bluuebunny/crossref_metadata_2025 huggingface dataset:
Alternative therapy use in HIV-infected patients receiving highly active antiretroviral therapy
Authors: Risa Kathleen J , Nepon Lisa , Justis Janice C , Panwalker Anand , Berman Stephen M , Cinti Sandro , Wagener Marilyn M , Singh Nina
Published: October 2002

The extent of use of alternative therapies, psychosocial and disease-specific variables predictive of alternative therapy use, and factors motivating the use of alternative therapies in HIV-infected patients receiving highly active antiretroviral therapy (HAART) have not been well defined. Types of alternative therapies used, demographic and medical data, coping (Billing and Moos inventory of coping with illness styles), social support (Irwing and Sarason questionnaire), sense of personal control (Pearlin's Mastery scale), quality of life (Medical Outcome Study scale), health beliefs, and adherence rate were prospectively assessed in 118 HIV-infected patients receiving HAART. Of 38% (45/118) of the patients who used alternative therapies, 56% (25/45) began using alternative therapies since the initiation of HAART. While Caucasian patients were more likely to use alternative therapies than all other patients ( P = 0.015), new users of alternative therapies were more likely to be African-American ( P = 0.022). Alternative therapy users reported less satisfaction with their emotional support ( P = 0.027), and had greater psychological distress ( P = 0.048), but were more likely to utilize problem-focused coping ( P = 0.015). Patients who used alternative therapies were less likely to believe that HAART was beneficial ( P = 0.06). Physicians were unaware of patients' alternative therapy use in 40% (18/45) of all patients who used alternative therapies, in 67% of herbal therapy users, and in 100% of dietary supplement users. Adherence to antiretroviral therapy, CD4 count, and HIV-RNA level were neither predictive nor affected by alternative therapy use. Despite scepticism about the benefits of HAART, resort to alternative therapies did not undermine adherence with antiretroviral therapy. Although able actively to cope with their illness, users of alternative therapies had greater psychological distress and were less satisfied with their emotional support. Interventions aimed at promoting their psychological well-being and enhancing the emotional support should be considered in these patients.
Relapse of early syphilis on first line treatment
Authors: Goorney Ben , Leahy Martin
Published: October 2002

We describe a case of a heterosexual HIV-negative man treated for primary syphilis with oral doxycycline in accordance with Clinical Effectiveness Group guidelines for treatment of early syphilis. Following an initial adequate response, he developed secondary syphilis three months later. We discuss the most likely cause of this relapse and the significance of such cases in the context of an outbreak of syphilis.
The effects of peer education on STD and AIDS knowledge among prisoners in Mozambique
Authors: Vaz Rui Gama , Gloyd Stephen , Trindade Ricardo
Published: October 2002

The study was designed to evaluate the impact of education on AIDS knowledge among prison inmates in Maputo, Mozambique. A 6-month follow-up study was carried out in 1993 among 300 prisoners. A knowledge, attitudes, and practices questionnaire regarding AIDS and STD was administered to each subject as part of the intake medical examination and after an educational intervention provided by 30 prisoner 'activists'. A large proportion of prisoners had high risk behaviours (65% had 2 or more sexual partners per month and 39% had a history of STD) and low AIDS knowledge at incarceration. Statistically significant increases in knowledge occurred after the intervention. Prisoners with less formal education had a poorer performance on the initial questionnaire (43% vs 69% P <0.00001) and had a greater improvement after the intervention (41% vs 24%, P <0.00001). The results demonstrate that educational interventions involving peer health educators contribute positively to the acquisition of knowledge among prisoners.
Undernotification of tuberculosis in patients with AIDS
Authors: Balogun M A , Wall P G , Noone A
Published: October 2002

The purpose of this study was to establish the extent of undernotification of tuberculosis in AIDS patients resident in 2 inner London local authorities. For residents of the 2 authorities, statutory notifications of tuberculosis between 1986 and 1992 were compared, using soundex codes of surnames, sex and year of birth, with AIDS cases reported to the Public Health Laboratory Service (PHLS) AIDS Centre during the same period where TB had been recorded on the AIDS report form. In 36 of 613 AIDS cases reported as residents of the 2 authorities tuberculosis was recorded on the AIDS report form. Matching revealed that only 2 (6%) of these cases had been notified to the local authority. These results highlight the need to resolve the dilemma between concerns about patient confidentiality and the statutory requirement to notify tuberculosis so that clinical management of contacts can be undertaken and the true impact of HIV infection on the incidence of tuberculosis in the UK can be elucidated.
Coinfection with chlamydia and gonorrhoea among pregnant women with bacterial vaginosis
Authors: Joesoef M. R. , Wiknjosastro G. , Norojono W. , Sumampouw H. , Linnan M. , Hansell M. J. , Hillis S. E. , Lewis J.
Published: October 2002

