bluuebunny/crossref_metadata_2025 huggingface dataset:
Audit of outcome following positive chlamydial test results in family planning clinics in Southampton
Authors: Willmott Fred , Tolcher Ros
Published: October 2002

Chlamydia trachomatis is increasingly being identified outside of genitourinary medicine (GUM) clinics, concern has been expressed about the management of these patients. An audit was undertaken on a group of women identified with chlamydia in family planning clinics (FPCs) in Southampton. Forty-seven women were identified positive over a period of one year. Fifty-nine per cent attended a GUM clinic for treatment, 15% were treated at family planning clinics or by their general practitioners (GPs) but 26% remained untreated. The median time from knowing the positive result to attending GUM was more than 3 weeks in 27%. In those that attended GUM, 44% had an associated genital infection and 79% of named sexual partners were traced. As a result of the audit, a new protocol has been introduced in the family planning clinics for the management of women found to have chlamydia.
Attitudes regarding vaccinations of STDs and other diseases
Authors: Lewis Lisa M , Stanberry Lawrence R , Rosenthal Susan L , Stewart Deborah A , Succop Paul A , Bernstein David I
Published: October 2002

The purpose of this study was to examine, among 2 groups of individuals with different risk profiles, the similarity of their attitudes towards vaccines for sexually transmitted diseases (STDs) and non-STDs. Subjects were recruited from an undergraduate psychology class at an urban university ( n =518) or were participants in genital herpes vaccine trials ( n =87). The participants were asked to complete a questionnaire regarding their attitudes about vaccines for selected diseases. The results of this study revealed that, in general, both groups supported vaccination for most diseases. There were differences, however, between groups regarding 3 diseases: measles, genital warts, and chlamydia. The vaccine trial participants were more likely to accept vaccines for measles and the college students were more likely to accept vaccines for chlamydia and genital warts. The results of this study suggest that negative attitudes regarding vaccination to control STDs may not be a significant barrier to use.
Significance of laboratory findings for the diagnosis of neurosyphilis
Authors: Luger A F , Schmidt B L , Kaulich M
Published: October 2002

Our objective is to assess the specificity and sensitivity, and thus elaborate the relevance, of different laboratory findings for the diagnosis of neurosyphilis. One hundred and fourteen HIV-negative pairs of serum and cerebrospinal fluid (CSF) samples were examined by the Venereal Disease Research Laboratory (VDRL) test, a fluorescent treponemal antibody-absorption (FTA-ABS) test, micro-haemagglutination assay with Treponema pallidum antigen (MHA-TP) test (serum) and Treponema pallidum haemagglutination assay (TPHA) test (CSF); further, albumin, total protein, and total IgG were determined and, in the CSF, cell count was performed. The donors were 60 patients with active neurosyphilis and 54 healthy persons with a former history of syphilis and with persisting positive results in the T. pallidum haemagglutination tests (serum: MHA-TP, CSF: TPHA), who supplied specimens for control. Albumin quotient, IgG index, TPHA index, modified TPHA index, Intrathecally produced T. pallidum Antigen (ITpA) index, its 2 modifications and, in 12 samples, the adenovirus group antibody (AVGA)/TPHA index were ascertained. The specificity and sensitivity of the TPHA index were 100% and 98.3%, of the modified TPHA index 50.0% and 96.7%, of the ITpA index 42.6% and 90.0%, of the modified ITpA indices 51.8% and 68.3% (first modification) and 53.7% and 63.3% (second modification). The AVGA/TPHA index yielded a specificity of 91.7% (11/ 12). The CSF VDRL test was positive in 55/60 (91.7%) of samples from patients with neurosyphilis and in none of the controls (0/54). A CSF-TPHA titre greater than 1:320 was observed in 59/60 (98.3%) of the neurosyphilis specimens and in none of the controls (0/54). A TPHA index above an outcome of 70, a positive CSF-TPHA test at a titre greater than 1:320 and, with lower sensitivity, the criteria of the Centers for Disease Control (CDC) guidelines yield the most reliable results for laboratory support to a diagnosis of neurosyphilis. The modified TPHA index, the ITpA index, and its 2 modifications produce results of minor sensitivity and poor specificity. Observations on the AVGA/THPA index are too limited yet for judgement. The diagnostic significance of a CSF-TPHA titre above 320 needs further confirmation on a greater number of observations made by different laboratories.
Management of intravaginal warts in women with 5-fluorouracil (1%) in vaginal hydrophilic gel: a placebo-controlled double-blind study
Authors: Md Tanweer A Syed , Qureshi A , Ahmad Seyed Ali , Ali Shahida M
Published: October 2002

