bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of HIV infection and risk behaviours among Montreal street youth
Authors: Haley N , Leclerc P , Lemire N , Boivin J-F , Frappier J-Y , Claessens C
Published: October 2002

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.
Actinomycosis in HIV infection: a review of a rare complication
Authors: Chaudhry S I , Greenspan J S
Published: October 2002

The emergence of the human immunodeficiency virus (HIV) and the onset of the AIDS epidemic has been associated with the frequent presentation of otherwise rare opportunistic infections and neoplasms. Despite the impairments of cellular and humoral immunity that accompany HIV infection, the prevalence of actinomycosis in the HIV-infected population has remained low. This article reviews previously reported cases of actinomycosis in HIV-positive and AIDS patients. Microbiological, pathological, diagnostic, clinical and therapeutic aspects of actinomycosis in this population are discussed. Clinicians should be aware of the possibility of actinomycosis as the cause of a persistent inflammatory lesion in these patients and know the correct techniques for collecting and submitting tissue specimens for anaerobic culture.
Peripheral neuropathy: zalcitabine reassessed
Authors: Carey Peter
Published: October 2002

Given that the long-term medical management of HIV infection necessitates making best use of all available antiretrovirals, it is somewhat surprising that the nucleoside analogue reverse transcriptase inhibitor (NRTI) zalcitabine is less commonly used. This may be due to the potential for peripheral neuropathy (PN) which has been associated with the use of this drug. The perception that zalcitabine is poorly tolerated appears to have arisen largely from the results of early monotherapy trials in patients with AIDS and low CD4 cell counts. In contrast, results of more recent studies show that PN is relatively infrequent when zalcitabine is used in combination with other antiretrovirals in current treatment settings.
Undergraduates' perception of HIV immunization: attitudes and behaviours as determining factors
Authors: Liau A. , Zimet G. D.
Published: October 2002

The development of a vaccine to prevent human immunodeficiency virus (HIV) infection is a highly desirable goal. However, there may be a number of psychosocial barriers to HIV vaccine acceptance. The purpose of this study was to evaluate the relationship of health beliefs and health lifestyles to acceptability of hypothetical HIV immunization. The subjects were 549 college students who completed self-administered questionnaires that addressed health beliefs, health behaviours, and acceptability of hypothetical HIV vaccines. Results showed that all 6 variables of health beliefs, based in part on the Health Belief Model, independently predicted HIV vaccine acceptability. For the overall sample, 5 health behaviours were significantly correlated with HIV vaccination: diet, smoking, drug use, alcohol use, and prior sexual experience. The results suggest that universal HIV acceptance cannot be assumed, and that certain health beliefs and behaviours are likely to influence decisions regarding HIV immunization.
Frequent re-infection in a community with hyperendemic gonorrhoea and chlamydia: appropriate clinical actions
Authors: Thomas James C. , Weiner Debra H. , Schoenbach Victor J. , Earp Jo Anne
Published: October 2002

In a cohort of 1200 individuals experiencing an index infection of gonorrhoea or chlamydia in a rural North Carolina county, we studied the risk factors for re-infection within 16 months. The occurrence of asymptomatic reinfection was estimated from a sample of controls. Re-infection with either of the two STDs occurred in one-quarter (24%) of the study participants and 22% of the controls. The factors associated with re-infection were age less than 25 years, African-American race, male sex, and infection prior to the index infection. The behavioural and attitudinal variables tested were not associated with re-infection. The patterns of re-infection in this study do not provide guidance for targeting resources toward a subgroup of the clinic population. Structuring clinical services to make them more available and acceptable to all potential clinic clients can contribute to decreasing the duration of infections. Lowering the community prevalence in this way will then decrease the likelihood of re-infection rates.
Prevalence of bacterial vaginosis in women attending one of three general practices for routine cervical cytology
Authors: Lamont R F , Morgan D J , Wilden S D , Taylor-Robinson D
Published: October 2002

A prospective observational study of asymptomatic women from three different general practices was set up to establish the incidence of bacterial vaginosis (BV). The study group comprised 287 women recalled to their general practitioner's surgery for routine cervical smears. The prevalence of an abnormal vaginal flora was about the same in women attending the 3 practices. Nearly 14% of women had abnormal vaginal flora and about 9% had BV on Gram stain examination of vaginal secretions. This was 2-3 times more common than findings consistent with vaginal candidiasis (3.8%). Significant numbers of women with BV had received antifungal therapy suggesting a misdiagnosis. Because of its potential complications, women should be offered screening for BV in a well-women setting and, if found, should be treated if symptomatic or at risk of adverse obstetric or gynaecological sequelae.
Genital herpes simplex typing in genitourinary medicine: 1995–1999
Authors: Thompson C
Published: October 2002

Retrospective study of all culture-positive first episode genital herpes (HSV) presenting to genitourinary medicine (GUM) over a 4-year period, showing a high prevalence of type 1 (71%) HSV infection, most marked in women. This has implications for counselling patients and for the use of type-specific serological testing.
Would you get your gonorrhoea treated in the north of England?
Authors: Elawad B. B. , White Conrad
Published: October 2002

