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PubMed1991

The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals.

OBJECTIVES: To study risk factors for sexually transmitted diseases (STDs) and sexual behaviour. Especially to assess whether there is a higher risk of being infected with STDs among ethnic minorities, and if so for what reasons. SETTING: STD-clinic of the Municipal Health Service of Amsterdam, the Netherlands. SUBJECTS: Cross-sectional study of heterosexuals (255 men and 343 women) with multiple sexual partners, who participated between October 1987 and January 1990. RESULTS: Besides STD-related complaints, ethnicity was an important independent predictor of one or more diagnosed genital STDs. STD-prevalence was higher among men born in Turkey (47%, OR = 3.4) and men born in Surinam (36%, OR = 2.1), compared with Dutch men (21%). While Turkish men had mainly riskful sexual behaviour with prostitutes, Surinam men had more often riskful sexual contact with private partners. Among women, STD prevalence was higher among West-European (38%, OR = 2.3) and Latin-American women (30%, OR = 1.6), compared with Dutch women (21%). Latin American women had more often riskful sexual contact with clients; sexual behaviour of West-European women was riskful with both clients and private partners. CONCLUSIONS: Prevention activities should be directed at specific sexual and ethnic groups, sources of information should be carefully selected, and some groups should be addressed differently with regard to language but to content as well.

Adult↗

PubMed2000

Validity of the vaginal discharge algorithm among pregnant and non-pregnant women in Nairobi, Kenya.

OBJECTIVE: To evaluate the validity of different algorithms for the diagnosis of gonococcal and chlamydial infections among pregnant and non-pregnant women consulting health services for vaginal discharge in Nairobi, Kenya. METHODS: Cross sectional study among 621 women with complaints of vaginal discharge in three city council clinics between April and August 1997. Women were interviewed and examined for symptoms and signs of sexually transmitted infections (STIs). Specimens were obtained for laboratory diagnosis of genital infections, HIV, and syphilis. The data were used to evaluate the Kenyan flow chart as well as several other generated algorithms. RESULTS: The mean age was 24 years and 334 (54%) were pregnant. The overall prevalence rates were: 50% candidiasis, 23% trichomoniasis, 9% bacterial vaginosis, 7% gonorrhoea, 9% chlamydia, 7% syphilis, and 22% HIV. In non-pregnant women, gonococcal and chlamydial infection was significantly associated with (1) demographic and behavioural risk markers such as being single, younger than 20 years, multiple sex partners in the previous 3 months; (2) symptom fever; and (3) signs including presence of yellow or bloody vaginal discharge, cervical mucopus, cervical erythema, and friability. Among pregnant women only young age, dysuria, and fever were significantly associated with cervical infection. However, none of these variables was either sensitive or specific enough for the diagnosis of cervical infection. Several algorithms were generated and applied to the study data. The algorithm including risk markers performed slightly better than the current Kenyan algorithm. CONCLUSION: STIs form a major problem in the Nairobi area and should be addressed accordingly. None of the tested algorithms for the treatment of vaginal discharge would constitute a marked improvement of the existing flow chart. Hence, better detection tools for the specific aetiology of vaginal discharge are urgently needed.

Adult↗

PubMed2003

Baseline survey of sexually transmitted infections in a cohort of female bar workers in Mbeya Region, Tanzania.

OBJECTIVES: To determine baseline prevalence of sexually transmitted infections (STI) and other reproductive tract infections (RTI) and their association with HIV as well as sociodemographic and behavioural characteristics in a newly recruited cohort of female bar workers in Mbeya Region, Tanzania. METHODS: 600 female bar workers were recruited from 17 different communities during September to November 2000 and underwent gynaecological examination, laboratory testing for HIV/STI, and interviews using structured questionnaires. RESULTS: HIV-1 seroprevalence was 68%. Prevalences of STI/RTI were high titre syphilis (TPPA/RPR >/=1/8), 9%; herpes simplex virus 2 antibodies, 87%; chlamydia, 12%; gonorrhoea, 22%; trichomoniasis, 24%; and bacterial vaginosis, 40%. HIV infection was associated with TPPA and HSV-2 seropositivity, bacterial vaginosis and clinically diagnosed genital ulcers, blisters, and warts. Reported high risk sexual behaviour during the past year (having multiple casual partners) was associated with prevalent STI. CONCLUSION: Female bar workers in Mbeya are at high risk of STI and HIV infection. Targeted STI/HIV prevention interventions for these women and their sexual partners need to be reinforced. Methods should be sought to improve healthcare seeking and to provide easily accessible and affordable STI care services.

