bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of lateral cystic swellings of the neck, in the over 40s’ age group
Authors: Andrews P. J. , Giddings C. E. B. , Su A. P.
Published: March 2003

We present a series of three case reports of patients over the age of 40 with cystic swellings in the lateral neck. Clinically they masqueraded as branchial cysts, but subsequently were diagnosed as being squamous cell carcinoma cystic lymph node metastasis arising from an occult tonsillar primary.

Currently there is an absence of national guidelines for the treatment of lateral neck cysts in the over 40s’ age group that subsequently prove to be cystic metastases from occult tonsillar primaries. This disease process is more common than thought, with up to 80 per cent of so-called branchial cysts in the over 40s’ age group being malignant.

We recommend that patients over the age of 40 presenting with lateral cystic swellings in the neck should have a high suspicion of malignancy and require a panendoscopy, ipsilateral tonsillectomy and blind biopsies of Waldeyer’s ring. This avoids inadvertent excision of a possible cystic lymph node metastasis. If the panendoscopy histology proves to be benign, then proceed to excision of the cyst with frozen section analysis of it. If this confirms it to be benign then that is all that is necessary; if the frozen section is however positive for carcinoma then the surgeon can proceed at that time to a formal neck dissection and therefore avoid a further procedure. In the event of an occult tonsillar malignancy, excision of the cyst as part of a neck dissection with post-operative radiotherapy is recommended.

It is our aim to treat a cystic lymph node metastasis as you would a solid lymph node metastasis.
Teratocarcinosarcoma of the nose, paranasal sinuses and nasopharynx
Authors: Prasad Kishore Chandra , Pai Radha R. , Padmanabhan K. , Chawla Sanjeev
Published: March 2003

Teratomas affecting the head and neck are rare tumours of ambiguous origin. The benign form is seen in children and mostly affects the nasopharynx. Malignant tumours in the upper jaw have been reported rarely. They are almost exclusively seen in the adult male. They are highly aggressive tumours that are difficult to diagnose pre-operatively due to the varied histological patterns. Treatment options available are surgery, radiotherapy or a combination of both. Despite intensive treatment, the prognosis is still poor. A rare case of teratocarcinosarcoma of the nose, paranasal sinuses and nasopharynx in a 25-year-old male is presented. The tumour had a non-germ cell tumour origin. The clinical features, pathologic characteristics and treatment are detailed. It was managed by surgery, radiotherapy and chemotherapy.
Post-abortion endometritis–myometritis and HIV infection
Authors: Okong P , Biryahwaho B , Bergström S
Published: March 2003

The objective was to explore if HIV-1 infection is a risk factor for post-abortion endometritis–myometritis (PAEM) in an urban hospital in Kampala, Uganda. HIV-1 seroprevalence in women with and without post-abortion infection was established using two standard enzyme-linked immunosorbent assays. Fifty-two women with PAEM and 106 without PAEM infection were recruited. The HIV-1 seroprevalence was 17 (32.7%) among women with PAEM and 38 (36.5%) among women without post-abortion infection. HIV infection was not found to correlate with the risk for PAEM. HIV-1 seroprevalence in both groups was double that among antenatal clients in the same hospital, 14.6% in 1997. Life-threatening infections such as septicaemia, peritonitis and pelvic abscesses were observed among 12 cases (23%). HIV-1 infection was not shown to be a risk factor for PAEM, but women with abortions with and without PAEM have a higher prevalence of HIV-1 than antenatal clients.
HIV-risk behaviours of American spring break vacationers: a case of situational disinhibition?
Authors: Apostolopoulos Y , Sönmez S , Yu C H
Published: March 2003

Young adults are at high risk for acquiring STDs/HIV due primarily to multiple sex partners, unprotected sex, and substance use combined with sexual activity. Contranormative settings — such as the annual spring break vacation — provide ideal conditions for the potentially lethal interaction between alcohol, drugs, and sexual risk-taking. As a steadily growing form of youth travel and characterized by binge drinking, illicit drug use, and unsafe sexual practices, spring break has become a North American institution involving large numbers of travellers. In this study, the theory of interpersonal behaviour was used to explain college students' health-risk behaviours in the context of spring break and pre- and post-spring break surveys were used to examine casual sex and condom use behaviours. Multivariate analyses revealed peer influences, prior experiences with casual sex, alcohol consumption prior to sex, and impulsivity to be significant predictors of casual sex, while impulsivity and condom availability were significant predictors of students' use of condoms during casual sex.
Prevalence and predictors of HIV-associated weight loss in the era of highly active antiretroviral therapy
Authors: Batterham Marijka J , Garsia Roger , Greenop Philippa
Published: March 2003

This study was a cross-sectional study of 122 HIV-positive subjects to determine the prevalence and predictors of weight loss in the era of highly active antiretroviral therapy (HAART). Forty per cent reported lipodystrophy, 40% had documented weight loss (mean 6.6 kg). Mean intake 13400 kJ (118% of estimated requirements calculated using the Harris-Benedict equation). One hundred (82%) were taking antiretroviral therapy.

