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Medical treatment of sexually transmitted diseases in developing countries. Part II: Other venereal diseases.
Although gonorrhoea and syphilis are the better known of the sexually transmitted diseases, attention has been drawn to the other sexually transmitted diseases caused by bacteria, viruses, fungi and parasites. Although statistics are not available in most developing countries, herpes genitalis has been suggested as commoner than syphilis as a cause of genital ulceration while non-specific urethritis is commoner than gonorrhoea as a cause of urethritis. The incidence, clinical features and diagnostic procedures of syphilis, herpes genitalis, non-gonococcal urethritis, lymphogranuloma venereum and trichomoniasis have been briefly discussed. The management of these conditions in developing countries have been outlined.
Examining the homosexual male for sexually transmitted diseases.
Homosexual men may be deterred from seeking an examination for sexually transmitted diseases because it would require an open admission of sexual preference. For these diseases to be controlled, gay men must be motivated to be examined for sexually transmitted diseases. If a medical or health professional feels unable to respond to a gay patient's needs, he should refer the patient to someone who deals well with gay patients. Health care services must be offered in a way that minimizes the anxiety many homosexuals associate with examination and treatment for sexually transmitted diseases.
Pediculosis pubis in a clinic for treatment of sexually transmitted diseases.
The symptoms, clinical findings, epidemiology, and associated sexually transmitted diseases are described for 121 patients with pediculosis pubis who were seen in a clinic. Phthirus pubis was observed in the pubic hair of 118 patients, and in 38 men (37.3%) and 18 women (94.7%) the pubic region was the sole area of involvement. Pruritus was reported by 104 patients (85.9%), while excoriations were observed in 30 (24.8%) and maculae ceruleae in one. The median waits from detection of organisms to presentation at the clinic were two days for men and one day for women. This motivation for medical care was fortuitous, because 31.4% of the patients infested with P. pubis had other sexually transmitted diseases.
Strategic planning system for control of venereal disease: record keeping in a clinic for treatment of sexually transmitted diseases.
A manual data processing system and a computer-based system that was integrated into the operations of a clinic for treatment of sexually transmitted diseases were developed. The automated system can generate routine management reports and cross-tabulate data for special studies. It is flexible and adaptable to other localities but is not a panacea for clinical problems.
Spotting and treating "the other" sexually transmitted diseases.
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Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases.
At a clinic for treatment of sexually transmitted diseases, 1,453 patients were examined for pharyngeal colonization with Neisseria gonorrhoeae. A history of oral sex was reported by 895 (61.2%) of the patients. N. gonorrhoeae was isolated from the pharynges of 42 (2.9%) of the 1,453 patients. Twenty-seven of the 42 patients with N. gonorrhoeae-positive cultures gave histories of oral sex, and all 42 patients reported orogenital contact when questioned again at a follow-up visit. Seven patients with positive cultures had pharyngeal symptoms; all seven practiced fellatio. Eleven of the infected men were asymptomatic heterosexuals whose only orogenital contact was cunnilingus.
Relative and seasonal incidences of the sexually transmitted diseases. A two-year statistical review.
In the United States statistics on sexually transmitted diseases (STDs), other than gonorrhoea and syphilis, are meagre. In this study the relative and seasonal incidences of most STDs in an American clinic where 34,938 patient visits were recorded over a two-year period (1975-76) are assessed. Gonorrhoea was the most common STD in male and female patients combined (18%), while nongonococcal urethritis (NGU) was most common in men (23%), and vaginitis (trichomonal 7.5%, yeast 7.1%, and non-specific 7.1%) was the most common in women. A significantly higher incidence of NGU occurred in Caucasian (63%) than in black (42%) men (P less than 0.005). No other STD was diagnosed in more than 5% of patients, and 31% had normal findings on clinical examination and investigation, and could be described as the 'worried well'. Two or more STDs co-existed in 4.2% of patients. In 1976 the incidence of genital herpes and scabies decreased in contrast to other STDs and total patient visits, which increased. A seasonal peak in late summer and early autumn was observed for most STDs. These observations indicate the importance of a comprehensive approach when attempting to compile accurate statistics on selected epidemiological aspects of sexually transmitted diseases.
How suitable are available pharmaceuticals for the treatment of sexually transmitted diseases? 1: Conditions presenting as genital discharges.
The relative prevalence of sexually transmitted diseases and the agents available for the treatment of these diseases commonly presenting as genital discharges-namely, gonorrhoea, candidosis, trichomoniasis, and non-specific genital infection-are reviewed. The many agents that are active against gonorrhoea are listed, but none is ideal. Penicillin, in spite of its allergic side effects, has remained the drug of choice for 25 years because it is cheap, easily obtained, lacks toxicity even in pregnancy, and is effective. Its use is now threatened by the emergence of some strains that are able to produce penicillinase. At present the policy is to obtain the best results from penicillin while these are acceptable, but the clinician in some countries is badly served by the availability of procaine penicillin in aqueous suspension. There is a need for an effective penicillin or cephalosporin that is penicillinase resistant and cheap. Cefuroxime offers considerable hope but it is likely to be expensive in the immediate future.There are many preparations for the local treatment of candidosis. The confidence expressed by the manufacturers in recommending a three-day treatment is, it is hoped, based on a superior product. Nevertheless there is a need for a safe systemically absorbed fungicide which could be used orally, or some substance that could render the vagina an inhospitable environment for the organism.In the treatment of trichomoniasis the pharmaceutical industry in providing substances more than 90% effective in a single dose has done all that can be expected. Any further advances lie in the field of human behaviour rather than pharmaceutical research.In the treatment of non-specific genital infection the needs are more of research than of therapy. More knowledge is required of the cause of the condition and the relative role of contending pathogens, and of the results of treatment of patients and contacts in which Chlamydia or other suspect pathogens have been isolated.
