bluuebunny/crossref_metadata_2025 huggingface dataset:
Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited
Authors: O'Farrell Nigel , Egger Matthias
Published: October 2002

There is debate on the role of male circumcision in HIV transmission. Most case-control and cohort studies from Africa have shown an association between a lack of circumcision and an increased risk of HIV infection in men. The evidence is conflicting, however, with cross-sectional surveys from Tanzania and Rwanda either showing no relationship or an association in the opposite direction. A recent review and meta-analysis of the literature concluded that the risk of HIV infection was lower in uncircumcised men (combined odds ratio 0.94, 95% confidence interval 0.89 to 0.99). However, the analysis was performed by simply pooling the data from 33 diverse studies, which is an inappropriate method for combining studies. We re-analysed the data, stratifying by study, and found that an intact foreskin was associated with an increased risk of HIV infection: combined odds ratio 1.43 (1.32 to 1.54) with a fixed effect model and 1.67 (1.25 to 2.24) with a random effect model. There was significant between-study heterogeneity (P < 0.0001) which was partly explained by stronger associations in studies in high-risk groups. The results from this re-analysis thus support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic. A systematic review is required to clarify this issue. Such a review should be based on an extensive search for relevant studies, published and unpublished, and should include a careful assessment of the design and methodological quality of studies. Much emphasis should be given to the exploration of possible sources of heterogeneity. In view of the continued high prevalence and incidence of HIV in many countries in sub-Saharan Africa, the question of whether circumcision could contribute to prevent infections is of great importance, and a sound systematic review of the available evidence should be performed without delay.
Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission
Authors: Dowe G , Smikle M , King S D , Baum M , Chout R , Williams Y
Published: October 2002

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU ( n = 339), and control groups including asymptomatic men who were STD contacts ( n = 61), asymptomatic men who were not STD contacts ( n = 32) and men with gonococcal urethritis (GU) ( n = 61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts ( P < 0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)= 1.76; P < 0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P < 0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.
Diagnosis of bacterial vaginosis by wet mount identification of bacterial morphotypes in vaginal fluid
Authors: Schmidt H , Hansen J G
Published: October 2002

In order to develop a more practical way of diagnosing bacterial vaginosis (BV), we evaluated a scoring system, weighting small bacterial morphotypes versus lactobacillary morphotypes in wet mounts, assessed criteria for BV and normalcy from this scoring, and then evaluated their reproducibility and accuracy. We examined 754 women for pH, homogeneous vaginal discharge, amine odour, clue cells and the composite clinical diagnosis. We also examined wet mounts for small bacterial morphotypes and lactobacillary morphotypes, and weighted their quantitative presence as a bacterial morphotype score. The term 'small bacterial morphotypes' denotes a group of small bacillary forms comprising coccobacilli, tiny rods, and mobile curved rods. The different characteristics of BV were all gradually associated with increased bacterial morphotype scoring. We deemed a score of 0-1 as normal, 2-4 as intermediate phase, grade I, 5-6 as intermediate phase, grade II, and 7-8 indicative of BV. Reproducibility of the interpretation was high, both for the new grading system (weighted Kappa 0.90 in women perceiving and 0.81 in women not perceiving abnormal vaginal discharge) and for the new criterion for BV (non-weighted Kappa 0.91 and 0.84 in the 2 groups of women). The new criterion also proved highly concurrent with the composite clinical diagnosis (Kappa 0.91 and 0.81 in the 2 groups). In conclusion, the wet mount bacterial morphotype scoring is valid for grading of the disorder of the vaginal microbial ecosystem, and the new criterion for BV a more practical option than existing diagnostic methods.
Is it evidence-based practice? Prophylactic antibiotics for termination of pregnancy to minimize post-abortion pelvic infection?
Authors: Uthayakumar S , Tenuwara W , Maiti H
Published: October 2002

Sexually transmitted infections (STIs) causing upper genital tract problems after termination of pregnancy (TOP) is well recognized. We undertook this study to assess the local prevalence of Chlamydia trachomatis infection and to estimate the potential benefits of introducing screening. The prevalence rate of C. trachomatis was 6%. Nine sexual contacts of the index cases were identified. They were symptom free, but all had non-specific urethritis (NSU). Four of them were positive for C. trachomatis. We conclude that screening for chlamydial infection is essential and routine prophylactic antibiotic cover may not be beneficial.
Ureaplasma urealyticum colonization in the vaginal introitus and cervix of human immunodeficiency virus-infected women
Authors: Linhares I M , Witkin S S , Giraldo P , Sziller I , Jeremias J , Pinotti J A , Segurado A
Published: October 2002

Ureaplasma urealyticum colonization was examined in paired cervical and introital specimens from 56 untreated HIV-seropositive women. Specimens were tested for U. urealyticum by polymerase chain reaction (PCR). Peripheral blood was examined for CD4 lymphocyte counts and HIV RNA concentration. U. urealyticum was detected in the cervix of 38 (69.1%) women. Introital U. urealyticum was present in 16 (28.6%) women, all of whom were cervical-positive. Cervical motion pain was present in 40.0% of women with U. urealyticum in the introitus and cervix, 23.8% of those with only cervical U. urealyticum and 5.9% of women negative for this organism ( P = 0.03). There was no relation between U. urealyticum colonization and CD4 lymphocyte count. However, 64.3% of women with introital U. urealyticum had circulating HIV RNA levels > 10,000 copies per ml as compared with 28.6% of women with only cervical U. urealyticum and 7.1% of women negative for this organism ( P < 0.01).
Determinants of condom use in female sex workers in Surabaya, Indonesia
Authors: Joesoef M R , Linnan M , Kamboji A , Barakbah Y , Idajadi A
Published: October 2002