The role of sexual transmission of microorganisms in bacterial vaginosis (BV) is controversial. If sexual intercourse were a risk factor for BV, then we would expect that women with BV would also be coinfected with other sexually transmitted diseases (STD). We investigated the prevalence of STD among pregnant women of low socio-economic status with bacterial vaginosis in Indonesia. Among these women, 23.3% had at least one STD (chlamydia, gonorrhoea, syphilis or trichomoniasis). Chlamydial infection was the most prevalent (19.5%), followed by trichomoniasis (3.8%), gonorrhoea (3.2%) and syphilis (0.4%). Compared to the rates of STD observed in a previous study of all pregnant women (with or without BV) in Indonesia, pregnant women with BV have more than a 2-fold increase in chlamydia (19.5% vs 8.2%) and a 6-fold increase in gonorrhoea (3.2% vs 0.5%). Because detection of BV by Gram stain is easy to perform and economical, detection of BV has potential as a prescreening marker for chlamydia and gonorrhoea among asymptomatic pregnant women of low socio-economic status in Indonesia. Further work is needed to evaluate the usefulness of BV as a prescreening marker for chlamydia and gonorrhoea.
Azithromycin in the prophylaxis of opportunistic infections in AIDS
Authors: Mccutchan J A
Published: October 2002

Prevention of opportunistic infections contributes to improved quality of life and survival in individuals with acquired immunodeficiency syndrome (AIDS). Agents which are more effective and convenient, less costly, and better tolerated are needed for multiple organism primary prophylaxis. Azithromycin, an azalide with high and prolonged intracellular levels, promises to provide protection against Mycobacterium avium complex (MAC) disease in those with advanced AIDS when given weekly. A large trial comparing rifabutin (300 mg daily), a currently approved primary prophylactic agent for MAC, with azithromycin (1200 mg weekly) has been completed and is under analysis. If weekly azithromycin provides equivalent or better protection from disseminated MAC, the cost, effectiveness and convenience of MAC prophylaxis may be improved.
Clinical features of early HIV in the Edinburgh City Hospital cohort
Authors: Brettle Raymond P , Foreman Angus , Povey Sarah
Published: October 2002

In order to describe the clinical features of HIV (non-AIDS), particularly injection drug use (IDU) related HIV, in patients attending the Regional Infectious Diseases Unit in Edinburgh, a prospective review utilizing the WHO staging system of the 680 HIV positive patients, 30% of whom were women and 68% were infected via IDU, was undertaken. Despite the fact that the majority of drug users and heterosexuals enrolled asymptomatic, by 1993, 71% of the patients had developed some HIV related clinical problem . The im portant clinical problems observed for the cohort were; minor skin problems, m inor bacterial infections, major bacterial sepsis, oral thrush, oral hairy leucoplakia, significant weight loss of >10%, HIV related thrombocytopenia and of course AIDS. Unlike previous reports from other areas, in Edinburgh drug users were not more likely than other risk groups to develop severe bacterial disease. Differences in morbidity and mortality rates by risk group but not by gender were noted but these may well be affected by the very different enrolment pattern observed in the various risk groups. The pre-AIDS mortality rates for drug users were remarkably similar to published rates from other centres.
HIV-1 infection in a Ugandan town on the trans-African highway: prevalence and risk factors
Authors: Nunn A J , Wagner H U , Okongo J M , Malamba S S , Kengeya-Kayondo J F , Mulder D W
Published: October 2002

All adult residents (aged 13 years or m ore) of 154 randomly selected households in 3 urban and one semi-rural ward of a town in South West Uganda on the trans-African highway were invited to participate in a socio-demographic, behavioural and medical survey. An unambiguous HIV-1 serostatus was obtained for 389 (80%) adults. The overall sero-prevalence rate was 40.4%; all age groups except males aged 13-19 years had infection rates in excess of 20%. Rates above 50% were found in females aged 20-34 years and m ales aged 35-44 years. For fem ales seropositivity rates increased steeply with increasing num bers of lifetime sexual partners up to a maximum of 3; in contrast, for males rates continued to increase with increasing numbers of partners. The risk of infection am ongst those with only one reported partner was 17%. A high proportion of males (14%) and females (18%) reported a history of genital ulcer disease within the previous 6 months; on exam ination genital lesions were observed in 12% of all participants. Interventions with a single focus are unlikely to have much impact in such a situation and a strategy is suggested which includes 3 components, namely im proved STD control, a reduction in partner change and an increase in condom utilization.
Access to genitourinary medicine services by women attending a family planning clinic
Authors: Gunneberg N , Mann M C , Radcliffe K W
Published: October 2002

The purpose of this study was to assess the need for genitourinary medicine (GUM) referral in family planning clinics (FPC) and to investigate whether women were more likely to attend an appointm ent if the consultation took place in the FPC or in the GUM clinic. A total of 98 women were referred from the FPC for GUM testing. They were randomly referred to be tested either in a local FPC or in the local GUM clinic. Sixty-three per cent of the 49 women randomized to be tested in the GUM clinic attended the consultation compared to 83% of the 49 wom en who attended the consultation in the FPC. This was statistically significant (P <0.05). Twenty-six per cent of those attending the GUM clinic for testing and 29% of those women attending the FPC had a sexually transmitted disease (STD), that is, excluding candidiasis and bacterial vaginosis. There was no statistical difference between the 2 groups. Full GUM testing was successfully carried out in the FPC setting. This study showed that women were less likely to attend for GUM testing if the consultation took place in the GUM clinic compared to the FPC. It is known that there is a need for GUM services to be accessible to FPC attenders (and vice versa ). Further research is needed to determine why women are reluctant to attend GUM clinics.
Clinical features of drug use and drug use related HIV
Authors: Brettle R P
Published: October 2002