Using forward stepwise logistic regression analysis only viral load (VL) was significantly associated with weight loss when intake, CD4 T-cell count, lipodystrophy, and age were entered into the model with VL (log copies/mL). Every one log increase in HIV VL was associated with an odds of weight loss of 1.58 ( P=0.0008). Weight loss is still common in the HAART era. HIV VL was the most significant predictor of weight loss in this sample. Inadequate dietary intake and self-reported lipodystrophy were not related to weight loss in this population.
Mean cell volume (MCV) changes in HIV-positive patients taking nucleoside reverse transcriptase inhibitors (NRTIs): a surrogate marker for adherence
Authors: Steele Richard H , Keogh Gary L , Quin John , Fernando Suran L , Stojkova Violet
Published: March 2003

To assess whether changes in mean cell volume (MCV) could be used as a surrogate marker of adherence, the percentage rise from the baseline MCV (%MCV rise) was compared to an independent marker of adherence, the number of days of medications dispensed in a 24-week period. Nucleoside analogues were found to differ in the extent to which they affect the MCV. The correlation between zidovudine (AZT) (30 subjects) and stavudine (D4T) (41 subjects) with adherence based on prescriptions was 0.82 ( P<0.05) and 0.55 respectively ( P<0.05). When adherence was categorized into 10% intervals, there was a progressive rise in the average MCV with increasing adherence that plateaus at 70% adherence. Plotting %MCV rise on time charts appears to detect those subjects with adherence of less than 70%. In conclusion, changes in MCV for HIV-positive patients taking either AZT or D4T may be a useful surrogate marker for adherence to anti-retroviral medications.
Application of a novel human cervical mucin-based assay demonstrates the absence of increased mucinase activity in bacterial vaginosis
Authors: Wiggins R , Millar M R , Soothill P W , Hicks S J , Corfield A P
Published: March 2003

Enzymes produced in bacterial vaginosis (BV) have been proposed as possible mediators of pre-term birth. Most studies have concentrated on mid-trimester measurements of enzyme activity, and utilize synthetic substrates to measure enzyme activity, which may not accurately represent mucinase activity in vivo. We have developed a novel ELISA mucinase assay using biotinylated human cervical mucin as a substrate. The assay is rapid, sensitive and can be used to screen large numbers of samples. The new assay has been used to assess vaginal mucinase activities in 92 women <14 weeks gestational age with and without BV. No differences in mucinase activity were detected between normal and BV groups while significant elevation of sialidase and other glycosidases was confirmed as reported before. This study shows that significant mucinase activity is a normal event in the mucus barrier, but does not reflect changes identified for individual enzyme activities associated with BV.
Investigation of isolated positive syphilis enzyme immunoassay (ICE Murex) results
Authors: Ooi C , Robertson P , Donovan B
Published: March 2003

This study was conducted to determine the significance of an isolated positive (where all other syphilis serology is negative) syphilis enzyme immunoassay (EIA) test (ICE syphilis: Murex Diagnostics) in a sexual health clinic population.

There were significantly greater numbers of isolated positive syphilis EIA tests at Sydney Sexual Health Centre (SSHC) (22/5478) compared to lower risk populations; Southeastern Sydney antenatal clinics (1/11560, P<0.01) and Sydney Children's Hospital (0/3550, P<0.01). We conducted a case control study comparing the cases at SSHC with two control groups drawn from the clinic population. A manual review of the case medical records searched for a history of suggested syphilis.

Within the 22 cases, 32% had clinical grounds for suspecting that the EIA test signified syphilis. Men reporting homosexual contact in the past 12 months significantly distinguished cases from controls who tested negative for syphilis (OR=6.06).

An isolated positive EIA test should prompt further investigation for syphilis, past or present.
Association of cervical SIL and HIV-1 infection among Zimbabwean women in an HIV/STI prevention study
Authors: Chirenje Z M , Loeb L , Mwale M , Nyamapfeni P , Kamba M , Padian N
Published: March 2003

A cross-sectional study was conducted on women attending family planning clinics in Harare, Zimbabwe to determine the prevalence of cervical neoplasia among HIV-1 positive women relative to an HIV-1 negative control group.

Five hundred and fifty four women were recruited and the prevalence of HIV-1 was 36.8%. Cervical cytology was abnormal in 25.6% of HIV-infected women compared to only 6.7% HIV-1 seronegative women. Cervical neoplasia was significantly associated with HIV infection (χ2=42.4, P<0.001). Cellular changes typical of HPV infection (koilocytocis) were recorded in 6.4% of HIV infected women compared with 1.7% of HIV-1-uninfected women (χ2=8.43, P=0.004). HIV-1-positive women had twice the risk of having abnormal cervical cells than HIV-negative women (relative risk 2.47, odds ratio 10.14, P<0.001).

