bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes?
Authors: Vonau B. , Chard S. , Mandalia S. , Wilkinson D. , Barton S. E.
Published: October 2002

An increasing proportion of the population perceive complementary medicine as a safer alternative for non-life threatening conditions such as genital herpes. The extract of the plant Echinacea purpurea (Echinaforce) has been shown to have immunomodulating properties and has been advocated in the lay press for the treatment of genital herpes. This study, a single centre, prospective, double blind, placebo-controlled cross-over trial set out to assess whether an extract of the plant and root of E. purpurea can prevent or decrease the frequency and severity of genital herpes recurrences. These were assessed using a detailed history and clinical review of symptoms. Visual analogue scales were used for documentation and haematological and immunological parameters were measured. Over a one-year period, 50 patients took part in the study receiving 6 months' placebo and 6 months' Echinaforce each. No statistically significant benefit could be detected in this study comparing placebo versus Echinaforce in the treatment of frequently recurrent genital herpes.
Successful treatment of molluscum contagiosum with topical imiquimod in a severely immunocompromised HIV-positive patient
Authors: Strauss R. M. , Doyle E. L. , Mohsen A. H. , Green S. T.
Published: October 2002

Molluscum contagiosum is a common viral infection in the immuno-compromised HIV-positive patient where it is often severe and affecting the face and neck. It is frequently resistant to conventional, locally destructive therapies. Anecdotal evidence suggests that the immunomodulatory drug imiquimod might be a valid therapeutic option in this group of patients. We report the case of a severely immunocompromised HIV-positive patient with resistant facial molluscum contagiosum lesions that responded to topical imiquimod. The response to therapy and the possible implications for pathogenesis are discussed.
The endogenous interferon system in anal squamous epithelial lesions with different grades from HIV-positive individuals
Authors: Arany I. , Muldrow M. , Tyring S. K.
Published: October 2002

Anal intraepithelial lesions (ASILs) are considered as precursors of anal cancer. The incidence of high-grade ASIL (HSIL) and progression of low-grade ASIL (LSIL) to HSIL are high in HIV-positive men. Endogenous cytokines, such as interferons (IFNs) play an important role in the regulation of proliferation and immune responses in epithelial cells, and thus, they might control the above-mentioned progression events. Accordingly, we determined mRNA levels of IFN-γ and IFN-γ receptors, levels of IFN-γ receptor-associated kinases (JAK1 and TYK2) and signalling molecules (signal transducer and activator of transcription-1 [STAT1], STAT3, interferon-responsive-factor-1 [IRF-1] and IRF-2) as well as inhibitors of cytokine signalling (protein inhibitor of activated STAT1 [PIAS1] and suppressor of cytokine signalling 2 [SOCS2]) in biopsies of anal condylomas, LSILs as well as HSILs from HIV-positive individuals by a semi-quantitative reverse transcribed polymerase chain reaction (RT-PCR) method. We found that HSIL significantly differs in expression of these genes from LSIL and condylomas. Expression profile of HSIL samples showed activation of STAT3 signalling, probably accounting for the observed high levels of genes that support cellular proliferation (IRF-2, c-fos and c-myc). Decreases in levels of suppressors (IFN-γ and IRF-1) and JAK1 kinase, but increases in levels of inhibitors of cytokine signalling (PIAS1 and SOCS2) might also contribute to the altered cytokine signalling in HSIL biopsies. These findings might reveal important molecular events associated with progression of LSIL to HSIL in HIV-infected men.
Gay men's estimates of the likelihood of HIV transmission in sexual behaviours
Authors: Gold R. S. , Skinner M. J.
Published: October 2002

In 3 studies we recorded gay men's estimates of the likelihood that HIV would be transmitted in various sexual behaviours. In Study 1 (data collected 1993, n=92), the men were found to believe that transmissibility is very much greater than it actually is; that insertive unprotected anal intercourse (UAI) by an HIV-infected partner is made safer by withdrawal before ejaculation, and very much safer by withdrawal before either ejaculation or pre-ejaculation; that UAI is very much safer when an infected partner is receptive rather than insertive; that insertive oral sex by an infected partner is much less risky than even the safest variant of UAI; that HIV is less transmissible very early after infection than later on; and that risk accumulates over repeated acts of UAI less than it actually does. In Study 2 (data collected 1997/8, n=200), it was found that younger and older uninfected men generally gave similar estimates of transmissibility, but that infected men gave somewhat lower estimates than uninfected men; and that estimates were unaffected by asking the men to imagine that they themselves, rather than a hypothetical other gay man, were engaging in the behaviours. Comparison of the 1993 and 1997/8 results suggested that there had been some effect of an educational campaign warning of the dangers of withdrawal; however, there had been no effect either of a campaign warning of the dangers of receptive UAI by an infected partner, or of publicity given to the greater transmissibility of HIV shortly after infection. In Study 3 (data collected 1999, n=59), men induced into a positive mood were found to give lower estimates of transmissibility than either men induced into a neutral mood or men induced into a negative mood. It is argued that the results reveal the important contribution made to gay men's transmissibility estimates by cognitive strategies (such as the 'availability heuristic' and 'anchoring and adjustment') known to be general characteristics of human information-processing. Implications of the findings for AIDS education are discussed.
Management of chronic prostatitis in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 2000
Authors: Dale Adam , Wilson Janet , Forster Greta , Daniels David , Brook Gary
Published: October 2002

