bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual practices of HIV discordant and concordant couples in Rwanda: effects of a testing and counselling programme for men
Authors: Roth David L. , Stewart Katharine E. , Clay Olivio J. , van der Straten Ariane , Karita Etienne , Allen Susan
Published: October 2002

As part of a longitudinal investigation, the husbands and cohabiting male partners of 684 Rwandan women were recruited to participate in an HIV testing and counselling programme. All of the women and 256 of the men (37%) had previously received standard testing and generic counselling services. In this project, all of the men participated in an extensive, male-focused counselling programme. This included 428 men who were receiving testing and counselling for the first time. Interview responses indicated that rates of condom use during sexual intercourse increased dramatically at the one-year follow-up assessment for the serodiscordant couples. This effect was especially strong for couples whose male partners were receiving testing and counselling for the first time. Rates of condom use also increased substantially in seroconcordant HIV-positive couples whose partners had both been tested previously. Women in couples with at least one seropositive partner reported lower rates of coercive sex by their male partners after they completed the counselling programme. Male-focused and couple-focused testing and counselling programmes appear to be effective in reducing risky sexual behaviours in heterosexual couples, even if one or both partners have received testing and counselling services previously.
Meningococcal infection in patients with the human immunodeficiency virus and acquired immunodeficency syndrome
Authors: Pearson I. C. , Baker R. , Sullivan A. K. , Nelson M. R. , Gazzard B. G.
Published: October 2002

Meningococcal infection is believed to be rare in HIV-positive individuals. We present 2 cases from our reference caseload within the last 10 years.
Gynaecomastia in a male patient during stavudine and didanosine treatment for HIV infection
Authors: Aquilina C , Viraben R
Published: October 2002

We report a case of gynaecomastia developed in a HIV-seropositive man, associated with a severe lipodystrophy. We hypothesize the responsibility of stavudine and didanosine in the development of these 2 complications. If many reports suggest that the protease inhibitors may promote gynaecomastia, long-term nucleoside analogue therapy may also cause this side effect.
The metabolic toxicities of antiretroviral therapy
Authors: Herman J S , Easterbrook P J
Published: October 2002

Since the adoption of highly active antiretroviral therapy (HAART) in the mid-1990s, certain metabolic toxicities have been increasingly recognized. These include a fat redistribution syndrome (lipohypertrophy, lipoatrophy), hyperlipidaemia, altered glucose metabolism and insulin resistance, mitochondrial toxicity (presenting as anaemia, myopathy, pancreatitis, neuropathy, hepatic steatosis and lactic acidosis), and bone density abnormalities (osteoporosis and osteonecrosis). Metabolic complications are principally reported with protease inhibitors and nucleoside reverse transcriptase inhibitors, but may be seen with all classes of antiretroviral therapy. In this review, we summarize the epidemiology, pathogenesis and management of these various toxicities.
Protease inhibitor therapy is associated with markedly prolonged time to relapse and improved survival in AIDS patients with cytomegalovirus retinitis
Authors: Skiest Daniel J , Chiller Tom , Chiller Katarinia , Park Anna , Keiser Philip
Published: October 2002

Prior to the use of highly active antiretroviral therapy (HAART), cytomegalovirus retinitis (CMV-R) in AIDS patients was characterized by multiple relapses and decreased survival. Recent data suggest that CMV-R in patients treated with HAART may remain relapse-free for long periods. We performed a study of the effects of HIV protease inhibitors (PIs) on the incidence of relapse and time to death in AIDS patients with CMV-R treated with anti-CMV therapy. Medical records of all AIDS patients with CMV-R at Parkland Memorial Health and Hospital System treated with anti-CMV agents were reviewed for date of diagnosis of CMV-R, date of CMV-R relapse, type and duration of anti-CMV therapy, and duration of PI therapy. Relapse rates in subjects treated with PIs were compared with the relapse rates in those who were not treated with PIs. The primary endpoint was the time to relapse and death as determined by Kaplan-Meier analysis. Multivariate analysis was performed by Cox proportional hazard model. One hundred and nine cases of CMV-R were identified in 75 patients. Median follow-up time was 247 days (range 31-1818 days). There were 0.54 relapses per 1000 patient days in the group treated with PIs compared with 1.83 relapses per 1000 patient days in the non-PI treatment group (relative risk [RR]=0.29, P<0.01). Time to relapse was increased in the PI treatment group compared with the non-PI treatment group (endpoint not reached vs 182 days, P<0.001, log-rank). Similarly, the time to relapse or death was increased in the PI group compared with the non-PI group (543 days vs 103 days, P<0.001, log-rank). Multivariate analysis utilizing the Cox proportional hazards model demonstrated that only PI therapy but not anti-CMV therapy was associated with decreased risk of CMV-R relapse or death. Only 3 patients with an undetectable HIV viral load and one patient with a CD4 count >120 cells/ µl had a relapse. We conclude that patients with CMV-R treated with HAART containing a PI have increased time to relapse and have prolonged survival.
The detection of Chlamydia trachomatis by DNA amplification methods in urine samples from men with urethritis
Authors: Templeton K , Roberts J , Jeffries D , Forster G , Aitken C
Published: October 2002

