bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual molestation of men: interviews with 224 men attending a genitourinary medicine service
Authors: Coxell Adrian W , King B , Mezey Gillian C , Kell Philip
Published: October 2002

Prevalence studies of sexual molestation in men attending genitourinary medicine (GUM) clinics have concentrated on experiences in adulthood or as a child, or on men who report male sexual partners only. Use of questionnaires in such studies can lead to under-reporting of 'sensitive' events. Our aim is to identify the lifetime prevalence of sexual molestation in men attending a GUM clinic using a self-administered, computerized interview via a cross-sectional survey. Eighteen per cent of respondents reported sexual molestation as an adult and 12% reported child sexual abuse (CSA). Sexual molestation in adulthood was more common in men who reported male sexual partners and in men reporting child sexual abuse. Fourteen per cent of victims reported being infected with a sexually transmitted infection (STI) after adult sexual molestation. In conclusion, a significant proportion of men attending GUM services report sexual molestation. Further research is required into effective ways of addressing this unmet need.
Off-street sex workers and their use of genitourinary medicine services
Authors: Bell G , Rogstad K
Published: October 2002

Our objective was to identify barriers to the use of genitourinary medicine (GUM) services for off-street female sex workers in a provincial city, using self-administered anonymous questionnaires distributed to premises during outreach sessions by a clinic health adviser. Questionnaires were completed by 85 (56%) of the estimated 150 women working in the 13 targeted premises. The main obstacles to service use were the length of time spent in clinic (83%), dislike of needles (28%), difficulty getting to clinic (18%) and dislike of examinations (16%). The majority (71%) rejected sex worker-only sessions. Women using the local service, which provided outreach sessions, were more likely to have disclosed their occupation to the service (82% vs 36%; P = 0.035). GUM clinics may optimize their accessibility to sex workers by minimizing the time required per visit, and introducing non-invasive screening methods where possible. Outreach visits by clinic staff may encourage women to disclose their occupation, enabling them to assess vaccinations for hepatitis B.
New approaches to sexual health services in a rural health board area: involving service users and primary care professionals
Authors: Doherty L
Published: October 2002

Research was undertaken to inform the future development of sexual health services for the population of a rural health board. Three separate surveys were carried out: (i) users of local and regional genitourinary medicine (GUM) services, (ii) users of local family planning clinics, and (iii) all local general practitioners (GPs) and practice nurses - to obtain views on current sexual health services and the optimum future configuration of services. Respondents to the GUM survey ( n = 137) attended GUM service for a range of sexual health reasons; confidentiality was the most important factor affecting choice of service provider and almost half (44%) would have been happy to receive the service from their GP. Family planning clinic respondents ( n = 298) attended clinics for a range of reasons; confidentiality was the most important factor affecting choice of service provider and less than one-third (29%) would attend their GP for a similar service. Both GUM and family planning clinic survey respondents supported the development of clinics providing a broad range of sexual health services. Almost all (97%) GP respondents in the primary care professionals survey saw patients for sexual healthrelated consultations; over half (54%) treated sexually transmitted infections (STIs). Significant training needs in sexual health were identified for primary care professionals. New models for the provision of sexual health services are proposed for this health board area.
A case of pneumocystis pneumonia after cessation of secondary prophylaxis
Authors: Quah S. P. , McBride M.
Published: October 2002

Improvement in the immunological and virological profile of HIV-infected population during the era of highly active antiretroviral therapy (HAART), has allowed guidelines on discontinuation of Pneumocystis carinii pneumonia (PCP) prophylaxis to be published. A case of a 37-year-old homosexual man, who had sustained CD4 count over 200 cells/mul for 2 years while on secondary prophylaxis for PCP, who then developed PCP after cessation of prophylaxis, is presented. This case emphasizes the need for close monitoring of patients who discontinued secondary PCP prophylaxis with respiratory symptoms.
Selected Abstracts
Authors: Quah S. P.
Published: October 2002

The Royal Society of Medicine Press produce, as a regular feature of the Journal, a selection of abstracts from 60 of the leading journals which regularly publish in the field of sexually transmitted infections and HIV. The aim is to inform readers of recent advances, which they may otherwise have overlooked. The articles included are personal selections made by Dr W. W. Dinsmore (Editor) and myself. We hope that this will provide a valuable service.
Plasma cell balanitis of Zoon: response to Trimovate cream
Authors: Tang A. , David Nelson , Horton L. W. L.
Published: October 2002

Our objective was to evaluate the response to Trimovate cream in patients with Zoon's balanitis. Patients attending the penile dermatosis clinic between October 1996 and October 1999 with the clinical and histological features diagnostic of Zoon's balanitis were included in this study. They were treated with Trimovate cream for a varying length of time according to clinical response, having declined circumcision as first-line treatment. All cases had photographs taken before and after treatment. Ten cases of histologically-confirmed Zoon's balanitis were treated. Clinical resolution was observed in all cases, all of whom remain on long-term follow-up. In conclusion, topical Trimovate cream is an effective treatment for Zoon's balanitis.
Antimicrobial susceptibilities and plasmid patterns of Neisseria gonorrhoeae in Bénin
Authors: Van Dyck E. , Alary M. , Guédou A. , Abdellati S. , Lafia E. , Anagonou S.
Published: October 2002