Therefore the introduction of national cervical screening programme in HIV-1 endemic countries like Zimbabwe where the highest burden of pre-malignant lesions is among HIV-1-infected women needs careful planning because these women have other competing health needs including high rates of opportunistic infections.
Sexual risk behaviours and STIs in drug abuse treatment populations whose drug of choice is crack cocaine
Authors: Ross Michael W , Hwang Lu-Yu , Zack Carolyn , Bull Lara , Williams Mark L
Published: March 2003

We investigated sexually transmissable infection (STI) prevalence in 407 drug users in three drug treatment programmes in two Texan cities and associated demographic and sexual behaviours. Data analysis focused on differences between those for whom crack cocaine was the drug of preference compared with other drugs, since crack is associated with sexual arousal and a sex for drugs economy. Data indicate that having crack as a drug of preference is significantly associated with increased levels of previous STIs, previous drug treatment, African–American race, selling or buying sex for drugs or money, and increased infection markers for syphilis, chlamydia and herpes simplex-2. Crack preference was also significantly associated with lower rates of injecting drugs or sharing injection equipment and hepatitis C infection markers. Crack preference in heterosexual respondents was significantly associated with increased partner numbers in the past four weeks, more female partners for men and more vaginal sex contacts for men. Analysis of sex differences comparing those for whom crack was the preferred versus non-preferred drug indicated that female crack users were significantly more likely to engage in oral sex. This supports previous ethnographic data suggesting that oral sex is a common mode of sex for drugs exchange in crack houses. In 7.4% of the total sample (14.4% of the crack-preferring sample), treatable STIs were detected. These data suggest that drug users generally, and crack-using populations in particular, in drug treatment programmes should be routinely screened for STIs as an integral part of drug treatment.
Do clinic-based STD data reflect community patterns?
Authors: Howards Penelope P , Thomas James C , Earp Jo Anne
Published: March 2003

Sexually transmitted disease (STD) interventions in communities are often based on studies conducted in STD clinics. Clinic-based studies are relatively easy to conduct, but they do not include all people at risk for STDs in the community. Although it is widely believed that clinic-based data present a biased picture of the community, the differences between clinical and community perspectives seldom have been quantified. The Sexually Transmitted Epidemic Prevention (STEP) Project included in-depth standardized interviews administered in an STD clinic and the neighbourhoods of the same town. The populations could be quantitatively compared on some questions. The two samples yielded similar estimates of the proportions using condoms, the average age at first intercourse, and the proportion sexually abused as a child. Risky sexual behaviours were more common in the clinic population, however, and the community sample was more socio-economically stable. Clinic-based data may be useful for targeting high risk people in the community but less useful for reaching those at lower risk. The utility of clinic-based studies for community-based interventions may be enhanced by collecting extra information from clinic patients with lower risk profiles.
A five-year audit of the treatment of extensive anogenital warts by day case electrosurgery under general anaesthesia
Authors: Challenor Rachel , Alexander Ian
Published: March 2003

A retrospective five-year audit of patients with extensive anogenital warts (AGW) treated by day case electrosurgery was undertaken to determine clearance rates and recurrence rates. Published studies using these treatment modalities are few and most involve small numbers of patients. We present a series of 213 patients. One hundred and seventy-six patients underwent single procedures, 35 underwent repeat procedures and two (1%) spontaneously cleared before surgery. The outcome was known in 137 patients. Sixty-five (57%) of the single procedures, 18 (78%) of the repeat procedures and 83 (61%, {95% confidence interval [CI] 52.4-68.8%}) of the whole sample were clear by three months. Recurrence rates were 27 (24%), six (23%) and 33 (24%, {95 CI 16.9-31.2%}) respectively. These figures appear to be consistent with published data using electrocautery and surgical/scissor excision. There was a higher prevalence of smokers (compared to general population) but there was no difference in outcome between smokers and non-smokers.
Syphilis epidemic in Slovenia influenced by syphilis epidemic in the Russian Federation and other newly independent states
Authors: Grgič-Vitek M , Klavs I , Potočnik M , Rogl-Butina M
Published: March 2003

In 1994 an 18-fold increase in the annually reported incidence rate of early syphilis (to 1.81 cases per 100,000 total population) in comparison to the preceding year was observed in Slovenia. The reported incidence rates remained elevated for a period of five years. The possible link between the evolving syphilis epidemic in the Russian Federation and newly independent States (NIS) during the 1990s and the observed increases in the reported early syphilis incidence rates in Slovenia, was explored. Surveillance data obtained by mandatory reporting of all newly diagnosed syphilis cases between 1994 and 1999 were analysed according to the information on sexual partners, the country of probable source of infection, and occupation. More than half of all reported cases (62%) were directly or indirectly linked to a source of infection abroad. Among these, the majority of cases (73%) were linked to the Russian Federation or NIS. Of these, 68% occurred in males, a high proportion being long-distance lorry drivers.
Feasibility of testing for Chlamydia trachomatis in a general population sexual behaviour survey in Slovenia
Authors: Klavs I , Rodrigues L C , Wellings K , KešE D , ŠVab I
Published: March 2003

Our objective was to assess the feasibility of integrating first void urine (FVU) specimens testing for Chlamydia trachomatis genitourinary infection into a general population sexual behaviour survey. A total of 752 randomly selected respondents aged 18 to 54 were enrolled into the survey. Face to face interviewing with self-administered sensitive questions was used. Overall survey response rate was 77.4%. A convenience sub-sample of 83 respondents were invited to provide FVU specimens for confidential testing for C. trachomatis genitourinary infection. Fifty-five complied. This resulted in 66% FVU specimen participation rate among targeted respondents. Two specimens tested positive by Amplicor polymerase chain reaction. High feasibility study overall response rate indicated good acceptability of the survey. It proved feasible to collect FVU specimens for C. trachomatis testing in the small sub-sample. Consequently, we proceeded with integration of testing for C. trachomatis into the ongoing main survey.
Significance of sexual route of transmission of hepatitis B and C in Russia
Authors: Mikhailov M I , Gomberg M A , Dolzhanskaya N A , Koubanova A A
Published: March 2003