The purpose of this placebo-controlled, double-blind study was to determine the safety, tolerability and clinical efficacy of 5-fluorouracil (1%) in a vaginal hydrophilic gel (hydroxyethylcellulose, 1%) to cure intravaginal papillomas in women. Pre-selected, 60 women ranging between 18 and 50 years of age (mean 24.6), having 312 vaginal condylomas (mean 5.2) joined the study. The diagnosis of human papillomavirus (HPV) was established with clinical, histopathological and polymerase chain reaction (PCR) techniques. Subjects were randomized into 2 parallel groups. Each patient was allocated a pre-coded tube 15 g (active or placebo) with graduated vaginal applicators (disposable), and instructions how to insert 4 g of the trial medication deep into the vagina once at bedtime on every other day (1, 3 and 5) per week, to visit the clinic on day 7 for clinical evaluations and to receive the same pre-coded replacement to continue the regimen for another week. A maximum 12 applications were to be used in 4 weeks. Cure was defined as absence of clinical signs of infection, re-confirmed by PCR and Southern blot hybridization negative HPV DNA. By the end of the treatment 48.4% patients and 51.9% lesions were cured. Breaking the code revealed that 5-fluorouracil (1%) gel had cured 83.3% patients and 87% intravaginal warts. Placebo resolved 13.3% patients and 14% condylomas; (active gel versus placebo; P < 0.001). Twelve patients (20%) mostly in the active gel experienced mild erythema, erosion and oedema, with no drop-outs. Among cured patients 3 had a relapse after 16 months. In conclusion, the clinical results of the study demonstrate that 5-fluorouracil (1%) in a vaginal hydrophilic gel is safe, tolerable and significantly more effective than placebo to cure intravaginal warts in women.
Serological prevalence of herpes simplex virus type 2 amongst GUM clinic attenders in a district general hospital setting
Authors: Woolley P D , Chandiok S , Pumphrey J , Sharratt S , Shanley L , Bennett Pumphrey S
Published: October 2002

Our objective was to determine the seroprevalence of herpes simplex virus (HSV) type 2 infection amongst genitourinary medicine (GUM) clinic attenders at a district general hospital using a commercially available enzyme immunoassay (EIA). In a prospective study, heterosexual patients attending the Department of GUM at Trafford General Hospital attending with a new clinical problem and having a blood sample taken for routine syphilis serology had the same sample tested for HSV type 2 antibodies. The prevalence of HSV type 2 seropositivity amongst participants was 9.9% (24/242) for men and 18.7% (46/246) for women. With respect to undiagnosed, asymptomatic infection the seroprevalence was 8.6% and 17% respectively. For those attenders locally resident the seroprevalence was 10.1% and 17.5% respectively, and undiagnosed, asymptomatic infection 8.5% and 17.1% respectively. Although seroprevalence figures in this study are lower than the only previous report in the UK, these results, nevertheless, show that seropositivity is not confined to large urban centres. Patients attending GUM clinics are likely to have high rates of undiagnosed HSV type 2 infection.
Transmission of HIV from injecting drug users to their wives in India
Authors: Panda S. , Chatterjee A. , Bhattacharya S. K. , Manna B. , Singh P. N. , Sarkar S. , Naik T. N. , Chakrabarti S. , Detels R.
Published: October 2002

We aimed to identify factors associated with transmission of human immunodeficiency virus (HIV) from injecting drug users (IDUs) to their wives in Manipur, northeast India, where the prevalence of HIV among IDUs is 80% via a case-control study. One hundred and sixty-one HIV-infected IDUs and their wives were recruited from September 1996 to August 1997 inclusive. HIV status was determined by enzyme-linked immunosorbent assay (ELISA) plus Western blot. Interviews were administered anonymously. Regression analysis identified factors associated with transmission of HIV from IDU husbands to their non-injecting wives. Seventy-two wives (45%) were HIV-positive. Only 15% of the couples reported regular usage of condoms during intercourse. On multivariate analysis, a sexually transmitted disease (STD) in either member, reported by the husband, estimated duration of HIV in the husband for >8 years, and a history of blood transfusions were associated with infection in the wife. In conclusion, STDs are associated with transmission of HIV from husband to wife. Improved control of STDs, condom promotion, and improved blood screening are urgently needed in Manipur.
Employment and contextual impact of safe and unsafe sexual practices for STI and HIV: the situation in China
Authors: Wang Shuguang M , Gao Melissa Y
Published: October 2002

China's dual employment system plays a crucial role in sexually transmitted infections (STIs) and HIV-related safe and unsafe sexual practices among young Chinese people. Social and psychological determinants of safe and unsafe sexual practices for HIV infection among young people in Sichuan, China were examined. Our findings indicate that changes in China's social structure and employment system impact upon the social contextual involvement and sociosexual practice of young Chinese people. The findings in the study suggest that the employment-related contextual involvement was a major predictor in the relationships between demography, information, and psychological risk-taking factors on one hand and the people's safe and unsafe sexual practices on the other. Selfemployed people (officially called 'getihu') were more likely than the stateemployed people to engage in unprotected sex with casual sexual partners. As China undergoes social restructuring and many state-employed people are laid off, the risk may also extend into the broader non-self-employed population as more state-employed people become involved not only in the self-employed getihu 's socioeconomic activities but also in their unconventional socio-sexual practices. Collective vulnerability to STI and HIV, due to the current socio-sexual practices of the getihu young people, has created a new frontier for STI and HIV prevention in today's China, as well as demonstrating the importance of collective action with STI and AIDS prevention strategies within relevant social and sub-cultural contexts.
HIV-associated Hodgkin's disease
Authors: Powles T , Bower M
Published: October 2002

