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PubMed1985

Genital infections in women undergoing therapeutic abortion.

We studied the prevalence of genital infections and the frequency of infectious complications in 170 women who requested an abortion in Antwerp, Belgium, where termination of pregnancy is still illegal. Chlamydia were isolated in 12% of these women, compared to a 0.6% isolation rate for N. gonorrhoeae. After the abortion 5.5% developed PID and 3% endometritis. There was a strong correlation between an infection with C. trachomatis before abortion and the appearance of infectious complications after the aspiration curettage. No such relationship was found with any other micro-organism. Depending on the prevalence of C. trachomatis in a given population, screening followed by selective treatment or prophylactic use of antimicrobial medication for all women is indicated to prevent post-abortum infections.

Abortion, Therapeutic↗
PubMedDate not supplied

Low risk of sexual transmission of hepatitis C virus in Somalia.

The prevalence in Somalia of antibody to hepatitis C virus (anti-HCV) was determined in a survey of 236 female prostitutes, 80 sexually transmitted disease (STD) clinic patients, 79 male soldiers, and 43 tuberculosis patients. Of 98 (22%) serum samples repeatedly anti-HCV reactive by first and second generation enzyme-linked immunosorbent assay kits, only 8 (1.8%) were anti-HCV positive by immunoblot assay (RIBA-2). Anti-HCV seropositivity by immunoblot assay was not associated with any risk group or with positive syphilis serology (found in 18% of subjects) or antibody to human immunodeficiency virus 1 (in 1.4% of subjects). These data indicate that sexual transmission of hepatitis C virus is not common in Somalia among sexually active populations, including female prostitutes and other groups at high risk of STDs and the acquired immune deficiency syndrome.

Adolescent↗
PubMed1999

Use of sexually transmitted disease risk assessment algorithms for selection of intrauterine device candidates.

Sexually transmitted diseases (STD) are an important contraindication for intrauterine device (IUD) insertion. Nevertheless, laboratory testing for STD is not possible in many settings. The objective of this study is to evaluate the use of risk assessment algorithms to predict STD and subsequent IUD-related complications among IUD candidates. Among 615 IUD users in Kenya, the following algorithms were evaluated: 1) an STD algorithm based on US Agency for International Development (USAID) Technical Working Group guidelines: 2) a Centers for Disease Control and Prevention (CDC) algorithm for management of chlamydia; and 3) a data-derived algorithm modeled from study data. Algorithms were evaluated for prediction of chlamydial and gonococcal infection at 1 month and complications (pelvic inflammatory disease [PID], IUD removals, and IUD expulsions) over 4 months. Women with STD were more likely to develop complications than women without STD (19% vs 6%; risk ratio = 2.9; 95% CI 1.3-6.5). For STD prediction, the USAID algorithm was 75% sensitive and 48% specific, with a positive likelihood ratio (LR+) of 1.4. The CDC algorithm was 44% sensitive and 72% specific, LR+ = 1.6. The data-derived algorithm was 91% sensitive and 56% specific, with LR+ = 2.0 and LR- = 0.2. Category-specific LR for this algorithm identified women with very low (< 1%) and very high (29%) infection probabilities. The data-derived algorithm was also the best predictor of IUD-related complications. These results suggest that use of STD algorithms may improve selection of IUD users. Women at high risk for STD could be counseled to avoid IUD, whereas women at moderate risk should be monitored closely and counseled to use condoms.

Adult↗
PubMed1998

AIDS and reproductive health.

Over 24 million adults worldwide have been infected with HIV. Primarily a sexually transmitted disease, AIDS is inexorably linked to reproductive health and care. Because HIV tends to infect those who are in their reproductive years, the impact of this disease on population growth and life expectancy is projected to be immense in some parts of the world, especially in sub-Saharan Africa. Not least is the challenge to individual families and infant care programs to care for AIDS babies. Estimates of the rate of vertical transmission of HIV range from < 10 to 46%. Transmission through sexual contact accounts for 75-85% of HIV infection worldwide, and today, nearly 20 years into the epidemic, the main tool to stall the spread is advocating change in sexual conduct. Numerous studies leave no doubt that the attributable risk of co-infection with other STDs--both ulcerative and non-ulcerative--in heterosexual transmission is substantial. The only known contraceptive method proven to reduce both infectiousness and susceptibility to HIV is barrier contraception. Spermicidal agents currently available have not been shown to reduce HIV concentrations in genital secretions, or to reduce transmission of the virus. The challenges that lie ahead are tremendous: we must continue to focus on development of affordable preventive measures; urge policy-makers to back further research in prevention to complement condom use; and advocate for continued support of basic research to learn more about fundamental mechanisms of HIV transmission.