It is generally understood that hepatitis B and hepatitis C may be sexually transmitted. During the last decade there was a sharp growth of hepatitis B and C in Russia. In comparison to 1992 the incidence of hepatitis B in Russia rose two-fold and in 1999 there were 43.31 cases per 100,000 of population (in some cities up to 150/100,000 and even more). The incidence of hepatitis C in 1999 (19.31 per 100,000 of population) rose to six times more than in 1994. At the same time there was a dramatic growth in syphilis and other sexually transmitted infections in Russia. The proportion of sexual transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) compared with other routes of transmission increased. According to the data from Moscow City Centre of Epidemiology during the last two years, up to 40% cases of HCV and HBV were sexually transmitted.

The most dramatic growth of registered cases of hepatitis was seen among the sexually active population aged 14-29. Confirmation of the sexual route of transmission of HBV and HCV in teenagers was seen when the results of the study showed various markers of HBV and HCV to be significantly more common among sexually active (n=45) than sexually inactive (n=341) teenagers (13.33% vs. 4.39% for HBsAg; 46.67% vs. 12.61% for HBsAg+anti-HBs+anti-HBc; 9.47% vs. 3.95% for anti-HCV, respectively).
The natural course of asymptomatic Chlamydia trachomatis infections: 45% clearance and no development of clinical PID after one-year follow-up
Authors: Morré Servaas A , Van Den Brule Adriaan J C , Rozendaal Lawrence , Boeke A Joan P , Voorhorst Feja J , De Blok Sjoerd , Meijer Chris J L M
Published: March 2003

The natural course of asymptomatic Chlamydia trachomatis infections in women was studied during one year in a cohort based nested case-control study. Healthy women (n = 744, from four company health services in Amsterdam) with a medical check-up prior to job engagement were included. C. trachomatis-positive women (n = 30, cases) and a randomly selected control group of C. trachomatis-negative women (n = 186, controls) were followed for one year. Urine specimens (at one, six and 12 months) were analysed for the presence of C. trachomatis-DNA and the C. trachomatis-serovars, and questionnaires were filled in. The C trachomatis prevalence and natural course in relation to demographic and sexual characteristics after one, six and 12 months were studied. The main outcome measures were 1) the prevalence of C. trachomatis using urine specimens; 2) self-reported complaints; 3) clinical symptoms reported to the coordinating physicians. The prevalence of asymptomatic C. trachomatis infections was 4% and there was no correlation with demographic and sexual characteristics. The person/year clearance rate was 44.7% per year. None of the C. trachomatis-positive women developed clinical symptoms or used C. trachomatis specific antibiotic treatment. Women with or without an asymptomatic infection had the same number of self-reported urogenital complaints during follow-up. In persisting infections twice as many C. trachomatis-serovar E infections were detected as compared to clearing infections. Our findings showed that almost half of the asymptomatic C. trachomatis infections in women cleared during one year of follow-up and none developed clinical pelvic inflammatory disease (PID), which is a much lower figure than previously suggested. Therefore these data are important for cost effectiveness calculations in screening programmes for asymptomatic C. trachomatis infections.
Experience with the new German hepatitis B vaccination strategy since 1995
Authors: Krämer Alexander , Prüfer-Krämer Luise
Published: March 2003

In Germany general hepatitis B (HB) vaccination for newborns and adolescents was introduced in all federal states following the recommendation of the STIKO (Permanent Vaccination Commission) of 1995.

In 1998 serological studies of the German National Health Survey showed that at least 9.8% in the age group of 18 to 19 years had been vaccinated against HBV infection. By 1996 the vaccine doses sold for children rose dramatically and started to reach a plateau of approximately five million per year in 1997.

Data from the kassenärztliche Vereinigung of the Oberpfalz region in Bavaria also indicate that the new policy started to be implemented in 1996. At school entry, however, in 1997 only 10% of the children in seven West German states showed serological evidence of HB vaccination coverage.

According to observations of virologists, paediatricians and public health experts the current acceptance of the HB vaccination recommendations is 80%–90% in children below the age of six years but only 30% to 40% in adolescents.

To achieve high HB vaccination coverage rates in Germany more rapidly a modern surveillance system providing detailed data about vaccination coverage in the different age and population groups is needed. Based on those data additional targeted vaccination strategies for those that can only be contacted by the traditional health care system, such as teenagers and vulnerable groups, should be developed, involving the public health service, local communities and other agencies.
Vaccine candidates in STD
Authors: Fletcher Mark A
Published: March 2003