In the developing world condom use among sex workers and their clients plays a dominant role in the transmission of HIV/STD. In Surabaya, Indonesia, data from the 1993 STD prevalence survey in female sex workers (brothels, street, massage parlours, barber shops, call-girl houses, and nightclubs) reveal that only 5% (33/692) of the brothel workers and 14% (25/177) of the street walkers had condoms in their possession at the time of the interview. During the last paid sexual intercourse, sex workers from the brothels, streets, and nightclubs used condoms infrequently (14%, 20%, and 25%, respectively). Sex workers from massage parlours, barber shops, and call girls were about 5 to 3 times more likely to use condoms than sex workers from nightclubs (adjusted odds ratio of 3.5, 4.9, and 4.2, respectively); thus condom promotion programmes should be targeted at sex workers at brothels, streets, and nightclubs. Programmes should include: (1) free distribution of condoms to sex establishments at the initial stage, and condom social marketing at later stages; (2) penalties, including legal sanctions, against any sex establishments that do not consistently use condoms; (3) participation of brothel owners and madams in encouraging sex workers to consistently have clients use condoms during sexual intercourse; and (4) establishment of sentinel surveillance to monitor STD/HIV and condom-use compliance.
Symptomatic and health status outcomes in the Canadian randomized MAC treatment trial (CTN010)
Authors: Singer Joel , Thorne Anona , Khorasheh Shideh , Raboud Janet M , Wu Albert W , Salit Irving , Tsoukas Christos M , Lemieux Claude , Shafran Stephen D
Published: October 2002

Our objective was to compare the effect of 2 regimens for treatment of Mycobacterium avium complex (MAC) bacteraemia in an HIV-positive population on symptoms and health status outcomes using a substudy of an open-label randomized controlled trial. The study was conducted in 24 hospital-based human immunodeficiency virus (HIV) clinics in 16 Canadian cities. Patients had HIV infection and MAC bacteraemia and were given either rifampin 600 mg, ethambutol 15 mg/kg daily, clofazimine 100 mg daily and ciprofloxacin 750 mg twice daily (4-drug arm) or rifabutin 600 mg daily (amended to 300 mg daily in mid-trial), ethambutol 15 mg/kg daily and clarithromycin 1000 mg twice daily (3-drug arm). The primary health status outcome was the change on the 8-item symptom subscale of the Medical Outcome Study (MOS)-HIV Health Survey adapted for MAC. Changes on other MOS-HIV subscales and on the Karnofsky score were also evaluated. Patients on the 3-drug arm had better outcomes on the MOS-HIV symptom subscale at 16 weeks (P = 0.06), with statistically significant differences restricted to night sweats and fever and chills (P < 0.001). The proportion of patients improving on the symptom subscale relative to baseline was 55% on the 3-drug arm and 40% on the 4-drug arm. Patients on the 3-drug arm also had better Karnofsky score at 16 weeks (P < 0.001) and better outcomes on the social function, mental health, energy/fatigue, health distress and cognitive function subscales of the MOS-HIV. The 3-drug arm is superior to the 4-drug arm in terms of impact on MAC-associated symptoms, functional status and other aspects of health status.
Can a two-glass urine test or leucocyte esterase test of first-void urine improve syndromic management of male urethritis in southern Thailand?
Authors: Chandeying Verapol , Skov Steven , Tabrizi Sepehr N , Kemapunmanus Marisa , Garland Suzanne
Published: October 2002

The goal of this study was to determine whether a urine two-glass test or a leucocyte esterase (LE) test of first-void urine (FVU) improve the sensitivity or specificity of the World Health Organization (WHO) algorithm for the syndromic management of men with urethritis in southern Thailand. A secondary aim was to determine whether infection with Trichomonas vaginalis was sufficiently common to include treatment for it in a syndromic management protocol. One hundred and twenty-nine men with symptoms of urethritis seen at 2 STD clinics in Songkla Province, Thailand were enrolled. Symptoms and signs of each man were recorded and a urethral swab collected for microscopy and culture for Neisseria gonorrhoeae . A two-glass urine test and an LE test of an FVU specimen were performed. The FVU was tested by polymerase chain reaction (PCR) for N. gonorrhoeae , Chlamydia trachomatis and T. vaginalis . Dysuria was a symptom in 78% of men. A urethral discharge was a symptom in 68% but was evident on examination in 95% of the men. The prevalences of infection were 32.6% for N. gonorrhoeae , 23.3% for C. trachomatis , 1.6% for T. vaginalis and 51.9% for any infection. The sensitivities and specificities of urethral discharge on examination, two-glass test and LE test of FVU as indicators of infection with either or both of N. gonorrhoeae or C. trachomatis were 97% and 8%; 57% and 83%; and 59% and 78% respectively. Combinations of urethral discharge on examination and one of the other indicators were more specific but much less sensitive than the presence of discharge alone. Culture for N. gonorrhoeae was found to be only 43% sensitive compared with an expanded gold standard involving a PCR test. Our analysis demonstrates that neither the two-glass test nor the LE test of FVU were useful in improving on the WHO algorithm for management of men with urethritis. T. vaginalis was not common enough to include in a first-line syndromic management protocol for male urethritis. We recommend that, in southern Thailand, men with symptoms of urethritis in whom a urethral discharge is present on examination be offered immediate treatment for both N. gonorrhoeae and C. trachomatis as per the WHO algorithm.
Community control of Chlamydia trachomatis
Authors: Rogstad K E , Kinghorn G R , Horton M
Published: October 2002