AIDS-Related Opportunistic Infections↗
PubMed1975

Polymicrobial etiology of acute pelvic inflammatory disease.

We studied 204 women with acute pelvic inflammatory disease to delineate further the causes of that illness. Gonococci were recovered from 91. Gonococcal pili antibody rose or fell significantly in 12 of 18 patients with positive cultures and only two of 19 who had negative cultures and smears for Neisseria gonorrhaoea(P smaller than 0.005). N. gonorrhoeae was found in peritoneal exudate from eight of 21 patients with, and none of 33 without, cervical gonococcal infection. Among patients with severe disease, other bacteria were recovered from peritoneal exudates from five of 16 with, and 19 of 22 without, cervical gonococcal infection (P smaller than 0.025). Mixed anaerobic and aerobic bacterial peritoneal infection was common in nongonococcal pelvic disease. The most common species recovered were Bacteroides fragilis, peptostreptococci, and peptococci. Tuboperitoneal gonococcal infection probably causes pelvic inflammatory disease in most patients with cervical gonococcal infection, whereas polymicrobial tuboperitoneal infection probably causes most nongonococcal cases.

Acute Disease↗
PubMed1993

A fractal model of HIV transmission on complex sociogeographic networks: towards analysis of large data sets.

"A paradigm of HIV (human immunodeficiency virus) transmission along very large 'sociogeographic' networks--spatially focused nets of social interaction--is extended to include fractal (dilationally self-similar) structures upon which a metric of 'sociogeographic' distance can be defined.... Techniques are sketched for determining the sociogeographic structure of a large, geographically centered social network, providing a possible empirical basis for predicting forms and rates of spread of the initial, rapid stages of an HIV outbreak for networks not yet infected, and perhaps greatly expanding the utility of routinely collected small-area administrative data sets in the design of mutually reinforcing, multifactorial disease-control strategies."

Communicable Diseases↗
PubMed1997

Health seeking behaviour and the control of sexually transmitted disease.

What people do when they have symptoms or suspicion of a sexually transmitted disease (STD) has major implications for transmission and, consequently, for disease control. Delays in seeking and obtaining diagnosis and treatment can allow for continued transmission and the greater probability of adverse sequelae. An understanding of health seeking behaviour is therefore important if STD control programmes are to be effective. However, taboos and stigma related to sex and STD in most cultures mean that gaining a true picture is difficult and requires considerable cultural sensitivity. At the moment relatively little is known about who people turn to for advice, or about how symptoms are perceived, recognized or related to decisions to seek help. It is argued that such knowledge would assist programme planners in the development of more accessible and effective services, that studies of health seeking behaviour need to include a combination of qualitative and quantitative methods, and that studies should include data collection about people who do not present to health care facilities as well as those who do. A pilot protocol for studying STD-related health seeking behaviour in developing countries is briefly presented.

Clinical Protocols↗
PubMed1991

Knowledge of AIDS among secondary school pupils in Bagamoyo and Dar-Es-Salaam, Tanzania.

We assessed knowledge of AIDS among pupils in selected schools in Tanzania in August 1989. Four hundred and eight-one pupils from four randomly selected secondary schools, two from Dar-Es-Salaam (a city) and two from Bagamoyo (a semi-rural town), were interviewed using a structured questionnaire. Of these, 476 (99.0%) had heard of AIDS, and 447 (92.9%) were able to mention spontaneously at least one sexually transmitted disease (STD), of whom 374 (83.7%) mentioned AIDS. Knowledge was found to increase with age and tended to be higher among women in Dar-Es-Salaam than in Bagamoyo. These data suggest that communication channels directed at women in rural areas should be strengthened. While knowledge of sexual transmission of HIV was generally high, and prevalence of reported misconceptions about modes of transmission was very low, knowledge of non-sexual means of transmission (transfusions, injections, vertical) was lacking. Although 80% of pupils mentioned reduction of number of sexual partners as a means of AIDS prevention, only 22% mentioned condom use, and less than 5% reported that they had ever used a condom. Future research should concentrate on means of promoting sexual behavior change, the ultimate aim of any AIDS prevention strategy.