Hodgkin's disease (HD) appears to occur more frequently in people with HIV and within this population HD demonstrates a number of differences. In people with HIV, Epstein-Barr virus (EBV) is found more frequently in Reed-Sternberg cells and mixed cellularity and lymphocyte depleted histological subtypes predominate. Patients with HIV present with more advanced stage HD often with extranodal disease. The prognostic variables for HD in patients with HIV relate to the HIV rather than the HD. In people with HIV the response rates are lower, the relapse rates higher, the infectious complications more frequent and the overall survival worse than for HD in the general population.
Determinants of condom-use behaviour among STD clinic attenders in South Africa
Authors: Reddy Priscilla , Meyer-Weitz Anna , Borne Bart Van Den , Kok Gerjo
Published: October 2002

This cross-sectional study analyses determinants of condom-use behaviour among patients attending dedicated STD clinics in South Africa. A structured interviewer-administered survey was conducted among 1473 patients. Patients' beliefs and attitudes towards condom use in general, as well as their personal condom-use behaviour were measured. Their perceptions, regarding the social influence of their partners and friends on their condom use, and of their selfefficacy in using condoms, while infected with an STD were also measured. Condom use, as a dependent variable, was examined and patients were placed in a pre-contemplation stage if they had never used a condom, contemplation if they had seriously thought of using a condom, some action stage if they sometimes used a condom and regular action stage if they used a condom every time. The relationships between the stages of change, as dependent variables, and the independent variables were investigated for both those patients with steady partners and those with outside partners. This was performed by stepwise multiple regression analyses. The variables that significantly explained stages of change were similar for patients with steady partners and those with outside partners. In both partner groups communication was the variable most strongly associated with the use of condoms. General self-efficacy in condom use, self-efficacy in condom use with a partner and attitudes towards the use of condoms played a role in determining patients' different stages of change.
Clinical features and risk factors of lactic acidosis following long-term antiretroviral therapy: 4 fatal cases
Authors: Hofstede Hadewych J M Ter , De Marie Siem , Foudraine Norbert A , Danner Sven A , Brinkman Kees
Published: October 2002

Our objective was to describe clinical features and predisposing factors attributed to lactic acidosis in 4 HIV-infected patients on long-term nucleoside reverse transcriptase inhibitor (NRTI) therapy. All patients had received at least 6–20 months of NRTI-containing antiretroviral therapy: all used stavudine (d4T), in one combined with lamivudine (3TC), in the other 3 with didanosine (ddI); in one hydroxyurea was added. In all, the initial symptoms were gastrointestinal (nausea and vomiting), followed by tachypnoea preceding the lactic acidosis; death followed 6–22 days after admission (liver failure and uncontrollable arrhythmias). Treatment with riboflavin was unsuccessful in one patient. The only definite risk factor in all cases was NRTI-induced mitochondrial toxicity; one patient was concomitantly treated for Kaposi's sarcoma (with bleomycin and vinblastine) and one just recovered from pneumococcal sepsis. None of the patients had a history of chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. In all patients, some sort of toxicity to other previously used NRTIs had occurred earlier. Lactic acidosis occurred after months of NRTI therapy in patients who had already suffered other forms of NRTI toxicity. Concomitant diseases or comedication might have aggravated the mitochondrial toxicity of the NRTIs. Screening methods to detect mitochondrial toxicity are necessary, since lactic acidosis occurs rather unexpectedly, with a rapid, fatal course.
Varicella zoster virus-associated neurological disease in HIV-infected patients
Authors: Brown M. , Scarborough M. , Brink N. , Manji H. , Miller R.
Published: October 2002

Varicella zoster virus (VZV) is an uncommon but well recognized cause of neurological disease in HIV-infected patients. Analysis of cerebrospinal fluid (CSF) using the polymerase chain reaction (PCR) in HIV-infected patients presenting with neurological disease has increasingly allowed diagnosis of VZV-associated pathology. We report clinical, radiological and virological data from 15 consecutive patients with VZV-associated neurological disease. Clinical presentation was varied, including meningo-encephalitis in 9 and isolated cranial nerve palsies in 6. VZV deoxyribonucleic acid (DNA) was detected by PCR in CSF of 11/15; pleocytosis was present in only 6/15, raised protein in 11/15. Magnetic resonance imaging (MRI) appearances were focal signal abnormalities in 8, meningeal enhancement in 2 and normal in 2. With specific anti-VZV therapy 10 patients recovered fully. The predictive value of PCR on CSF for diagnosis of VZV-associated neurological disease should take into account the patient's clinical presentation, concurrent infections and response to anti-VZV therapy.
Management of Chlamydia trachomatis genital tract infection in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 1999
Authors: Dale A. W. S. , Horner P. J. , Forster G. E. , Daniels D. , Tomlinson D. , Brook M. G.
Published: October 2002