Twenty-two Genitourinary Medicine (GUM) clinics in North Thames participated in a survey of policies and case notes audit of chronic prostatitis managed within the past 2 years, compared with the UK National Guideline. For 32/33 cases notes reviewed (97%) chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/CPPS) were diagnosed. Of these, 14/32 cases (44%) were following non-chlamydial non-gonococcal urethritis (NGU), 1/32 cases (3%) followed Chlamydia trachomatis infection and for 17/32 cases (53%) no predisposing cause was identified. The single case of chronic bacterial prostatitis (CBP) was caused by prostatic infection with Staphylococcus spp. All cases were prescribed antibiotics, initial follow-up appointments coinciding with completion of antibiotics. Fourteen cases (42%) were discharged following GUM clinic management; only 7 of these cases (50%) were asymptomatic, the others having residual problems. Nine cases (27%) were referred to a specialist. Ten cases (30%) defaulted follow-up appointments; 7 of these did not attend their first follow-up appointments.
Impact of an alarm device on medication compliance in women in Mombasa, Kenya
Authors: Frick Pamela A , Lavreys Ludo , Mandaliya Kishorchandra , Kreiss Joan K
Published: October 2002

A randomized controlled clinical trial was conducted to determine the efficacy and acceptability of an alarm device for improving medication compliance among women in resource poor countries. Study participants were given a one-month supply of daily multi-vitamins in an electronic medication vial. Women randomly received either an alarmed vial or a non-alarmed vial. Sixty per cent of women had good compliance (defined as 95% ≥ of pills ingested). Women randomized to use the alarmed vial were significantly more likely to have good compliance than those in the non-alarmed control group (82% vs 36%, P < 0.001). Vial acceptability was high and 99% of participants said they would choose to use the vial again. In conclusion, the alarm device was found to significantly improve medication adherence rates and may be particularly beneficial for improving adherence to antiretroviral therapy among HIV-1 infected persons in developing countries.
Salvage treatment in HIV disease
Authors: Youle Mike
Published: October 2002

The need for salvage treatment is related to the imperfection of current antiretroviral therapy. Sequential therapy with suboptimally suppressive regimens results in a need for this intervention. The aim of salvage treatment is as yet uncertain; virological suppression; immunoenhancement or stability or avoidance of clinical disease. Therapeutic options are constantly improving and the knowledge base concerning individual agents and different combinations comprising highly active antiretroviral treatment (HAART) regimens increases daily. The utility of new agents in salvage appears vital with numbers of new or recycled agents to which no demonstrable resistance exists is a major predictive factor of a positive outcome in this setting. Patient commitment, physician knowledge and an informed supportive environment are also conducive to success in salvage treatment.
Syphilis in New South Wales (Australia) prisons
Authors: Butler Tony , Robertson Peter , Kaldor John , Donovan Basil
Published: October 2002

This paper describes the prevalence of, and risk factors for, exposure to syphilis in a random sample of male and female prisoners. We found that only 2% of male and 1% of female prison inmates in New South Wales (NSW) had confirmed evidence of untreated syphilis, and none appeared to be in an infectious phase. In the multivariate analysis, indigenous ethnicity remained the most potent predictor for confirmed syphilis (either past or present). There was some evidence to suggest that syphilis among indigenous prisoners may be associated with limited access to health services outside prison. The epidemiology of syphilis reflects that of the general community suggesting that prisons could be used as sentinel sites to help evaluate the effectiveness of STD prevention and control strategies.
Management of sexually transmitted diseases in urban pharmacies in The Gambia
Authors: Leiva Anya , Shaw Matthew , Paine Katie , Manneh Kebba , McAdam Keith , Mayaud Philippe
Published: October 2002

This study aimed to describe the quality and costs of sexually transmitted disease (STD) case management in urban pharmacies in The Gambia, and explore pharmacy workers' (PWs) willingness to improve the STD care they provide. PWs from 24 registered pharmacies were interviewed in order to collect information on their knowledge and practices regarding management of STDs. The same pharmacies were visited by a male 'simulated client' (SC) to ascertain how urethral discharge syndrome (UDS) cases were managed in practice. Fifteen (63%) pharmacies were equipped for treatment of UDS, pelvic inflammatory disease (PID) and genital ulcer syndrome (GUS), according to national guidelines. Appropriate syndromic management for UDS was mentioned by 11% of PWs but actually given to 4.4% of the SC visits. None of the PID or GUS cases would be treated correctly. Forty-two per cent of PWs advised on partner notification, 38% on safe sex and 29% on treatment compliance in the SC visits. The reported costs for treatment of UDS, PID and GUS ranged from $2.5-$15.0. The cost of treatment actually purchased by the SC averaged $3.5 (range $1.5-$9.6) for UDS. Excluding the pharmacy sector from interventions will limit the impact of STD control measures. Regular training in syndromic management and rational drug use, with a concise manual for reference are recommended. Strategies to lower the cost of drugs should be explored.
Changing patterns of presentations of patients with HIV-related disease at a tertiary referral centre and its implications for physician training
Authors: Segal Robert , Poznansky Mark C , Connors Larissa , Sands Kenneth , Barlam Tamar
Published: October 2002