Acquired Immunodeficiency Syndrome↗
PubMed1998

A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda.

OBJECTIVE: To describe the design and first-round survey results of a trial of intensive sexually transmitted disease (STD) control to reduce HIV-1 incidence. STUDY DESIGN: Randomized, controlled, community-based trial in Rakai District, Uganda. METHODS: In this ongoing study, 56 communities were grouped into 10 clusters designed to encompass social/sexual networks; clusters within blocks were randomly assigned to the intervention or control arm. Every 10 months, all consenting resident adults aged 15-59 years are visited in the home for interview and sample collection (serological sample, urine, and, in the case of women, self-administered vaginal swabs). Sera are tested for HIV-1, syphilis, gonorrhea, chlamydia, trichomonas and bacterial vaginosis. Following interview, all consenting adults are offered directly observed, single oral dose treatment (STD treatment in the intervention arm, anthelminthic and iron-folate in the control arm). Treatment is administered irrespective of symptoms or laboratory testing (mass treatment strategy). Both arms receive identical health education, condom and serological counseling services. RESULTS: In the first home visit round, the study enrolled 5834 intervention and 5784 control arm subjects. Compliance with interview, sample collection and treatment was high in both arms (over 90%). Study arm populations were comparable with respect to sociodemographic and behavioral characteristics, and baseline HIV and STD rates. The latter were high: 16.9% of all subjects were HIV-positive, 10.0% had syphilis, and 23.8% of women had trichomonas and 50.9% had bacterial vaginosis. CONCLUSIONS: Testing the effects of STD control on AIDS prevention is feasible in this Ugandan setting.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Sexual bridging by Cambodian men: potential importance for general population spread of STD and HIV epidemics.

BACKGROUND: Linkages between sexual networks influence STD and HIV epidemics. GOAL: This study quantifies male sexual "bridging" and associated factors in Cambodia's 1997 behavioral surveillance survey. STUDY DESIGN: Among persons randomly selected from clusters of military, police, and motorcycle taxidrivers in five cities, associations between individual characteristics, behaviors, social context, and "active bridging" were tested using logistic regression analyses. RESULTS: The authors defined 20.5%, 15.7%, and 14.7% of military, police, and motorcycle taxidrivers as active bridgers (men who have unprotected sex with high and low risk partners). Among the military and police, logistic regression revealed that age (odds ratio [OR], 1.05), age of first sexual intercourse (OR, 0.89), having friends who frequent sex workers (OR, 3.31), and residence in the port city (OR, 3.34) were associated with active bridging. Among motorcycle taxidrivers, residence in the border city (OR, 2.23) or the port city (OR, 2.84) was associated with active bridging. Sexually transmitted disease symptoms during the past year were significantly associated with active bridging. CONCLUSIONS: Social characteristics influence sexual bridging more than individual ones. The pervasiveness of bridging and the association with sexually transmitted disease symptoms underscore the potential of men who are active bridgers to spread sexually transmitted disease and HIV in Cambodia beyond high-risk groups.

Adult↗
PubMed2000

Pattern of sexually transmitted diseases and risk factors among women attending an STD referral clinic in Nairobi, Kenya.

BACKGROUND: In Kenya, sexually transmitted disease (STD) clinics care for large numbers of patients with STD-related signs and symptoms. Yet, the etiologic fraction of the different STD pathogens remains to be determined, particularly in women. GOAL: The aim of the study was to determine the prevalence of STDs and of cervical dysplasia and their risk markers among women attending the STD clinic in Nairobi. STUDY DESIGN: A cross-section of women were interviewed and examined; samples were taken. RESULTS: The mean age of 520 women was 26 years, 54% had a stable relationship, 38% were pregnant, 47% had ever used condoms (1% as a method of contraception), 11% reported multiple partners in the previous 3 months, and 32% had a history of STDs. The prevalence of STDs was 29% for HIV type 1, 35% for candidiasis, 25% for trichomoniasis, 16% for bacterial vaginosis, 6% for gonorrhea, 4% for chlamydia, 6% for a positive syphilis serology, 6% for genital warts, 12% for genital ulcers, and 13% for cervical dysplasia. Factors related to sexual behavior, especially the number of sex partners, were associated with several STDs. Gonorrhea, bacterial vaginosis, cervical dysplasia, and genital warts or ulcers were independently associated with HIV infection. Partners of circumcised men had less-prevalent HIV infection. CONCLUSION: Most women reported low-risk sexual behavior and were likely to be infected by their regular partner. HIV and STD prevention campaigns will not have a significant impact if the transmission between partners is not addressed.