Assessment of clinical management of Chlamydia trachomatis genital tract infection was made, with particular regard to the UK National Guideline. Questionnaires for self-completion, mailed to lead clinicians in 31 Genitourinary Medicine (GUM) clinics in the North Thames Region between May and June 1999, focused on policies and practice. Audit of actual management of up to 10 most recent cases (5 male and 5 female) attending each clinic within the past 2 years was also undertaken. Twenty-two units (71% response) completed the survey questionnaire and 23 units (74% response) audited a total of 229 cases (males=108, females=118, sex not stated=3). Findings indicate that GUM clinics are managing these infections largely as recommended in the national guideline. Nucleic acid amplification techniques will supersede established diagnostic tests for GUM clinics in North Thames, increasing costs for the service, but also sensitivity of detection.
The dysfunctional foreskin
Authors: Porter W. M. , Bunker C. B.
Published: October 2002

Although important, the foreskin is not absolutely essential to penile function. Dysfunction is common and a cause of considerable morbidity, and is sometimes associated with mortality from squamous cell carcinoma (SCC). Penile dermatoses herald, complicate or cause preputial dysfunction. Their effective diagnosis and management reduces morbidity and possibly mortality. Medical treatment has its limitations and circumcision is often required.
Psychosocial factors are associated with prolonged hospitalization in a population with advanced HIV
Authors: Cheng Allen C , Mijch Anne M , Hoy Jennifer F , Wesselingh Steven L , Fairley Christopher K
Published: October 2002

Our aim was to define a subgroup of patients with HIV at risk of adverse outcomes in terms of psychosocial factors in order to improve the targeting of hospital resources. The International Classification of Diseases, 9th Revision (ICD-9) coded discharges of all inpatients with HIV discharged from a tertiary hospital between July 1996 and March 1999 were matched against variables in the HIV/AIDS database. A 'prolonged hospitalization' subgroup was defined as those patients whose cumulative length of stay exceeded 90 days in the 33-month period. There were 2778 non-day stay discharges ( n=757 patients) constituting 21,286 bed-days. The prolonged hospitalization group ( n=62) accounted for 44.3% of the bed-days. Psychosocial co-diagnoses were associated with prolonged hospitalization in both crude and adjusted logistic analyses. These included psychiatric diagnoses such as mania, psychosis and anxiety, HIV dementia, housing issues and the need for social work interventions. In conclusion, a small group of individuals at risk of adverse outcomes has been defined by markers of psychosocial dysfunction. Increased understanding of this group should enable the development of programmes directed at morbidity and mortality.
Attitudes towards prenatal HIV testing and treatment among pregnant women in southern India
Authors: Brown H. , Vallabhaneni S. , Solomon S. , Mothi S. , McGarvey S. , Jackson T. , Putcha M. , Brenner S. , Mate K. , Cu-Uvin S.
Published: October 2002

During June and July 1999, oral interviews were conducted on 666 women seeking prenatal care at 9 medical facilities in Chennai and Mysore, India, to assess their attitudes towards prenatal HIV testing and antiretroviral prophylaxis for preventing perinatal HIV transmission if needed. Seventy-eight per cent were aware of the risk of perinatal HIV transmission and 36% knew that intervention could reduce the chances of such transmission. Eighty-six per cent would agree to undergo prenatal HIV testing but only 21% of all respondents would make this decision independently while 46% said their husband would have to decide. Of those women who would not agree to testing, 21% would agree if testing were compulsory. Ninety-seven per cent of respondents would undergo antiretroviral prophylaxis to prevent vertical transmission, and 94% would consider alternatives to breastfeeding if HIV positive. Considering its widespread acceptability, prenatal voluntary counselling and testing may be an affordable method of HIV prevention for this population.
Sexually transmitted infections in Estonia—syndromic management of urethritis in a European country?
Authors: Uusküla Anneli , Plank Toomas , Lassus Allan , Bingham James S.
Published: October 2002

Sexually transmitted infections (STIs) are considered a major public health problem, globally. In particular, increasing STI rates have been documented throughout eastern Europe and central Asia. The Russian Federation and adjacent countries have, traditionally, managed STIs on an aetiological basis. This approach is expensive in terms of laboratory costs and it may lead to delayed diagnosis and treatment. To overcome the limitations of the aetiological management of STIs, the World Health Organization (WHO) has placed an increased emphasis on integrated care using syndromic management at the primary care level, especially in developing countries. This article reviews the current aetiology of STIs in Estonia, an eastern European country bordering the Baltic Sea and formerly a part of the Soviet Union, with the aim of defining whether infection with Trichomonas vaginalis is common enough to include its management in a syndromic management protocol. The use of syndromic management, in general, is also discussed.
Paediatric HIV infection - diagnostic and epidemiological aspects
Authors: Yeung S M , Gibb D M
Published: October 2002

There are currently more than 1.3 million children living with HIV in the world today and many more who have been orphaned by the epidemic. This review explores the nature of the widening gap in the experience of HIV infection between high- and low-income countries. The global epidemiology is described, highlighting the burden carried by sub-Saharan Africa and the alarming increase being witnessed in the Asia/Pacific region. Most of these infections are acquired vertically and are now largely preventable in well-resourced settings, and finding and implementing appropriate measures in poorer countries is urgently needed. Finally the ability to diagnose paediatric HIV infection is explored, highlighting the difference in the implications of doing so in settings with limited resources.
Molluscum contagiosum—a novel presentation
Authors: Bates C M , Carey P B , Dhar J , Hart C A
Published: October 2002