Our objective was to compare 3 deoxyribonucleic acid (DNA) amplification methods for the diagnosis of chlamydial infection with an enhanced enzyme immunoassay (EIA) method for antigen detection in urine samples, from men with non-gonococcal urethritis (NGU) attending a busy inner city genitourinary medicine centre. Urethral swabs and urine samples were collected from 346 male patients with NGU attending the clinic. All swabs and urines were tested for chlamydial infection (CT) using the EIA (Dako PCE immunoassay). Three aliquots of the urine samples were stored immediately at -70°C for subsequent testing by: Amplicor polymerase chain reaction (PCR) (Hoffmann-La Roche, Switzerland); the amplified Chlamydia trachomatis assay (AMP CT) using transcription mediated amplification (TMA) (GenProbe, USA); and BDProbeTecET using the strand displacement assay (SDA) (Becton Dickinson, USA). The positive rate for the 3 amplified assays PCR, TMA and SDA (on urine) was 88/346 (25.4%), 80/346 (23.1%) and 88/346 (25.4%), respectively compared to 56/346 (16.2%) by EIA on urethral swabs, the current means of diagnosis in this laboratory. Thirty-one samples were positive in 2 or more of the amplification assays but negative in the EIA, 50 positives (53% sensitivity) detected in the urine samples by the EIA assay were detected by all 3 of the amplified assays. Three samples were positive by PCR only, 5 were positive by TMA only and 7 were positive by SDA only. DNA amplification assays are superior to standard immunoassays for the diagnosis of C. trachomatis infections in urine samples. Urine samples are suitable for use in these amplified assays to detect C. trachomatis. Freezing of samples before testing reduces the rate of inhibition reported in other published studies.
Is there any role for rapid tests for Chlamydia trachomatis?
Authors: Rani Ranjana , Corbitt Gerald , Killough Rosemary , Curless Eric
Published: October 2002

The main aim of this pilot study was to evaluate the sensitivity and specificity of a recently introduced rapid diagnostic test, the QuickVue® chlamydia test against polymerase chain reaction (PCR) for endocervical samples. Due to concerns surrounding the low specificity of rapid tests for a low prevalence population we assessed its performance for both high and low prevalence populations. The sensitivity and specificity of the QuickVue® test compared to PCR were 65% (95% confidence interval [CI] 42-87%) and 100% respectively for the high prevalence population and 25% (95% CI: 5-70%) and 100% respectively for the low prevalence population. The positive predictive value (PPV) was 100% for both high and low prevalence population. The sensitivity of the QuickVue® test for a high prevalence population was comparable to laboratory-based immunoassay techniques. However, for a low prevalence population, this test did not identify one in 4 cases due to its low sensitivity and its use cannot be recommended. Although the high specificity and PPV of this test indicate that for positive results no confirmatory test would be needed, because of the small number of cases included in this pilot study, this finding needs to be explored through a larger study.
Dried blood spots (DBS): a valuable tool for HIV surveillance in developing/tropical countries
Authors: Solomon Sunil S , Solomon Suniti , Rodriguez Irma I , McGarvey Stephen T , Ganesh A K , Thyagarajan S P , Mahajan Anish P , Mayer Kenneth H
Published: October 2002

Dried blood spots (DBS) on filter paper have been used as a practical method of sample collection in sero-surveillance studies of numerous diseases. DBS may be particularly useful for HIV screening in remote areas, in which unrefrigerated transfer time to a laboratory may take a number of days. In this study, we evaluate the ability to detect human immunodeficiency virus (HIV) type-1 antibodies from DBS that have been subjected to a tropical climate in southern India for 6 days. DBS were prepared from blood samples of 59 known HIV-positive individuals and 30 known HIV-negative individuals. ELISA and Western blot results from DBS that were subjected to a mean temperature of 35.8°C and humidity of 73% for 6 days had a sensitivity of 100% and 92%, respectively, and a specificity of 100% and 100%, respectively. Based on these findings, we conclude that DBS sampling could serve as a cost-effective and convenient tool for widespread HIV sero-surveillance in remote areas within tropical countries.
Vulvodynia—new and more effective approaches to therapy
Authors: Bates C M , Timmins D J
Published: October 2002

Two cases are described of treatment-resistant vulvodynia that responded well to gabapentin. Gabapentin, an anti-epileptic drug, has been used in the treatment of neuropathic pain such as diabetic neuropathy and post-herpetic neuralgia. However, there has been little experience of its use in the relief of symptoms in vulvodynia and we add our observations to the one report of its use in these circumstances that has been published so far.
The sac-4 gene of Neisseria gonorrhoeae correlates with gonococcal subtype not co-existing chlamydial infection
Authors: Gretton S , Patrizio C , Young H
Published: October 2002

