Microbicide for prevention of sexually transmitted diseases using a pharmaceutical excipient

Preferred microbicides are expected to inactivate most sexually transmitted viral and nonviral pathogens, including HIV-1, without affecting lactobacilli, components of the natural defense system against sexually transmitted diseases (STDs), be widely available, be inexpensive, and have an established safety record for human use. We show here that cellulose acetate phthalate [C-A-P enteric coating polymer (Eastman)], a compound used for coating of enteric tablets, meets all these criteria.     

Clinical management and prevention of sexually transmitted diseases: a review focusing on women

This review highlights some of the difficulties inherent in controlling sexually transmitted diseases (STDs) in developing countries--especially amongst women. Considerable efforts have been made to improve the syndromic approach to STD management but the poor performance of the algorithm for managing vaginal discharge limits the effectiveness of this strategy. The facilitating role of the human immunodeficiency virus (HIV) has been the main impetus to STD control rather than reduction of morbidity in women, especially pregnant women and their children. There are no easy solutions--but action on several fronts, with more attention to core groups, men and adolescents is indicated.     

Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials

Two randomised controlled trials of sexually transmitted disease (STD) treatment for the prevention of HIV-1 Infection, in Mwanza, Tanzania, and Rakai, Uganda, unexpectedly produced contrasting results. A decrease in population HIV-1 incidence was associated with improved STD case management in Mwanza, but was not associated with STD mass treatment in Rakai. Some reductions in curable STDs were seen in both studies. These trials tested different interventions in different HIV-1 epidemic settings and used different evaluation methods; the divergent results may be complementary rather than contradictory. Possible explanations include: differences in stage of the HIV-1 epidemic, which can influence exposure to HIV-1 and the distribution of viral load in the infected population; potential differences in the prevalence of Incurable STDs (such as genital herpes); perhaps greater Importance of symptomatic than symptomless STDs for HIV-1 transmission; and possibly greater effectiveness of continuously available services than of intermittent mass treatment to control rapid STD reinfection. Implications of the trials for policy and future research agenda are discussed.     

Screening and treatment of sexually transmitted diseases: an important strategy for reducing the risk of HIV transmission

The role of sexually transmitted diseases (STDs) in the spread of human immunodeficiency virus (HIV) infection is reviewed. The rationale for and approach to reducing STD prevalence in high-risk communities are presented. Given the asymptomatic nature of these infections and problems associated with delivering curative therapy, effective interventions will require the use of diagnostic tests for screening and the use of single-dose therapies in appropriate settings: Treatment of individuals with STDs will likely reduce individual risk, while reduction of STD prevalence in high-risk communities may curtail the epidemic spread of HIV.     

Declining sexually transmitted infections among female sex workers: the results of an HIV and sexually transmitted infection prevention strategy in Honduras, 2006-08

In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.     

The use of urine and self-obtained vaginal swabs for the diagnosis of sexually transmitted diseases

Studies have reported that self-collected specimens, such as urine or vaginal swabs, can be successfully used to diagnose sexually transmitted infections when they are used with nucleic acid amplification assays. This eliminates the necessity for a clinician-performed pelvic examination for women, or a urethral swab for men, for sample collection. These nucleic acid amplification assays used with selfcollected specimens are highly sensitive and specific, and their use may be extended to broad nonclinic screening venues, where their use can augment public health programs designed to control the epidemic of sexually transmitted diseases.     

Developing evidence-based guidelines for the management of sexually transmitted diseases in former Soviet Union countries

The countries of the former Soviet Union (FSU) are experiencing overlapping, interrelated and severe epidemics of sexually transmitted diseases (STD), HIV and intravenous drug use. There are reasons to believe that better control of STD in these countries will contribute to the amelioration of these problems. A project was carried out by IUSTI-Europe and World Health Organisation-Europe to facilitate the production of evidence-based management guidelines in the local language in each of five FSU countries. The goals of the project were achieved, although the challenge remains to be faced to ensure the implementation of the recommendations of the guidelines into routine clinical practice in those countries.     

Observations of the management of sexually transmitted diseases in the Russian Federation: a challenge of confidentiality

The clinical management of sexually transmitted diseases (STDs) in Russia has long been characterized by coercion and social control. A nationwide network of dermatovenereology clinics was established in the 1920s. Patients were required, by law, to disclose details of contacts and were subject to lengthy inpatient treatment and to long-term surveillance. In 1993 the Russian Ministry of Health issued a new order designed to reduce barriers to seeking care, in particular by improving the quality of care and enhancing confidentiality. One element was the establishment of clinics offering a degree of anonymity. We report a study combining a review of available literature, interviews with patients and physicians, and non-participant observation. This indicates that the concept of confidentiality is poorly understood among physicians and accorded little priority. It is, however, valued by patients and aspects of the system related to confidentiality act as barriers to access.     

Changing sexual attitudes and behaviour in China: implications for the spread of HIV and other sexually transmitted diseases

In Imperial China sexual behaviour was regarded as an indispensable activity to reach harmony with the universe, through the unity of the interaction of two opposing forces: yin and yang. Sexual intercourse was accepted when linked to procreation within a family context, while an individual's sexuality was not considered important. Homosexuality was tolerated although not advocated, while masturbation was denounced. Since the One Child Family and Open Door policies in the 1970s and the economic reforms of the 1980s, attitudes towards sexuality in China have changed. Premarital sex has become widely accepted among young people and people in China are now more tolerant toward extramarital sex. Nowadays young people consider that love should dominate marriage and the quality of an individual's sex life is currently more valued than it used to be. Attitudes towards masturbation have become more tolerant and though homosexuality has been hidden by society for a long time, in recent years it has begun to be considered as a legitimate lifestyle choice. Attitudes towards sex and sexual behaviour have become recognized as an individuals' responsibility as long as no offence occurs against society or the interests of other individuals, resulting in the recognition of diversity of sexual behaviour. As part of the changing attitudes to sex and sexual behaviour, heterosexual transmission is becoming the most important route of HIV transmission in China. This is complicated by the internal migration of an estimated 120 million labourers moving from the countryside to the cities as the result of economic reforms, most of whom are sexually active young men. Unless addressed directly, these factors may add to the estimated 300,000 HIV-infected Chinese, further fuelling an already rapidly spreading epidemic. The ramifications of the Chinese HIV epidemic will not only be felt within China, but also within the surrounding Asian countries thereby fuelling the HIV pandemic.