This study describes antimicrobial susceptibility patterns of Neisseria gonorrhoeae isolates obtained from female sex workers in Cotonou, Bénin. All isolates were susceptible to spectinomycin, ceftriaxone and ciprofloxacin, and susceptible to moderately susceptible to kanamycin; 9.8% of isolates were resistant to thiamphenicol; 9%, 87.5% and 3.5% were susceptible, moderately susceptible, resistant to trimethoprim-sulfamethoxazole, respectively; 94.4% and 99.3% were resistant to penicillin and tetracycline, respectively. All isolates with a minimal inhibitory concentration of tetracycline of > 8 mg/l carried the 'American type' tetM plasmid; 94% and 6% of penicillinase-producing isolates possessed a 3.2 MDa and a 4.4 MDa β-lactamase plasmid, respectively. Surveillance of antimicrobial susceptibility of N. gonorrhoeae isolates to currently used drugs in Africa should become part of sexually transmitted diseases (STDs) control programmes.
The use of anabolic agents in HIV disease
Authors: Newshan Gayle , Leon Wade
Published: October 2002

Anabolic steroids are synthetic analogues of the natural adrogenic 'male' hormone called testosterone that is produced primarily in the testes in males and in the ovaries in females. Anabolic steroids and other agents are fast becoming part of the standard of care for HIV disease, gaining acceptance in reversing loss of lean body mass, increasing muscle strength, improving sexual functioning and appetite and creating a general sense of well-being. This article will review commonly prescribed anabolic agents, discuss potential side effects and contraindications.
Antiretroviral resistance in clinical practice
Authors: Geretti Anna Maria , Easterbrook Philippa
Published: October 2002

Despite the success of potent combination therapy against HIV, a large proportion of patients experiences treatment failure. Due to the high degree of plasticity of the HIV genome, ongoing virus replication in the presence of drug pressure will result in the selection of virus mutants with reduced drug susceptibility. As a result, antiretroviral drug-resistance is a common denominator in treatment failure. Two methods, genotyping and phenotyping, are commercially available for measuring resistance in clinical samples. Whereas genotyping detects resistance-conferring mutations in the HIV reverse transcriptase and protease genes, the recombinant virus assay is a newly developed phenotyping technique which determines drug-susceptibility in a virus culture assay. With both methods, result interpretation remains challenging. Retrospective studies and randomized controlled clinical trials support the clinical utility of resistance testing in the setting of treatment failure. The optimal applications of resistance testing in a variety of other clinical settings remain to be defined.
A rural HIV epidemic in Zimbabwe? Findings from a population-based survey
Authors: Gregson Simon , Mason Peter R. , Garnett Geoff P. , Zhuwau Tom , Nyamukapa Constance A. , Anderson Roy M. , Chandiwana Stephen K.
Published: October 2002

The aim of the study was to use population-based data from 689 adults to describe the socio-demographic, behavioural and biomedical correlates of HIV infection and aid identification of effective HIV control strategies for rural Zimbabwe. Dried blood spot and urine samples were collected for HIV and sexually transmitted disease (STD) testing and participants were interviewed on socio-demographic characteristics, sexual behaviour and experience of STD symptoms. HIV seroprevalence was 23.3% and was higher in females, divorcees, widows, working men, estate residents, and respondents reporting histories of STD symptoms. Female HIV seroprevalence rises sharply at ages 16-25. A third of sexually-active adults had experienced STD-associated symptoms but there were delays in seeking treatment. Herpes simplex virus type 2 (HSV-2) and Trichomonas vaginalis are more common causes than syphilis, gonorrhoea, and chlamydia, and are strongly associated with HIV infection. Local programmes promoting safer sexual behaviour and fast and effective STD treatment among young women, divorcees and working men could reduce the extensive HIV transmission in rural communities.
Testicular atrophy in 80 HIV-positive patients: a multivariate statistical analysis
Authors: Mhawech Paulette , Onorato Michelle , Uchida Tatsuo , Borucki Michael J.
Published: October 2002

This retrospective study of risk factors for testicular atrophy in HIV-infected men investigates the relationship between complications of AIDS such as wasting or opportunistic illness and testicular atrophy. Microscopic sections of the right testis were evaluated for testicular atrophy by assessing the mean score in each of 80 selected HIV-infected patients who underwent an autopsy during a one-year period. A significant association was observed between testicular atrophy and body mass index (BMI) ( P=0.0496). Thus, underweight patients with HIV infection were 3.52 times more likely to have testicular atrophy than those with acceptable body weight. Other significant associations between other variables were not found.
Prognostic score of short-term survival in HIV-infected patients admitted to medical intensive care units
Authors: Bonarek M. , Morlat P. , Chêne G. , Rapin D. , Hilbert G. , Pillet O. , Gabinski C.
Published: October 2002