We examined the hypothesis that the sac-4 gene of Neisseria gonorrhoeae varies with gonococcal subtype and that this could account for an earlier report that sac-4 increased the likelihood of co-infection with Chlamydia trachomatis. A polymerase chain reaction (PCR) assay was used to determine the prevalence of sac-4 in 435 gonococcal isolates. The prevalence of sac-4 was analysed in relation to chlamydial co-infection, serovar, auxotype, gender and sexual orientation. Although the prevalence of sac-4 was higher in isolates from patients with chlamydial co-infection (55%) than in those without chlamydial co-infection (42%) the difference was not significant ( P<0.05). Statistically significant differences in association with sac-4 were, however, shown between various serovars and auxotypes. Dual classification based on auxotype/serovar (A/S) classes showed highly significant differences in sac-4 prevalence between groups: 95% in NR/1B18 and 8% in P/1B2 ( P<0.001). Sac-4 was also significantly less common ( P<0.05) in isolates from homosexual men (35%) than from heterosexual men (49%) or women (49.5%). Sac-4 appears to have an epidemiological association with gonococcal auxotype and serovar rather than a direct association with chlamydial co-infection.
Sexually transmitted diseases in Germany
Authors: Petzoldt D , Jappe U , Hartmann M , Hamouda O
Published: October 2002

In the former West Germany, in specific venereal diseases legislation passed in 1953, only syphilis, gonorrhoea, ulcus molle, and lymphogranuloma venereum were defined as venereal diseases and subject to mandatory notification. The proportion of unreported cases was as high as 75% for syphilis and up to 90% for gonorrhoea. Epidemiological data for the past 10 years exist only on selected populations from research studies and are summarized in this article. In the former East Germany reporting of sexually transmitted infections (STIs) was mandatory and, due to the centralized organization, underreporting was considered to be low, although no specific studies have examined this. After the unification in 1990 of the two German states the West German laws were adopted in East Germany. Since 1982 - when the first AIDS case was reported in Germany - information on AIDS cases has voluntarily been collected at the national register at the AIDS Centre of the Robert Koch Institute in Berlin. The law governing the reporting of infectious diseases has recently been revised. Under the new Protection against Infection Act, which became effective on 1 January 2001, clinical diagnoses of STIs (with the exception of hepatitis B) are no longer notifiable diseases. Laboratory reporting of positive test results for Treponema pallidum has been introduced. With T. pallidum and HIV notifications, additional disaggregated data are collected. Since T. pallidum and HIV remain the only notifiable STIs, all other STIs have to be monitored through sentinel surveillance systems. These surveillance systems are currently being established. Under the new legislation, local health authorities have to provide adequate counselling and testing services for STIs, which may be provided free of charge if necessary.
The organization of STI control in the Netherlands — an overview
Authors: Coenen A J J , Berends R , Van der Meijden W I
Published: October 2002

The organization of STI-control in the Netherlands is described. STIs represent a relatively modest health problem in the Netherlands. Chlamydia trachomatis is the most frequent STI. Recent reports show that STIs are on the rise again, especially amongst gay men. The general health system deals with STIs, the main professionals are: the general practitioners, public health nurses and dermatovenereologists. The larger cities have specific STI-clinics. Prevention is a cornerstone in Dutch STI-control. At a regional level, the municipal health services play a major role in policy and prevention. At a national level, several specific organizations are active. In general the STI-system is of good quality. Future attention is needed for the financial arrangement, surveillance and the rising incidence of STIs.
A systematic review of strategies for partner notification for sexually transmitted diseases, including HIV/AIDS
Authors: Mathews Catherine , Coetzee Nicol , Zwarenstein Merrick , Lombard Carl , Guttmacher Sally , Oxman Andrew , Schmid George
Published: October 2002

This review compares the effects of various sexually transmitted disease (STD) partner-notification strategies. Using review methods endorsed by the Cochrane Collaboration, it updates previous reviews, and addresses some of their methodological limitations. It includes 11 randomized controlled trials (RCTs) comparing two or more strategies, including 8014 participants. Only two trials were conducted in developing countries, and only two trials were conducted among HIV-positive patients. The review found moderately strong evidence that: (1) provider referral alone, or the choice between patient and provider referral, when compared with patient referral among patients with HIV or any STD, increases the rate of partners presenting for medical evaluation; (2) contract referral, when compared with patient referral among patients with gonorrhoea, results in more partners presenting for medical evaluation; (3) verbal, nurse-given health education together with patient-centred counselling by lay workers, when compared with standard care among patients with any STD, results in small increases in the rate of partners treated. The review concludes that there is a need for evaluations of interventions combining provider training and patient education, for evaluations conducted in developing countries, and for the measurement of potential harmful effects.
Syphilis, gonorrhoea and chlamydial infection among women undergoing legal or illegal abortion in Maputo
Authors: Machungo F , Zanconato G , Persson K , Lind I , Jorgensen B , Herrmann B , Bergström S
Published: October 2002