A variety of important medical problems, both non-infective and infective in nature, are associated with drug use. A number of micro-organisms are associated with the non-sterile nature of injection drug use (IDU) whilst a number of blood borne viruses, including retroviruses such as HIV, are easily transmitted to individuals involved in the sharing of injection equipment. Practitioners require knowledge of infection and non-infection related medical conditions associated with IDU since they may mimic each other.
Survey of the management of genital herpes in general practice
Authors: Woolley P D , Chandiok S
Published: October 2002

In a questionnaire survey of the management and treatment of genital herpes in the community by general practitioners (GPs) in 16 UK cities considered to have good access to genitourinary services, the mean number of cases seen per GP in the previous 12 months was 1.37 for first episodes and 0.96 cases for recurrent episode genital herpes. First episode genital herpes was regularly managed solely in the community by 21% of responding GPs, while 45% of those referring directly to the genitourinary medicine clinic initiated treatment prior to referral; the vast majority prescribing acyclovir. Overall, three-quarters of GPs prescribed oral acyclovir for first episode genital herpes. Recurrent genital herpes was regularly treated solely in the community by 47% of responding GPs, while 53% of those referring directly to the genitourinary medicine clinic initiated treatment prior to referral. There was almost equal usage between acyclovir cream and tablets in the treatment of recurrent infections.
Pyrexia of undetermined origin in patients with human immunodeficiency virus infection and AIDS
Authors: Miller R F , Hingorami A D , Foley N M
Published: October 2002

The case records of consecutive patients admitted to a specialist HIV/AIDS inpatient unit between 1989 and 1993 with pyrexia of undetermined origin (PUO) were reviewed in order to determine the eventual diagnosis. Seventynine episodes occurred in 75 patients; 52 patients had a prior AIDS defining diagnosis. CD4+ lymphocyte counts ranged widely, 0-0.79 (median=0.04) 109/l. Infections were found in 63 episodes (79%), including mycobacterial infection in 41 episodes (53%) and bacterial infection in 12 episodes (15%). Tumours were found in 6 episodes (8%), 5 of these were lymphoma. Factitious fever accounted for 2 episodes (3%) and connective-tissue disease for 1 episode (1%); no definite diagnosis was reached in 7 episodes (9%). PUO in HIV positive patients is commonly due to infection or tumour. Unexplained fever in this patient group should not be ascribed to HIV infection itself and should be vigorously investigated to find a cause.
Clinical features of AIDS in the Edinburgh City Hospital Cohort
Authors: Brettle Raymond P , Foreman Angus , Povey Sarah
Published: October 2002

In order to describe the clinical features of AIDS, particularly injection drug use (IDU) related AIDS in patients attending the Regional Infectious Diseases Unit in Edinburgh a prospective review of the 680 HIV-positive patients, 30% of whom were women and 68% were infected via IDU was undertaken. The commonest AIDS-related clinical problem in Edinburgh was Pneumocystis carinii pneumonia (PCP). Whilst gender differences were not apparent in terms of clinical problems, differences were observed in risk groups as previously reported; Kaposi's sarcoma (KS), cytomegalovirus (CMV) and toxoplasmosis were commoner in homo/ bisexuals whilst oesophageal candidiasis was commoner in drug users. Extrapulmonary tuberculosis was uncommon unlike cohorts from the USA or Italy. Each patient with AIDS can expect 1-2 AIDS-related clinical events per year of survival. Considerable differences in mortality rates by risk group but not by gender were observed and explanations for this difference need to be considered further. The mortality rates for drug users were however remarkably similar to published rates from Amsterdam and the Bronx, New York.
Presumptive specific clinical diagnosis of genital ulcer disease (GUD) in a primary health care setting in Nairobi
Authors: Ndinya-Achola J O , Kihara A N , Fisher L D , Krone M R , Plummer F A , Ronald A , Holmes K K
Published: October 2002

Of 22,274 patients 12 years of age or older attending a primary health care clinic in Nairobi, 1076 (4.8%) complained of symptoms suggesting a sexually transmitted disease (STD). Of these, 518 females and 462 males underwent complete clinical evaluation, and 78% had objective microbiologic or clinical evidence of STD, including 168 (17.1%) with genital ulcer disease (GUD). Presumptive specific clinical diagnoses on initial physical examination in cases of GUD were chancroid (131 patients), syphilis (25), genital herpes (15) and lymphogranuloma venereum (LGV) (1). Clinical diagnoses correlated only weakly with microbiological and serological diagnoses. Haemophilus ducreyi was isolated from 51 (41%) of the 125 with a clinical diagnosis of chancroid, and 4 (22%) of 18 with a diagnosis of syphilis, herpes, or LGV (P =0.13). The rapid plasma reagin (RPR) test was reactive in 6 (24%) of 25 with a clinical diagnosis of syphilis, 18 (12.3%) of 146 with a diagnosis of chancroid or herpes, and 37 (4.7%) of 786 without a genital ulcer (P <0.001, GUD vs no GUD). Sensitivity, specificity, and positive predictive value for presumptive clinical diagnosis of chancroid, relative to H. ducreyi isolation, were 93%, 16%, and 41%; and for diagnosis of syphilis, relative to reactive RPR, were 25%, 88% and 25%. Specific treatment based on presumptive specific clinical diagnosis frequently was inadequate for syphilis among patients with GUD and reactive RPR test. Syndromic treatment of GUD with antimicrobial combinations active against both chancroid and syphilis would be preferable to treatment with single drugs based on presumptive specific clinical diagnoses for this population.
Asymptomatic shedding of herpes simplex virus from the genital tract: uncertainty and its consequences for patient management
Authors: Barton S E , Munday P E , Patel R J
Published: October 2002