A retrospective cohort was set up to identify prognostic factors associated with in-hospital survival in HIV-infected patients admitted to medical intensive care units (MICUs), from 1991 to 1994. Survival from MICU admission to hospital discharge (or in-hospital fatal issue) was estimated and a prognostic score at MICU admission was developed. One hundred and thirty patients were recruited of whom 20% were AIDS-free prior to admission. In-hospital mortality rate was 65%. Median survival was 20 days. The following variables were predictive of mortality: Simplified Acute Physioloy Score II (SAPS II): (hazard ratio [HR]=1.5 for 10 points higher, P<10-3), time between HIV diagnosis and admission >5 years (HR=2.7, P<10-4), hypoalbuminaemia (HR=1.2 per 5 g/l lower, P=0.03). The prognostic score developed was: SAPS II+25 (if time between HIV diagnosis and MICU admission >5 years) albuminaemia (g/l). A new prognostic score including SAPS II, prior HIV history and albuminaemia better reflected the in-hospital mortality than SAPS II alone. Our findings may still be useful to better evaluate the immediate prognosis of current HIV-infected patients admitted to MICU, particularly those naive to antiretroviral therapy or in treatment failure.
Safe sexual behaviour among female partners of HIV-infected men in Rio de Janeiro, Brazil
Authors: Guimarães Mark D C , Boschi-Pinto Cynthia , Castilho Euclides A
Published: October 2002

A cross-sectional study was designed to assess safe sexual behaviour among heterosexual couples after the woman learned of her partner's infection with HIV. Female partners who had known their partners' serostatus for at least 4 weeks were eligible for participation. Couples were interviewed separately and independent predictors of safe sexual behaviour were identified using multiple logistic regression. Safe sexual behaviour was defined as no unprotected vaginal, oral, or anal intercourse. Of 328 women, 197 (60%) reported safe sexual behaviour since learning of their partners' infection. Significant independent predictors of safe sexual behaviour included older women (>30 years old) (odds ratio [OR]=1.89; 95% confidence intervals [CI]=1.01–3.51), current negative HIV serostatus (OR=2.72; 95% CI=1.50–4.94), advanced clinical stage of the index case (OR=1.96; 95% CI=1.07–3.59), longer duration of relationship (10+ years) (OR= 2.35; 95% CI=1.15–4.82), fewer sex contacts (<100) (OR=2.01; 95% CI=1.14–3.56), only one lifetime partner (OR=2.29; 95% CI=1.26–4.17), non-smoking (OR=2.67; 95% CI=1.43–4.99), not practising oral sex (OR=3.35; 95% CI=1.82–6.19) and previous HIV testing (OR=2.11; 95% CI=1.09–4.07). In addition, women who had known their partner's infection for longer were less likely to report safe sexual behaviour ( P < 0.001). Our results indicate that among female partners of HIV-positive Brazilian men, learning of their partner's infection does not uniformly result in safe sexual behaviour. Counselling must emphasize disclosure of serostatus to female partners and target couples with short-term relationships, as well as those where the woman has known about her male partner's infection for a long time, because these are the least likely to maintain safe sexual behaviour.
Use of complementary therapies in a sexual health clinic setting
Authors: Trutnovsky G , Law C , Simpson J M , Mindel A
Published: October 2002

This prospective cohort study examined the health-seeking behaviour of patients diagnosed with genital warts and vulvodynia who presented to Manly Sexual Health Service from March to June 2000. A self-administered questionnaire was used to assess patients' perceptions of their condition and their use of complementary therapies. Thirty-seven patients with genital warts and 26 patients with vulvodynia participated in the study. The use of at least one complementary health product or method was reported by 59% of patients with genital warts and 96% of vulvodynia patients ( P < 0.001). Having received conflicting information and being worried about the condition was significantly associated with visits to complementary health providers. Acknowledgement of this search for complementary therapies and open discussion can help patients make informed decisions and to avoid drug interactions, and should ultimately lead to better patient care.
Body piercing: lifestyle indicator or fashion accessory?
Authors: Willmott Fred E.
Published: October 2002

A study was undertaken to assess the prevalence of body piercing (BP) in women attending a sexually transmitted disease (STD) clinic, and any associated demographic, socioeconomic and sexual indicators. One hundred and fifty-two new female patients attending the Southampton clinic were the subjects of the study; of these 52 (32%) had BP, the most common site being the navel (25%). BP was more common in women who had their ears pierced more than once (35:71, 49%). It was less common in women who were non-smokers, being present in 17:77 (22%), and in older women, only one of 18 (6%) women aged 35 or older having had BP done. The presence of BP was not associated with socioeconomic class, method of contraception, multiple partners, or the presence of any genital infection. The study supports the suggestion that most BP is done for fashion reasons.
Temperature stability of vaginal specimens for Chlamydia trachomatis detection by Amplicor polymerase chain reaction assay
Authors: Witkin S S , Tolbert V , Sharma G , Polaneczky M
Published: October 2002

Vaginal introital specimens were collected from 17 women – 10 positive and 7 negative for Chlamydia trachomatis, and kept in Amplicor collection medium at ambient temperature. Aliquots were removed at intervals for up to 34 days and frozen at -80°C. Samples were thawed and assayed for C. trachomatis by polymerase chain reaction (PCR). The results of all specimens remained unchanged over this time interval.
Screening for Chlamydia trachomatis infection using the BDProbeTec™ ET Chlamydia trachomatis amplified DNA assay on urine in a GUM clinic setting: a simple, fast and cost-effective alternative
Authors: Browning M R , Corden S , Mitchell B , Westmoreland D
Published: October 2002