Our objectives were to compare the prevalence of sexually transmitted infections (STIs) in 103 women undergoing induced legal abortion (LA) and in 101 women with confirmed, recent illegal abortion (IA), in Maputo, Mozambique. For the purpose of this study, LA was considered the abortion provided in the Maputo Central Hospital with the approval of the Ministry of Health, and IA the one not provided through the approved facility, mentioned above. Women with IA were recruited in the outpatient gynaecology ward and women with LA in the emergency gynaecology ward in the Maputo Central Hospital, during the same time period. Serological tests for syphilis (rapid plasma reagin, ELISA-IgG and fluorescent treponemal antibody absorption), gonorrhoea (indirect haemagglutination) and chlamydia (microimmunofluorescence) were carried out. Direct immunofluorescence for detection of Chlamydia trachomatis antigen was done on endocervical smears from all the women. The prevalence of syphilis seropositivity in IA women is twice that of LA women (odds ratio [OR] 2.13; 95% confidence interval [CI] 0.55-9.95), with 10.9% and 4.9%, respectively. Exposure to gonorrhoea in these 2 groups is similar (OR 1.18; 95% CI 0.63-2.20), with seroprevalence of 31.1% in the LA and 34.7% in the IA group. The high titres are also similar in both groups. Serology findings for C. trachomatis indicate prevalence of seropositivity of 40.6% in the LA and 44.4% in the IA group with no significant difference (OR 1.17; 95% CI 0.64-2.13). In conclusion, STIs are highly prevalent in both IA and LA groups in Maputo. Urgent interventions are needed to reduce their prevalence and consequently their adverse consequences.
Sensitivity evaluation of the Gen-Probe AMP-CT assay by pooling urine samples for the screening of Chlamydia trachomatis urogenital infection
Authors: Gomes J P , Viegas S , Paulino A , Catry M A
Published: October 2002

The sensitivity of two urine pool sizes versus individual testing, to detect Chlamydia trachomatis urogenital infection, was evaluated using the Gen-Probe AMP-CT assay.

Thirty-three (33) known polymerase chain reaction (PCR) positive urine specimens were combined with 231 fresh first-catch urine (FCU) samples in 33 groups of four and 33 groups of eight, to make up 4X and 8X pooled samples, respectively. Gen-Probe AMP-CT assay was performed on pools as well as on individual samples at the same time. For the discrepant cases, the known positive samples were diluted 1:4 and 1:8 using the manufacturer's dilution buffer and were retested. Additional positive specimens found among fresh FCU samples were also tested by the Amplicor-PCR assay to confirm their positivity. The sensitivities of 8X pooling, 4X pooling and individual testing were 86.5%, 94.3% and 91.9%, respectively.

The Gen-Probe AMP-CT assay applied to a 4X urine pooling model was highly sensitive and may be useful for a population based screening programme.
Tamoxifen in antiretroviral-associated gynaecomastia
Authors: Kegg Stephen , Lau Richard
Published: October 2002

Gynaecomastia arising in the context of antiretroviral therapy for HIV infection presents a number of challenges in diagnosis and management. We describe a thirty year old gay man with rapidly developing breast enlargement who was successfully treated with the anti-oestrogen tamoxifen.
Audit of official STD returns from genitourinary medicine
Authors: Tariq A , Huengsberg M , Cook A , Ross J D C
Published: October 2002

We audited the accuracy of KC60 coding in our department over a two-week period in 1999. Case notes of 400 consecutive new and rebook patients who attended during each of the audit periods were reviewed, and their clinical diagnosis was compared with KC60 returns entered into the computer and sent to the Department of Health. We concentrated on four KC60 diagnoses of positive sexually transmitted infections: uncomplicated gonorrhoea (B1) and chlamydia (c4a), first episodes of anogenital warts (C11a) and herpes (C10a). At the end of the audit, specific recommendations were introduced, aiming at improving accuracy of KC60 coding, and a re-audit was carried out in 2000, using identical methodology. In the first audit period there were 106 positive diagnoses, of which 41 (38.7%) were not recorded in the KC60 returns. In the second audit period there were 149 positive diagnoses, of which 20 (13%) were not recorded, showing a significant improvement (Chi square P = 0.0005).
Paradoxical recurrent meningitis following therapy of cryptococcal meningitis: an immune reconstitution syndrome after initiation of highly active antiretroviral therapy
Authors: King Mark D , Perlino Carl A , Cinnamon Jay , Jernigan John A
Published: October 2002

We report a case of paradoxical recurrent meningitis in response to initiation of highly active antiretroviral therapy in a patient receiving maintenance fluconazole for a previous diagnosis of cryptococcal meningitis. We describe the unusual radiographic and histopathologic findings which are consistent with an immune reconstitution induced paradoxical inflammatory response to residual cryptococcal infection.
Azithromycin in gonorrhoea
Authors: Waugh M A
Published: October 2002

The clinical applications of azithromycin in gonorrhoea, often complicated by simultaneously acquired infection with Chlamydia trachomatis, are reviewed in this paper. Clinical trials from major centres in Europe are compared with a large, more recent US study. At the present time, azithromycin is recommended throughout the world as a useful antibiotic in the treatment of gonorrhoea. It has several advantages in that it can be given as single-dose therapy, it can be given where the causative pathogen of urethritis/cervicitis is uncertain, and it is often, therefore, most useful in acute therapy where there is no immediate microbiological back-up. All these considerations are reviewed in detail.
Behcet's syndrome: a review for the genitourinary medicine physician
Authors: Lewis D A
Published: October 2002