A frequent component of the management of patients with genital herpes concerns the possibility of asymptomatic shedding and potential sexual transmission of the virus. Approaches intended to provide supportive counselling and reassurance of patients about these issues need now to be modified in the light of increasing data of the frequency of asymptomatic detection of virus and the effects of antiviral therapy on this phenomenon. Further studies to delineate the relationship between asymptomatic detection of HSV in the genital tract and the mechanism of sexual transmission of this virus need to be conducted before clinicians instigate antiviral suppressive treatment primarily to prevent sexual transmission of HSV. However, it is important that the new data and our greater understanding of the natural history of genital herpes is translated into accurate and comprehensible information for our patients.
Defining bacterial vaginosis: to BV or not to BV, that is the question
Authors: Hay Phillip E , Taylor-Robinson David
Published: October 2002

The history of bacterial vaginosis (BV), now extending over more than 40 years, has been remarkable not only in terms of repeatedly changing the name of the bacterium that we now know as Gardnerella vaginalis but also in relation to what is thought to constitute the condition, what it should be called and how the diagnosis can best be made. The composite clinical criteria are often confusing for the nonspecialist, provide room for inter-observer error, and misinterpretation of just one criterion can lead to considerable over or under diagnosis. There is no doubt that diagnosis should be through a Gram-stained vaginal smear, allowing detection not only of 'full blown' BV but also patterns of vaginal flora that while not in this category are nevertheless abnormal. Accurate diagnosis is important in view of the ever-growing list of other important conditions that may occur as a consequence of the abnormal flora. In addition to this, we raise the question of whether the name and abbreviation BV is the best either scientifically or from the point of view of the lay public. While recognizing that it now may be too ingrained for further change, is it possible to have a better term, at least for lay use?
Ocular toxoplasmosis in HIV infection
Authors: Rodgers C A , Harris J R W
Published: October 2002

Toxoplasmosis accounts for 1-3% of ocular infections in patients with AIDS1. There are a variety of clinical manifestations that can be confused with other ocular disease. It may be the first manifestations of intracranial and disseminated Toxoplasma gondii infection. Prompt recognition and early treatment with antiparasitic drug therapy will prevent widespread tissue destruction, preserve vision and reduce dissemination. This current review will provide a broad-based overview of toxoplasmosis and ocular infection.
Non-consultant career grade staff in GUM: a reliable silent backbone of the specialty or, a spare pair of hands?
Authors: Hiscock Ted
Published: October 2002

Much of the genito-urinary medicine (GUM) medical workforce of the UK is composed of non-consultant career grade doctors (NCCG) whose lot in the specialty has been much neglected. A questionnaire was sent to the 108 known members of 1994 and a resume of their replies is presented. The greatest plight of this group apart from its non-uniformity of status, are 2 concerns over employment conditions and lack of continuing medical education. An interim report was presented to the main national AGUM committee and a programme for tackling some of the major issues has been proposed. As the International Journal of STD and AIDS has now been approved to be an intrinsic part of AGUM membership, it is felt that a report in its pages would be appropriate.
STD care in Zambia: an evaluation of the guidelines for case management through a syndromic approach
Authors: Hanson S , Sunkutu R M , Kamanga J , Hojer B , Sandstrom E
Published: October 2002

Clinical diagnosis of STDs is unreliable and therefore constitutes a poor basis for choice of treatment. A syndromic approach has been suggested to increase effectiveness of treatment in resource poor settings. Algorithms for the treatment of STD syndromes were evaluated. A total of 436 patients were followed; cure rates were defined and estimated for genital ulcer disease (GUD), urethral and vaginal discharge. Cure rates for the discharge syndromes were high, 97-98%, for both sexes. The cure rate for GUD was 83% for female and 69% for male patients. A higher prevalence of syphilis in the female study population probably contributed to this. It is likely that a large proportion of the treatment failures were due to decreased susceptibility of Haemophilus ducreyi to trimethoprim-sulpha. The determination of cure rates met with a number of methodological problems. This makes it difficult to evaluate the algorithms as part of routine activities, as suggested earlier by WHO.
Prevalence of Mycoplasma genitalium in men with gonococcal urethritis
Authors: Uno M , Deguchi T , Komeda H , Yasuda M , Tamaki M , Maeda S , Saito I , Kawada Y
Published: October 2002

A significant association of Mycoplasma genitalium with non-gonococcal urethritis has been reported, but the prevalence of this mycoplasma in men with gonococcal urethritis has not been so well studied. In this study, we examined urethral swab specimens from 45 Japanese male patients with gonococcal urethritis for the presence of M. genitalium by using a polymerase chain reaction-based assay. We also sought Chlamydia trachomatis by an enzyme immunoassay Chlamydiazyme . Of the 45 specimens, 2 4.4 were positive for the mycoplasma and 12 26.7 were positive for C. trachomatis. The findings suggest that M. genitalium may be a cause not only of non-gonococcal urethritis but also of postgonococcal urethritis.
An economic exploration of oral and intravenous ganciclovir in the induction and maintenance treatment of AIDS-related cytomegalovirus retinitis
Authors: Davies Linda , Maynard Alan
Published: October 2002