A case history is described of an HIV-seropositive man who presented with a swelling on the right cheek and a history of disseminated molluscum contagiosum. Electron microscopy of the abscess aspirate showed pox virions indicative of molluscum contagiosum. This is an unusual presentation of molluscum contagiosum and the authors review the literature of other presentations.
Genitourinary medicine services in the United Kingdom are failing to meet current demand
Authors: Djuretic Tamara , Catchpole Mike , Bingham James S , Robinson Angela , Hughes Gwenda , Kinghorn George
Published: October 2002

Recent increases in the incidence of sexually transmitted disease (STD) in the UK have given rise to concerns over the ability of genitourinary medicine (GUM) services to cope with increased demands. We conducted a postal survey to assess the capacity of GUM clinics to meet patient demand for both routine and emergency consultations. A questionnaire was sent to all lead GUM physicians in the UK. The response rate was 80%. In some clinics, patients had to wait for up to 28 days for routine appointments. Urgent appointment patients were seen within 24 h by only 54% of clinics and some had to wait for at least one week (5% of clinics). Prolonged waiting times were reported nationwide in addition to widely expressed concerns about the increasing workload. Additional resources should be made available to GUM services if the population's sexual health is to be improved.
Intention of residents in internal medicine to care for patients infected with HIV at a university hospital in Taiwan
Authors: Hsiung P C , Tsai Y F , Hung C C , Chen M Y
Published: October 2002

The purpose of this study was to investigate internal medicine residents' HIV-related knowledge and their attitudes towards caring for HIV-infected patients, and determine the extent to which these variables influence their care-providing intention. A cross-sectional survey was conducted in 56 internal medicine residents at a university hospital in Taiwan. Results showed residents' lack of sufficient knowledge was reflected by their inaccurate assessment of HIV-associated risk and their tendency to overuse protective gear in unnecessary situations. In general, residents expressed slightly positive attitudes with a neutral intention to care for HIV-infected patients. Knowledge and attitudes were significantly correlated with intention. The use of stepwise regression analysis revealed attitudes accounted for 59% of the variance in intention. Future efforts should focus on designing, implementing, and evaluating educational programmes that address residents' needs to ensure a solid HIV-related knowledge base, support their positive attitudes, address their ambivalent feelings toward providing HIV care, and enhance their intention to care for HIV-infected patients.
The Legal Framework Covering the Practice of Genitourinary Medicine in the UK: The Venereal Diseases Regulations
Authors: Thin R N
Published: October 2002

The legal framework governing the practice of genitourinary medicine is traced from 1916 to the present. The first legislation, the Public Health (Venereal Diseases) Regulations of 1916 was comprehensive, and accompanied by guidance on setting up outpatient clinics and their supporting laboratories with practical advice on taking samples to support clinical diagnosis. Confidentiality was emphasized. The regulations led to the development of a nationwide network of clinics providing free care, open at times convenient to the public, and situated in general hospitals in large centres of population. Most of the principles still apply. Subsequent legislation centred on maintaining the confidentiality of all information obtained in relation to persons examined or treated for venereal disease, but allows transfer of details between healthcare providers to facilitate care and contact tracing. While the initial regulations stated that the venereal diseases were syphilis, gonorrhoea and chancroid, the legislation now covers all sexually transmitted diseases.
Imiquimod 5% Cream is a Safe and Effective Self-Applied Treatment for Anogenital Warts — Results of an Open-Label, Multicentre Phase IIIB Trial
Authors: Garland S M , Sellors J W , Wikstrom A , Petersen C S , Aranda C , Aractingi S , Maw R D
Published: October 2002

Our objective was to determine the efficacy and safety of imiquimod 5% cream in the treatment of external genital/perianal warts in an open-label Phase IIIB trial. Patients applied imiquimod 5% cream 3 times per week, for up to 16 weeks. Those who cleared their warts were monitored during a 6-month follow-up period. If their warts recurred, or new warts developed during this time, patients could be re-treated for up to 16 additional weeks. Patients who experienced partial clearance during the initial treatment period entered an extended treatment period of up to an additional 16 weeks. A total of 943 patients from 114 clinic sites in 20 countries participated in this study. Complete clinical clearance was observed in 451/943 (47.8%) patients (intent-to-treat (ITT) analysis) during the initial treatment period, with clearance in an additional 52 (5.5%) patients during the extended treatment period beyond 16 weeks. The overall clearance rate for the combined treatment periods was 53.3%. In a treatment failure analysis, the overall clearance rate was 65.5%; a greater proportion of female patients (75.5%) experienced complete clearance than male patients (56.9%). Low recurrence rates, of 8.8% and 23.0%, were observed at the end of the 3- and 6-month follow-up periods, respectively. The sustained clearance rates (patients who cleared during treatment and remained clear at the end of the follow-up period) after 3 and 6 months were 41.6% and 33.0% (ITT analysis), respectively. Local erythema occurred in 67% of patients. In the majority of patients local skin reactions were of mild to moderate severity. In conclusion, imiquimod 5% cream is an effective self-applied treatment for external genital/perianal warts when applied for up to 16 weeks and is well tolerated for up to 32 weeks.
Do questions on sexual behaviour and the method of sample collection affect participation in a screening programme for asymptomatic Chlamydia trachomatis infections in primary care?
Authors: van Valkengoed Irene G M , Morré Servaas A , Meijer Chris J L M , van den Brule Adriaan J C , Boeke A Joan P
Published: October 2002