Behcet's syndrome is a multisystem disorder due to vasculitis of unknown aetiology. It may present to genitourinary m edicine physicians with genital ulceration. Careful history-taking and clinical examination should allow a correct diagnosis which may be confirmed by reference to the new diagnostic criteria including perform ing a pathergy test. Of particular im portance is a prompt referral to an ophthalmologist for an ocular slit-lam p assessm ent as eye involvement can be severe and therapy needs to be started early in the course of the illness. The managem ent of Behc et's syndrome may also involve rheumatologists, gastroenterologists, neurologists and immunologists. Close liaison between these clinicians may be necessary to provide optim um care for the patient with Behcet's syndrome.
The psychosocial impact of human papillomavirus infection: implications for health care providers
Authors: Clarke Peggy , Ebel Charles , Catotti Diane N. , Stewart Steven
Published: October 2002

The American Social Health Association (ASHA) surveyed people with human papillomavirus (HPV) about their experiences with the disease and its effect on their lives. A sample of 837 was chosen from the subscribers to HPV News , ASHA's quarterly journal for people with HPV. Of the sample, 489 returned completed surveys, which addressed medical history, health care experiences, personal impact, and demographic information. Data analysis was descriptive. Data illustrated that the psychosocial impact of HPV can be serious. More than threequarters of respondents reported feelings of depression and anger, and two-thirds feelings of shame. Sexual enjoyment and activity were also negatively affected by HPV. Additionally, respondents expressed dissatisfaction with the diagnosing health care providers' counselling on emotional and sexual issues. These results may be instructive to those delivering health services by providing insight into the significant personal impact of HPV on those infected.
Audits of the treatment of genital warts: closing the feedback loop
Authors: Reynolds M , Fraser P A , Lacey C J N
Published: October 2002

An initial audit of the treatment of patients presenting to the GUM Department at Leeds General Infirmary with a first episode of anogenital warts was reported in 1993. Treatment was found to be unselective and poorly monitored and the results of treatment were disappointing. As a consequence, guidelines for the management of new patients presenting with genital warts were devised. In order to establish whether these guidelines had produced any improvements in outcome, a second audit was performed looking at the results of treatment in patients with new genital warts who attended 6 months or more after the new guidelines were introduced. Progress was documented for 6 months after presentation. There was a significant fall in the numbers of patients receiving podophyllin 25% solution as firstline treatment, and corresponding increases in the initial use of cryotherapy, trichloracetic acid and, in men, podophyllotoxin solution. (Podophyllotoxin was not licensed for use in women at the time of the second audit.) There were significant improvements in the outcome of treatment. Originally 44% of men had warts despite receiving treatment for 3 months, and 32% were still attending for treatment 6 months after presentation. After the introduction of treatment guidelines, these figures had fallen to 8% and 3% respectively. In the first audit 38% of women still had warts after 3 months' treatment but in the second audit this figure was reduced to 18%. At 6 months, the percentage of women still attending for treatment was halved from 12% in the first audit to 6% in the second audit. The mean number of clinic visits fell from 5 to 3 in men and from 9 to 6 in women. The treatment protocols have been modified and now include the use of podophyllotoxin cream and solution in both men and women.
Topical treatment of venereal warts: a comparative open study of podophyllotoxin cream versus solution
Authors: Claesson Urban , Lassus Allan , Happonen Hanno , Hogstrom Lars , Siboulet Antoine
Published: October 2002

Podophyllotoxin solution 0.5 is licensed for use in the treatment of condylomata acuminata genital warts in men in a number of European countries. In some countries, approval also extends to treatment of genital warts in women. This controlled randomized prospective study evaluated the efficacy and safety of a cream formulation of podophyllotoxin at 2 concentrations 0.15 and 0.3 , using 0.5 podophyllotoxin solution as a reference treatment. Two separate studies were initiated, to assess the 3 treatment groups in a male patients, and b female patients. Statistical evaluation was based on a 'response rate' calculated at each clinic visit. The mean 'response rates' in the male patient study at 4 weeks were 75.1 , 79.0 and 85.6 in the 0.15 cream, 0.3 cream and 0.5 solution groups, respectively. The corresponding 'response rates' for the female patient study were 86.2 , 92.6 , and 93.1 , respectively. The relapse rates for both male and female patients were 6.0 in the 0.15 cream group, 8.6 in the 0.3 cream group and 8.6 in the 0.5 solution group. The results show that there were no statistically significant differences between the 3 treatments with regard to both efficacy and safety. This was true for both the male and female patient groups.
To test or not to test, could you repeat the question?
Authors: Meyrick Jane , Lawrence A G , Barton S E , Boag F C
Published: October 2002

We aimed to investigate clinical practice in the offering of HIV tests and subsequent uptake in a central London genitourinary medicine (GUM) clinic. A random sample (n=330) of attenders at 3 inner-London GUM departments was surveyed. Reasons for and rates of offering of HIV tests were recorded and analysed in relation to demographic, risk group information and uptake. The results were integrated with the latest unlinked, anonymous seroprevalence data for the clinic. After exclusion of patients known to be HIV-positive or to have recently undergone HIV testing, HIV tests were offered to 96% of homo/bisexual men, 55% of heterosexual men and 60% of heterosexual women. Comparison with anonymous HIV seroprevalence data showed an inverse relationship between seroprevalence rates for heterosexual men/women (2.5% vs 1%) and rates of HIV test offering. A lack of research into the policy of offering HIV tests may have resulted in inconsistencies in practice. An evidence based policy should offer HIV tests in line with seroprevalence.
Awareness of sexually transmitted disease among women and service providers in rural Bangladesh
Authors: Khanam Parveen A , e Khuda Barkat , Khane Thomas T , Ashraf Ali
Published: October 2002