The objective of the study was to compare the impact of oral and i.v. ganciclovir on resource use and direct health care costs, from the perspective of the UK National Health Service NHS . The analytical framework used was cost analysis. The sources of data were an open, randomized clinical trial, and additional research which collected resource use and cost data. From the perspective of the UK NHS, the expected cost of i.v. ganciclovir for initial induction and 140 days maintenance and reinduction therapy was 730 higher than that of oral 8145 vs 7415 . Conservative estimates which did not favour oral ganciclovir were used wherever possible. Overall, the resource use and costs of maintenance therapy with oral ganciclovir calculated in the model used for this study were lower than those of i.v. ganciclovir, principally reflecting lower costs for the administration of therapy. In this model the drug cost of ganciclovir maintenance therapy was excluded.
Correlation between total and CD4 lymphocyte counts in HIV infection: not making the good an enemy of the not so perfect
Authors: Beck E J , Kupek E J , Gompels M M , Pinching A J
Published: October 2002

The aim of this study was to assess the correlation and average cost of total lymphocyte count compared with CD4 count as a broad estimate of immunosuppression in HIV-1 infected individuals. Spearman's partial rank correlation were calculated between total lymphocyte count, absolute CD4 count and CD4 per cent stratified by stage of HIV-1 infection for routinely collected samples. Data were collected prospectively from a T cell-subset register combined with clinical data obtained retrospectively from case notes of HIV-infected patients managed at St Mary's Hospital, London 1982-1991. Costing data were obtained through a survey of the departments of haematology and immunology 1989 90 prices . The correlation between 1534 paired absolute lymphocyte count and CD4 lymphocyte count was found to be high R 0.76 . When analysed by stage of HIV infection, the correlation increased from R 0.64 for asymptomatic patients, to R 0.72 for patients with symptomatic non-AIDS HIV infection and R 0.73 for AIDS patients. Correlations between absolute lymphocyte count and CD4 per cent were considerably weaker: R 0.41 all paired counts; R 0.32 for asymptomatic patients; R 0.25 for symptomatic non-AIDS patients; R 0.32 for AIDS patients. Average cost was 8 per full blood count compared with 38 per T-cell subset analysis. The high correlation between total and CD4 lymphocyte counts, especially for patients with symptomatic HIV disease, demonstrates the suitability of the use of total lymphocyte count in the absence of CD4 counts. Given the considerably lower prices of total lymphocyte counts compared with T-cell subset analysis, this is particularly relevant for developing countries.
The cost of health care for HIV-positive patients
Authors: Brettle R P , Atkinson F I , Wilcock J , Richardson A , Lewis R , Maccallum L , Bath G
Published: October 2002

Utilizing a prospective study of health service activity for HIV/AIDS, 2 estimates of hospital costs of care analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) were undertaken. Utilizing combined costs per life year (based on hospital and hospice activity but not primary and community care) the ratio of costs for CD4< 200 and cd4> 200 was for most risk groups between 2-5 : 1 whilst for AIDS : pre-AIDS it was between 3.6-8.3 : 1 except for homosexuals where it was 12.6 : 1. A comparison of the standard hospital costs for infectious diseases with the published accounts for clinical AIDS care in Lothian suggests a 3-4-fold underestimate in the costs of providing a comprehensive health care service.
Heterosexual gonorrhoea at St Thomas'I: patient characteristics and implications for targeted STD and HIV prevention strategies
Authors: Daker-White G , Barlow D
Published: October 2002

This paper compares the socio-demographic characteristics of patients with gonorrhoea with a control group of other attendees to an inner-London genitourinary medicine (GUM) clinic. Between 16 May and 21 December 1994 inclusive there were 312 culture-confirmed heterosexually-acquired cases of Neisseria gonorrheae treated in our clinic: 192 (61.54%) men and 120 (38.46%) women. There were significant differences between the population of cases and controls. Both male (z=- 5.36, P< 0.001) and female (z=- 6.6, P< 0.001) cases were younger than controls. Cases were more likely to be black African-Caribbean than were controls and these differences were more marked in men ( =47.85, P< 0.001). Cases were also more likely to reside in south London postal districts than were controls 2 ( =24.98, P< 0.001). The implications of these findings for targeted health interventions are discussed and we suggest avenues for further work. 2
Homosexual encounters in different venues
Authors: De Wit John B F , De Vroome Ernest M M , Sandfort Theo G M , Van Griensven Godfried J P
Published: October 2002

Summary: We aim to provide empirical data regarding the role of various sex-onpremises venues for gay men in the spread of HIV infection and homosexual activity with casual partners at different (public) venues was assessed. A questionnaire was filled out by participants in a cohort study in Amsterdam, The Netherlands. Questions were asked regarding sex in private homes, baths, cruising areas, darkrooms, cinemas, and hotel rooms. The majority of the 410 men who had sex with casual partners had done so in private homes (67.8%). However, cruising areas, baths and darkrooms were also highly frequented. Three general 'scenes' of venues frequented could be distinguished, and characteristics of men frequenting different types of venues were found to differ. Men who reported unprotected anal sex did so for only one type of venue. Private homes were the locations where most men engaged in high-risk behaviours. However, the number of partners practising unprotected anogenital sex was highest in (semi) public venues.
A national survey to medical and dental schools to assess the level of undergraduate teaching and research about HIV/AIDS in the UK
Authors: Carter Y H , Greenfield S M , Kenkre J E
Published: October 2002