Highly active antiretroviral therapy (HAART) has been shown to be highly effective in controlling HIV-related disease progression. Our objective was to determine whether HAART had altered the spectrum of HIV-related disease presentations at a tertiary medical referral centre and if a change in the clinical presentations of HIV-infected individuals to the hospital had impacted on physicians' training. A retrospective study which examined all admissions of HIV-infected patients identified between 1 October 1996 to 30 September 1998 using a hospital-designed computer database was undertaken at the Beth Israel Deaconess Medical Center (BIDMC) tertiary medical referral centre. All medical residents were surveyed in order to assess their knowledge of HIV-associated admissions and their confidence treating HIV-infected patients. There were significant changes in the admitting diagnosis for HIV-related illness between 1996 and 1998. Admissions for opportunistic infections (OIs) declined whereas admissions with bacterial infections increased significantly. Use of HAART remained stable between the 2 years of the study. Physicians' overestimated the use of HAART and only 8% of residents felt very comfortable taking care of an HIV-infected patient. In conclusion, the spectrum of presentations with HIV-related disease to a tertiary referral centre continues to change in the HAART era and impacts on physicians' experience of the management of HIV disease.
A prospective study of the psychological impact on patients of first diagnosis of human papillomavirus
Authors: Conaglen H M , Hughes R , Conaglen J V , Morgan J
Published: October 2002

This study assessed the psychological impact of the first time diagnosis of human papillomavirus (HPV) in consecutive clients attending the Hamilton Sexual Health Clinic, and sought to determine whether this changed over time. Clients with a diagnosis other than HPV and those found to have no diagnosis were compared with HPV clients. All participants completed a battery of questionnaires following their initial visit and again at 4 weeks. The battery consisted of the General Health Questionnaire, Illness Attitude Scales, the International Index of Erectile Function or the Brief Index of Sexual Function for Women, and a 6-question test of the client's knowledge of HPV. One hundred and one participants completed the first questionnaires and 47 of those completed follow-up questionnaires. We found those diagnosed with first episode of HPV had considerable psychological difficulties. However these were no different to those associated with other sexually transmitted infections (STIs) or even those with no active diagnosis.
Behavioural Assessment for HIV Prevention: A Model Programme Design
Authors: Miles Steven H , Song John
Published: October 2002

This paper describes a model HIV prevention programme for relief agencies working in extremely impoverished or socially disrupted areas. A detailed behavioural inventory is proposed to assess: sexual behaviours, traditional cutting procedures, midwifery practices, the availability of injectables and injection equipment in local markets, the use of intoxicants, sex workers, prisons, military behaviours, community beliefs, and the performance of the community health infrastructure. The needs of AIDS orphans and the stigmatizations of person's with AIDS are also assessed. This assessment also examines who has authority to address these issues and what measures of programme assessment could be used for each programme area. The model is currently being tested in south Sudan.
Sexually transmitted infections in Turkey
Authors: Özarmagan Güzin , Bingham James S
Published: October 2002

Turkey is a Moslem country where lay knowledge regarding sexually transmitted infections (STIs) is poor. Surveillance arrangements are limited, and frequently ignored, with the result that the true incidence of STIs is unknown. The prevalence of syphilis is definitely increasing, and probably that of the other infections is too. Modern diagnostic techniques are not widely deployed and there is little standardization of medical arrangements. However, there has been a high level of governmental involvement in HIV prevention in recent years and it is now believed that most HIV transmission in Turkey is by the heterosexual route.
Gonococcal ophthalmia treated with ciprofloxacin
Authors: Price Lynn M , O'Mahony Colm
Published: October 2002

Neisseria gonorrhoeae infection in the eye and its treatment with ciprofloxacin is presented.
Valaciclovir versus aciclovir for herpes simplex virus infection in HIV-infected individuals: two randomized trials
Authors: Conant M A , Schacker T W , Murphy R L , Gold J , Crutchfield L T , Crooks R J
Published: October 2002

Our objective was to evaluate valaciclovir for anogenital herpes in HIV-infected individuals using 2 controlled trials conducted before highly active antiretroviral therapy (HAART) was used. In Study 1, 1062 patients (CD4+ ≥ 100 cells/mm3) received suppressive valaciclovir or aciclovir for one year and were assessed monthly. In Study 2, 467 patients were treated episodically for ≥5 days with valaciclovir or aciclovir and evaluated daily. Valaciclovir was as effective as aciclovir for suppression and episodic treatment of herpes. Hazard ratios [95% confidence interval (CI)] for time to recurrence for valaciclovir 500 mg twice daily and 1000 mg once daily vs aciclovir were 0.73[0.50, 1.06], P=0.10, and 1.31[0.94, 1.82], P=0.11. Valaciclovir 500 mg twice daily was superior to 1000 mg once daily, P=0.001. Valaciclovir 1000 mg twice daily was comparable to aciclovir on herpes episode duration (hazard ratio 0.92[0.75, 1.14]). Adverse events were similar among treatments. In conclusion, valaciclovir is a safe, effective, convenient alternative to aciclovir for HSV infection in HIV-infected individuals.
Chlamydial infection in males and conseqences for their female sexual partners, an example from rural Kilimanjaro, Tanzania
Authors: Klouman Elise , Masenga Elisante J , Sam Noel E , Klepp Knut-Inge
Published: October 2002