Sexually transmitted diseases (STDs) are caused by organisms that infect the mucosal surfaces of the genitourinary tract. In spite of its public health importance, current STD vaccine research lags behind work against pathogens that target another mucosal region, the respiratory tract. In the latter case, live-attenuated viral vaccines, killed whole-cell bacterial vaccines, subunit/protein bacterial vaccines, and bacterial polysaccharide vaccines have been enormously successful. To move STD vaccine research forward, complex issues must be resolved. Those include selection of an appropriate antigen (e.g. scientific feasibility and intellectual property rights), the manufacture of the vaccine (e.g. delivery systems, formulation processes, and production steps), and the appropriate public health approach (e.g. medical indications and marketing aspects). Particular scientific problems have delayed STD vaccine development, like 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 human papilloma virus. It may be predicted that eventual STD vaccines (administered either for prophylaxis or for therapy) will use approaches that include (1) live-attenuated viruses, (2) subunit proteins or inactivated whole organisms given with mucosal adjuvants or with cellular immune response adjuvants, and (3) DNA plasmids expressing the vaccine antigen.
Do Dutch dermatologists care for venereology? An inquiry among all non-academic dermatologists in The Netherlands
Authors:   (on behalf of the STD-committee of the Dutch Society for Dermatology and Venereology), Mommers J M , Van Der Meijden W I
Published: March 2003

The financing of STD outpatient clinics in The Netherlands is currently undergoing structural changes. Because these changes also have implications for the infrastructure of STD care as a whole, the STD committee of the Dutch Society for Dermatology and Venereology (STD committee NVDV) and the National Society of Municipal Health Services (GGD-Nederland) are currently exploring the possibilities and feasibility of intensified regional collaboration between Municipal Health Services (MHSs) and dermatologists. However, for fruitful collaboration it is essential that a substantial number of dermatologists has an interest in STD care. Therefore, the STD committee NVDV has conducted a structured survey in order to study the support of Dutch dermatologists for such a regional collaboration. In this paper, the results of the survey are presented. It appears that the majority of Dutch dermatologists is (still) interested in STD, and although a minority currently collaborates with local MHSs on a regular basis, a large group is willing to do so in the future. We conclude that the majority of dermatologists in the Netherlands (still) cares for venereology and that there is a sound basis for a fruitful cooperation with MHSs.
Modernization in GUM/HIV services: what does it mean?
Authors: Robinson Angela J , Rogstad Karen
Published: March 2003

Genitourinary medicine services are expected to modernize in order to meet the needs of the NHS in the 21st century. Although increased funding is essential, there is a need for services to look at new ways of delivering care in order to deal with the increasing rate of sexually transmitted infections (STIs) including HIV in the community. This must include a review of skill-mix and roles. Some changes may appear to lower the quality of service. There must be auditing of changes to ensure that standards are not lowered. A short-lived working group was put together at the request of the RCP joint speciality committee for GUM consisting of representatives from diverse GUM clinics which have all been involved in extensive modernization of their service in order to meet demand. This report does not hold all the answers but provides suggestions for clinics wishing to initiate change. Changes must be appropriate to the local population and access pressures. More extreme measures may only be appropriate in the most severely stretched clinics and with consideration of measuring outcomes.
Should we offer antibiotic prophylaxis post sexual assault?
Authors: Gibb A M , McManus T , Forster G E
Published: March 2003

Our objective was to assess whether antibiotic prophylaxis should be offered to women post sexual assault by considering acceptability of prophylaxis, follow up attendance rates and the prevalence of sexually transmitted infections (STIs) in these women. Retrospective case notes review of female survivors of rape or sexual assault attending the Rose Clinic, Ambrose King Centre, Royal London Hospital between 1 January 1997 and 31 May 1999 was carried out. The following selection criteria were applied: age greater than 16 years; attending within two weeks of assault; having experienced vaginal and/or anal penetration. All women were screened for STI using standard investigation methods detailed below. Antibiotic prophylaxis was offered within two weeks of the assault, the antibiotic regimens used as recommended. The women were invited to attend for results at two weeks and offered a further screen at three months post assault. Bacterial vaginosis was present in 32% of the women screened, Chlamydia trachomatis was identified in 8%, none tested positive for Neisseria gonorrhoeae. Of the 25 women who were offered antibiotic prophylaxis, 88% accepted. Follow up attendances were 57% at two weeks and 30% at three months. Antibiotic prophylaxis was acceptable to women. Among recent rape victims, follow-up rates are low confirmed by our study. These factors support the use of antibiotic prophylaxis post sexual assault. There was an apparently high prevalence of STIs amongst women in this study. More research is required with respect to this aspect of the work and to consider the cost–benefit analysis of antibiotic prophylaxis.
Protease inhibitor drug levels in the management of human immunodeficiency virus-1 antiretrovial therapy
Authors: Urban A W , Bean P , Aziz D , Graziano F M , Neudeck B L
Published: March 2003

In order to evaluate the relationship between protease inhibitor (PI) plasma concentrations and viral suppression in individuals receiving highly active antiretroviral therapy (HAART), plasma concentrations and area under the time concentration curve (AUC0.5–4) for 35 HIV-infected adults receiving their initial (or first salvage) nelfinavir- (NFV) or indinavir (IDV)-based HAART were studied. Two groups were evaluated: those who had achieved HIV-RNA suppression (HIV-RNA <500 copies/mL, group 1, n=21) and those who had achieved incomplete HIV-RNA suppression (HIV-RNA>500 copies/mL, group 2, n=14) at the time of study entry. NFV one-hour pre-dose concentrations were significantly higher in group 1 compared to group 2 ( P=0.023). The NFV AUC0.5–4 for group 1 approached significance ( P=0.068). No significant differences in IDV concentrations or AUC0.5–4 were found between group 1 and group 2. It is feasible to use PI drug level monitoring in the outpatient setting.
Co-infection with gonorrhoea and chlamydia: how much is there and what does it mean?
Authors: Creighton Sarah , Tenant-Flowers Melinda , Taylor Christopher B , Miller Rob , Low Nicola
Published: March 2003