This study compared the BDProbeTec™ ET Chlamydia trachomatis amplified DNA assay on urine specimens with culture of genital swabs for the detection of C. trachomatis in patients attending the Department of Genitourinary Medicine (GUM), Cardiff Royal Infirmary. Almost twice as many patients tested positive by BDProbeTec™ ET than by culture. A similar difference was found for both males and females. The case notes of those patients positive by BDProbeTec™ ET alone were analysed and a significantly greater number were found to have risk indicators for C. trachomatis infection when compared with age and sex comparable controls, providing clinical validation of our findings. The BDProbeTec™ ET assay was easy to use, more importantly, the test format features an internal control integral with every sample. The cost per true positive was calculated as comparable with culture. We conclude that the BDProbeTec™ ET assay is a superior alternative to culture for identifying patients infected with C. trachomatis in the GUM clinic setting.
Selected Abstracts
Authors: Quah S. P.
Published: October 2002

The Royal Society of Medicine Press produce, as a regular feature of the Journal, a selection of abstracts from 60 of the leading journals which regularly publish in the field of sexually transmitted infections and HIV. The aim is to inform readers of recent advances, which they may otherwise have overlooked. The articles included are personal selections made by the Editor and myself. We hope that this will provide a valuable service.
Quality of life among urban Canadian HIV/AIDS clinic outpatients
Authors: Burgoyne Robert W. , Saunders Douglas S.
Published: October 2002

Perceived health-related quality of life (QOL) of 113 adult people living with HIV/AIDS (PHA) attending an outpatient hospital clinic was assessed upon initial registration using the Medical Outcomes Study SF-36. QOL ratings on both physical functioning and psychological well-being aspects of the SF-36 were lower than for the general population, especially among PHA in the sample who were symptomatic or for whom AIDS had developed. Although not compromised in terms of physical functioning, asymptomatic PHA had well-being QOL scores comparable to other chronic medical conditions. In general, demographic, social, and many of the health and immune status variables examined were not significantly related to QOL. Number of symptoms was negatively associated with both physical status and emotional well-being dimensions of QOL. PHA in the asymptomatic stage of HIV infection reported better QOL than symptomatic/AIDS patients on few QOL dimensions. Mean QOL ratings did not significantly differ between AIDS patients and those with symptomatic (non-AIDS) infection. These findings suggest that although becoming symptomatic has a significant impact on a majority of dimensions of QOL, being diagnosed with HIV affects well-being dimensions the most. An emphasis on support for both adjusting to diagnosis and symptom management is as important as viral suppression in maximizing QOL for PHA.
Over-the-counter advice for genital problems: the role of the community pharmacist
Authors: Ralph S. G. , Preston A. , Clarke J.
Published: October 2002

This year, in the UK, levonorgestrel was approved for sale in pharmacies for emergency contraception. This study assessed, using a postal questionnaire, the ability of community pharmacists to provide advice relating to sexual health, their comfort and training in this area, and their knowledge of local genitourinary medicine (GUM) services. Fifty-four per cent of pharmacists responded. Most (79%) did not know where their nearest GUM department was; only 21% had ever advised a patient to attend a GUM clinic. Twenty-nine per cent said they were not able to broach the possibility of a sexually transmitted infection (STI) with a patient of both sexes. Forty-four per cent had received training related to post-coital contraception. Greater liaison between GUM departments and community pharmacists is suggested as a way of increasing the proportion of patients presenting to a pharmacist who are referred appropriately to a GUM clinic.
Seroepidemiology of low and high oncogenic risk types of human papillomavirus in a predominantly male cohort of STD clinic patients
Authors: Slavinsky Joseph , Kissinger Patricia , Burger Lauren , Boley Allison , DiCarlo Richard P. , Hagensee Michael E.
Published: October 2002

Human papillomaviruses (HPV) infecting the genital tract are associated with warts and anogenital malignancies. Although HPV is a highly prevalent sexually transmitted disease (STD), the majority of research has focused on female cohorts due to gender specific sequelae. Our objective was to measure the epidemiological features and seroprevalences of HPV-6/11 and 16 in a predominantly male group of STD clinic patients. High-risk individuals ( n=687), who attended the public STD clinic were administered a behavioural questionnaire and serum tested for antibodies against HPV-6/11 and HPV-16 capsids via capture enzyme-linked immunosorbent assay. Despite the male predominance in this study, women were significantly more likely to have antibodies against both HPV-6/11 and HPV-16. Condom use appeared to be partially protective against HPV-16 seropositivity only. In conclusion, despite exhibiting increased risk behaviour, men were less likely to be HPV seropositive. Additional studies utilizing male cohorts are warranted to further elucidate this phenomenon.
'They never tell you about the consequences': young people's awareness of sexually transmitted infections
Authors: Garside R , Ayres R , Owen M , Pearson V A H , Roizen J
Published: October 2002

Young people are at risk from sexually transmitted infections (STIs)—the incidence of chlamydia in the UK is highest among young women aged 16–19. Despite this, young people lack knowledge about STIs and are more aware of the risks of unwanted pregnancy than their risk of acquiring an STI. This study used qualitative and quantitative methods to examine what teenagers know about STIs, their prevention, symptoms, treatment and services. Only one-third of respondents recognized chlamydia as an STI. The little knowledge of STIs that was revealed was superficial. Few were aware that special services existed for STIs. Condoms were seen as contraception, not as a method of preventing infection transmission. High teenage pregnancy rates have received much publicity but less attention has been paid to rising STI incidence. Programmes aimed at decreasing pregnancy rates through adoption of effective hormonal contraception not only fail to address STIs but may be detrimental to prevention efforts.
HIV antibody testing among the Hong Kong mainland Chinese cross-border sex networking population in Hong Kong
Authors: Lau Joseph T F , Wong Wing S
Published: October 2002