Adult↗

PubMed2003

A population based study of herpes simplex virus 2 seroprevalence in rural Costa Rica.

OBJECTIVES: To determine seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity, in a random sample of a population based cohort of 10 049 women of Guanacaste, Costa Rica, using a highly sensitive and specific serological assay. METHODS: Seroprevalence was determined by a type specific HSV-2 ELISA assay in an age stratified random sample of 1100 women. Univariate and multivariate logistic regression was used to calculate odds ratios and 95% confidence intervals for risk factors of seropositivity. RESULTS: Overall age adjusted HSV-2 seroprevalence was 38.5% (95% CI, 37.5 to 39.5), and it was strongly associated with increasing age (p(Trend<0.0001)), both among monogamous women and women with multiple sexual partners. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% (95% CI, 24.4 to 32.2) seroprevalence among monogamous women and 75% (95% CI, 65.6 to 83.0) seroprevalence for those with four or more partners (OR = 7.6 95% CI, 4.7 to 12.4 p(Trend<0.0001)). Barrier contraceptive use was negatively associated with HSV-2 seropositivity (OR 0.54, 95% CI, 0.31 to 0.94). Women with antibodies against HPV 16, 18, or 31 were 1.6 times more likely to be HSV-2 seropositive (OR 1.6, 95% CI, 1.2 to 2.1). CONCLUSIONS: HSV-2 infection is highly endemic in Guanacaste, even among lifetime monogamous women, suggesting a role of male behaviour in the transmission of the infection. Until vaccination against HSV-2 is available, education to prevent high risk sexual behaviour and the use of condoms appear as preventive measures against HSV-2.

Adolescent↗

PubMed1999

HTLV-II risk factors in Native Americans in Florida.

Earlier virologic studies established that human T-cell lymphotropic virus type II (HTLV-II) is the predominant retrovirus type found among Seminole Indians in southern Florida. We studied 46 members of the Seminole tribe living on 3 reservations to determine the risk factors for HTLV-II and to investigate disease association with the virus. The donors' plasma samples were evaluated with the enzyme-linked immunosorbent and Western blot assays. DNA extracted from their peripheral blood mononuclear cells were analyzed by type-specific polymerase chain reaction amplification and detection of the HTLV pol gene using the primer pair SK110/SK111, and the probes SK112 or SK188. One of 46 (2%) subjects was identified as HTLV-I positive and 11 (24%) were identified as HTLV-II positive. Restriction fragment length polymorphism and sequence analyses indicated that all of the HTLV-II strains were subtype b. Mitochondrial DNA analyses indicated that all of the HTLV-II-positive subjects had an Amerindian haplotype. HTLV-II was more prevalent in Indians who were >45 years of age or female, had multiple sex partners or had received a blood transfusion. However, only the latter risk factor was statistically significant. Three of the HTLV-II-positive Indians demonstrated signs and symptoms of an ataxic neuropathy. The data support that HTLV-IIb is endemic among the Seminoles and that they will be a key population for further virologic studies.

Adult↗

PubMed1996

Testing for human immunodeficiency virus infection in patients with tuberculosis.

To investigate the utility of testing all tuberculosis patients for HIV infection in Los Angeles, we prospectively evaluated 183 hospitalized patients with acid-fast smear-positive tuberculosis who gave no history of HIV infection. HIV serologic testing was performed, and the presence of risk factors for HIV infection was assessed by interview and review of the medical record. Thirty-three patients (18%) were infected with HIV. Based on data obtained by interview, 124 (68%) of 183 patients had at least one risk factor for HIV infection. The most common risk factors were related to heterosexual transmission of HIV (prostitute contact, multiple sex partners, and a history of sexually transmitted disease). These risk factors were frequently not documented in the medical record. Among the 33 patients who were infected with HIV, 30 were identified by interviewing as having significant risk factors. We concluded that most tuberculosis patients in Los Angeles have risk factors for HIV infection and that systematic questioning does not identify risk factors in all HIV-infected tuberculosis patients. These data support current recommendations to screen all tuberculosis patients for HIV infection.

AIDS Serodiagnosis↗

PubMed1995

Predictors of high and low levels of HIV risk behavior among adults with chronic mental illness.