In order to determine the amount of Chlamydia trachomatis that is diagnosed outside genitourinary medicine (GUM) clinics in a large university city, a review of all positive chlamydial infections diagnosed on specimens received from hospitals (non-GUM) and community sources in 1996 was performed. It was also ascertained whether these patients subsequently attended at GUM. Eight hundred and nine cases of C. trachomatis were diagnosed during the study period. Three hundred and ninety-seven (49%) were initially diagnosed outside GUM of which 264 (66.5%) were referred, giving an overall involvement of GUM in 667 (83.6%) of all cases. The proportion of cases referred varied according to service: Family Planning Clinics 94.5%, Obstetrics and Gynaecology 73%, General Practice 52.5%. Referral rates also showed within service variation, with University Health Services referring 19% vs 73% (P <0.001).High levels of referral to GUM of patients diagnosed with C. trachomatis are achievable, but referrals show inter- and intra-service variations. Efforts should be made to improve referral rates from those services with the lowest rates. In conclusion: (1) The proportion of cases of C. trachomatis diagnosed in the community who are referred to a GUM clinic, varies according to service type. (2) Referral rates vary within services and (3) Distance of services from a GUM clinic does not appear to influence referral rates.
Herpes zoster and HIV infection in Tanzania
Authors: Naburi A E , Leppard Barbara
Published: October 2002

Two hundred consecutive patients with herpes zoster attending the skin clinic at the Kilimanjaro Christian Medical Centre (KCMC) were examined and checked for HIV infection. They ranged in age from 10 months to 86 years with the majority in their 20s and 30s. The dermatomes involved were thoracic (97), trigeminal (50), cervical (37), lumbar (19) and sacral (3). Six (3%) had more than one dermatome involved and 2 (1%) had disseminated disease. Only 2 (1%) had severe ulceration of the skin and all healed in less than 4 weeks. In children under the age of 10 years and in adults between the ages of 20 and 49 years virtually 100% were HIV positive; even in the age group 50-59 more than three-quarters were HIV positive. We conclude that the presence of herpes zoster at any site is a good indication that the patient is HIV positive except in the teens and the very elderly.
Anaerobic bacteria and non-gonococcal urethritis
Authors: Woolley P D
Published: October 2002

Anaerobic bacteria are frequent inhabitants of the urethra of both normal men and men with non-gonococcal urethritis. All microbiologically-based studies have shown them not to have a role in the aetiology of the condition. However, Bacteroides ureolyticus continues to be an enigma having been isolated more commonly from men with urethritis in some studies, not confirmed by others, as well as in treatment-based studies in which the organism has been implicated by some authors. Few studies related to anaerobic organisms in the male genital tract have been conducted during the last decade.
The prevalence of urethral infections amongst asymptomatic young men in Hat Yai, southern Thailand
Authors: Chandeying Verapol , Skov Steven , Duramad Paurene , Makepeace Ben , Ward Michael , Khunigij Paiwan
Published: October 2002

The aim of this study was to survey sexual behaviour and estimate the prevalence of urethral infections amongst male vocational college students. A crosssectional survey was performed among 479 young men attending 2 vocational colleges in Hat Yai, southern Thailand. Polymerase chain reaction (PCR) tests of first-void urine (FVU) samples were used to detect infection with Chlamydia trachomatis , Neisseria gonorrhoeae , Ureaplasma urealyticum , Mycoplasma genitalium and Mycoplasma hominis . Girlfriends were the usual sexual partners for 89% of men with only 11% regularly patronizing sex workers. Condom usage was low. The prevalence of any urethral infection was 15.9% with: C. trachomatis 4%, N. gonorrhoeae 0.2%, U. urealyticum 10.9%, M. genitalium 2.3% and M. hominis 1.3%. Infection with more than one organism was found in 2% of men. While the prevalence of infection with chlamydia or gonorrhoea was relatively low, the prevalence of 'any urethral infection' was moderately high and suggests that unprotected sexual intercourse is commonly occurring. As girlfriends were the most usual sexual partners, they must be at significant risk of pelvic infection. There is a need for programmes targeting this group of people.
Cutaneous cryptococcosis in two patients with acquired immunodeficiency syndrome
Authors: Sánchez P. , Bosch R. J. , de Gálvez M. V. , Gallardo M. A. , Herrera E.
Published: October 2002

We present 2 cases of systemic cryptococcosis with cutaneous involvement in patients with acquired immunodeficiency syndrome (AIDS). Both patients were male, intravenous drug abusers, 31 and 35 years old, with severe immunodepression and a CD4+ lymphocyte count of 10/ml and 1/ml, respectively. They both had papular lesions reminiscent of molluscum contagiosum and in one patient with concomitant systemic leishmaniasis, there were spores of Cryptococcus neoformans coexisting with the leishmanias in the cutaneous lesions, constituting the first reported case of this particular association. Both patients responded well to amphotericin B followed by fluconazole.
Integrated sexual healthcare: the development and review of one model of service delivery
Authors: Dawson S. G. , Callander N. , Roche C. , Kingsland T. , Desmond N.
Published: October 2002