The present study reports the results of 2 surveys examining the likelihood of performing HIV antibody test among the Hong Kong mainland China traveller population. The 2 studies interviewed 1325 and 2074 male adult Hong Kong residents. Among those who had had sexual intercourse with a female sex worker (FSW) in the past 6 months, 31.1% in the first sample indicated that they intended to take an HIV antibody test in the future, whereas 16.4% in the second sample reported they had actually taken a blood test for HIV antibody. In both samples, no association was found between demographic variables, attitudinal/knowledge-related variables and intention to do a blood test for HIV antibody and actual testing behaviour. Moreover, in both samples, those who had more female sexual partners in the past 6 months were more likely to report an intention for HIV test or to have taken an HIV test.
Factors involved in clearance of genital warts
Authors: Wilson J D , Brown C B , Walker P P
Published: October 2002

Consecutive patients with first presentation of external anogenital warts had the location, duration at presentation, number of warts and wart area, age, smoking and sun bed use, and presence of coexistent sexually transmitted infections (STIs) recorded. The number of treatment episodes, and number of weeks, to clear the warts were documented. Number of warts and wart area at presentation were associated with time and number of treatments to clear. Those with 1-3 warts required significantly fewer treatment episodes and less time to clear than those with 11-41 warts, as did those with warts area 2-19 mm2 compared with wart area 100-1038 mm2. Using survival analysis, the number of warts was significant for the number of treatments and weeks to clear. The hazard ratio for clearance with double the number of warts after 4 treatments was 0.53 (95% confidence interval [CI] 0.37-0.76), and at 4 weeks was 0.70 (0.45-0.86). The clearance rates in non-smokers compared with smokers were higher, but not significantly different. Wart burden at presentation is an indicator of time to clearance. The number of warts is the best predictor — fewer warts results in earlier clearance.
Development of a heminested polymerase chain reaction assay for the detection of Haemophilus ducreyi in clinical specimens
Authors: Tekle-Michael Tsegaye , Van Dyck Eddy , Abdellati Saïd , Laga Marie
Published: October 2002

Detection of Haemophilus ducreyi in genital ulcer specimens by culture lacks sensitivity. To enhance detection, a heminested polymerase chain reaction (PCR) assay was developed targeting the nucleotide sequence of a gene, designated p27, which encodes for a 27 kDa H. ducreyi-specific protein. The p27 PCR assay detected all (37/37) H. ducreyi strains tested and gave no amplified product from DNA extracts of any of 31 other microorganisms, from 30 non-genital ulcer specimens, or from 29 urethral and vaginal swab specimens collected from non-chancroid STD patients. In genital ulcer disease specimens, compared to combined positive results obtained by culture and a previously described PCR assay, the p27 PCR assay showed a sensitivity of 91% (48/53). The p27 PCR assay provides a specific and a sensitive detection of H. ducreyi in clinical specimens.
An urban epidemic — an audit of an inner city young persons' clinic
Authors: Burns F , Curran B , Tobin R , Kell P
Published: October 2002

In 1996 a young persons' clinic was set up at the Archway Sexual Health Clinic. A retrospective case note review of all attendees for 7 months in 1999 was performed to assess the demography and incidence of sexually transmitted infections (STIs) amongst attenders of the clinic. There were 567 attendances, comprising 364 individuals (331 women and 33 men). Ten per cent of attendees were less than 16 years of age, and 48% were 16-18 years. Fifty-eight per cent were from ethnic minorities. Chlamydial and gonococcal infection was identified in 21.3% and 8.4%, respectively. Thirty-five per cent of new presentations by women involved pregnancy testing, 28.6% were positive. The introduction of the clinic has been successful judged both by the amount of attendances and diseases diagnosed. Specific provision of services for this group needs to be addressed by all sexual health providers.
Determinants of gonorrhoea infection among STD clinic attenders in Trinidad—I: Sociodemographic factors, knowledge, risk perception and history of STD
Authors: Castor D , Prabhakar P , Furlonge C , Rao A , Brown A , Camara B , Weiss H , Jolly P E
Published: October 2002

We determined the prevalence of Neisseria gonorrhoeae and describe sociodemographic factors, knowledge and sexually transmitted disease (STD) history associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI). The prevalence of gonorrhoea was 25%. Predictors for gonorrhoea were: male gender (odds ratios [OR] 3.5), age 15-19 (OR 2.5) and 20-29 years (OR 2.1), unawareness of the term STD (OR 1.5), self-perceived risk for STDs (OR 1.7) and no history of syphilis (OR 2.0). When the data were analysed by gender, significant associations were identified between gonococcal infection and age <30 years, single status, and self-perceived risk for STDs for males. Among females, significant associations existed between gonorrhoea and age <30 years, and unawareness of the term STD. This study is novel in describing sociodemographic characteristics of STD clinic attenders, and risk markers associated with gonococcal infection in Trinidad.
Are sexually transmitted infections associated with scabies?
Authors: David Nelson , Rajamanoharan S , Tang A
Published: October 2002