OBJECTIVE: Several recent studies confirm elevated rates of human immunodeficiency virus infection among acute and chronic mentally ill adults in large urban areas. This research sought to characterize risk for HIV infection among adults with chronic mental illness and to examine psychosocial factors predictive of risk. METHODS: Two hundred and twenty-five adults with chronic mental illness who were sexually active in the past year outside of exclusive relationships were individually interviewed in community mental health clinics using a structured HIV risk assessment protocol. RESULTS: More than 50 percent of the study participants were sexually active in the past month, and 25 percent had multiple sexual partners during that period. Fifteen percent of the men had male sexual partners. In more than 75 percent of occasions of sexual intercourse, condoms were not used. When participants were categorized as at either high or lower risk for HIV infection based on their pattern of condom use, psychosocial factors that predicted risk level included measures of participants' self-reported efficacy in using condoms, perceptions of social norms related to safer sex among peers and sexual partners, and expectations about outcomes associated with condom use, as well as participants' level of objectively assessed behavioral skills in negotiation and assertiveness in sexual situations. CONCLUSIONS: Interventions aimed at prevention of HIV and AIDS are urgently needed in settings that provide services to persons with chronic mental illness.

Adolescent↗

PubMed1988

Detection of Chlamydia trachomatis in adolescent females using direct immunofluorescence.

Direct immunofluorescent slide tests for the detection of genital Chlamydia trachomatis have attracted considerable attention because of their speed and economy, but most evaluation trials have concentrated on adult, high-risk populations. Using 152 paired specimens, we compared the Syva Micro Trak direct specimen test with culture in a population of adolescent females attending a general adolescent medicine clinic. The direct slide test was 90 percent sensitive and 95 percent specific overall, with positive and negative predictive values of 74 percent and 98 percent, respectively. Prevalence by culture was 13 percent. Six of our 23 positive slide tests could not be confirmed by culture. A positive chlamydia culture was significantly associated with nonwhite race, a positive Gram's stain, and the presence of mucopurulent endocervical discharge, but not with oral contraceptive pill use, obstetrical history, Pap smear results, multiple sexual partners, coexisting vaginitis or gonorrhea, or a history of prior sexually transmitted diseases. The direct test appears to be an acceptable substitute for culture in higher prevalence adolescent settings and a useful screening adjunct in lower prevalence groups.

Adolescent↗

PubMed1990

Characteristics of a population volunteering for human immunodeficiency virus immunization. NIAID AIDS Clinical Trials Network.

A total of 166 volunteers for an AIDS vaccine study (Vaxsyn, baculovirus produced recombinant GP160; MicroGeneSys Inc, West Haven, Connecticut, USA) were interviewed and examined. Blood was collected for routine laboratory testing as well as T-cell counts, HIV ELISA (EIA), Western blot (WB) and p24 Ag. Eighty-five men (mean age 22.2 years, range 18-42) and 81 women (mean age 23.9 years, range 17-50) volunteered; 130/166 (78%) were university students. Most had learned of the study from news media (55%), friends or workplace (37%). The most common causes for exclusion were the presence of indeterminate WB (26.5%) or a change of mind after the initial interview (24%). Other causes were abnormal cell count and differential (7.2%), elevated alanine aminotransferase (3.6%), positive hepatitis B antibody (3.6%), abnormal urinalysis (3.4%), recent venereal disease (3.0%), T4 cell count less than 400 (1.9%), abnormal chest X-ray (1.7%), recognized high-risk behaviour (1.7%), multiple sex partners (1.2%), positive rapid plasma reagin test (1.2%), failure to meet age criteria (1.2%), unable to be available for entire study (1.2%), abnormal physical examination (0.6%) and positive p24 Ag (0.6%). No volunteers had positive EIA, but 14.5% had more than one reason for exclusion. Even in a community with low prevalence for HIV, a large majority of healthy heterosexual volunteers can be expected to be ineligible for enrollment in HIV vaccine trials. An average of 4.8 volunteers were screened for each of 12 vaccinees chosen.

AIDS Vaccines↗

PubMedDate not supplied

Sentinel testing for the human immunodeficiency virus antibody at the Murray Street Clinic, Perth, Western Australia.

Sentinel testing for human immunodeficiency virus (HIV) infection aims to monitor the HIV epidemic by testing subgroups of the population, and such testing has been carried out at the Murray Street Clinic in Perth, Western Australia since August 1989. This clinic is part of the State Health Department and is dedicated to the diagnosis, management and control of sexually transmitted diseases (STDs) in Western Australia. Sentinel testing at this clinic is both voluntary and confidential. In the first 6 months of testing at the clinic, 2351 new patients were seen and 3000 HIV antibody tests were performed. The refusal rate for participation was 8%. No patient tested as a sentinel test or because of multiple heterosexual partners was HIV antibody positive. The first 6 months of sentinel testing at the Murray Street Clinic does not indicate a silent HIV infection in the self-selected sexually active group of people using the facilities of the clinic.