The management outcome of gonorrhoea in the northern region of England was assessed and compared with the recently published national guidelines. An audit questionnaire was completed by all genitourinary medicine (GUM) clinics in the region. Information with regard to demographic data, microscopy, culture results, test of cure, antibiotic use and sensitivity and contact tracing were recorded. A total of 420 cases of gonorrhoea were diagnosed in 1998. The ratio of males to females with gonorrhoea was 2.1:1. Half were heterosexual males and one-third females. Direct microscopy was positive in 85% of heterosexual males but in less than one-third of females. Ciprofloxacin was the most commonly used antibiotic. One-third of the isolates were resistant or partially resistant to penicillin. Health advisors saw 85% of patients and 41-68% of 'potential' contacts were seen. The management of gonorrhoea in the northern region of England complies with the national guideline recommendations.
A comparative study of cervical cytology, colposcopy and PCR for HPV in female sex workers in Singapore
Authors: Chan Roy , Khoo Lawrence , Ho T. H. , Koh C. F. , Lee I. W. , Yam K. L. , Chandra Denas , Pang Minnie , Chow Vincent
Published: October 2002

This study examined the prevalence of human papillomavirus (HPV) infection in a cohort of female sex workers in Singapore. HPV infection was diagnosed by clinical examination, Papanicolaou (Pap) smears, histology and polymerase chain reaction (PCR). One hundred and eighty-seven female sex workers who came for their routine medical screening were enrolled into the study. PCR was positive for HPV in 27 (14.4%), 20 of these had a single HPV type detected, while 7 had multiple types of HPV detected. The most common HPV types identified were types 16, 58 and 18. In conclusion, HPV infection is moderately prevalent among sex workers as tested by PCR, but routine screening with Pap smears does not appear to be a sensitive method of diagnosis for HPV infection.
Sexually transmitted diseases: magnitude, determinants and consequences
Authors: Aral Sevgi Okten
Published: October 2002

Sexually transmitted diseases (STDs) including human immuno-deficiency virus (HIV) infections constitute a major reproductive health burden for sexually-active individuals. The short-term and long-term consequences of STD have been well documented and include genital and other cancers, pelvic inflammatory disease, ectopic pregnancy, infertility, and adverse outcomes of pregnancy including pre-term delivery and low birth weight. The burden of sexually transmitted infections falls disproportionately on the young, the poor, minorities and women. At the societal level, there is a continuing need to educate people, particularly adolescents, about their risk for STDs and their sequelae and to increase the use of barrier methods including condoms. Policy decisions that facilitate more open discussion of sexuality and STDs, and that expand the accessibility and acceptability of sexual risk assessment, STD screening and treatment services would help decrease STD rates in the United States to levels similar to those observed in other industrialized countries.
Difficult wart cases - use of imiquimod cream 5%
Authors: O'Mahony C.
Published: October 2002

Treatment of genital warts is a significant part of genitourinary medicine work load. Home therapies are the sensible way forward. Even problem cases can be managed successfully. Four difficult cases with successful outcomes are discussed.
A tale of 2 cities: a comparison of demographic details, source of referral, spectrum of infection and contraceptive practice in patients under 16 years attending genitourinary medicine clinics in London and Swansea
Authors: Radja Neelam , Slatter Elaine , Thin Nicol , Blackwell Anona
Published: October 2002

Sexually transmitted infections (STIs) in young people are increasing, with children aged less than 16 years being particularly vulnerable. We compared the demographic details, spectrum of infection, contraceptive practice and source of referral in patients aged less than 16 years attending 2 genitourinary clinics, one in Swansea and the other in London. In the London population, children aged less than 16 years represented 0.7% of the total new attendances compared with 1.4% in Swansea. The female to male ratio was almost 4:1 in both clinics with most infections confined to female attenders. In females the incidence of chlamydial infection, genital warts and anaerobic (bacterial) vaginosis was 5.5%, 19% and 8%, respectively in London compared with 27%, 32% and 36% in Swansea. Seventy-two per cent of patients attending the clinic in London were self referred compared with 40% in Swansea. Contraceptive practice was also markedly different in the 2 populations, and over one-third of children in both clinics used no contraception. The high incidence of STIs in both populations and low use of contraception has serious implications for the sexual health of young people and emphasizes the need for effective sexual health education at an early age.
'Condom club': an interface between teenage sex and genitourinary medicine
Authors: Thompson C , Smith H
Published: October 2002