Sexual health is topical with many factors impacting upon its concept and hence provision. In 1995 the Sexual Health Service in East Berkshire was formed by the integration of the clinical services of Family Planning, Genitourinary and HIV Medicine with Sexual Health Promotion. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. This article outlines the practical developments and the strengths and weaknesses of this model of service.
The association of Chlamydia trachomatis and Mycoplasma genitalium with non-gonococcal urethritis: observations on heterosexual men and their female partners
Authors: Keane F. E. A. , Thomas B. J. , Gilroy C. B. , Renton A. , Taylor-Robinson D.
Published: October 2002

Our objectives were to study the distribution of Chlamydia trachomatis and Mycoplasma genitalium in men with or without non-gonococcal urethritis (NGU) and their respective female partners.

A case-control study was carried out to which men with or without NGU and their female partners were recruited. All study participants were tested for the presence of C. trachomatis and M. genitalium. An analysis firstly of the distribution of each of these microorganisms among men with or without urethritis and their respective female partners was carried out. Furthermore, we examined the association of each of these microorganisms and NGU when the other had been excluded.

Chlamydia trachomatis was present in 14 (36%) of 39 men with NGU compared to none of 12 men without NGU (P = 0.022). The prevalence rates for female partners of men with NGU were 10 (26%) of 39 compared to none of 12 partners of men without NGU (P = 0.092). M. genitalium was detected in 12 (33%) of 36 men with NGU compared to 1 (9%) of men without NGU (not significant; P = 0.147). The prevalence rates for female partners of men with NGU were 10 (32%) of 31 women compared to none of 7 partners of men without NGU (not significant; P = 0.156). There was a greater concordance than discordance of carriage of each of the 2 microorganisms among the study couples and each tended to be carried independently of the other by men.

Analysis of the association between the presence of C. trachomatis in men and NGU was significantly improved by the exclusion of men with M. genitalium (P = 0.0058). Likewise, the association between the presence of M. genitalium in men and NGU was significantly improved by the exclusion of couples in whom either the man or woman was C. trachomatis-positive (P = 0.049). The independent carriage of C. trachomatis and M. genitalium by men with NGU, coupled with the improved association between each pathogen and NGU by exclusion of the other provides support for the separate role of each in the aetiology of NGU.
Sexual assault and sexually transmitted infections: an updated review
Authors: Lamba H , Murphy S M
Published: October 2002

The purpose of this review is to provide an overview of sexual assault (in adults). In particular, the aim is to emphasize changes regarding medical, legal and management issues since the subject was reviewed in this journal1 in 1990. However some aspects will not have changed in the last 10 years.
Factors related to delayed diagnosis of HIV infection in southeastern France
Authors: Rotily Michel , Bentz Laurence , Pradier Christian , Obadia Yolande , Cavailler Philippe
Published: October 2002

We aimed to identify risk factors associated with delayed diagnosis of HIV infection in a French region highly affected by AIDS. Data were collected in southeastern France through the HIV-surveillance system based upon anonymous declarations by laboratories and physicians prescribing HIV testing. From January 1996 to December 1997, 825 persons were diagnosed for the first time as HIV infected (female: 32%; >40 years: 28%); 46% had been infected through heterosexual intercourse, 26% through homosexual intercourse, and 19% through intravenous drug use. The semestrial (6 monthly) incidence rate decreased from 122.7 to 69.7 per million inhabitants (P <0.001). County of residence, age, sex, country of birth, and transmission category did not change significantly during the observation period. Twenty-seven per cent had a delayed diagnosis of HIV infection. This proportion did not differ significantly according to sex or country of birth, or during the observation period. However, after controlling for the other factors, delay was more frequent among injecting drug users (IDUs) (35%, P <10-2) than other transmission categories; it was also positively associated with age (47% above 50 years vs 13% under 30 years, P <10-2). This study highlights that, in spite of the current AIDS prevention policy and wide access to HIV screening, the proportion of delayed diagnosis of HIV infection remains high. Physicians should concern themselves with this public health issue, and campaigns should target people insufficiently aware, especially IDUs and older people. Further research is needed to understand better the causes of delayed diagnoses and of inequalities in access to HIV screening.
Diagnosing PID–getting the balance right
Authors: Marks C , Tideman R L , Estcourt C S , Smart S , Page J , Wagner K , Mindel A
Published: October 2002