Adolescent↗
PubMed1998

HIV-1 DNA shedding in genital ulcers and its associated risk factors in Pune, India.

HIV infection status was determined in 302 consecutive patients with genital ulcer disease (GUD) presenting to two sexually transmitted disease (STD) clinics in Pune, India. Of the 71 (24%) individuals with HIV infection, 67 (94%) were HIV antibody-positive, and 4 (6%) were HIV antibody-negative but p24 antigen-positive at the time of presentation. HIV-1 DNA was detected in 24 (34%) specimens. The genital ulcers of all four acutely infected p24-antigenemic subjects were HIV-1 DNA-positive by polymerase chain reaction (PCR) assay, compared with 20 of 67 (30%) seropositive patients (p = .01). Presence of chancroid, GUD symptoms for > 10 days, and concurrent diagnosis of cervicitis or urethritis were significantly associated risk factors for HIV-1 DNA shedding in ulcers. Early GUD diagnosis and aggressive treatment of HIV-infected patients may significantly reduce secondary transmission of HIV to other sex partners.

Adolescent↗
PubMed1990

Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion.

Most of the small increased risk in pelvic inflammatory disease (PID) associated with the intrauterine contraceptive device (IUCD) appears to be caused by bacterial contamination of the endometrial cavity at the time of insertion. This randomized clinical trial of 1813 women in Nairobi, Kenya, assessed the effectiveness of 200 mg of doxycycline given orally at the time of insertion in reducing the occurrence of PID. The rate of this infection in the doxycycline-treated group was 31% lower than that in the placebo-treated group (1.3 and 1.9%, respectively; RR 0.69; 95% CI 0.32 to 1.5). The rate of an unplanned IUCD-related visit to the clinic was also 31% lower in the doxycycline-treated group (RR 0.69; 95% CI 0.52 to 0.91). Although the significance level (P = 0.17) for the reduction is PID does not meet the conventional standard of 0.05, the results may be suggestive of an effect. Moreover, the reduction in IUCD-related visits (P = 0.004) not only represents an important decrease in morbidity but also substantiates the reduction found for PID. Further studies are needed to corroborate these results. Consideration should be given to the prophylactic use of doxycycline at the time of IUCD insertion as an approach to preventing PID and other IUCD-related morbidity.

Adult↗
PubMed1984

Intrauterine devices and pelvic inflammatory disease.

There is convincing clinical evidence that PID is more common in IUD users than in users of other contraceptive methods. There appears to be a smaller but significant increase when IUDs are compared with sexually active noncontraceptive users. However, the incidence of PID severe enough to warrant hospitalization is only of the order of 1 to 2 per 1,000 women per year. The question which remains is whether beyond this low figure of moderate and severe disease there is a much higher incidence of subclinical PID which may result in complications for IUD users. Development of a marker such as C-Reactive protein or the split complement component C3d to detect mild PID would prove invaluable in the elucidation of several crucial problems in the clinical management of women using IUDs.

Actinomycosis↗
PubMed1996

Unusually high seroprevalence of Borna disease virus in clade E human immunodeficiency virus type 1-infected patients with sexually transmitted diseases in Thailand.

The seroprevalence of Borna disease virus (BDV) in human immunodeficiency virus type 1-infected individuals in Thailand was examined by using recombinant BDV p24. A high (38 to 48%) rate of seroprevalence of BDV was observed in clade E-infected patients with sexually transmitted diseases, compared with those in clade E-infected prostitutes (8.3%), pregnant women (0%), clade B-infected intravenous-drug users (0%), and human immunodeficiency virus type 1-negative blood donors (1.9%).

AIDS-Related Opportunistic Infections↗