Sexually transmitted infections (STIs) have been previously reported to be associated with scabies in sexually active people. The UK national guidelines on STIs recommend screening for other STIs in patients with scabies attending a genitourinary medicine (GUM) clinic. However, there is a paucity of literature on this association, which we reviewed. We looked at the sexual behaviour and the coincidence of STIs in patients with scabies attending a GUM clinic and in inmates from a young offender institution (YOI) attending between 1 January 1998 and 31 December 1999. A total of 47 patients with scabies were identified in the GUM clinic population during this period and 15 patients in the YOI group. Consecutive new and rebooked sex-matched patients served as a control group. Among the GUM clinic attendees 36% of patients with scabies had multiple sexual partners in the preceding 3 months compared with 21% in the control group ( P=0.11). Thirty-four per cent of patients with scabies had a previous history of STI vs 17% in the control group ( P=0.058). The number of patients with coexistent STIs was not significantly different in both groups (49% vs 44%, P=0.68). The number of patients in the YOI group was too small for a statistical analysis. This study showed that patients with scabies had comparable rates of STIs as with the GUM clinic population. It therefore supports the national guidelines in recommending screening for other STIs in patients with scabies.
A retrospective study of the clinical effectiveness of the treatment of genital co-infection with N. gonorrhoeae and C. trachomatis in Coventry
Authors: Das S , Wade A A H , Allan P S
Published: October 2002

Concomitant infection of Neisseria gonorrhoeae and Chlamydia trachomatis is frequent and it is common practice to prescribe ancillary treatment for chlamydial infection when infection with N. gonorrhoeae is suspected or confirmed. In Coventry cases are treated as they are diagnosed. Our objective was to determine the clinical effectiveness of treating gonorrhoea and chlamydial infection separately in cases of co-infection. Case notes of co-infection with N. gonorrhoeae and C. trachomatis diagnosed in Coventry GU clinic from March 1989 to February 2000 were reviewed retrospectively. There were 1250 episodes of gonorrhoea, 4127 of chlamydial infections, and both infections were found in 332 cases. The two infections were treated in 322 cases and in 235 cases were treated separately. Ten cases did not come back for treatment of chlamydial infection, which is less than one case per year and 0.2% of total chlamydial infection in 11 years. On the other hand, 918 (73%) of total number of gonorrhoea patients did not have to take unnecessary treatment for chlamydial infection. In some clinical settings co-infection with N. gonorrhoeae and C. trachomatis could be treated separately with significant success and in the long run this might prevent development of antibiotic resistance of C. trachomatis infection.
HIV treatments optimism is associated with unprotected anal intercourse with regular and with casual partners among Australian gay and homosexually active men
Authors: Van de Ven Paul , Rawstorne Patrick , Nakamura Tamo , Crawford June , Kippax Susan
Published: October 2002

We examined HIV optimism and unprotected anal intercourse (UAI) in a nationwide sample of gay and homosexually active men. Questionnaires were distributed throughout Australia through pornographic catalogues. 1832 men responded, 1181 (64.5%) classified as gay community attached (GCA) and 651 (35.5%) as non-GCA (NGCA). Mean HIV optimism scores tended toward scepticism rather than optimism, with no significant difference between GCA and NGCA men. Men who had UAI with regular partners were significantly more optimistic than men who did not ( P<0.001). There was a significant UAI-casual/GCA interaction ( P<0.001). GCA men who engaged in UAI-casual were significantly more optimistic than GCA men who did not ( P<0.001). Likewise, NGCA men who had UAI-casual were significantly more optimistic than NGCA men who did not ( P<0.001). These findings corroborate earlier evidence that gay men's UAI is associated with - not necessarily caused by - HIV optimism. Importantly, these data come from a broad national sample rather than one drawn from within a 'gay precinct'.
High levels of sexual HIV/STD risk behaviour among Roma (Gypsy) men in Bulgaria: patterns and predictors of risk in a representative community sample
Authors: Kabakchieva Elena , Amirkhanian Yuri A , Kelly Jeffrey A , McAuliffe Timothy L , Vassileva Sylvia
Published: October 2002

Studies on HIV and STD risk factors among vulnerable minority groups in Eastern Europe are underrepresented in the literature. The rapid increase in HIV and STD rates observed throughout the region may quickly affect impoverished, stigmatized, and underprivileged communities. Roma (or Gypsies) constitute such a vulnerable group. A total of 324 men aged 14-37 years were recruited during June-July 2001 in a Roma community neighbourhood in Sofia, Bulgaria. HIV/STD risk behaviours were widespread. Men reported a mean of 2.4 female partners in the past 3 months and 77% did not use a condom during their most recent vaginal intercourse. 72% of Roma men said they had engaged in anal intercourse with women in the past 3 months and almost 75% of these heterosexual anal intercourse occurrences were unprotected. 27% reported having sex with other men during their lifetimes, 10% had same-sex anal intercourse partners in the past 3 months, and 58% of the most recent anal intercourse acts by these men were not condom-protected. 16% of men reported selling sex, and 32% paid someone for sex. Positive condom-use attitudes, intentions, norms and self-efficacy, as well as younger age and condom availability, were factors associated with lower sexual risk. These factors should be targeted in rapid, comprehensive, and culturally sensitive prevention interventions for Roma communities.
Audit of hepatitis B immunization at the genitourinary medicine department in Middlesbrough, UK
Authors: Opaneye A A , Bashford J
Published: October 2002