Sexually transmitted disease (STD) in rural Bangladesh is currently a topic of great concern. To date, little information is available in the literature regarding its prevalence. It is now known, however, that the current level of STD awareness among the rural population with regard to modes of transmission and means of prevention is inadequate. In 1994, the MCH-FP Extension Project (Rural) of ICDDR, B surveyed 8674 married women of reproductive age (MWRA) in 4 rural thanas to examine their awareness of STDs. The association between sociodemographic and programmatic factors (variables which affect STD information availability) and awareness of STDs was examined by both bivariate and multivariate analyses. Seven focus group discussions were conducted among groups of government health and family planning workers and paramedics to assess their knowledge of STDs and attitudes about their prevention. Only 12% of the original group had even a basic understanding about STDs and how to protect themselves from them. Twenty-five per cent of the women surveyed had ever heard of either syphilis or gonorrhoea. Of these women, less than half could mention specific mechanisms involved in the transmission of these diseases. Seven per cent reported that syphilis and gonorrhoea are transmitted through sexual intercourse. Thirteen per cent reported that the infections are transmitted from spouses to their partners. Four per cent reported that STDs can be spread by having multiple sexual partners. The results of logistic regression analysis indicate that awareness of STDs was higher among relatively older women than among younger women. Awareness of STDs was most strongly and positively associated with the education of both the women and their husbands. Awareness of STDs was also found to be higher among women who were more socially mobile (e.g. those who frequent cinemas or mothers' clubs). The findings of focus group discussions indicate that family planning and health care service providers have a moderate level of STD awareness. Modes of transmission and means of prevention, however, were areas of weakness. It will, therefore, be necessary, whether to prevent a potential STD epidemic or to combat current STD prevalence, to implement culturally acceptable and affordable means of disseminating knowledge in rural areas of Bangladesh. Training of health care providers will be an essential first step.
An evaluation of the capillus HIV-1/HIV-2 latex agglutination test using serum and whole blood
Authors: Windsor I. M. , Gomes Dos Santos M. L. , De La Hunt L. I. , Wadee A. A. , Khumalo S. , Radebe F. , Dangor Y. , Ballard R. C.
Published: October 2002

Summary: The capillus HIV-1/HIV-2 latex agglutination (LA) test was evaluated for its potential as an initial screening test in primary health care. For the serum study, panels totalling 289 HIV-positive sera and 323 known HIV-negative sera plus 50 individual seroconversion samples were tested by capillus. Paired blood specimens were also collected in heparinized and plain tubes from 501 consecutive patients with newly diagnosed sexually transmitted diseases (STDs) attending an STD clinic at a Transvaal hospital. Overall, an initial sensitivity of 99.3% and an initial specificity of 99.7% were obtained by visual reading of the capillus HIV-1/ HIV-2 LA tests on serum samples. Capillus also detected 40 (80%) of the 50 seroconversion samples. Of the 501 paired plain and heparinized blood specimens, serum testing by enzyme immunoassay (EIA) and indirect immunofluorescence/ Western blot (IFA/WB) showed 147 (29%) to be HIV Ab positive. Capillus testing of the paired specimens correctly identified all 147 known positive patients and 345 of the 346 negative patients, thus showing an initial sensitivity of 100% and an initial specificity of 99.7% for the testing of heparinized whole blood by a relatively unskilled health worker. It was concluded that the capillus HIV-1/HIV-2 LA test would be suitable for use as a primary screening test in small outlying laboratories or primary health care clinics.
Antimicrobial self medication in patients attending a sexually transmitted diseases clinic
Authors: Adu-Sarkodie Y A
Published: October 2002

One of the health education messages given in sexually transmitted disease (STD) control is patients' adopting appropriate health seeking behaviour. This includes reporting to health facilities for appropriate diagnosis and treatment. In parts of the world where STD aetiologic agents have assumed resistance to commonly used antimicrobials, this is important. The antimicrobial self medication practices of 764 patients attending an STD clinic in a developing country were studied. Seventy-four and a half per cent admitted to self medication before reporting to the clinic. The antibiotics taken in inappropriate dosages were purchased over the counter, given by friends or were 'left-overs' from previous medications. In the fight to control STD spread as a means of reducing the incidence of HIV/AIDS, indiscriminate use of antimicrobials needs to be guarded against.
An actual use comparison of condoms meeting Australian and Swiss standards: results of a double-blind crossover trial
Authors: Benton K W K , Jolley D , Smith A M A , Gerofi J , Moodie R
Published: October 2002