Trichomoniasis and other sexually transmitted diseases.
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Some problems in microscopy encountered in clinics for sexually transmitted disease.
The actual field diameter of 24 microscopes used in clinics for sexually transmitted diseases has been measured by means of a stage micrometer. The variation in findings is given, and the difficulties in producing accurate measurements are discussed.
Medical treatment of sexually transmitted disease in developing countries I: Gonorrhoea.
The statistics relating to the incidence of sexually transmitted diseases in many developing countries are not available and where there are, they are unreliable. Nevertheless, the impression of many physicians is that they constitute serious public health problems as they are endemic in some developing countries. The facilities for diagnosis and treatment of the diseases have been briefly discussed. The merits and the demerits of various antimicrobial agents have been outlined with the causes of failure of treatment in the developing countries. The economic importance of the "traitment minute" in the tropical environment has been stressed because of its economic advantage in terms of time spent in overcrowded hospitals. The resultant effect of the widescale misuse of antibiotics in developing countries has been suggested as a cause of the increasing resistant strains encountered. A plea is made for stricter control of the antimicrobial agents in developing countries.
Urinary tract infection in a clinic for sexually transmitted diseases.
A study of the prevalence of urinary tract infection (UTI) in 430 women attending a clinic for sexually transmitted diseases and its relationship to sexual activity is presented. UTI, usually asymptomatic, was found to be slightly more common in women attending the clinic than in the general population, its prevalence being 4.9%. UTI was more commonly found in patients who gave a history of recent sexual intercourse, which suggests that recent coitus was a factor in the development of significant bacteriuria. The likelihood of finding significant bacteriuria was not related to the number of sexual partners in the previous year. Trichomoniasis was more common in the small group of patients with UTI than in other women. The most common causative organism of UTI was Escherichia coli, and the isolates were usually sensitive to ampicillin, sulphonamides, trimethoprim, and nitrofurantoin.
Seasonsal variations in the reported incidence of sexually transmitted diseases in Scotland (1972-76).
The seasonal variation in the quarterly incidence of some sexually transmitted diseases and other conditions in Scotland is compared with that of gonorrhoea and of conceptions leading to live births or abortions. The seasonal incidence for non-specific genital infections and for other conditions not requiring treatment in both men and women was similar to that of gonorrhoea, thus indicating an association with promiscuity, whereas the seasonal variation for candidosis in men and women-an infection not usually associated with promiscuity-was similar to that of conceptions. Differences between the sexes occurred, however, in the seasonal incidences of scabies, pubic lice, genital herpes, trichomoniasis, and other conditions requiring treatment; thus men with these conditions appeared to be more promiscuous than women. The seasonal variations in incidence of genital scabies and pubic lice indicate that these infestations are more easily transmitted by close bodily contact indoors during cold weather than in the open air.
[Laboratory methods used for the screening and the control of sexually transmitted diseases (author's transl)].
The most currently used methods by laboratories for the screening of sexually transmitted diseases were reviewed by the authors and their comparative reliability and sensitiivity examined. The authors endeavoured to give guidance to physicians and bacteriologists in the choice of available techniques as regards collection sites, transport of specimens, choice of transport media, serological tests for syphilis screening and diagnostic methods for urethritis or non-gonococcal vaginitis.
How suitable are available pharmaceuticals for the treatment of sexually transmitted diseases? (2) Conditions presenting as sores or tumours.
The pharmaceutical industry is not supplying the penicillin preparations that are required for the treatment of syphilis. For those in whom penicillin hypersensitivity is suspected there is a need for a safe injectable alternative that is effective if given once daily or, preferably, at two- or three-day intervals. Existing treatments for chancroid, lymphogranuloma venereum, and granuloma inguinale are described, but even collectively there are few cases and treatments for other sexually transmitted diseases merit priority. Treatments for scabies and pediculosis pubis, although not perfect, are reasonable. There is a need for better local treatment for condylomata acuminata and systemic immunological methods, including those that increase cell-mediated immunity, deserve attention. The same is true for molluscum contagiosum. There is an urgent need for an effective, safe treatment of herpes genitalis that is able to eradicate the virus from the host. If it is proved that the herpes virus is responsible for carcinoma of the cervix this could then be the most serious sexually transmitted disease as in many countries such carcinomas are responsible for approximate seven times more deaths in women than is syphilis in men and women together. The limitations of prophylactic methods in preventing all possibility of infection with one or more of the sexually transmitted diseases are discussed.
The role of the venereal disease laboratory, Mulago Hospital, Kampala in the diagnosis of sexually transmitted diseases in Uganda.
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Sexually transmitted diseases.
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