associated with poorer parental monitoring.Preparation of this paper was supported in part by Grants HD26249 from the National Institute of Child Health and Human Development, MH45651 from the National Institute of Mental Health, and CA44648 and CA38272 from the National Cancer Institute.     

The Sexunzipped Trial: Optimizing the Design of Online Randomized Controlled Trials

Background

Sexual health problems such as unwanted pregnancy and sexually transmitted infection are important public health concerns and there is huge potential for health promotion using digital interventions. Evaluations of digital interventions are increasingly conducted online. Trial administration and data collection online offers many advantages, but concerns remain over fraudulent registration to obtain compensation, the quality of self-reported data, and high attrition.

Objective

This study addresses the feasibility of several dimensions of online trial design—recruitment, online consent, participant identity verification, randomization and concealment of allocation, online data collection, data quality, and retention at 3-month follow-up.

Methods

Young people aged 16 to 20 years and resident in the United Kingdom were recruited to the “Sexunzipped” online trial between November 2010 and March 2011 (n=2036). Participants filled in baseline demographic and sexual health questionnaires online and were randomized to the Sexunzipped interactive intervention website or to an information-only control website. Participants were also randomly allocated to a postal request (or no request) for a urine sample for genital chlamydia testing and receipt of a lower (£10/US$16) or higher (£20/US$32) value shopping voucher compensation for 3-month outcome data.

Results

The majority of the 2006 valid participants (90.98%, 1825/2006) were aged between 18 and 20 years at enrolment, from all four countries in the United Kingdom. Most were white (89.98%, 1805/2006), most were in school or training (77.48%, 1545/1994), and 62.81% (1260/2006) of the sample were female. In total, 3.88% (79/2036) of registrations appeared to be invalid and another 4.00% (81/2006) of participants gave inconsistent responses within the questionnaire. The higher value compensation (£20/US$32) increased response rates by 6-10%, boosting retention at 3 months to 77.2% (166/215) for submission of online self-reported sexual health outcomes and 47.4% (118/249) for return of chlamydia urine samples by post.

Conclusions

It was quick and efficient to recruit young people to this online trial. Our procedures for obtaining online consent, verifying participant identity, automated randomization, and concealment of allocation worked well. The optimal response rate for the online sexual health outcome measurement was comparable to face-to-face trials. Multiple methods of participant contact, requesting online data only, and higher value compensation increased trial retention at 3-month follow-up.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 55651027; http://www.controlled-trials.com/ISRCTN55651027 (Archived by WebCite at http://www.webcitation.org/6LbkxdPKf).     

Tackling sexually transmitted infection burden in Ugandan communities living in the United Kingdom: a qualitative analysis of the socio-cultural interpretation of disease and condom use

BackgroundDespite being in a different country and social environment, Ugandans living in the UK still reportedly have the lowest rates of condom usage and one of the highest incidences of STIs in UK. In Uganda, STIs and HIV prevalence has been reported to be on the increase. Understanding peoples'' beliefs and the attitudes that influence their behavior is a key factor to effectively designing control programs.MethodsA qualitative study that interviewed 37 purposively selected Ugandans living in the UK was conducted. Lay theories and interpretations were derived using thematic analysis.ResultsCondoms generally carried a lot of stigma and were perceived for use primarily in extramarital affairs and pregnancy control. HIV/AIDS was most feared due to its perceived socio-psychological or physical effects unlike other STIs described as “non-threatening” due to wide availability of “quality” treatment in UK. Notions of trust, the purpose of relationships, symptom recognition and partner selection greatly influenced decisions to undertake consistent condom use.ConclusionsThe socio-cultural understanding of STIs, sex, trust and relationships are symbolic in influencing consistent condom use among Ugandans. This indicates a need to acknowledge community beliefs and values about sexual health and design messages about STIs and condoms that would help eliminate these serious condom-related misconceptions.     

Sexually Transmitted Infections: Need for Extragenital Screening

Extragenital infections can occur concurrently with simultaneous urogenital infections. Extragenital sites are believed to serve as hidden reservoirs and play a critical role in their transmission. The etiological relationship of the most widespread Sexually transmitted diseases (STD) pathogen to reproductive tract has long been established, but the distribution to extragenital sites appears to be infrequent and its correlation with the sexual practice still requires to be investigated. Optimal-screening strategies for extragenital infections are largely unknown. However, there is a lack of data on clinical outcomes and optimal treatment regimens for rectal and pharyngeal extragenital infections. Further studies are needed in settings other than reproductive health and STD clinics, especially in primary care clinics and resource-limited settings.     

Use of the Internet for Sexual Health Among Sexually Experienced Persons Aged 16 to 44 Years: Evidence from a Nationally Representative Survey of the British Population

BackgroundThose who go online regarding their sexual health are potential users of new Internet-based sexual health interventions. Understanding the size and characteristics of this population is important in informing intervention design and delivery.ObjectiveWe aimed to estimate the prevalence in Britain of recent use of the Internet for key sexual health reasons (for chlamydia testing, human immunodeficiency virus [HIV] testing, sexually transmitted infection [STI] treatment, condoms/contraceptives, and help/advice with one’s sex life) and to identify associated sociodemographic and behavioral factors.MethodsComplex survey analysis of data from 8926 sexually experienced persons aged 16-44 years in a 2010-2012 probability survey of Britain’s resident population. Prevalence of recent (past year) use of Internet sources for key sexual health reasons was estimated. Factors associated with use of information/support websites were identified using logistic regression to calculate age-adjusted odds ratios (AORs).ResultsRecent Internet use for chlamydia/HIV testing or STI treatment (combined) was very low (men: 0.31%; women: 0.16%), whereas 2.35% of men and 0.51% of women reported obtaining condoms/contraceptives online. Additionally, 4.49% of men and 4.57% of women reported recent use of information/support websites for advice/help with their sex lives. Prevalence declined with age (men 16-24 years: 7.7%; 35-44 years: 1.84%, P<.001; women 16-24 years: 7.8%; 35-44 years: 1.84%, P<.001). Use of information/support websites was strongly associated with men’s higher socioeconomic status (managerial/professional vs semiroutine/routine: AOR 1.93, 95% CI 1.27-2.93, P<.001). Despite no overall association with area-level deprivation, those in densely populated urban areas were more likely to report use of information/support websites than those living in rural areas (men: AOR 3.38, 95% CI 1.68-6.77, P<.001; women: AOR 2.51, 95% CI 1.34-4.70, P<.001). No statistically significant association was observed with number of sex partners reported after age adjustment, but use was more common among men reporting same-sex partners (last 5 years: AOR 2.44, 95% CI 1.27-4.70), women reporting sex with multiple partners without condoms (last year: AOR 1.90, 95% CI 1.11-3.26), and, among both sexes, reporting seeking sex online (last year, men: AOR 1.80, 95% CI 1.16-2.79; women: AOR 3.00, 95% CI 1.76-5.13). No association was observed with reporting STI diagnosis/es (last 5 years) or (after age adjustment) recent use of any STI service or non-Internet sexual health seeking.ConclusionsA minority in Britain used the Internet for the sexual health reasons examined. Use of information/support websites was reported by those at greater STI risk, including younger people, indicating that demand for online STI services, and Internet-based sexual health interventions in general, may increase over time in this and subsequent cohorts. However, the impact on health inequalities needs addressing during design and evaluation of online sexual health interventions so that they maximize public health benefit.