The performance of condoms in actual use has been poorly researched in the past, especially in comparing condoms that met different quality control standards as indicated by laboratory testing. The present study used a double-blind crossover design to compare the performance of 2 types of condoms in actual use; one that met the Australian and International Organization for Standardization (ISO) standards for condom quality and one that met the more stringent Swiss Quality Seal requirements. Ninety-two men recruited from Metropolitan Melbourne completed a self-report diary sheet after each condom was used which assessed the performance of the condom and the conditions under which it was used. From a total of 1917 condom uses, there was an overall breakage risk of 2.7%. The breakage risk ratio (Australian/ISO : Swiss) for all types of use was 1.16 (95% confidence interval 0.68-1.99). When subanalyses by method of entry were performed, the condoms meeting the Swiss standard appeared to fare better than the Australian/ ISO standards for anal sex (RR=4.84, 95% CI 1.07-21.8, P =0.022), while the opposite was the case for vaginal sex (RR=0.74, 95% CI 0.35-1.53, P =0.41). The result for anal use was statistically significant at the 5% level, despite being based on fewer condom trials than that for vaginal use, but this result needs to be replicated. Although the participants appeared representative of the general male population in Melbourne in the age bracket 18-46 years, there was a significant history of condom usage reported. This may have influenced the risk of breakage.
The associations between risk behaviour and reported history of sexually transmitted diseases, among young women: a population-based study
Authors: Jonsson Monica , Karlsson Roger , Rylander Ewa , Gustavsson Ake , Wadell Goran
Published: October 2002

The aim of this study was to determine the associations between risk behaviour and women's reported sexually transmitted diseases (STDs). All the women aged 19, 21, 23 and 25, residing in a specified housing area, were invited to answer a questionnaire regarding their sexual behaviour, smoking and alcohol consumption and previous history of STD. Of the 611 women participating, one out of 4 women had a history of at least one STD. In an univariate analysis, self-reported STD was found to be related to age, having more than 4 lifetime sexual partners, having practised intercourse at first date, inconsistent use of condoms, alcohol consumption of more than 3 bottles of wine per month and smoking. These factors were, however, not independent of each other and when subjected to a multivariate logistic regression analysis 2 factors, i.e. the lifetime number of sexual partners (more than 4 partners vs one; OR 7.94, (3.41-18.50)) and coitus on first date (practised more than once vs never, OR 2.99 (1.55-5.78)) emerged as independently associated with a previous STD.
Intracavitary contact X-ray therapy of oral HIV-associated Kaposi's sarcoma
Authors: Caccialanza Massimo , Piccinno Roberta , Gnecchi Luigi , Beretta Mariavittoria , Cusini Marco
Published: October 2002

A retrospective study was performed to assess the efficacy and low mucosal toxicity of intracavitary contact X-ray therapy (ICRT), a proposed treatment of small/medium sized lesions of oral HIV-associated Kaposi's sarcoma (HIV-KS). Twenty-six patients with histologically confirmed oral HIV-KS underwent ICRT in the period 1986-1995. No patient received antiblastic or interferon therapy during the radiotherapy or follow-up periods. ICRT was performed according to the usual technical modalities of contact X-ray therapy, but the end of the source of ionizing radiations was introduced into the oral cavity. The total doses administered ranged from 10 to 50 Gy per field, in one or two weekly fractions of 5 Gy each. The follow-up ranged from 1 to 44 months (mean 7.5 months). Complete remission was obtained in 20 cases (76.92%), partial remission in 6 (23.08%) and relapse in one case (3.84%). Pain was relieved in all cases. Mucosal reaction was mild and did not result in any interruption of treatment. Our data suggest that ICRT is an effective and well tolerated treatment. It can be used in the management of oral HIV-KS instead of external radiotherapy, provided that the size and the location of the lesions and the conformation of the palate are suitable to this technique.
Low HIV and high STD among commercial sex workers in a brothel in Bangladesh: scope for prevention of larger epidemic
Authors: Sarkar Swarup , Islam Nazrul , Durandin Florence , Siddiqui Nahid , Panda> Samiran , Jana Smarahit , Corbitt Gerald , Klapper Paul , Mandal Debashis
Published: October 2002

Summary: The present study documents the first systematic assessment of a brothel in Bangladesh in terms of sexually transmitted disease (STD) and human immunodeficiency virus (HIV). A cross sectional study was undertaken on brothel-based commercial sex workers (CSWs) selected systematic random sampling to assess the prevalence of STDs and HIV among CSWs in a brothel setting. Two hundred and ninety-six CSWs were selected from a brothel with a population of 593 women. Following informed consent, endocervical and blood samples were obtained for the diagnosis of genital chlamydia, gonorrhoea, HIV and syphilis respectively. In addition, another 170 consecutive blood samples were collected from the total CSW population for HIV tests. All blood samples for HIV testing were made anonymous by removing patient identifiers before testing. Endocervical specimens were tested by polymerase chain reaction (PCR) for the diagnosis of genital chlamydia and gonorrhoea. Syphilis and HIV infections were diagnosed by serology. One hundred and sixty-nine (57.1%) of the women were Treponema pallidum haemagglutination (TPHA)-positive, 20 (6.8%) of the women were Venereal Disease Research Laboratory (VDRL)-positive at a greater than 1:8 dilution. Eighty-two (28%) of the women were found to be infected either by gonorrhoea or chlamydia. No HIV antibody was found in any of the 466 blood samples. A high prevalence of STDs and low prevalence of HIV in the CSWs in Bangladesh suggest potential for the rapid spread of HIV once it is introduced in this high-risk population. The opportunity to control STD and HIV infection in this population should not be missed, in order to prevent a large epidemic in the future.
Detection of male genital infection with Chlamydia trachom atis and Neisseria gonorrhoeae using an automated multiplex PCR system (Cobas AmplicorTM)
Authors: Higgins Stephen P , Klapper Paul E , Struthers J Keith , Bailey Andrew S , Gough Alison P , Moore Rita , Corbitt Gerald , Bhattacharyya Mukti N
Published: October 2002

