PubMed Health⌕ Search

Biomedical subjects

Richard Steen

Publications and source records attributed to Richard Steen.

8 recordsLinked to original sources
PubMed2004

Sexually transmitted infections: prevention and management.

In the early 21st century, STI and HIV have been linked inextricably. Although the focus of this article is STI, some discussion on the diagnosis and management of individuals with HIV infection is necessary. The history of HIV diagnosis in the workplace is checkered. The authors have seen cases of prospective workers being subjected to HIV testing without their knowledge as part of a pre-employment medical examination. If the test came back positive, the men were told that they would not be employed without explanation. This approach is a breech of the human rights of the individual being tested and cannot be condoned. Any HIV testing must be done with the full and informed consent of the individual, with counseling given before and after testing to enable individuals with HIV infection to seek care and protect their families and to give individuals without HIV infection counseling on risk reduction. Men and women who present with an STI are at risk for HIV infection. With increasing options for management and secondary prevention, it is important to recognize people who are at risk. This identification should be done through HIV VCT. The location, funding, and supervision of VCT sites related to workplace populations should be a subject for serious debate. Although fears of mass layoffs after HIV testing largely have been unfounded, it is natural for workers to be fearful, unless there is a clearly articulated policy stating that the company observes and enforces nondiscriminatory practices. The workplace examples show that syndromic STI management, allied to comprehensive prevention programs, can have a genuine and measurable impact on STI prevalence. The potential interventions and partners are listed in Table 2. A community-based, randomized study in Tanzania showed that the institution of a well-managed STI syndromic management program can reduce HIV incidence by up to 40%, in the context of a rising HIV epidemic. Presumptive STI treatment for female sex workers (see Box 1) may prove useful as a short-term measure to reduce high STI prevalence rates while more sustainable preventive and curative services are established. The laboratory diagnosis of STIs remains problematic in the face of commonly available technologies of limited sensitivity and specificity and often substandard quality-assurance practices. For these and other reasons, syndromic management became the recommended strategy for treating STIs. The availability of rapid, accurate, and inexpensive diagnostics, especially for cervical infections for women, would alter management recommendations. Work is being done by the WHO and others to develop and assess low-cost diagnostics. Managing STIs and altering the behavior that leads to STIs are essential elements of any HIV prevention and management program. The issues surrounding a practical, compassionate, and comprehensive HIV program can be difficult. Numerous publications exist to help program managers navigate these issues and appropriately tailor a program to the needs of individual organizations. Some of these publications are listed in the next section.

Developing Countries↗
PubMed2004

Intrauterine contraceptive devices and risk of pelvic inflammatory disease: standard of care in high STI prevalence settings.

The intrauterine contraceptive device (IUD) is highly effective and cost-effective. IUD use is limited in some regions, however, due to concerns about increased risk of pelvic inflammatory disease (PID) and subsequent complications such as infertility and ectopic pregnancy. Recent reviews suggest that the overall risk of PID with modern IUDs is lower than previously thought, at least in regions with a low prevalence of sexually transmitted infections (STIs). Risk of PID may be higher, however, in places where gonorrhoea and chlamydia are prevalent, where screening for STIs is limited and where aseptic conditions for insertion are difficult to ensure. A World Health Organization multi-centre study and other studies have confirmed regional differences in STI prevalence, and the WHO study established that PID risk is temporally related to IUD insertion procedures. Studies of the effectiveness of antibiotic prophylaxis to prevent infectious complications are inconclusive due at least in part to use of sub-therapeutic regimens for pathogens commonly implicated in PID. In summary, the IUD can be safe and effective if inserted under aseptic conditions in women free of cervical infection. Further study is needed to define appropriate standards of care for IUD insertion where STI prevalence is high and ability to rule out infection is limited. Even with safe insertion, IUD promotion in areas of high STI/HIV prevalence must address women's needs for dual protection from infection and unwanted pregnancy.

Attitude to Health↗
PubMed2004

The prevention and management of congenital syphilis: an overview and recommendations.

The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant.

Female↗
PubMed2003

Sexually transmitted infection control with sex workers: regular screening and presumptive treatment augment efforts to reduce risk and vulnerability.

Sex workers have high rates of sexually transmitted infections (STIs), many of them easily curable with antibiotics. STIs as co-factors and frequent unprotected exposure put sex workers at high risk of acquiring HIV and transmitting STIs and HIV to clients and other partners. Eliminating STIs reduces the efficiency of HIV transmission in the highest-risk commercial sex contacts--those where condoms are not used. This paper reviews two STI treatment strategies that have proven effective with female sex workers and their clients. 1) Clinical services with regular screening have reported increases in condom use and reductions in STI and HIV prevalence. Such services include a strong peer education and empowerment component, emphasize consistent condom use, provide effective treatment for both symptomatic and asymptomatic STIs, and begin to address larger social, economic and human rights issues that increase vulnerability and risk. 2) Presumptive treatment of sex workers, a form of epidemiologic treatment, can be an effective short-term measure to rapidly reduce STI rates. Once prevalence rates are brought down, however, other longer-term strategies are required. Effective preventive and curative STI services for sex workers are key to the control of sexually transmitted infections, including HIV, and are highly synergistic with other HIV prevention efforts.

Antibiotic Prophylaxis↗