We examined the effect of a questionnaire addressing sexual behaviour on participation in a systematic screening programme for asymptomatic Chlamydia trachomatis infections. Furthermore, we compared participation among persons requested to mail a home-obtained urine sample directly to the laboratory and persons requested to bring a sample to the physician's office. Seven hundred and fifty men and women were randomly assigned to receive a questionnaire with or without intimate questions and to deliver or mail the samples. The inclusion of questions about sexual behaviour did not affect participation among both men and women. Among women there was no difference in participation between delivering or mailing the sample. Among men delivering the sample, participation was 18% (95% confidence interval [CI]: 5-32) lower. This study shows that questions on sexual behaviour can be included in a screening questionnaire without adversely affecting participation. Furthermore, mailing the specimens is the most efficient strategy for men, when screening for C. trachomatis by means of home-obtained urine specimens.
HIV risk behaviour among gay and bisexual men in Budapest, Hungary
Authors: Csepe Peter , Amirkhanian Yuri A , Kelly Jeffrey A , McAuliffe Timothy L , Mocsonoki Laszlo
Published: October 2002

HIV is a growing public health threat in Central and Eastern Europe. In Hungary and a number of other countries, men who have sex with men (MSM) account for a high proportion of HIV infections. However, there has been very little systematic study of the sexual risk practices and characteristics of MSM in this region. This study surveyed 469 MSM recruited in Budapest gay community venues in June 2001. Half the men (50%) engaged in unprotected anal intercourse (UAI) in the past 3 months. Of these, 40% of men's insertive and 50% of their receptive acts were unprotected, and 25% had multiple AI partners in the past 3 months. 17% of MSM exchanged sex for money, 26% had female partners in the past year, and condoms were used in only 23% of their vaginal intercourse occasions. Multivariate analyses showed that high-risk behaviour was predicted by not having condoms available when needed, weak risk reduction intentions, negative attitudes toward safer sex, being in a steady relationship, and having a bisexual orientation. Community-based HIV prevention programmes focused on the needs of gay or bisexual men in Central and Eastern Europe are urgently needed.
Sexual behaviour in a low-income high school setting in Stockholm
Authors: Edgardh Karin
Published: October 2002

Teenage abortions and sexually transmitted infections (STIs) are increasing in Sweden, and risky adolescent sexual behaviour is an issue of major concern. The aim of the present cross-sectional questionnaire-based study was to investigate adolescent sexual experience in a low-income high school setting in Stockholm. Among 340 students, 258 participated, response rate=75.9%, mean age=17 years. Homo- or bisexual preference was reported by 11.6% (29/250). Experience of oral sex was reported by 66.3% (163/246), vaginal intercourse by 55.5% (141/254), and anal sex by 10.0% (25/250), with no gender-specific differences. Five or more coital partners were reported by 29.8% (34/114). Condom use at first and most recent intercourse was reported by 61.7% (87/141) and 42.6% (60/141), respectively, and condom breakage by 39.5% (34/86). Truancy, smoking, alcohol and drug use were factors associated with coital experience. Sexual abuse was reported by 2.2% (3/134) of the boys and 13.0% (16/123) of the girls.
Risk behaviours and prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital infections among Montreal street youth
Authors: Haley N , Roy É , Leclerc P , Lambert G , Boivin J F , Cédras L , Vincelette J
Published: October 2002

We estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital tract infections among 302 Montreal street youth (223 boys) and identified associated risk factors. Study participants, 14-25 years old (average 20.9 years), meeting specific criteria for homelessness, were recruited in street youth agencies. Participation included a structured interview and provision of a urine specimen. Among sexually active youth, ( n = 300) 30.0% had more than five heterosexual partners and 13.0% had at least one homosexual partner (last year), 10.7% had received money in exchange for sex (last six months) and 47.0% reported sexual relations resulting in pregnancy (lifetime). Among all youths, 82.1% had used at least one type of illicit drug, and 30.1% injected drugs at least once (last six months). The prevalence of C. trachomatis infection was 6.6% (95% CI 4.1-10.0%). Prevalence did not vary significantly by sex, age or any other variable, except history of pregnancy (10.4% among youth with history of pregnancy vs 3.6% among others, P = 0.02). No cases of N. gonorrhoeae infection were found.
Chlamydial co-infection among patients with gonorrhoea
Authors: Dragovic B , Greaves K , Vashisht A , Straughair G , Sabin C , Smith N A
Published: October 2002

The objective was to determine how often gonococcal (GC) infection is accompanied by chlamydial co-infection and to determine risk factors for dual infection. All GC-positive cultures were identified between 24 April and 9 September 1998, among patients seen at the three genitourinary medicine (GUM) clinics across the Chelsea and Westminster Directorate. Chlamydia trachomatis was diagnosed using an enzyme-linked immunosorbent assay (ELISA) (Dade-Behring). One hundred and fifty-three episodes of gonorrhoea were identified. Information on chlamydial infection was available for 149 cases of GC of whom 16 (10.7%) were found to be co-infected with C. trachomatis. In univariate analysis, chlamydial co-infection was exclusively diagnosed in heterosexuals, and was more likely to be diagnosed among females, in younger individuals and in individuals of black Caribbean ethnic group. In multivariable analyses, however, only the sex and age of the individual were independently associated with chlamydial co-infection. The rate of co-infection was 10.7%. Independent risk factors were being less than 20 years old and being female.
Vulvovaginal candidiasis: a comparison of HIV-positive and -negative women
Authors: Sobel Jack D
Published: October 2002