Summary: We evaluated Cobas AmplicorTM, a highly automated polymerase chain reaction (PCR) system, to test first-void urine (FVU) and urethral swab specimens for Chlamydia trachomatis and Neisseria gonorrhoeae in men attending a sexually transmitted infection (STI) clinic. Results were compared against an inhouse radioimmune dot blot (DB) test for C. trachomatis and selective culture for N. gonorrhoeae . Three hundred and ninety sets of specimens were obtained from 378 consecutive new and returned-new patients. Gonorrhoea prevalence was 9.49%, with no significant difference in sensitivity or specificity between culture and PCR. Chlamydia prevalence was 15.4%, with sensitivities of: DB 55%, PCR of FVU 86.7%, urethral swab PCR 90%. The specificity of PCR on FVU and urethral swabs was 100%. We have shown that Cobas AmplicorTM PCR is highly sensitive and specific in the diagnosis of chlamydia and gonorrhoea in men attending an STI clinic. Further economic and scientific studies are needed to determine the costeffectiveness of this technique for screening in primary care settings.
Low HIV and high STD among commercial sex workers in a brothel in Bangladesh: Scope for prevention of larger epidemic
Authors: Sarkar Swarup , Islam Nazrul , Durandin Florence , Siddiqui Nahid , Panda Samiran , Jana Smarajit , Corbitt Gerald , Klapper Paul , Mandal Debashis
Published: October 2002

The present study documents the first systematic assessment of a brothel in Bangladesh in terms of sexually transmitted disease (STD) and human immunodeficiency virus (HIV). A cross sectional study was undertaken on brothel-based commercial sex workers (CSWs) selected systematic random sampling to assess the prevalence of STDs and HIV among CSWs in a brothel setting.

Two hundred and ninety-six CSWs were selected from a brothel with a population of 593 women. Following informed consent, endocervical and blood samples were obtained for the diagnosis of genital chlamydia, gonorrhoea, HIV and syphilis respectively. In addition, another 170 consecutive blood samples were collected from the total CSW population for HIV tests. All blood samples for HIV testing were made anonymous by removing patient identifiers before testing. Endocervical specimens were tested by polymerase chain reaction (PCR) for the diagnosis of genital chlamydia and gonorrhoea. Syphilis and HIV infections were diagnosed by serology.

One hundred and sixty-nine (57.1%) of the women were Treponema pallidum haemagglutination (TPHA)-positive, 20 (6.8%) of the women were Venereal Disease Research Laboratory (VDRL)-positive at a greater than 1:8 dilution. Eighty-two (28%) of the women were found to be infected either by gonorrhoea or chlamydia. No HIV antibody was found in any of the 466 blood samples.

A high prevalence of STDs and low prevalence of HIV in the CSWs in Bangladesh suggest potential for the rapid spread of HIV once it is introduced in this high-risk population. The opportunity to control STD and HIV infection in this population should not be missed, in order to prevent a large epidemic in the future.
Prevalence and risk of HIV infection among female sex workers in Burkina Faso
Authors: Nicolas Salif Lankoande , Sangare Meda Lassana , Compaore Issaka P , Catraye Joseph , Sanou Paul T , Dyck Eddy Van , Cartoux Michel , Sankara Olga , Curtis Valerie , Soudre Robert B
Published: October 2002

Summary: Little information is available regarding human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Burkina Faso, West Africa. A cross-sectional study was conducted in Ouagadougou and Bobo-Dioulasso, the 2 largest cities of the country, to determine the prevalence of HIV infection and other sexually transmitted diseases (STDs) among FSWs, and to investigate the factors which were associated with HIV infection in this population. From October to November 1994, 426 FSWs were recruited. The method of anonymous and unlinked HIV screening recommended by the World Health Organization (WHO) was used. The overall HIV seroprevalence was 58.2% (95% confidence interval: 53.4-62.9) and 52.6% of FSWs had at least one STD agent. The most common STDs were trichomoniasis (23%), syphilis (15%) and gonorrhoea (13%). In a logistic regression analysis, risk factors for HIV infection were high gravidity ( 2 pregnancies), low perception of personal risk of HIV infection, syphilis and the presence of genital warts. These results suggest that FSWs in Burkina Faso need better information about HIV transmission and prevention and then need better access to STD detection and management services.
High occurrence of HBV among STD clinic attenders in Bombay, India
Authors: Kura Mahendra M , Hira Subhash , Kohli Malvika , Dalal Prathiba J , Ramnani V K , Jagtap M R
Published: October 2002

The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.