The aim of this paper is to examine the reproductive health status for the wives of chlamydia-infected, but largely asymptomatic men. In a cross-sectional study in rural Tanzania 447 men and 393 women, aged 15–44 years, were screened for chlamydial infection. The prevalence was 9.6% and 6.9%, respectively. Among 43 chlamydia-positive men, 17 were married. Data from both spouses, independently examined, could be matched for 12 couples. None of the 12 husbands had discharge, one had dysuria and 3 had pyuria. Three wives tested positive for chlamydial infection, two others had pelvic inflammatory disease, four others had pyuria. Men reported more sexual partners than women and were considered being the index case for the chlamydial infection. While three of 11 wives (27%) tested chlamydia-positive from a cervical sample, transmission might have occurred in 5–8 cases (transmission rate (42–67%), indicating that these 12 largely asymptomatic chlamydia-positive men were highly infectious to their sexual partners.
Autoimplantation technique in the treatment of anogenital warts: a clinico-immunological study
Authors: Usman N , Udayashankar K , Subramanian S , Thyagarajan S P
Published: October 2002

An autoimplantation technique was adopted in the treatment of 50 cases of anogenital warts and was compared with the conventionally used podophyllin regimen in a matched group of 50 patients. They were assessed with 15 untreated subjects in a control group for the rate of clinical cure after 6 weeks, recurrence after 1 year follow up and for humoral and cell mediated immune responses before and after treatment. In the podophyllin group, 70% of patients were cured after 6 weeks while in autoimplantation, only 44% of patients were cured, and none in the control group had natural remission of warts without any treatment. After 1 year all the cured cases (100%) that completed follow up had recurrence of warts with podophyllin treatment, while none had recurrence of lesions in the autoimplantation group. Results of the humoral and cell mediated immune (CMI) response studies revealed that autoimplantation technique significantly augmented both humoral and CMI responses while there was no significant change in the immune status after podophyllin treatment (P>0.001).
Treatment and prophylaxis of Mycobacterium avium complex
Authors: Young L S
Published: October 2002

The most common pathogens involved in disseminated bacterial infection in people with acquired immunodeficiency syndrome (AIDS) are organisms of the Mycobacterium avium-intracellulare complex (MAC). Azithromycin and clarithromycin, a new azalide and macrolide, respectively, are among the most potent monotherapies for MAC bacteraemia, although many bloodstream isolates demonstrate increased minimum inhibitory concentrations after 4 months of treatment. Current recommended prophylaxis, based on the results of two randomized, double-blind, prospective studies, is rifabutin 300 mg daily for people with AIDS with <100 CD4 lymphocytes/mm3. In the beige mouse model, we have shown that both azithromycin and clarithromycin prevent MAC bacteraemia following repetitive oral challenge. Clinical trials are now underway to confirm these effects in man; comparative treatments include placebo, rifabutin and an azalide/macrolide plus rifabutin. While combinations might be more effective and reduce the emergence of resistance, the spectre of cytochrome P-450 drug interactions necessitates careful study before combination prophylactic approaches are accepted. Such interactions are associated with rifabutin and some macrolides, although azithromycin may be less problematic in this respect as it appears to have little potential to interact with other antimicrobial agents.
Human cryptosporidiosis
Authors: Hoepelman I M
Published: October 2002

Cryptosporidium parvum is a protozoan which can cause severe debilitating disease in immunocompromised individuals. Animal models have shown that cellular immunity is the most important factor against the development of the disease. Individuals with a humoral immune deficiency are also at risk. In HIV-infected patients there is a clear relationship between disease severity and CD4 cell counts. Insight into the pathogenesis and development of new agents is hampered by the lack of an in vitro culture system. Prevention is of the utmost importance due to the difficulties of therapy and the severity of the clinical disease which can develop. Oocysts are highly resistant to commonly used disinfectants. In HIV-infected patients with cryptosporidiosis, antiretroviral therapy should be instituted or modified. Moreover, non-specific therapy with antidiarrhoeal agents should also be instituted. If no effect is seen, therapy with paromomycin 500 mg 4 times daily for 2–3 weeks should be initiated, followed by maintenance therapy with 500 mg twice daily to prevent relapse.
Venous thrombosis in HIV infection
Authors: Laing R B S , Brettle R P , Leen C L S
Published: October 2002

Previous reports indicate that venous thrombosis is an infrequent problem in patients with HIV infection. Despite this, various HIV-related factors have been proposed as potentially thrombogenic and an HIV-related hypercoagulability has been suggested. At the present time, there exists no consensus of opinion regarding prophylaxis against venous thrombosis for hospitalized patients with HIV. This article aims to provide an overview of venous thrombosis in HIV infection with particular reference to published and personal evidence for possible risk factors and their implications for prophylaxis.
Human papillomavirus deoxyribonucleic acid in cervix only detected in girls after coitus
Authors: Andersson-Ellstrom Agneta , Hagmar Bjorn M , Johansson Bo , Kalantari Mina , Warleby Bengt , Forssman Lars
Published: October 2002