Although considerable information has accumulated in the last decade regarding rates of both vaginal colonization and vulvovaginal candidiasis (VVC) in HIV-positive women, gaps in our knowledge remain, particularly with regard to pathophysiology of clinical disease. Unfortunately, early and possibly premature conclusions were reached in the late 1980s which resulted in the widespread dissemination of information indicating that recurrent VVC (RVVC) was a manifestation of HIV infection and that women with RVVC should be tested for HIV. Unfortunately, subsequent data from cohort studies involving HIV-positive women failed to determine attack rates of symptomatic Candida vaginitis requiring therapy. Recent studies indicate that Candida vaginitis, even if more frequent in HIV infected women, is clinically similar to that experienced in HIV-negative women and does not appear to be of increased clinical severity. VVC in HIV-positive women can be treated by conventional methods including the use of maintenance suppressive antifungal therapy and most importantly RVVC in women is not in itself a sentinel of HIV infection. Ongoing concerns include vaginal acquisition of non- albicans Candida species and the development of antimycotic drug resistance in C. albicans vaginal isolates.
Chlamydia—inside out
Authors: Dodd Andrea , Comber Diane Lesley , Hernon Mary
Published: October 2002

The aim was to inform other health care professionals within the field of sexual health about the expanding role of the health adviser in genitourinary medicine. It also highlights the complementary role of a community health adviser that may develop if the chlamydia pilot study became a national screening programme. An audit of time management and workload created by partner notification for the positive patients generated by the chlamydia pilot was undertaken. This was done prospectively over a two-month period and the data were collected by the health advisers in the genitourinary medicine department. The results showed that 164 people generated by the pilot study were treated for chlamydia (80 cases and 84 partners): 25 letters and 8 phone calls were required to achieve this. The national sexual health strategy now addresses the issue of integration of sexual health services. It may be suggested that the role of the health adviser could be fundamental to this strategy and development of a community health adviser may then evolve.
Pelvic inflammatory disease in the People's Republic of China: aetiology and management
Authors: Hong Shang , Xin Chen , Qianhong Ye , Yanan Wang , Wenyan Xu , Peeling Rosanna W , Mabey David
Published: October 2002

Objectives: To study the causes of pelvic inflammatory disease (PID) in Shenyang, Northeastern China, and to assess the efficacy of the syndromic management flowchart for PID recommended by World Health Organization (WHO).

Methods: 200 outpatients with PID attending Gynaecologic Clinic of No. 1 and No. 2 hospital of China Medical University in Shenyang, and 155 control women without symptoms underwent pelvic examination, and were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma hominis (MH), bacterial vaginosis (BV), Candida albicans (CA) and Trichomonas vaginalis (TV).

Results: In PID patients, the prevalence of MH was 26%, of BV 26%, of CT 16%, of CA 11%, of TV 4% and of NG 2.5%. In the control population, prevalences were 5.2%, 8.4%, 0%, 5.2%, 0.7%, 0% respectively. MH, BV and CT were significantly more common in PID patients than in controls ( P<0.01). One hundred and thirty-seven of the 200 patients with PID (68.5%) returned for follow-up. Symptoms had resolved completely in 64 (47%), and had improved in 68 (50%). There was no improvement in five (4%).

Conclusions: The management protocol for female lower abdominal pain recommended by WHO is effective in this setting.
AIDS defining conditions in Africans resident in the United Kingdom
Authors: Amo J. Del , Goh B. T. , Forster G. E.
Published: October 2002

A retrospective study of 55 HIV-1 seropositive African patients living in the UK, seen between January 1986 and November 1993, showed a total of 26 (47%) patients with AIDS. Thirty-one (56%) had symptomatic HIV disease at the time of presentation of whom 19 (34.5%) had an AIDS defining condition. Tuberculosis was the most common AIDS defining illness, accounting for 27% of all initial AIDS diagnoses, followed by Pneumocystis carinii pneumonia and oesophageal candidiasis in 19% each and chronic mucocutaneous genital herpes in 15%. The mean CD4 count at the time of the first AIDS defining event was 91 multiply 10/mm3 (range 4-320 10/ mm3). The profile of AIDS defining illnesses was different to published data of homosexual men and injecting drug users in the UK. This has practical implications when considering differential diagnoses and screening as well as prophylaxis for opportunistic infections in this group of patients.
Increasing trend of HIV seropositivity in a sexually transmitted diseases centre and epidemiology of HIV seropositive individuals
Authors: Ray Krishna , Ramesh V , Karmakar S N , Misra R S
Published: October 2002