Community Health Centers↗

PubMedDate not supplied

Trends in sexual behaviour in a cohort of homosexual men: a 7 year prospective study.

A cohort of homosexual men at risk for human immunodeficiency virus (HIV) infection were studied prospectively over a 7-year period (1982/88) to assess trends in sexual behaviour and amyl nitrite intake. During the period, there were dramatic declines in the proportion of HIV seropositive and seronegative subjects reporting multiple casual partners for anal intercourse, unprotected anal intercourse and recreational use of amyl nitrite. Reported rates of orogenital intercourse remained the same during the period, whilst the total number of seroconversions fell from 17 for the period 1982-84 to 8 for 1985-88. High-risk sexual and related social behaviour among homosexual men, as assessed by patterns of anal intercourse behaviour and nitrite intake, changed over the 7-year period, with the greatest changes apparent before the widespread availability of HIV antibody testing and public education campaigns. This highlights the effectiveness of peer-group and community-based programmes in modifying the sexual behaviour of their members.

Adolescent↗

PubMedDate not supplied

Prevalence of HIV-2 infection in a family planning clinic in Lisbon.

A significant proportion (10%) of notified AIDS cases in Portugal are due to HIV-2 infection as a result of the close connections of Portugal with Western African Countries (ex-Portuguese colonies) where there is a high HIV-2 seroprevalence. We conducted a seroepidemiological study of HIV-1 and HIV-2 infection in 1400 women attending family planning and antenatal clinics in a health centre in Lisbon with the objective of analysing whether there was evidence of HIV-2 spread in this population. The seroprevalence for HIV, as determined by ELISA and confirmed by Western Blot, was 0.42% (6 cases) and 50% of these were of HIV-2 infection. Analysis of the epidemiological inquiries reveals that out of the 6 seropositive cases, only one was a drug addict (HIV-1) and another a western African black woman (HIV-2). The other 4 cases (2 HIV-2 and 2 HIV-1) were white Portuguese women with no history of travelling to Africa or previous blood transfusions, and the only risk factor was a history of multiple sexual partners (in 3 out of 4).

Adult↗

PubMedDate not supplied

Factors associated with trichomoniasis, candidiasis and bacterial vaginosis.

Of 6125 women attending an STD clinic from 1988 to 1991, 5365 (88%) were tested for vaginitis of whom 97 (1.8%) had trichomoniasis, 945 (17.6%) had candidiasis, 734 (13.7%) had bacterial vaginosis and 3628 (67.6%) were free of vaginal infection. Dual infections occurred in 49 (0.9%) patients. Independent predictors for trichomoniasis by multivariate analysis were being pregnant (odds ratio (OR) = 2.4), having vaginal discharge or dysuria (OR = 4.7), being Aboriginal (OR = 4.3), being Asian (OR = 5.0), being unemployed (OR = 2.1) or tattoed (OR = 1.9). Many factors, including use of oral contraception (OR = 1.2) and current antibiotic medication (OR = 1.5), had a small significant association with candidiasis. Independent predictors for bacterial vaginosis were having multiple sex partners in the past month (OR = 1.6), being unmarried (OR = 1.5), being unemployed (OR = 1.3) being a prostitute (OR = 1.5) and not currently using antibiotic medication (OR = 2.5). The epidemiological profiles were consistent with trichomoniasis and bacterial vaginosis being sexually transmitted diseases with epidemiology different from that of gonorrhoea and chlamydia and different from each other, and candidiasis being a disease in which constitutional factors are more important than issues relating to sexual transmission.

Candidiasis↗

PubMedDate not supplied

Factors associated with hepatitis B infection.

Men and women patients not previously immunized or tested, attending the Adelaide (South Australia) STD clinic from 1988-1991, were tested for hepatitis B infection, and potential risk factors detected by multiple logistic regression. Of 7055 men and 3425 women patients tested 811 (11.5%) men and 250 (7.3%) women were seropositive. Among men seropositivity was associated with being Asian (odds ratio (OR) = 14.5), being Aboriginal (OR = 2.2), homosexual behaviour (OR = 3.8), intravenous drug use (OR = 3.2) being over 24 (OR = 2.7), previous STD (OR = 1.8), being unemployed (OR = 1.3) and having sex outside the state in the past 3 months (OR = 1.3). Among women seropositivity was associated with being Asian (OR = 10.3), being Aboriginal (OR = 2.4), intravenous drug use (OR = 3.8), being over 24 (OR = 1.6) and having vaginal discharge or dysuria (OR = 1.4). Seropositivity was not independently associated with being a prostitute or having multiple sex partners in the past 3 months. Among seropositive individuals, risk factors were not readily identifiable for 15% of men and 43% of women. Univariate analysis may provide misleading indicators of risk factors because of the confounding influence of other factors, particularly intravenous drug use. In selective vaccination campaigns the target group should be determined on the basis of local circumstances. In South Australia this group should include men with an STD. The success of selective campaigns will be jeopardized by the failure to identify risk factors in many of those who become infected, and in such situations universal vaccination or widespread screening may be more appropriate strategies.