A cross-sectional study of new clients with either gonorrhoea or chlamydia attending King's College Hospital in 1998. One thousand two hundred and thirty-nine women and 1141 men had gonorrhoea, chlamydia or both. Overall, 24.2% (124/512) of heterosexual men and 38.5% (136/353) of women with gonorrhoea also had chlamydia ( P<0.001). Of heterosexual males 18.8% (124/660) and 13% (136/1022) of females with chlamydia also had gonorrhoea ( P=0.002). Ethnicity had no effect on the proportion of co-infection after controlling for age and gender. Clients with dual infection were younger than those with either infection alone ( P=0.0001). Over half of women and a quarter of men aged 15 to 19 years were dually infected so testing for both gonorrhoea and chlamydia may be appropriate in this age group in settings outside genitourinary clinics. The high proportion of cases of gonorrhoea that also have chlamydia justifies the policy of epidemiological treatment for chlamydia.
Evaluation of a novel diagnostic test for bacterial vaginosis: 'the electronic nose'
Authors: Hay P , Tummon A , Ogunfile M , Adebiyi A , Adefowora A
Published: March 2003

The objectives were, first, to determine the sensitivity and specificity of the Osmetech Microbial AnalyserTM (OMATM) for the diagnosis of bacterial vaginosis (BV) and, secondly, to determine the factors that interfere with the performance of the test. Women presenting to a genitourinary medicine clinic underwent routine screening for genital infections. Additional swabs were tested on the OMA, and by Nugent scoring. The optimum method for sampling was determined on the first 372 samples. BV was diagnosed in 182 (27%) of the remaining 665 subjects by Amsel criteria, and 188 (29%) of 642 women with evaluable Gram-stains. The sensitivity and specificity of the OMA were 81.45% and 76.1% compared to Amsel criteria and 82.9% and 77.3% compared to Gramstain. Further refinements to improve the sensitivity and specificity of the OMA are required to provide an accurate near patient testing method.
Prevalence of STD and HIV infections among attenders of the Erasmus MC STD clinic, Rotterdam, The Netherlands, during the years 1996 to 2000
Authors: van der Snoek E M , Götz H M , Mulder P G H , Verkooyen R P , van der Meijden W I
Published: March 2003

The purpose of the study was to investigate possible changes in the prevalence of STD and HIV collected at a Dutch STD clinic in the period 1996 to 2000. Age, gender, ethnic background, sexual preference, intravenous drug use and STD or HIV infection in persons attending an STD outpatient clinic were analysed and compared. The prevalence of HIV infection among the clinic visitors remained stable. The prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections increased significantly among heterosexual men and heterosexual women. Among homo- and bisexual men a significant increase was seen in chlamydial infections only. Because of the increasing prevalence of gonococcal and chlamydial infections among STD clinic visitors in Rotterdam, more attention should be paid to coordinated preventive activities, such as health education and contact tracing. Further subgroup analyses should be done in order to get more information on risk behaviour in the different groups.
The influence of the expanding HIV genetic diversity on molecular diagnosis in the Philippines
Authors: Espantaleon A , Kageyama S , Bernardo M T , Nakano T , Leaño P S , Alban P , Abrenica R , Morimatsu S , Teraoka H , Agdamag D M
Published: March 2003

Since the discovery in the Philippines of the first AIDS case in 1984, several subtypes of HIV-1 have been discovered. From the persons diagnosed in the early 1980s only subtype B was found and thereafter other subtypes, C, D, E, and F were also identified although HIV was not particularly prevalent at that time. In this paper, we determine whether the rapid expansion of genetic diversity will influence molecular diagnosis by polymerase chain reaction (PCR). First, we determine HIV-1 subtype on env (V3) and gag (p24) gene as a means of rapid genetic diversity. Secondly, we tried to analyse and identify homologous regions of gag (p24) gene of HIV genome for diagnostic purposes of designing primers. Out of 46 samples analysed, six subtypes were classified based on gag and env gene subtyping namely: 33 subtype B/B (71.2%), nine subtype A/E and one each subtype C/C, A/B and G/A (2.2% each). As a result, occurrence of non-subtype B and inter-subtype recombinant contributed to expanding genetic diversity. Based on inter- and intra-subtype gag alignment, oligonucleotides (>10 bases in length) could be easily selected as a universal primer to produce the PCR product composed of more than 100bp. This indicates that the PCR technology can be safely used with limited length of primers for the diagnosis of HIV infection in this country.
Voluntary HIV antibody testing amongst youth in Hong Kong
Authors: Lam Tai Hing , Janghorbani Mohsen , Fan Susan , Fielding Richard
Published: March 2003