Summary: The views of heads of academic departments in UK medical and dental schools on the extent of their speciality's involvement in teaching undergraduates about HIV/AIDS and undertaking research in this area was ascertained by postal questionnaire. Three hundred and nineteen responses were received from medical schools (61.7%) and 58 responses from dental schools (53.2%). The greatest number of responses in one speciality was received from the Departments of General Practice, Paediatrics and Children's Dentistry. The amount of teaching varied widely, was dispersed throughout the curriculum within a wide range of broader subject areas and tended to be carried out by senior staff using didactic lecture format. Dental courses were more often assessed than medical courses. The small number of patients available was seen as a major problem. Involvement in research was appreciable. However, knowledge of student awareness campaigns was not widespread. We conclude that more specific teaching on HIV/AIDS is needed, particularly discussion about attitudes towards patients and ethical issues. HIV/AIDS counsellors should have an increased involvement in undergraduate teaching and teaching methods should provide opportunities for interactive discussion. Extensive research is being conducted in the UK. However, further work is needed to identify the perceived needs of students and the extent to which these are being met.
Heterosexual gonorrhoea at St Thomas'- II: sexual behaviour and sources of infection
Authors: Daker-White G , Barlow D
Published: October 2002

Summary: This paper examines sexual behaviour in heterosexuals presenting to an inner-London genitourinary medicine (GUM) clinic with gonorrhoea. When comparing patients' documented sexual histories, there were notable differences between cases and a control group, especially in men. Male cases were more likely to have had both multiple sexual partners ( =18.5, P< 0.001) and concurrent sexual 2 relationships ( =15.2, P< 0.001) in the 30 days preceding presentation. Unlike cases, male controls were more likely to have used a condom at last intercourse with a 2 'casual' partner ( =17.5, P< 0.001). In an examination of the sources of infection in cases, women were far more likely to have been recipients of gonorrhoea than they were to transmit the infection. The source of their infection was most usually a regular sexual partner. In men, 'casual' and 'regular' partners and 'one night stands' were all important sources of infection. Our hypothesis that case patients would have met the sources of their infection in particular venues was not supported by the results of an original questionnaire survey. 2
Prevalence of sexual risk behaviour and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City
Authors: Kral A H , Molnar B E , Booth R E , Watters J K
Published: October 2002

Summary: We aim to assess the prevalence of HIV sexual risk behaviours and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City. Survey data were examined from 775 runaway and homeless adolescents recruited from street settings and youth agencies during 1992/1993. Nearly all (98%) reported having engaged in sexual intercourse, of whom 49% first had intercourse by the age of 13. Condom use during all vaginal intercourse in the previous 3 months was reported by 42%. Among males, 23% indicated that they had exchanged sex for money, as did 14% of the females. Ninety-seven per cent had used alcohol or drugs and 21% had injected drugs. Overall, 75% reported having had sex while under the influence of alcohol or drugs. Systematic epidemiological studies of this population and the development of innovative interventions are essential to reduce the threat of HIV among runaway and homeless youth.
Condom and Nonoxynol-9 use and the incidence of HIV infection in serodiscordant couples in Zambia
Authors: Hira S K , Feldblum P J , Kamanga J , Mukelabai G , Weir S S , Weir J C
Published: October 2002

We aimed to measure the effectiveness of latex condoms and of nonoxynol-9 [N-9] spermicides, in preventing HIV transmission in heterosexual serodiscordant couples in Lusaka. Each couple was examined at clinic visits scheduled at 3-month intervals for one year or more per couple, or until seroconversion or discontinuation. Couples were given condoms and their choice of 3 N-9 products and advised to use both at every intercourse. Sexual exposure was ascertained from coital logs that recorded coitus and barrier method use. HIV serological testing was done at each clinic visit (ELISA and Western blot if positive). One hundred and ten discordant couples were followed for a mean of 17.6 months. Seventy-eight per cent of coital episodes were protected by condoms, 85% by spermicides and 6.4% were unprotected. Fourteen seroconversions occurred (8.7 infections per 100 couple-years [c-y]). The rate was higher among seronegative men than seronegative women. Among couples who reported using condoms at every intercourse the infection rate was 2.3/100 c-y, compared with 10.7/100 c-y among couples using condoms less consistently (rate ratio [RR] 0.2; 95% confidence interval [CI] 0-1.6). Among couples who reported using N-9 at every intercourse, the seroconversion rate was 6.9/100 c-y; among couples who reported less than fulltime N-9 use, the rate was 8.9/100 c-y (RR 0.8; 95% CI 0.2-2.8). Among the subset of female seronegatives, the N-9 RR was 0.5 (95% CI 0.1-3.8). But when we calculated HIV rates according to N-9 consistency in coital acts when condoms were not used, there was no evidence of protection with higher N-9 use. Consistent use of latex condoms reduces the incidence of HIV infection, but the association between N-9 spermicides and HIV is less clear. The current study could not provide compelling data on the impact of N-9 spermicide use on risk of HIV infection. The study's small size, as well as the consistency of concurrent condom use, limited our inferences. Available spermicide products must be studied further.
Psychological stress and depression in older patients with intravenous drug use and human immunodeficiency virus infection: implications for intervention
Authors: Singh Nina , Squier Cheryl , Sivek Carla , Wagener Marilyn M , Yu Victor L
Published: October 2002