Adolescent↗

PubMedDate not supplied

Prevalence of neurosyphilis at Government Rajaji Hospital, Madurai, India.

Forty patients (34 males and 6 females) with neurological complaints/manifestations and with a past history of multiple sexual partners attending the Government Rajaji Hospital, Madurai, India between April 1992 and October 1992 were investigated for neurosyphilis. Metabolic disorders, hypertension, ischaemic heart disease, arrhythmias and trauma were excluded. Seven males (17.5%) were found to have neurosyphilis. The youngest was 26 years old and the oldest was 47. All were married and of low socioeconomic background. Meningovascular syphilis was the predominant presentation (6:1). Associated cardiovascular involvement was noticed in one of the cases. There was no associated HIV infection in these cases. The incidence is higher than previous reports from this centre.

Adult↗

PubMedDate not supplied

Prevalence and incidence of syphilis and its association with HIV-1 infection in a population-based study in the Kagera region of Tanzania.

Population-based prevalence and incidence studies on HIV-1 infection were started in the Kagera region of Tanzania in 1987. The prevalence and incidence of infection with Treponema pallidum was studied to enable development of better strategies for STD control. Serological diagnosis of a past or treated infection with Troponema pallidum was made by seropositivity only to TPHA testing while active syphilis was diagnosed by seropositivity to both VDRL and TPHA tests. Seroconversion was measured in 1989 by finding TPHA serologically positive individuals during the follow-up period among the initially seronegative study population of 1987. The overall prevalence of active syphilis in the total sample of adults in the region was found to be 5.9% while that of past syphilis was 13.5%. The association between the prevalence of HIV-1 infection and syphilis of both types was found to be highly significant. However, the association between one pre-existing infection and seroconversion in the other was present but not statistically significant. The overall incidence of syphilis based on seroconversion in a cohort of adults in the region was found to be 11.6 per 1000 person-years at risk. In view of these findings, syphilis is a significant health problem in the region with a high level of transmission and efforts should be made to control it. Intervention studies should use these base-line data and monitor changes in syphilis incidence which may indicate changes in sexual behaviour. Such indicators could also be useful for evaluating the impact of interventions directed at reducing the transmission of HIV, syphilis and other STDs in the region.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Adolescents and HIV: knowledge, behaviors, influences, and risk perceptions.

Although the rate of progression from HIV to AIDS has slowed, the incidence of HIV infection has continued to rise. Many teenagers are knowledgeable about the risks and consequences of HIV, yet a large percentage do not perceive that they are personally at risk. Gaining insight into the perceptions and factors influencing the behavior of teens is critical in HIV and AIDS prevention. A structured 39-item questionnaire was designed to elicit answers that explored 4 areas: knowledge of HIV and AIDS, reported sexual behavior, perceived susceptibility to HIV, and factors influencing behavior. The mean age of the 78 respondents was 15.9 years. One important finding was that 74% of respondents perceived their knowledge of HIV transmission to be "good," yet only 33% were able to answer all of the 8 test questions in this area correctly. In addition, 80% of those who reported engaging in risky behavior such as multiple sexual partners or having sex without condoms also felt they were not personally at risk for HIV.

Adolescent↗

PubMed1997

AIDS risk behaviors, knowledge, and attitudes among pregnant adolescents and young mothers.

This study assessed AIDS risk behaviors, knowledge, and related attitudes of pregnant adolescents and young mothers (n = 151). Results revealed that a substantial portion of the sample engaged in sexual behaviors (e.g., unprotected sex and multiple sex partners) that increased their risk for acquiring HIV and possibly transmitting the disease to their children. Knowledge about major modes of HIV transmission was high; however, commonly held misconceptions were expressed concerning the spread of disease and methods of prevention. Results suggest that neither the experience of having an unplanned pregnancy nor knowing about HIV transmission was a sufficient motivator to reduce risk behaviors in this sample.

Acquired Immunodeficiency Syndrome↗