We performed a study to estimate the prevalence of and factors associated with human immunodeficiency virus (HIV) antibody-testing behaviour among youth in Hong Kong. It was a population-based cross-sectional study. Questions on HIV testing were asked as part of a youth sexuality study conducted in July to December 1996 among young adults in Hong Kong. A total of 517 (53.6%) males and 447 (46.4%) females aged 17 to 28 years completed an anonymous structured self-administered questionnaire. Respondents had good knowledge about correct modes of HIV transmission and prevention. 9.4% (95% confidence interval [CI]: 7.0, 12.3) of males and 6.4% (95% CI: 4.3, 9.1) of females had been tested for HIV through blood donation. Excluding blood donation, 3.7% (95% CI: 2.2, 5.7) of males and 3.6% (95% CI: 2.1, 5.9) of females had been tested (voluntary testing). 47.5% (95% CI: 44.4, 50.7) of subjects reported at least one major risk factor for HIV infection. In multivariate analyses, factors independently associated with both voluntary HIV testing and HIV testing by blood donation were age and having had sex with multiple partners. A higher educational level was a predictor of HIV testing by blood donation. Self-assessment of having sufficient sex education was also significantly associated with voluntary HIV testing. HIV testing is not widespread in Hong Kong and those at risk are more likely to have been tested. It is of concern, however, that many of those reporting risk factors have not been tested.
Heterosexual transmission of HIV in Africa: an empiric estimate
Authors: Gisselquist David , Potterat John J
Published: March 2003

For more than a decade, most experts have assumed that more than 90% of HIV in African adults results from heterosexual transmission. In this exercise, we show how data from studies of risk factors for HIV can be used to estimate the proportion from sexual transmission, and we present our estimates.

Calculating two ways from available data, our two point estimates — we do not estimate confidence intervals — are that 25-29% of HIV incidence in African women and 30-35% in men is attributable to sexual transmission; these estimates assume 10% annual epidemic growth. These findings call for reconceptualization of research to more accurately assess routes of HIV transmission.
HIV in insurgency forces in sub-Saharan Africa — a personal view of policies
Authors: Miles Steven H
Published: March 2003

The special requirements for HIV-prevention programmes by armed forces or insurgency groups in very poor countries that are in active conflict have not been well described. Customary military programme components include: education on sexually transmitted diseases, condom distribution, and HIV testing. Programmes for these armed forces must address: a command structure that may not prioritize this activity, severe resource and logistical constraints, weak health systems for treating sexually transmitted illness, beliefs in traditional medicines for symptoms of sexually transmitted illness, illiteracy that diminishes the utility of educational pamphlets, rape and sexual bartering by soldiers, battlefield transfusions, tattooing and the co-epidemic of tuberculosis.
Confound it: latent lessons from the Mwanza trial of STD treatment to reduce HIV transmission
Authors: Gisselquist David , Potterat John J
Published: March 2003

In 1995, an international team reported that improved syndromic management of sexually transmitted disease (STD) in Mwanza, Tanzania, had reduced HIV incidence by 38% in intervention compared to control communities. However, the team has not addressed confound: project interventions might have reduced HIV transmission during health care through provision of syringes and benzathine (replacing short acting) penicillin and through interactions with a coeval safe injection initiative.

Mwanza's success in lowering HIV incidence is a puzzle, since it was achieved with only minor reductions in observed STD prevalence. Despite incomplete analyses, reports from Mwanza have encouraged expansion of STD treatment. However, should success be attributed to injection safety rather than to decreased STD prevalence — an hypothesis that fits published data — expanded STD treatment without attention to injection safety could, ironically, increase rather than decrease HIV incidence. To control for confound, additional data and analyses from the Mwanza study are warranted.
Sexually transmitted infections and sexual behaviour among commercial sex workers in a rural district of Malawi
Authors: Zachariah R , Spielmann M P , Harries A D , Nkhoma W , Chantulo A , Arendt V
Published: March 2003

In Thyolo District, Malawi, a study was conducted among commercial sex workers (CSWs) attending mobile clinics in order to; determine the prevalence and pattern of sexually transmitted infections (STIs), describe sexual behaviour among those who have an STI and identify risk factors associated with 'no condom use'.

There were 1817 CSWs, of whom 448 (25%) had an STI. Of these, the commonest infections included 237 (53%) cases of abnormal vaginal discharge, 109 (24%) cases of pelvic inflammatory disease and 95 (21%) cases of genital ulcer disease (GUD). Eighty-seven per cent had sex while symptomatic, 17% without condoms. Having unprotected sex was associated with being married, being involved with commercial sex outside a known rest-house or bar, having a GUD, having fewer than two clients/day, alcohol intake and having had no prior medication for STI.

The high levels of STIs, particularly GUDs, and unprotected sex underlines the importance of developing targeted interventions for CSWs and their clients.
Differential of HIV prevalence in women and men who attended sexually transmitted disease clinics at HIV sentinel surveillance sites in Kenya, 1990–2001
Authors: Joesoef M R , Cheluget B , Marum L H , Wandera C , Ryan C A , DeCock K M , Chebet K
Published: March 2003