11,539 STD clinic attenders and 20, 897 antenatal clinic (ANC) attenders at a New Delhi hospital were screened for HIV antibodies by ELISA over a 3-year period. Results were confirmed by Western Blot. A low HIV seropositivity rate (1 per 1000) with an increasing trend in 1993 (4 per 1000) was observed in the STD attenders as against 0.1 per 1000 in the normal control population. Most of the STD attenders including all the HIV seropositives had heterosexual contact with female sex workers. Both the HIV seropositive ANC attenders acquired the infection through blood transfusion. Thirteen of 23 HIV positive STD attenders had genital lesions, 5 having ulcerative and 8 have nonulcerative STD. Their clinical presentation did not differ from the HIV negative cases but the therapeutic response in 4 was altered. None had signs or symptoms of ARC/AIDS. Two out of 6 spouses and a 2-year-old child of HIV seropositive patients were seropositive. Increasing HIV seropositivity observed in this study reflects the changing situation in the country and highlights the importance of improvement of surveillance, early diagnosis and combined approaches to the management and control of STDs and HIV.
Contraceptive use and HIV infection in Kenyan family planning clinic attenders
Authors: Sinei S K A , Fortney J A , Kigondu C S , Feldblum P J , Kuyoh M , Allen M Y , Glover L H
Published: October 2002

This pilot study aimed to determine the feasibility of a larger study of contraception and risk of HIV infection in women. We also measured risk factors for and occurrence of HIV infection in the participants. A cohort of 1537 seronegative women attending a family planning clinic in Nairobi, Kenya was enrolled and followed for up to 12 months per woman. HIV testing was done quarterly. A nested case-control analysis was done with seroconverting women (cases) and 3 matched controls per case, who had detailed interviews and received physical examinations and STD tests. The prevalence of HIV at enrolment was 6.1%; seropositive women were excluded from further analysis. The 12-month life-table cumulative incidence of HIV was 2.1 per 100 women (95% confidence interval [CI] 1.1-3.2). In the nested case-control analysis (17 cases and 51 controls), the crude odds ratio of HIV infection comparing oral contraceptive (OC) users with other women was 3.5 (95% CI 0.8- 21.5), which persisted after control for single confounders at a time. The putative association between OC use and HIV infection is critical to public health policy, yet no study has been conducted specifically to measure it, yielding weak and conflicting evidence. We intend to conduct a larger study with a similar design as the current pilot study, which confirmed the feasibility or a more definitive project.
Laboratory-based HIV surveillance with information on exposure: importance of discriminating person-based from test-based results
Authors: van Duynhoven Y. T. H. P. , Houweling H. , Wiessing L. G. , Esveld M. I. , Nieste H. L. J. , Katchaki J. N.
Published: October 2002

Within a surveillance programme in a Regional Public Health Laboratory anonym ous information on HIV test, requesting physician and tested individual is automatically selected, regardless of test result. Thereby, personal identifiers are transformed into unique but meaningless num eric codes. Besides, requesting physicians receive a questionnaire on indication for testing (response 87%). Between April 1989 and June 1993 12,219 HIV tests were performed in 10,972 individuals. The percentage of positive tests (2.1%) was twice the percentage of positive individuals (1%). No increase in num ber of new infections was observed over tim e. Of individuals, 41.6% were tested due to third party requests (mainly insurance): HIV was demonstrated once (0.03%). Among the rem ainder, with medical indications, seroprevalence was 1.4%. At relatively little expense, we were able to provide valid information about patterns of HIV-testing and HIV seroprevalences am ong people tested in routine medical practice. Prevention of double counts proved to be important. Extension to other Dutch areas is expected.
Men with repeated episodes of gonorrhoea 1990-1992
Authors: Sherrard Jackie , Barlow David
Published: October 2002

Patients who acquire repeated infections of gonorrhoea are well described. A study was undertaken of male patients attending a central London clinic in an attempt to identify features of those acquiring repeated infections to facilitate risk reduction strategies. During the 3 years 1990 to 1992, 18.8% of patients contributed 35.8% of episodes with a mean time between episodes of 10.5 weeks. Those with repeat infections were more likely to be black and to have had more than one episode of gonorrhoea prior to the study period. They are also more likely to have had 3 or more recent partners. While those with repeated infections do not form a homogeneous group there are certain characteristics that should enable targeting of a subgroup.
University students' knowledge of STDs: labels, symptoms and transmission
Authors: Minichiello V , Paxton S , Cowling V , Cross G , Savage J , Sculthorpe A , Cairns B
Published: October 2002

A sample of 630 Victorian university students, aged between 17 and 24, completed a questionnaire on knowledge of sexually transmitted diseases (STDs). Overall students demonstrated moderate levels of knowledge about the names of diseases which are transmitted by sexual contact, symptoms and medical facts and transmission modes of common STDs. However, they had more knowledge about the labels than they did about symptoms and transmission modes and were misinformed about certain clinical aspects of STDs. It was found that the different levels of knowledge varied with the type of STD. Knowledge about symptoms or transmission did not correlate with a disease's incidence or clinical aspects. Sexual experience and having an Australian born mother correlated with higher scores. This study suggests that young people do not have high levels of knowledge about common STDs they may encounter. Identification of a label is of limited personal value if there is no concurrent knowledge about disease transmission and prognosis.