The objective of the study was to determine the clinical manifestations and diagnostic criteria used to diagnose presumptive pelvic inflammatory disease (PID) at the Sydney Sexual Health Centre (SSHC). The study was a retrospective, case-note review of all women diagnosed with presumptive PID between April 1991 and December 1997. Seven hundred and thirteen women were included. The commonest recorded symptoms were vaginal discharge (68%), lower abdominal pain (65%) and dyspareunia (57%), while adnexal tenderness (83%), cervical motion tenderness (75%) and cervicitis (56%) were the most frequently recorded examination findings. Sixty-two per cent were prescribed doxycycline and metronidazole. The recording of signs and symptoms in women with presumptive PID was poor and only 22% met the current Centers for Disease Control (CDC) diagnostic criteria. It is likely that PID is over diagnosed in this group of women. This may lead to under diagnosis of other conditions causing pelvic pain and may be detrimental to reproductive health.
A comparison of topical application of penciclovir 1% cream with acyclovir 3% cream for treatment of genital herpes: a randomized, double-blind, multicentre trial
Authors: Chen Xiang-Sheng , Han Guo-Zhu , Guo Zai-Pei , Lu Nian-Zhu , Chen Jin , Wang Jia-Bi , Multicenter Genital Study Group Penciclovir
Published: October 2002

Genital herpes simplex virus (HSV) infection, a sexually transmitted disease (STD), is the commonest cause of ulcerative genital infections among the young and adult population. The significant association of genital ulceration and transmission of human immunodeficiency virus (HIV) has been shown in many studies. To explore the potential efficacy of topical treatment of genital herpes with penciclovir cream, a randomized, double-blind, multicentre, acyclovir-controlled Phase II clinical trial of penciclovir 1% cream 5 times daily up to 7 days for suppression of genital herpes was conducted in China. A total of 205 patients aged 20-59 years (mean age 36.0±8.8 years for acyclovir and 34.8±8.4 years for penciclovir) with a clinical diagnosis of genital herpes were randomly allocated to one of the 2 parallel treatment groups and used for analysis. Clinical assessment were made before treatment and followed up at every visit during the study. Our results show that there was an encouraging improvement simultaneously in the 2 groups although no significant differences in clinical efficacy with respect to clinical cure rate, and times to healing, resolution of all symptoms, absence of blisters, cessation of new blisters, crusting, and loss of crust between penciclovir and acyclovir groups in terms of primary, non-primary and total patients were found. However a significantly shorter time to crusting was found in primary penciclovir group when compared with primary acyclovir group. Adverse experience was generally infrequent and mild, and was comparable in the 2 treatment groups. Based on these preliminary clinical findings, further evaluation of penciclovir 3% cream for topical treatment of genital herpes is planned.
Continuing medical ignorance: modern myths in the management of genital warts
Authors: Birley Humphrey D. L.
Published: October 2002

Genital warts are the most common sexually transmitted disease (STD) in industrialized countries. Since they also often respond poorly to current treatments, they account for substantial morbidity. Human papillomavirus (HPV) typing methods have shown that HPV 6 and 11, the most common types found in genital warts, are not found in cancer of the cervix. These types, however, do cause minor degrees of cervical dysplasia which also results in morbidity both through fear and through over-treatment. The sexual nature of transmission of genital warts has been known from ancient times; there is also good evidence of vertical transmission and transmission through non-genital contact. Barrier contractive methods do not completely prevent transmission of genital warts and may give little worthwhile protection. These facts, together with the established persistence of HPV contribute to the associated psychological morbidity.

There are a number of treatments for genital (and other) warts. This attests to the fact that no one of these is clearly superior to the others. Until better treatments are developed much of the management of this condition must consist of using such treatments that are available to maximize efficacy while trying to reduce unnecessary costs, inconvenience and potential injury and sustaining morale through what may be a long and demoralizing course.
Sexual behaviour, condom use and HIV risk situations in the general population of Quebec
Authors: Adrien A. , Leaune Viviane , Dassa Clément , Perron Michèle
Published: October 2002

We conducted 3501 telephone interviews to determine the sexual and protective behaviours of the general population in Quebec. Among the 858 respondents who had had at least one occasional partner during the last 5 years, 25.4% had had at least one occasional partner who refused to use a condom. More women had had an occasional partner who had refused than men (29.8% vs 21.1%, P < 0.001) and fewer women than men succeeded in negotiating condom use, but more of these women decided not to have sexual relations. The frequency of condom use during the last sexual relation changes if the partner is a regular cohabiting partner (12.5%), a regular non-co-habiting partner (42.2%) or an occasional partner (70.8%). Our study provides important information for the development of prevention programmes for the heterosexual population and demonstrates the importance of the type of relationship maintained by the partners on the sexual behaviours.
Negotiated safety and other agreements between men in relationships: risk practice redefined
Authors: Crawford J. M. , Rodden P. , Kippax S. , Van de Ven P.
Published: October 2002

This study examines patterns of agreement, knowledge and practice which can prevent or facilitate HIV transmission among men who are in regular ('primary') male-to-male relationships. Data are from a national volunteer phone-in survey of homosexually-active men in Australia. A sub-sample of 1070 men from a larger sample ( n=3039) were found to have one or more regular partners for longer than 6 months. Self-reported HIV serostatus of survey participant and his regular partner, type of agreement regarding anal intercourse both within and outside the regular relationship, and engaging in unprotected anal intercourse with regular and with casual partners were examined. Risk practice was defined as unprotected anal intercourse with a regular partner of different or unknown serostatus and/or unprotected anal intercourse with a casual partner. Agreements were classified as: negotiated safety (28.8%); no unprotected anal intercourse (33.6%); unsafe (10.6%) and no agreement (17.0%). Risk practice was reported by 17.8% of the men. Type of agreement was found to be the strongest predictor of risk practice. Negotiated safety agreements were common, and were kept on the whole. Men with unsafe agreements, although only a small proportion of men in relationships, had high levels of risk practice.
Characteristics of Vilnius street prostitutes
Authors: Chaplinskas Saulius , Mårdh Per-Anders
Published: October 2002