The outcomes of hepatitis B immunization programme at the genitourinary medicine (GUM) department in Middlesbrough during a period of five years were examined. The majority of those immunized were male homosexuals who had earlier requested an HIV test. All participants had preimmunization hepatitis B serology, and were negative. The default rate was high at 20/42 (47.6%). However, among those who completed all the processes, seroconversion rate was high at 21/22 (95.5%). The only non-responder was a man who was HIV-positive. The type of vaccine and immunization regimen are discussed.
The epidemiology of syphilis in pregnancy
Authors: Lumbiganon P , Piaggio G , Villar J , Pinol A , Bakketeig L , Bergsjo P , Al-Mazrou Y , Ba'aqeel H , Belizán J M , Farnot U , Carroli G , Berendes H
Published: October 2002

This study evaluated the magnitude, risk factors and outcomes of syphilis in pregnancy in a large cohort of women in four countries participating in the World Health Organization (WHO) antenatal care trial. All women attending the first prenatal care at each selected clinic were enrolled. Screening at the first antenatal visit was routinely performed with either rapid plasma reagin or Venereal Disease Research Laboratory and confirmed by fluorescent treponemal antibody absorption. All women also had the same syphilis tests after delivery. The initial prevalence, the incidence during pregnancy and the overall prevalence of syphilis at delivery were 0.9%, 0.4% and 1.3% respectively. Risk factors for syphilis during pregnancy were younger age for the incidence and older age and a history of stillbirth for the prevalence. Women with syphilis during pregnancy had significantly more adverse outcomes. We support the recommendation that in addition to the initial testing, a second routine test for syphilis ought to be established early in the third trimester even in low prevalence areas.
Is there a need for rescreening of patients treated for genital chlamydial infections?
Authors: Mårdh Per-Anders , Persson Kenneth
Published: October 2002

The present communication reviews reasons to perform rescreening of chlamydia-infected persons. It brings up difficulties to differentiate between relapse and reinfection. Studies on follow-up of chlamydia-positive cases after therapy are reviewed. It also highlights reasons for therapeutic failure, like compliance, pharmacological factors, including poor bioavailability, wrong dose regimens, lack of adherence to drug intake, neglect of partner notification and concomitant therapy in consorts, possible development of resistance to drugs generally prescribed, false negative or false positive diagnostic tests and reinfection from extra-genital not 'cured' sites. The review points to the need to establish programmes for routine rescreening of chlamydia-infected persons.
An outbreak of syphilis in Oslo
Authors: Halsos A M , Edgardh K
Published: October 2002

During 1999 and 2000, an outbreak of syphilis occurred in Norway: 93 cases were reported to the National Institute of Public Health. This report summarizes a retrospective investigation of the medical records of 60 patients with primary, secondary and early latent syphilis treated during 1999–2000 at the Department of STD at the Ullevål University Hospital in Oslo. Five women and 55 men were treated, mean age 38.6 and 44.9 years, respectively. Of the 60 cases, 14 (23.3%) had primary, 39 (65.0) secondary and seven (11.7%) early latent syphilis. Men who have sex with men (MSM) constituted 78.2% (43/55) of the male patients. Transmission among MSM was related to casual sexual contacts in bathhouses in Oslo. Two cases occurred among men with previously diagnosed HIV infection. Two new cases of HIV were reported. Condom use was inconsistent, and seldom used for oral sex.
Condom distribution: a cost–utility analysis
Authors: Bedimo Ariane Lisann , Pinkerton Steven D , Cohen Deborah A , Gray Bradley , Farley Thomas A
Published: October 2002

Objective: To explore the cost-effectiveness of a condom distribution programme. Methods: We conducted a cost-utility analysis of a social marketing campaign in which over 33 million condoms were made freely available throughout Louisiana. Surveys among 275,000 African Americans showed that condom use increased by 30%. Based on the estimated cost of the intervention and costs of HIV/AIDS-associated medical treatment, we estimated the quality-adjusted life years (QALYs) saved, and number of HIV infections averted by the programme. Results: The programme was estimated to prevent 170 HIV infections and save 1909 QALYs. Over $33 million in medical care costs were estimated to be averted, resulting in cost savings. Sensitivity analyses showed that these results were quite stable over a range of estimates for the main parameters. Condom increases as small as 2.7% were still cost-saving. Conclusion: Condom distribution is a community-level HIV prevention intervention that has the potential to reach large segments of the general population, thereby averting significant numbers of HIV infections and associated medical costs. The intervention is easy to scale up to large populations or down to small populations. The financial and health benefits of condom social marketing support making it a routine component of HIV prevention services nationally.
Sexual activity and condom use among Eastern European adolescents—the Study of Hungarian Adolescent Risk Behaviours
Authors: Gyarmathy V A , Thomas R P , Mikl J , McNutt L A , Morse D L , DeHovitz J , Ujhelyi E , Számadó Sz
Published: October 2002