Several studies in sub-Saharan Africa have reported that HIV prevalence in young women is higher than in young men. We used data from Kenya HIV sentinel surveillance conducted from 1990 to 2001 among sexually transmitted disease (STD) patients (15-49 years old) to investigate consistency of gender differentials over time and their risk factors. Of the 15,889 STD patients, the HIV prevalence ranged from 16.0% in 1990 to 41.8% in 1997. The odds ratios (ORs) of HIV infection for women compared to men decreased by age; women 15-24 years were nearly twice as likely as men of the same ages to be HIV infected (OR 1.7 [1.5-2.0]), but risk in those >44 years was almost equal (OR 0.8 [95% CI 0.7-1.2]). The odds of HIV infection for women compared to men were twice in unmarried patients (OR 2.1 [95% CI 1.8-2.3]). This association persisted after controlling for age groups or marital status, residence, level of education, and presence of STD syndromes. This pattern had been consistent over 12 years. Adolescent women with symptoms of STDs should be a focus for the HIV/STD intervention programmes because of their high risk for HIV.
Traditional healers and the management of sexually transmitted diseases in Nairobi, Kenya
Authors: Kusimba J , Voeten H A C M , O'Hara H B , Otido J M , Habbema J D F , Ndinya-Achola J O , Bwayo J J
Published: March 2003

To describe the role of traditional healers in STD case management, in-depth interviews were held with 16 healers (seven witchdoctors, five herbalists and four spiritual healers) in four slum areas in Nairobi, Kenya. All healers believed that STDs are sexually transmitted and recognized the main symptoms. The STD-caseload varied largely, with a median of one patient per week. Witchdoctors and herbalists dispensed herbal medication for an average of seven days, whereas spiritual healers prayed. Thirteen healers gave advice on sexual abstinence during treatment, 11 on contact treatment, four on faithfulness and three on condom use. All healers asked patients to return for review and 13 reported referring patients whose conditions persist to public or private health care facilities. Thus, traditional healers in Nairobi play a modest but significant role in STD management. Their contribution to STD health education could be strengthened, especially regarding the promotion of condoms and faithfulness.
Treponemal infection rates, risk factors and pregnancy outcome in a rural area of Senegal
Authors: Lagarde Emmanuel , Guyavarch Emmanuelle , Piau Jean-Pierre , Gueye-Ndiaye AÏssatou , Seck Karim , Enel Catherine , Pison Gilles , Ndoye Ibrahima , Mboup Souleymane
Published: March 2003

A rural population of east Senegal has been under demographic surveillance for more than 30 years and a high rate of infertility has been reported. The aim of the study is to describe HIV and treponemal infection epidemiology and association with outcome of pregnancy in a population of rural Senegal. A population-based cross-sectional study was conducted among 952 randomly-selected adults of a rural community of Senegal. No participant was found to be infected with HIV, 11% had evidence of past syphilis and 5% of active syphilis. Active syphilis was associated among men with age, long-term mobility and having partners in an urban area in the last 12 months and among women with being divorced or widowed. No association was found between past or active syphilis and abortion or stillbirth but women aged 40 and more with past or active syphilis were significantly more likely to have had no history of gestation than women with no evidence of syphilis infection. In conclusion our results call for more research to understand the epidemiology of treponemal infection and to elucidate types of Treponema pallidum involved.
Social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda
Authors: Jacobs B , Kambugu F S K , Whitworth J A G , Ochwo M , Pool R , Lwanga A , Tifft S , Lule J , Cutler J R
Published: March 2003

We implemented social marketing of pre-packaged treatment for men with urethral discharge ( Clear Seven) in Uganda, and studied its feasibility, acceptability and effectiveness as a possible means to treat STDs and thereby prevent HIV. Clear Seven was distributed at private health care outlets in three rural districts and two divisions of the capital. Comparisons were made with a pre-intervention period in the same sites plus one additional rural district. There were almost universally positive attitudes to Clear Seven. Cure rate (84% versus 47%), treatment compliance (93% versus 87%), and condom use during treatment (36% versus 18%) were significantly higher among Clear Seven users ( n=422) than controls ( n=405). Partner referral was similar but fewer Clear Seven partners were symptomatic when seeking treatment. Distribution of socially marketed pre-packaged treatment for male urethritis should be expanded in sub-Saharan Africa. Consideration should be given to developing similar kits for women.
Thalidomide Dosing in Patients with Relapsed or Refractory Multiple Myeloma
Authors: Thompson Jennifer L , Hansen Lea Ann
Published: March 2003

OBJECTIVE:

To evaluate the literature regarding the dosing of thalidomide in multiple myeloma.

DATA SOURCES:

A MEDLINE search (1990–February 2003) using the search terms thalidomide and multiple myeloma was performed to identify clinical trials and abstracts. Identified literature was then cross-referenced for further pertinent data.

DATA SYNTHESIS:

Patients with relapsed or refractory multiple myeloma have few therapeutic options. Thalidomide is a promising agent, although many dose-related issues are still in question. Starting doses studied ranged from 50 to 200 mg/d, usually given at bedtime. Gradual dose escalation up to 800 mg/d has been studied, with some evidence of improved outcome with doses of 400–600 mg/d, while thalidomide appears to be best tolerated at doses ≤400 mg/d.

CONCLUSIONS:

A reasonable approach for use of thalidomide in multiple myeloma is to initiate therapy at 50–100 mg nightly and escalate every 2 weeks in 50-to 100-mg increments as tolerated. Efforts should be made to titrate the dose to 400–600 mg/d, especially in patients with poor prognostic features. Efficacy should be assessed at approximately 8 weeks and the dose maintained if desired response is achieved.