We aim to assess the age-related differences in psychological stress and depression in patients with human immunodeficiency virus (HIV) infection. Prospective, longitudinal, observational study of patients with HIV followed at a university affiliated VA Medical Center. Fifty-six consecutive patients with HIV infection aged 19-68 were studied. Data on demographics, living arrangements, education, employment, income, social, religious, and community support, medical status, psychological stress, depression, and coping was assessed at baseline and every 6 months. Instruments for psychological testing included Beck Depression Inventory, Profile Mood Status (POMS) scale and ways of coping scale (inventory of coping with illness scale). Sixty-nine per cent (38/56) of the patients were older than 35 years of age. Older patients exhibited significantly greater emotional and psychological stress; the mean POMS score for older patients was 56.8 as compared to 21.5 for younger patients (P=0.004). Older patients had significantly greater depression (P=0.001), higher tension and anxiety (P=0.005), greater anger and hostility (P=0.03), greater confusion and bewilderment (P=0.01), and more fatigue (P=0.003) as compared with younger patients. Older patients were significantly more likely to have intravenous drug use as an HIV risk factor (P=0.02), less likely to be employed (P=0.005), and more likely to use non-traditional therapies (P=0). Intravenous drug use was an independent predictor of psychological stress in older patients. Patients with HIV, older than 35 years of age, are significantly more likely to suffer from depression and psychological stress; intravenous drug use was an independent predictor of stress. Interventions for the treatment of depression should be especially sought in this subgroup of patients with HIV.
History of sexual abuse among HIV- infected women
Authors: Bedimo Ariane Lisann , Kissinger Patricia , Bessinger Ruth
Published: October 2002

The objective of this study is to describe the characteristics associated with a history of sexual abuse among HIV-infected women enrolled in a public inner-city HIV outpatient clinic. A retrospective chart review of 238 women of childbearing age enrolled in the HIV outpatient clinic between 1987 and 1995 was performed. Characteristics of the study population were 83% African American, 69% single, and 53% finished high school or were still in school. The mean age was 25.7 years. Of the 238 women, 32% had a history of sexual abuse. Factors associated with sexual abuse history after controlling for age included living in a nonpermanent situation (OR=4.8), history of non-intravenous drug use (OR=4.65), and having dropped out of school (OR=2.2). HIV-infected women should be screened for a history of sexual abuse and carefully counselled regarding their reproductive choices and drug treatment.
Azithromycin and erythromycin resistant Neisseria gonorrhoea e following treatment with azithromycin
Authors: Young H , Moyes A , Mcmillan A
Published: October 2002

Summary: A pre-treatment and a 3-week post-treatment isolate of Neisseria gonorrhoeae from a 13-year-old boy treated with azithromycin in a single 1 g oral dose were characterized microbiologically. Both isolates were of the same serovar/ auxotype (1B6/non-requiring) and had similar antibiograms apart from erythromycin and azithromycin: the pre- and post-treatment MICs (minimum inhibitory concentrations) were: 1 mg/L and 32 mg/L to erythromycin and 0.125 mg/L and 3 mg/L to azithromycin. The finding that both isolates were 1B6/NR, had similar antibiograms (other than azithromycin and erythromycin), and no other 1B6/NR isolates were resistant to erythromycin supports the view that macrolide resistance developed following treatment. A high overall level of azithromycin susceptibility was confirmed by testing 67 clinical isolates: MIC 0.5 mg/L (range 0.023-0.75 mg/ L). We conclude that the long half-life of azithromycin which is beneficial in treating chlamydial infection may result in increased selective pressure for resistance in gonococci. This report also highlights the importance of antibiotic susceptibility surveillance of gonococci and stresses the need for appropriate treatment of gonococcal infection, particularly when it is prescribed outwith departments of genitourinary medicine. 90
Prevalence of sexual dysfunction in heterosexual patients attending a central London genitourinary medicine clinic
Authors: Goldmeier D , Keane F E A , Carter P , Hessman A , Harris J R W
Published: October 2002

Our objective was to determine the prevalence of sexual dysfunction among new heterosexual attendees at a central London genitourinary medicine (GUM) clinic. We carried out a cross-sectional study in which patients completed a self-administered questionnaire-the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and participated in a brief interview during which additional information was sought regarding the patient's sexual history. An overall > transformed score of 5 on the GRISS was defined as indicative of overall sexual > dysfunction and a score of 5 on any of the subscales as indicative of a specific sexual dysfunction. Twenty-five (24%) men and 10 (9%) women had a GRISS score in keeping with overall sexual dysfunction, the prevalence being significantly lower in women ( P =0.01, 2=6.56, 1df). Sixty-three men (59%) and 63 (60%) women produced scores indicative of significant abnormality on at least one subscale, including, in men: erectile dysfunction 20 (19%), premature ejaculation 23 (22%), and in women: vaginismus 26 (25%) and anorgasmia 23 (22%). Neither an abnormal overall or subscale score on the GRISS was associated with a current STD on KC60 diagnosis or a history of sexual assault for either men or women. There is a substantial prevalence of sexual dysfunction in new heterosexual attendees at our clinic, the service implications of which need to be addressed.
Central venous catheters in patients with AIDS
Authors: Goodman H E , Brettle R P , Stevenson B , Hamilton B , Kalima P , Leen C L S
Published: October 2002