Women prostituting in Vilnius City, Lithuania, were studied with regard to their socioeconomic background, drug and alcohol abuse, conditions for prostituting and for the carrier rate of sexually transmitted infectious agents. The 73 women studied represented a group of low-socioeconomic prostitutes with a great age span, i.e. 14-52 years. Forty-five per cent had one or more children. Roughly one-third were part-time prostitutes. Some had been trafficking for more than one decade. Some started trafficking at the age of 13, while the other extreme was a woman who began to prostitute at 51 years of age. This group of Vilnius street walkers had few customers per day. Eighteen were intravenous drug users and almost all abused alcohol. All, but one, had one or more sexually transmitted infections (STIs). Syphilis was diagnosed in 8 (13%) and another 10 (16%) had a serological scar of such an infection. HIV infections were not diagnosed. Condoms were not consistently used during their social contacts.
Audit of HIV testing: who, why and when?
Authors: Thompson C. , Smith H.
Published: October 2002

The risk factors, referral pattern and presence/absence of genital tract symptoms and/or sexually transmitted infections (STIs) in 189 patients having HIV counselling and/or testing at genitourinary medicine (GUM) clinics are reviewed. Eighty per cent were concerned about heterosexual transmission, 9.5% men who have sex with men (MSM) and 4.8% intravenous drug users (IDUs). Heterosexuals and first-time GUM attenders were more likely to have sought prior advice from their general practitioner (GP). The majority were asymptomatic for genital tract infections, but 83% accepted an STI screen, with 44 STIs being diagnosed. Only one individual who had attended primarily for HIV screening was found to have an STI. About half of individuals presented within the window period, and of those stating that they wished to proceed with deferred testing, half subsequently failed to return, resulting in wasted health adviser appointments.
An aggressive neuroendocrine tumour in a man with AIDS
Authors: Cox M. , Joseph A. T. , Sharma N. , Heaney O. , Hock Y. L.
Published: October 2002

Pancreatic neuroendocrine tumours (PETs), though rare, are usually slow growing tumours with a relatively good prognosis. We describe a case of an aggressive malignant neuroendocrine tumour of the pancreas occurring in an AIDS patient, which has not been reported previously.
Effect of highly active antiretroviral therapy on cytomegalovirus antigenaemia in AIDS patients
Authors: Borges L. H. B. , Villas Boas L. S. , Warren-Santoro S. H. , Estevam M. P. , Uip D. E. , Savalli C. , Curi M. , Pannuti C. S.
Published: October 2002

To assess the effect of highly active antiretroviral therapy (HAART) on cytomegalovirus (CMV) antigenaemia in AIDS patients, 70 patients with CD4+ cell counts ≤50/mm3 and positive anti-(CMV) immunoglobulin G (IgG) were tested at 15-30 day intervals for CMV antigenaemia. We selected those patients who had been followed up for more than 3 months. Three patient profiles were defined: A, followed up before the introduction of HAART; B, followed up before and after the use of HAART; and C, followed up after the use of HAART. Thirty-nine patients were included, 12 in group A, 17 in group B, and 10 in group C. Group A patients presented a lower median CD4+ cell count compared with groups B and C patients (9, 122 and 127 cells/mm3, respectively), with the increase in the last 2 groups being related to the use of HAART ( P<0.001). A lower proportion of positive antigenaemia was observed in group B after the introduction of HAART compared with the time before HAART ( P=0.02). HAART caused an immunological improvement and was found to be associated with negativity of CMV antigenaemia.
Management of epididymo-orchitis in Genitourinary Medicine clinics in the United Kingdom's North Thames region 2000
Authors: Dale A W S , Wilson J D , Forster G E , Daniels D , Brook M G
Published: October 2002

A questionnaire survey and case notes audit reviewing management of epididymo-orchitis (E-O) by 34 Genitourinary Medicine (GUM) clinics located in the North Thames was undertaken. Twenty-two clinics (65%) returned completed questionnaires and audited a total of 83 newly diagnosed cases. All participating clinics offer microscopy of urethral smears and screening for Neisseria gonorrhoeae and Chlamydia trachomatis to all patients, regardless of age. However, greater numbers of clinics would offer routine microbiology of mid-stream urine (MSU) samples (20/22, 91% versus 16/22, 73%) and scrotal ultrasound (5/22, 23% versus 1/22, 5%) to patients aged over 35, compared with men under 35. Half of the cases audited were due either to sexually transmitted infections (STIs) (41/83, 49%), or associated with ascending urinary tract infections (4/83, 5%). No obvious infectious cause was identified for 38/83 cases (46%). Reported management was appropriate for the causative conditions diagnosed and accorded with the UK National Guidelines for this and related conditions.
Quality of health education during STD case management in Nairobi, Kenya
Authors: O'Hara H B , Voeten H A C M , Kuperus A G , Otido J M , Kusimba J , Habbema J D F , Bwayo J J , Ndinya-Achola J O
Published: October 2002