In a prospective cohort study on the prevalence of HPV in a group of female Swedish students, we obtained repeated cytological specimens during a period of 2 years, for cytological diagnosis and PCR detection of HPV. The group comprised 98 girls, sampled between 15 and 17 years, and 82 of them completed the study. The girls were also followed every sixth month by a structured face-to-face interview regarding sexuality. Only the sexually experienced girls harboured HPVDNA in the cervix with a cumulative prevalence of 37% and HPV16 was the most common type encountered. Almost half of the infected girls were lacking any clinical or subclinical signs of HPV infection. There was a positive correlation between the presence of HPV and the number of coital partners. The time period since coitarche also had importance for the HPV detection rate.
Differentiation of central nervous system lesions in AIDS patients using positron emission tomography (PET)
Authors: Heald Alison E. , Hoffman John M. , Bartlett John A. , Waskin Hetty A.
Published: October 2002

To determine if positron emission tomography (PET) imaging using F-18 fluorodeoxyglucose (FDG) can accurately distinguish between malignant and infectious central nervous system (CNS) mass lesions in patients with human immunodeficiency virus (HIV) infection, a prospective case series of 18 patients with HIV infection and focal CNS lesions on computed tomography (CT) or magnetic resonance (MR) scans was analysed. The patients were divided into 3 groups based on biopsy results, serology and response to therapy. Group 1 consisted of 8 patients with infectious lesions (4 with toxoplasmosis, 2 with neurosyphilis, 2 with progressive multifocal leukoencephalopathy (PML) ). Group 2 consisted of 5 patients with biopsy proven CNS lymphoma. Group 3 consisted of 5 patients with presumed CNS lymphoma. Patients underwent FDG-PET studies as an adjunctive diagnostic procedure. The metabolic activity of each patient's lesion was graded using both a qualitative visual score and a semi-quantitative count ratio comparing the lesion with contralateral brain. CNS lesions diagnosed as lymphomas had statistically higher visual scores ( P =0.001) and count ratios ( P =0.002) than CNS lesions diagnosed as infections. FDG-PET could accurately differentiate lymphoma from infections in 16 of 18 cases. Two cases of PML had high metabolic activity and could not be differentiated from lymphoma. FDG-PET shows great promise in differentiating lymphoma from infectious lesions in the CNS of patients with HIV infection. If larger prospective studies confirm this impression, more specific and rapid treatment of CNS lesions could be performed and perhaps obviate the need for brain biopsy in many cases.
Heterogeneity of care for HIV-infected individuals decreases with the physician knowledge
Authors: Pattullo Andrew L S , Hogg Robert S , Schilder Arn , Goldstone Irene L , Sussel Robyn , O'Shaughnessy Michael V
Published: October 2002

In order to gain an understanding of the determinants of clinical management of HIV disease in adults just prior to the introduction of comprehensive guidelines, we undertook the present study among members of the British Columbia Persons with AIDS Society BCPWA . The aim of this study was to examine whether the heterogeneity of care for HIV-infected individuals decreases with physician knowledge of HIV AIDS and the stability of the physician-patient relationship. Eligible participants had to be full members i.e. HIV positive of the society, residents of British Columbia, and had to have previously agreed for the BCPWA society to include unsolicited material with their monthly newsletter. Our analysis demonstrates that compliance with appropriate care was associated with a more stable physician-patient relationship and with the perception on the patient's part of a greater level of knowledge on the part of their physician.
HIV infection among pregnant women in Burkina Faso: a nationwide serosurvey
Authors: Sangare Lassina , Meda Nicolas , Lankoande Salif , Van Dyck Eddy , Cartoux Michel , Compaore Issaka Pierre , Catraye Joseph , Sanou Paul Thomas , Soudre Robert
Published: October 2002

To determine the prevalence of HIV infection among pregnant women in Burkina Faso and to identify factors associated with HIV infection in this population, we performed in 4 antenatal clinics in 4 urban centres located in the centre, the north, the east and the south-west of the country cross-sectional serological surveys between 7 October 1994 and 7 February 1995 using unlinked anonymous HIV screening method. In the towns included in the study more than 94% of pregnant women attend at least 2 antenatal consultations. In each centre all pregnant women attending an antenatal consultation during a 2-week period were invited to take part in a study to measure the prevalence of syphilis. Women with positive syphilis serology were offered treatment free of charge. A total of 1294 pregnant women were recruited into the study. There were no refusals. Thirty-two women (2.5%) had positive syphilis serology. The overall seroprevalence of HIV infection was 8% (95% confidence interval [CI]: 6.6-9.6). There was no evidence that the prevalence of syphilis or HIV infection varied between the 4 towns ( P =0.12 and 0.52 respectively). In logistic regression analyses only the presence of syphilis infection was associated with risk of HIV (odds ratio=3.4; 95% CI: 1.4-7.9). The prevalence of syphilis among pregnant women in Burkina Faso is relatively low compared with that of HIV infection. These results suggest that HIV epidemic in Burkina Faso is important and that there is an urgent need to intensify HIVprevention activities. The need for HIV surveillance in this sentinel population is urgent to follow the course of the epidemic and to measure the impact of interventions. One of the consequences of the high prevalence of HIV infection among pregnant women which requires greater attention in Burkina Faso is the increasing number of children who will be infected with HIV by vertical transmission.
Recombinant human interferon- in the treatment of condylomata acuminata
Authors: Dinsmore Wallace , Jordan Joe , O'Mahony Colm , Harris John R W , McMillan Alexander , Radcliffe Keith W , Engrand Patrick , Jackson Brian W , Galazka Andrew R , Abdul-Ahad Ayad K , Illingworth John M
Published: October 2002