While rates of HIV and STD infection in Eastern Europe are increasing rapidly, little is known about sexual behaviour, including condom use, among Eastern European youths. The Study of Hungarian Adolescent Risk Behaviours was designed to assess the knowledge, attitudes, and behaviours of adolescents studying in secondary schools in Budapest, Hungary. Students ( n =3486) in a random sample of public secondary schools completed a self-administered questionnaire, including measures of sexual activity and condom use. Thirty-eight percent of students reported ever having had vaginal intercourse. Condom use by those reporting having had sex in the past five weeks was classified as consistent/every time (40%); irregular (25.6%); and none (34.3%). Multivariate analysis revealed positive opinions about condoms, fear of AIDS, and initiation of condom use by both partners to predict more frequent condom use. Implications for targeted AIDS/STD education and prevention among adolescents are discussed.
Facts and myths on recurrent vulvovaginal candidosis—a review on epidemiology, clinical manifestations, diagnosis, pathogenesis and therapy
Authors: Mårdh Per-Anders , Rodrigues Acacio G , Genç Mehmet , Novikova Natalia , Martinez-de-Oliveira J , Guaschino Secondo
Published: October 2002

Approximately three-quarters of all women will experience an episode of vulvovaginal candidosis at least once in their life and 5-10% of them will have more than one attack. Women suffering from three to four attacks within 12 months will be diagnosed with recurrent vulvovaginal candidosis (RVVC). This review covers the large number of proposed aetiological factors for RVVC. The diagnosis of the condition made by conventional means by health providers is often false and is also often misdiagnosed by the affected woman herself. The review covers various methods of diagnosing RVVC and the current knowledge on potential pathogenetic mechanisms proposed for genital candida infections. Treatment of RVVC, including local and systemic antimicrobial therapy and behaviour modification to decrease the risk of recurrences, are discussed. Recent knowledge on drug resistance in candida is also included.
Efficacy and safety of penile biopsy in a GUM clinic setting
Authors: David Nelson , Tang A
Published: October 2002

The UK National Guidelines on Sexually Transmitted Infections recommend penile biopsy in patients with persistent balanitis and balanitis of uncertain aetiology. Many GUM clinics perform penile biopsy. However, few studies have looked at the usefulness and safety of penile biopsy in a GUM clinic setting. We assessed the spectrum of dermatological conditions seen in a penile dermatoses clinic and looked at the usefulness and safety of penile punch biopsy in a GUM clinic setting. We reviewed the case notes of patients who attended the penile dermatoses clinic at the GUM department, Royal Berkshire Hospital, Reading over a period of 18 months. A total of 87 patients were seen in the penile dermatoses clinic. Their ages ranged from 17 to 73 and 70 (80%) were uncircumcised. Twenty-four (28%) patients had biopsies and five (6%) declined. Forty-nine (56%) patients did not have a biopsy either because of a clinically apparent diagnosis (45) or lesions were close to the urethral meatus (4). Five were referred for circumcision and one was referred to a dermatologist. Three patients were lost to follow-up. Penile biopsy was performed to exclude malignancy in 17 (71%) cases and due to diagnostic uncertainty in seven (29%) cases. Histological diagnoses were consistent with initial clinical diagnoses in 17 (71%) cases. Four (17%) had minor complications following biopsy, two had wound dehiscence, one had bleeding and another had a wound infection. In conclusion, a wide spectrum of penile skin disorders were seen in the penile dermatoses clinic. The majority of patients had a clinically apparent diagnosis. The histological diagnosis was consistent with initial clinical diagnosis in most of the biopsied patients. The main indications for biopsy were to exclude malignancy and for diagnostic dilemma. Penile biopsy is a safe procedure with minimal complications.
Evaluating health-related wellbeing outcomes among outpatient adults with human immunodeficiency virus infection in the HAART era
Authors: Saunders Douglas S , Burgoyne Robert W
Published: October 2002

Quality of life (QoL) changes among 56 adult patients living with HIV/AID (PHA) were assessed following two years of care in which most had received highly active antiretroviral therapy (HAART). The sample was stratified by initial disease stage; subjects were classified 'asymptomatic' if they had no HIV-related constitutional symptoms, 'symptomatic' if they had at least one symptom, and 'AIDS' if symptomatic with a history of opportunistic infections and/or CD4 count less than 200 cells/ µL. For the overall group, changes in mean QoL (Medical Outcomes Study Short-Form-36 [SF-36]) ratings were non-significant, irrespective of initial disease stage or prior HAART exposure. Although overall there were health status improvements over the two-year period, clinical changes were generally unrelated to changes in QoL ratings. Patients with better immunologic/virologic outcomes showed slight improvements in mean QoL ratings, while those with poorer clinical outcomes showed slight deterioration. These within-group changes over time were statistically non-significant. The corresponding between-group differences in changes in SF-36 social and psychological dimensions were significant. Statistically significant differences among the three disease stage groups on a number of subscales at baseline (Physical Function, Body Pain, Vitality, Role Limitations due to Physical Problems) became non-significant (i.e. nullified) at follow-up. Significant increases in mean number of symptoms for the asymptomatic and symptomatic groups were not associated with two-year changes in QoL ratings. Overall, wellbeing was moderately stable over the two-year follow-up period, although somewhat affected by symptom changes and immunologic/virologic outcome. The study results contrast with pre-HAART longitudinal research, in which deterioration in all areas of QoL occurred.