Quality of health education during STD case management in Nairobi was assessed in 142 healthcare facilities, through interviews of 165 providers, observation of 441 STD patients managed by these providers, and 165 visits of simulated patients. For observations, scores were high for education on contact treatment (74-80%) and compliance (83%), but unsatisfactory for counselling (52%) and condom promotion (20-41%). The World Health Organization (WHO) indicator for STD case management Prevention Indicator 7 (PI7) (condom promotion plus contact treatment) was poor (38%). Public clinics strengthened for STD care generally performed best, whereas pharmacies and mission clinics performed worst. Compared with observations, scores were higher during interviews and lower during simulated patient visits, indicating that knowledge was not fully translated into practice. Interventions to improve the presently unsatisfactory service quality would be wide distribution of health education materials, ongoing training and supervision of providers, implementation of STD management checklists, and the introduction of pre-packaged kits for STD management.
Impact of short-term adherence on virological and immunological success of HAART: a case study among French HIV-infected IDUs
Authors: Pradier Christian , Carrieri Patrizia , Bentz Laurence , Spire Bruno , Dellamonica Pierre , Moreau Joel , Moatti Jean-Paul
Published: October 2002

To evaluate the impact of injection drug users (IDUs) adherence on effectiveness of highly active antiretroviral therapy (HAART), repeated measures of plasma viral load and CD4+ counts before HAART initiation and at last visit in the cohort were studied. Data were collected by means of patient's face-to-face and self-administered questionnaires about adherence to HAART during the week prior to the last visit. Of a total of 119 patients treated with HAART, undetectable viral load was obtained for 55 patients (46.2%) (G3); 34 patients (28.6%) (G2) had a viral load decline > 0.5 log copies/ml but still detectable viral load at last visit in the cohort, while 30 patients (25.2%) (G1) had no decline or decline ≤ 0.5 log copies/ml. Proportion of 100% adherent patients was significantly higher in G3 (83.6%) than in G2 (64.7%) and G1 (56.7%). In spite of differences in virological success and adherence, mean increase in CD4+ counts was similar in G3 (123 ± 160 counts/mm3) and G2 (143 ± 147) while no immunological improvement was observed in G1. For the sub-groups of patients whose limited adherence has implied virological failure but did not impede short-term immunological reconstitution following HAART initiation, decision to switch HAART regimens could be delayed until interventions for improving future adherence have been carried out.
The provision of sexual dysfunction services by genitourinary medicine physicians in the UK, 1999
Authors: Kell Philip
Published: October 2002

Over 85% of clinical directors of genitourinary (GU) clinics in Britain support the provision of services for patients with sexual dysfunction in their clinics. However only 41% of those who support this provision are able to at present. The major barriers are a lack of resources and a lack of suitable training options for both medical and nursing staff. The Medical Society for the Study of Venereal Diseases (MSSVD) Special Interest Group (SIG) will be running a series of national meetings later this year in order to overcome the latter of these. Those clinics who are providing a service are offering a wider range of treatments than in 1997. As previously noted the services are still predominantly consultant and/or nurse led with junior medical staff having minimal involvement.
Severe lactic acidosis and thiamine administration in an HIV-infected patient on HAART
Authors: Arici C. , Tebaldi A. , Quinzan G. P. , Maggiolo F. , Ripamonti D. , Suter F.
Published: October 2002

Severe lactic acidosis has been increasingly reported as a potentially fatal complication of HIV treatment. We report on an asymptomatic HIV-infected woman treated with stavudine, lamivudine and indinavir for one year. She was hospitalized because of progressive dispnoea, oedema, cyanosis and severe lactic acidosis. Arterial blood pH was 6.98, bicarbonate 4.4 mmol/l (normal value 22-26), blood lactate: 29.7 mmol/l (normal value <2.2). Hepatic function was normal. She had an impressively rapid response (within a few hours) to empirical treatment with thiamine (100 mg i.v.). No evidence of sepsis or malabsorption were identified and vitamin B1 level was not tested before thiamine infusion. Three months later she was re-started successfully on nelfinavir plus nevirapine. The rapid response to thiamine infusion deserves a careful attention and such an approach should be considered in similar cases as a support treatment of this potentially life-threatening complication of HIV therapy.
Jail inmates and HIV care: provision of antiretroviral therapy and Pneumocystis carinii pneumonia prophylaxis
Authors: White M. C. , Mehrotra A. , Menendez E. , Estes M. , Goldenson J. , Tulsky J. P.
Published: October 2002

The objective of this study was to examine prescription and acceptance of antiretroviral therapy (ART) and Pneumocystis carinii pneumonia (PCP) prophylaxis in jail and at release. A retrospective cross sectional design was used, by record review, of 77 inmates receiving HIV-related care in the San Francisco City and County Jail and released to the community in 1997. Average CD4 cell count was 335/µl. Fifteen had undectable HIV RNA, and average viral load was 19,826 copies/ml. Fifty-eight per cent were put on ART in jail. Lower CD4 cell count was associated with ART ( P=0.017). All inmates with CD4 cell counts less than 200/µl received PCP prophylaxis. According to 1996 guidelines, 72% of those eligible for ART were on therapy. Of 24 inmates released on ART, 71% followed medical advice and picked up medication at release. HIV care in the San Francisco Jail met high standards and exceeded levels reported in other populations.
Prevalence of HIV and HIV-related diseases in the adult medical wards of a tertiary hospital in Durban, South Africa
Authors: Colvin M. , Dawood S. , Kleinschmidt I. , Mullick S. , Lallo U.
Published: October 2002