Central venous catheters (CVCs) for patients with AIDS are at risk of a number of complications including bacterial infections. A 6-year retrospective review was undertaken of the records of the 33 patients (42% infected by injection drug use (IDU)) who received intravenous therapy both in hospital and at home via CVCs. Twenty-eight per cent of 53 insertions suffered a complication, the commonest of which was a pneumothorax (8%). The post insertion complication rate was 0.98/100 catheter days (cd). Thrombotic occlusion (0.15/100 cd) was the commonest non septic event while sepsis was overall the commonest event (0.69/ 100 cd) of which half were considered serious (0.33/100 cd). The most frequently isolated organisms were Staphylococci spp. (71%). The median time to an exit site infection was 59 days and to serious catheter sepsis 86 days. Infection did not differ significantly with age, gender, transmission risk activity or catheter type although Portacaths had the lowest rate of infection (0.33/100 cd). The median survival of the 53 CVCs was 88 days although if the temporary catheters were excluded it was 118 days. Kaplan-Meier estimates of survival analysis revealed 55%, 32% and 19% of all the CVCs surviving 3, 6 and 12 months respectively. Our experience suggests that home intravenous therapy and previous IDU does not preclude the use of CVCs although further research is needed on reducing the infection-related complications of such therapy.
Are acetowhite lesions of the cervix correlated to the presence of Epstein-Barr virus DNA?
Authors: Voog Ewa , Ricksten Anne , Stenglein Monica , Jonassen Fredrik , Ternesten Annika , Ryd Walter , Lowhagen Gun-Britt
Published: October 2002

The purpose of this study was to investigate whether Epstein-Barr virus (EBV) is associated with acetowhite lesions of the portio cervix, demonstrating koilocytosis and/or cervical intraepithelial neoplasia (CIN) I-III. The study group comprised 37 women admitted to the Department of Gynaecology and Obstetrics, Sahlgrenska University Hospital, Go teborg because of pathological colposcopy or cytology of the portio cervix. Colposcopically, all exhibited acetowhite lesions of the portio cervix. Cells were sampled with a cytobrush for examination for EBV and human papillomavirus (HPV) DNA by polymerase chain reaction (PCR) and a biopsy was taken for histopathology. Biopsies from 5 patients positive for EBV by PCR in cervical cell samples were examined by an in situ hybridization technique for EBER (Epstein-Barr virus encoded RNA), RNAs expressed in latent EBV infection. The control group consisted of women attending the Department of Dermato-Venereology at the same hospital for STD check-up. These had a normal cytology and no signs of acetowhiteness of the portio cervix. In the study group, EBV DNA was found in 30% and HPV DNA in 51%. In the control group 57% exhibited EBV DNA and 23% HPV DNA. EBV was not found to be a predictive factor in the development of koilocytosis and/or CIN I-III. HPV was a predictive factor in acetowhite, koilocytotic lesions. No expression of EBER was found in the 5 biopsies examined by in situ hybridization.
Diagnosis of chronic prostatitis: overview and update
Authors: Thin N
Published: October 2002

Symptoms and signs are unhelpful in the diagnosis of chronic prostatitis which in many cases continues to rest on comparison of white cells and organisms in urine samples collected before (VB2) and after (VB3) prostatic massage to express prostatic secretion (EPS), and particularly in the EPS itself, if this is obtained. A series of 195 patients is reviewed, 38 with chronic bacterial prostatitis (CBP), 66 with chronic non-bacterial prostatitis (CNBP), 55 with prostatodynia, and 31 with a history of recurrent urethritis without prostatitis. Demographic characteristics and history of recurrent urethritis were similar in all groups indicating that recurrent urethritis alone does not predispose to prostatitis. The upper limit of normal for the EPS while cell count was taken as 1000/mm 3 in line with other reports. With this, the upper limit of normal for the estimate of white cells by simple microscopy appeared to be about 5/high power field (hpf) rather than the figure of 10 often quoted; with the latter figure, a number of cases of CNBP would have been missed. All microscopy was undertaken with the same microscope using a Culture results showed a predominance of enterococci, and cultural and cytological findings in EPS and VB3 were comparable. On microscopy, clumping of white cells was associated with increased numbers-mentioned previously in the literature but not supported by data. Ejaculation just before examination was associated with reduced rather than the increased numbers of cells previously reported. Individual investigators should assess their own methods in determining upper limits of normal for cells. In a separate series of 8 patients with symptoms compatible with prostatitis, transrectal ultrasound scanning showed a prostatic cyst; aspiration was associated with relief of symptoms. It is concluded that transrectal ultrasound scanning (TRUS) should precede prostatic investigation by prostatic massage as this may save the prolonged treatment often necessary for prostatitis. 40 objective.