The number of clinic consultations for condylomata acuminata (genital warts) has increased substantially during the last 30 years. Most infections produce benign lesions but a few types may be associated with cervical and penile cancers. Interferons (IFN) have shown antiviral properties to these infections and IFN- in particular has demonstrated a specific cytopathic effect in humans. A total of 124 patients with condylomata acuminata, the majority of whom had failed previous therapy, were treated intralesionally with either recombinant human interferon-beta 1a (r-hIFN--1a) or placebo. Up to 6 lesions were treated in each patient, and injections were made 3 times per week for a total of 9 injections. The patients were then followed up for 3 months. Efficacy assessments at all time points (day 19, week 6 and month 3) showed a clear advantage for the r-hIFN--1a interferon-beta treatment. Patients receiving rhIFN--1a showed a greater proportion of treatment success in terms of the complete or partial reduction (at least 50%) of the total area of the treated lesions. The treatment was also well tolerated. Headache, flu-like symptoms and asthenia were more common in patients receiving r-hIFN--1a, but these adverse events were generally mild in severity and rarely led to patient withdrawal. It was concluded that r-hIFN--1a has good efficacy in condylomata acuminata, and therefore presents a useful therapeutic alternative in this hard-to-treat condition.
Introduction of HIV into drug injector networks outside AIDS epicentres
Authors: Williams Mark L , Zhao Zixian , Bowen Anne M , Freeman Robert C , Elwood William N , Rusek Ryan
Published: October 2002

Injection drug users (IDUs) continue to be at risk for HIV infection despite high levels of knowledge about how human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) is transmitted. Yet, among notin-treatment injection drug users, the chances of becoming infected with HIV vary substantially. Information regarding the factors that facilitate the introduction of HIV into networks of drug injectors in low HIV seroprevalence cities is urgently needed. This study examines the factors related to HIV seroprevalence in a large ( n =9492), multi-site sample of IDUs recruited in 11 low seroprevalence cities. Univariate and multivariate associations between drug injection and sexual behaviours and travel to an AIDS epicentre were examined. Results show that, next to male-to-male sexual contact, having sex at least twice in an AIDS epicentre was the strongest predictor of HIV infection. Also associated with higher odds of being HIV-positive were racial/ethnic characteristics, daily drug injection, and injecting drugs in an AIDS epicentre. These results confirm that travelling to an AIDS epicentre and having sex or injecting drugs play a large role in the introduction of HIV into drug injector networks in low seroprevalence cities.
A study of Malaysian drug addicts with human immunodeficiency virus infection
Authors: Yoong Kar-Yaw , Cheong Izham
Published: October 2002

Summary: A cross-sectional study was undertaken to determine the clinical profile, haematological and biochemical changes, seroprevalence of common opportunistic pathogens, and AIDS-defining events in 49 Malaysian male drug addicts with HIV infection. Their mean age was 33.2 years, the majority had been injecting drugs for more than 5 years and 88% reporting sharing needles. Fatigue, weight loss and night sweats were common presenting symptoms and the most frequent physical findings were hepatomegaly (57%), lymphadenopathy (35%) and thrush (29%). Pulmonary infections were the commonest complications seen (61%) and of these, 13 had septic pulmonary emboli, 7 had bacterial pneumonias, 7 had pulmonary tuberculosis, and 4 had Pneumocystis carinii pneumonia. Eight patients had infective endocarditis and 5 had infected pseudoaneurysm in the groin. Anaemia (82%), leucocytosis (53%), hypoalbuminaemia (43%), hyperglobulinaemia (88%), elevated liver enzymes and hyponatraemia (57%) were frequent laboratory findings. The prevalence of HCV, HBV, cytomegalovirus and toxoplasma infection (by serology) were 100%, 12.2%, 72.7% and 59% respectively. All 7 patients with AIDS (4 P. carinii pneumonia, 2 extrapulmonary tuberculosis, and one oesophageal candidiasis) presented with their AIDS-defining illness, suggesting that HIV-infected intravenous drug user (IVDU) patients present late in the course of the disease.
A lasting public health response to an outbreak of HIV infection in a Scottish prison?
Authors: Goldberg David , Taylor Avril , McGregor James , Davis Barbara , Wrench John , Gruer Laurence
Published: October 2002