Our objective was to determine the prevalence of HIV and the distribution of HIV-related diseases among adult, medical inpatients. Consecutive admissions were recruited and a single ELISA assay was used to determine HIV infection. Demographic and clinical details were extracted from clinical records. Of 507 patients, 54% were infected with HIV of which 84% had AIDS. HIV-infected patients were significantly younger (34.9 years) than uninfected patients (47.1 years) and had significantly higher risks for oral/oesophageal candidiasis (risk ratio [RR] 18.6), generalized lymphadenopathy (RR 7.1), unexplained fever (RR 7.0), chronic diarrhoea (RR 6.2) and pulmonary tuberculosis (RR 3.1). Pulmonary tuberculosis was present in 56% of HIV cases. Mortality was 22% for HIV cases and 9% ( P=0.016) for others. The mean length of hospital stay was the same for HIV-infected and uninfected patients. AIDS is the most common reason for admission to adult medical wards and will increasingly limit the number of beds available for non-AIDS patients.
Vaccine candidates in STD
Authors: Fletcher Mark A
Published: October 2002

Sexually transmitted diseases (STDs) are caused by organisms that infect the mucosal surfaces of the genitourinary tract. In spite of its public health importance, particular scientific problems have delayed the development of an STD vaccine, such as incomplete attenuation (human herpes simplex virus type 2), accentuated immunopathology ( Chlamydia trachomatis), poor immunogenicity ( Treponema pallidum), and broad antigenic heterogeneity ( Neisseria gonorrhoeae). Nevertheless, efforts continue with the use of protein antigens: for example, the haemolysin toxoid of Haemophilus ducreyi; the major outer membrane protein(s) of N. gonorrhoeae and C. trachomatis; the glycoprotein D of human herpes simplex virus type 2; and the proteins E6 and E7 of the human papillomavirus. It could be predicted that eventual STD vaccines (administered either for prophylaxis or for therapy) will use approaches that will include (1) live-attenuated viruses, (2) subunit proteins or inactivated whole organisms given with mucosal adjuvants or with cellular immune response adjuvants, or (3) DNA plasmids expressing the vaccine antigen.
Penile fracture
Authors: Kingston M A , Carlin E M
Published: October 2002

A wide range of patients present to genitourinary medicine (GUM) clinics with diverse conditions, many of which may not be infective. One such condition, albeit rare, is penile fracture. This is a traumatic rupture of the corpus cavernosum usually associated with blunt trauma to the erect penis. Prognosis and management issues are discussed.
An association of disseminated Mycoplasma fermentans in HIV-1 positive patients with non-Hodgkin's lymphoma
Authors: Ainsworth J. G. , Easterbrook P. J. , Clarke J. , Gilroy C. B. , Taylor-Robinson D.
Published: October 2002

We examined the relationship between the haematogenous dissemination of Mycoplasma fermentans and non-Hodgkin's lymphoma (NHL) in 265 HIV-1 positive patients. A polymerase chain reaction (PCR) assay was used to detect M. fermentans in peripheral blood mononuclear cells (PBMCs) from 50 patients enrolled consecutively from an HIV outpatient clinic in 1991 (cohort 1), 56 patients with lower respiratory tract infection who underwent bronchoscopy in 1992 (cohort 2), and 159 patients who were enrolled into a natural history cohort study in 1994 (cohort 3). The incidence of NHL among the patients was determined in 1998. The PBMCs of 29 patients (10.9%) were positive for M. fermentans (8 in cohort 1, 13 in cohort 2 and 8 in cohort 3) and 11 patients (4.2%) developed NHL which was confirmed histologically (3 in cohort 1, 4 in cohort 2 and 4 in cohort 3). We found a statistically significant association between the presence of M. fermentans and the development of NHL in the combined cohort (risk ratio [RR]=6.78 [95% confidence interval (CI) 2.21-20.84], P=0.003 Fisher's exact test [FET]). This association remained significant even after adjustment in a multivariate analysis for CD4 cell count and HIV disease status at the time of M. fermentans testing (RR=7.97 [95% CI=2.16-29.47], P=0.002).
HIV seroprevalence and its associations with the other reproductive tract infections in asymptomatic women in Harare, Zimbabwe
Authors: Mbizvo E. M. , Msuya S. E. , Stray-Pedersen B. , Sundby J. , Chirenje M. Z. , Hussain A.
Published: October 2002

The objective was to determine the magnitude of HIV as well as the associations between HIV seropositivity with reproductive tract infections (RTIs) among healthy women in Harare, Zimbabwe. In a cross-sectional study, 393 informed consenting women aged 15-49 years, attending 2 primary healthcare clinics, were interviewed and screened for HIV and RTIs. HIV seroprevalence was 29.3%. Seropositivity was significantly associated with bacterial vaginosis, syphilis, gonorrhoea and/or Chlamydia trachomatis infection, warts and genital ulcers. Risk factors for HIV were absence of lactobacilli in vaginal fluid, vaginal pH >4.5, age >20 years, being unmarried, having had more than one lifetime sexual partner, having used a condom at least once in their lifetime, having experienced an infant mortality, and a partner who was non-monogamous or a frequent traveller. In view of the very high seroprevalence and concomitant RTIs in this population, we recommend promotion of women-controlled prevention methods along with proactive detection and treatment of RTIs.