Summary: Between April and June 1993, 8 cases of acute clinical hepatitis B infection and 2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day period commencing at the end of June. A team of 18 counsellors and phlebotomists was brought together rapidly as part of a unique organizational exercise in the field of public health. Fourteen cases of HIV infection were identified of which 13 were almost certainly infected in Glenochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean injecting equipment, a methadone detoxification programme, increased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measures had been sustained and several could be found in many other prisons throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HIV during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decreased over the last 3 years, these activities are still being reported and it is highly likely that transmissions of bloodborne infections, in paticular hepatitis C, continue to occur. The surveillance and prevention of infections associated with injecting drug use in the prison setting remain a high public health priority.
Views of Cameroonian sex workers on a woman-controlled method of contraception and disease protection
Authors: Visness Cynthia M , Pfannenschmidt Susan , Ulin Priscilla , Zekeng Leopold
Published: October 2002

Five hundred and twenty female Cameroonian sex workers participating in a clinical trial of the effectiveness of nonoxynol-9 (N-9) contraceptive film to prevent HIV infection were interviewed to determine their experience with this woman-controlled method. The sex workers liked the film, with over 80% stating they would continue to use it if it were shown to be effective against HIV and were to become widely available. However, they were much more likely to use condoms and films simultaneously with their clients (40%) than with their regular partners (16%). The advantages ascribed to the film were that its use was under the woman's control; it could be used without the partner's knowledge; it allowed direct contact between partners; and it provided back-up protection in case of condom breakage. Data from this small study suggest that development of an effective, womancontrolled method of pregnancy and disease protection would be welcomed by these women.
Gonorrhoea treatment failure and ciprofloxacin resistance
Authors: Ng P P L , Chan R K W , Ling A E
Published: October 2002

Summary: Ciprofloxacin-resistant strains of Neisseria gonorrhoeae have been on the increase over the past few years in Singapore and worldwide. The aim of this study is to correlate treatment failures with in vitro ciprofloxacin resistance of N. gonorrhoeae . A total of 694 patients attending the Department of STD Control (DSC) clinic in 1996 who were diagnosed to have gonococcal infection confirmed by culture were analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) of ciprofloxacin were traced for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant ( 1 mug/ml) and less sensitive (0.125-0.5 mug/ml) range were also reviewed to determine the clinical outcome. Ciprofloxacin treatment failure rate was 1.7% (8/461) which was lower than the percentage of ciprofloxacin-resistant strains isolated in the laboratory. Of these 8 cases, 6 were resistant and 2 were less sensitive to ciprofloxacin. Cure rates with ciprofloxacin for resistant and less sensitive strains were 40% and 92% respectively. In conclusion, in vitro resistance to ciprofloxacin may not translate into clinical treatment failure. Clinical treatment failures, on the other hand, are also seen in less sensitive strains.
HIV Infection and Sexually Transmitted Infections in Lithuania
Authors: Chaplinskas S , Trechiokas A
Published: October 2002

Lithuania is a small country with a population of 3.7 million. It has recently been released from the yoke of Soviet rule. HIV infection was first identified in 1988 and while the numbers of cases are small, the incidence is beginning to rise precipitously. A National AIDS Centre has been established in the capital, Vilnius, and a nationwide epidemiological survey is underway. Efforts are being made to prevent HIV infection. Sixty one per cent of notified cases of HIV infection are in Klaipéda, a port city adjacent to the Kaliningrad region and the predominant mode of transmission is by intravenous drug use. The majority of cases of AIDS, however, are seen in Vilnius. Sexually transmitted infections (STIs) are poorly controlled and there is no national control strategy. While the incidence of gonorrhoea is declining, new cases of syphilis have been on the increase, reaching 101.4 cases per 100,000 of the population. Cases of congenital syphilis are still seen.
Outreach Programmes for Female Commercial Sex Workers
Authors: Wilson Janet
Published: October 2002

Female commercial sex workers are at higher risk of sexually transmitted infections (STI) and may be important in the transmission of infections because of their multiple sexual partners. Sexual health may not be their top priority and current STI services may not be seen as user-friendly. An outreach approach is therefore appropriate for this group. This should be in collaboration with the women and include other services that they feel are appropriate. If possible it should also incorporate the use of sex workers as peer educators.
College Students’ Knowledge and Perceptions of Genital Herpes
Authors: Lewis Lisa M , Rosenthal Susan L , Succop Paul A , Stanberry Lawrence R , Bernstein David I
Published: October 2002

Given the rising prevalence of herpes simplex virus type 2 (HSV-2) and the lack of accurate information about STDs in general, it is important to understand specific aspects of knowledge and attitudes regarding genital herpes acquisition among college students. This study examined the knowledge and attitudes regarding HSV-2 among college students by recruiting subjects (n=518) from an undergraduate psychology class to complete a questionnaire. The percentage of students answering individual knowledge items correctly ranged from 67% to 99%. The media was a common source of information, and almost one-third of the students anticipated that their care provider would think negatively of them should they acquire the disease. There were gender differences in care-seeking behaviour, knowledge, and attitudes, with females having a more negative view of themselves if they acquired the disease. This study pointed to the challenges in ensuring accurate knowledge about genital herpes that will encourage preventive behaviours without causing undue alarm or shame.
Recurrent bacterial vaginosis and Netherton's syndrome
Authors: Nicholls S , Patel H C , Jones M
Published: October 2002

Netherton's syndrome, or 'bamboo hair' syndrome, is an unusual disorder in which ichthyosiform dermatosis and characteristic defects of the hair shaft are found. It is associated with atopy and recurrent infection, which often affects the skin. We report a case of severe recurrent bacterial vaginosis in a female patient with Netherton's syndrome.
Evaluation of 2 techniques of HIV pre-test counselling for pregnant women in West Africa
Authors: Cartoux Michel , Sombie Issiaka , Perre Philippe Van De , Meda Nicolas , Tiendrebeogo Sylvestre , Dabis Francois
Published: October 2002

This study compares the effect of group and individual pre-test counselling on uptake of HIV voluntary counselling and testing (VCT) by African pregnant women and knowledge about HIV/AIDS in 2 antenatal clinics of BoboDioulasso, Burkina Faso. Pre-test counselling was offered to 3958 pregnant women, 927 by group counselling and 3031 by individual counselling. Acceptance of the test improved with individual counselling, which was already high with group counselling (93.3% versus 89.4%). The return rate for results was independent of the pre-test counselling technique. At post-test session, knowledge about HIV/ AIDS was better after group than individual counselling, except for reporting the existence of an asymptomatic stage of HIV infection. At a public health level, group pre-test counselling can be easily integrated into existing sessions of antenatal care counselling, routinely performed by the current clinic staff. Our findings may help programme managers in the field of maternal and child health to choose optimal options of pre-test counselling adapted to local circumstances in resource-poor settings.
Accuracy and Consistency of KC60 Diagnoses and Coding in a Department of Genitourinary Medicine
Authors: Sherrard Jackie
Published: October 2002

The accuracy and completeness of KC60 coding is important to ensure that accurate local, regional and national data on sexually transmitted infections (STIs) are produced. Following alterations to the codes in 1995 a review of the process and accuracy in one department of genitourinary medicine was undertaken. Over a 6-month period 239 episodes and 407 diagnoses were reviewed in the notes of 172 patients. An error was found in 17.9% of diagnoses, and 32.6% of episodes had at least one error. Only one episode had been diagnosed but not coded. Subsequently the procedure for diagnosing episodes was altered and a subsequent review of 122 episodes and 239 diagnoses in the notes of 94 patients identified only 4 errors.
Advising patients with genital warts - a consensus approach
Authors: Mcowan A G , Broughton C , Robinson A J
Published: October 2002

This article reviews the evidence available to guide practitioners when advising patients with genital warts, by seeking to answer the questions most commonly asked in medical practice. It highlights where evidence is lacking and is intended to inform patients about their condition, and to identify areas where further research is warranted.
A prospective study of pharyngeal gonorrhoea and inconsistent condom use for oral sex among female brothel-based sex workers in Singapore
Authors: Wong M. L. , Chan Roy K. W.
Published: October 2002

Oral sex among female sex workers in Singapore has risen sharply from 27.1% in 1992 to 81.7% in 1997. A prospective cohort study was carried out on 724 female brothel-based sex workers who practised oral sex, to determine the risk of contracting pharyngeal gonorrhoea through inconsistent condom use. The prevalence of consistent condom use for oral sex was 70.4% compared to 96.8% for vaginal sex. One hundred and twenty-nine (17.8%) were lost to follow up because they quit prostitution. The other 595 sex workers were followed up for a maximum period of 6 months. Thirty-eight (5.2%) sex workers contracted pharyngeal gonorrhoea compared to 2.5% who contracted cervical gonorrhoea. Sex workers with inconsistent condom use for oral sex were 17.1 times (95% CI: 8.0-36.5) more likely than consistent condom users to develop pharyngeal gonorrhoea, after controlling for ethnic group, class and number of clients. STD control programmes for sex workers should place stress on consistent condom use for oral sex.
Cost analysis of a hospital-at-home initiative using discrete event simulation
Authors: Campbell Helen , Karnon Jonathan , Dowie Robin
Published: October 2002

Objectives: To examine whether, from a National Health Service (NHS) and local authority social services' viewpoint, a hospital-at-home service was cost saving compared with conventional inpatient care.

Methods: The subjects of this part-retrospective and part-prospective cost analysis were 51 elderly medical and orthopaedic surgical patients assessed at Hillingdon Hospital, West London, as being suitable for hospital-at-home care. Thirty patients received hospital-at-home care, provided for up to 14 days, while 21 patients remained in hospital and received standard inpatient care. All direct costs to the NHS hospital, community health services' provider and social services' department during the initial episode of care and the three months after discharge were collected for each group of patients. Costs and clinical event data were entered in a discrete event simulation model which generated baseline results. Uncertainty surrounding the model's parameters was explored using sensitivity analysis.

Results: The baseline simulation performed with 1000 patients in each group showed the mean cost per patient for hospital-at-home care and three-month follow-up to be around three-fifths the mean cost per patient of inpatient care and follow-up. Most of the excess cost in the inpatient group was attributable to the initial period of hospitalisation. Under all assumptions used in the sensitivity analysis, the hospital-at-home service was less costly.

Conclusions: For elderly patients assessed as needing no more than 14 days of hospital care, hospital-at-home care is cost saving to health and social care agencies when compared with conventional inpatient care.