In response to demand from young teenagers, a nurse-led 'condom club' was established in 1996. This paper reports the use of the service from 1996 to 1999 by retrospective case note review. Two hundred and eighty-six individual males and 327 individual females made 655 and 824 visits, respectively. Condoms were accessed by 495 individuals, but girls also requested emergency contraception and pregnancy testing. Young teenagers were reluctant to have screening for sexually transmitted infections (STIs), but in those that did, 50% were found to have an STI. It is concluded that young teenagers will access a nurse-led sexual health advice service. The use of nursing staff allows greater flexibility of access. Geographical accessibility was also shown to be important.
Stabilization of HIV infection rates in urban Burkina Faso, 1995–1999
Authors: Meda Nicolas , Cartoux Michel , Dabis François , Bazié Babou , Hetherington John , Dahourou Honorine , Ouangré Amadou , Kpozehouen Alphonse , Sombié Issiaka , Tiendrebeogo Sylvestre , Yaro Seydou , Ky-Zerbo Odette , Mandelbrot Laurent , Van de Perre Philippe
Published: October 2002

The objectives of this study were to monitor the trends of the HIV epidemic between 1995 and 1999 among pregnant women in Bobo-Dioulasso, the second largest town of Burkina Faso, and to discuss the possible effect of preventive interventions (condom availability) on sexual transmission of HIV in this context. Age-specific trends in HIV prevalence obtained from sentinel surveillance programme were analysed. Among antenatal clinic attendees, HIV prevalence was 7.5% ( n=401) in 1995, 10% ( n=200) in 1996, 7.6% ( n=448) in 1997, 8.4% ( n=642) in 1998 and 5.3% ( n=716) in 1999 without demonstrated temporal trend ( P=0.12). The average number of condoms available per person (aged 15-49 years) per year increased from 0.6 in 1992 to 5.7 in 1995 and 6.0 in 1999. Anonymous surveys are less subject to selection bias and suggest a stabilization of the HIV prevalence around 7.3% in Bobo-Dioulasso. Distribution of condoms could explain at least, partly, this stabilization of the HIV epidemic.
Mucocutaneous leishmaniasis in a patient with the human immunodeficiency virus
Authors: Sánchez P , Bosch R J , de Gálvez M V , Rodrigo A B , Herrera E
Published: October 2002

We report a case of mucocutaneous leishmaniasis (MCL) in a patient with the human immunodeficiency virus (HIV), Centers for Disease Control (CDC) Stage A2, with no previous history of cutaneous or systemic leishmaniasis. The patient had not travelled outside the province of Málaga, on the Mediterranean coast of southern Spain, so that it concerns an indigenous case, extremely unusual in this area. The HIV infection may well have influenced the defence against leishmania, but the exact mechanism by which this occurred is unknown.
Midwives and HIV Antibody Testing: Identifying the Key Factors for Achieving the Targets
Authors: Foley E , Barton S E , Harindra V , Hamer G , Mandalia S
Published: October 2002

A questionnaire study was designed to assess whether differences in knowledge and attitudes to HIV infection existed between midwives working in areas of higher and lower HIV prevalence, and the extent to which this influenced the uptake of HIV antibody testing by their clients. The response rate was 75% (219/292). Midwives in an area of a higher HIV prevalence had significantly greater experience with HIV-positive mothers, were more confident with HIV-related issues and were less judgemental in their attitudes than midwives in an area of lower HIV prevalence. However, midwives who had been offering HIV testing for more than 2 years were significantly less likely to achieve an HIV antibody test uptake rate of more than 75% than those who had been offering testing for less than 2 years, 35% (95% confidence interval [CI]: 22.2–48.6%) vs 67% (95% CI: 56.3–76.0%), respectively. This demonstrates the need for regular updating of midwives about HIV antibody testing.
What do Patients Attending HIV and GUM Outpatient Clinics Want from Service Providers? Results from a Large-Scale Consultation Exercise in West London
Authors: Hope S C , Williams A E , Barton S E , Asboe D
Published: October 2002

Our objectives were to understand patient demographic profiles, experiences of care and opinions about services. A questionnaire survey of 202 HIV patients and 389 genitourinary medicine (GUM) outpatients attending clinics during one week in 1999 was undertaken at a clinical directorate of HIV/GUM in west London. HIV and GUM patients differed by age (over 30: 84% vs 39%), sex (male: 88% vs 51%), and attendance (attended 6+ times: 55% vs 14%). Most indicated that they were satisfied with the general standard of care (97% HIV patients vs 95% GUM patients). Several clinic features were rated essential. When indicating reasons they might leave in the future, HIV patients were more likely to select leading edge care factors, such as lack of up-to-date treatment (54%). More GUM patients selected factors relating to convenience, such as waiting times (58%). In conclusion, most HIV and GUM patients were satisfied with their care, but differing experiences and opinions need to be addressed when planning services.
Candida dubliniensis candidaemia in an HIV-positive patient in Ireland
Authors: Boyle B M , Sullivan D J , Forkin C , Mulcahy F , Keane C T , Coleman D C
Published: October 2002

Candida dubliniensis was first identified in Dublin in 1995 in oral isolates recovered from human immunodeficiency virus (HIV)-infected individuals. Although C. dubliniensis has been primarily recovered from the oral cavities of HIV-infected individuals, the number of reports describing its isolation from HIV-negative individuals, including cases of candidaemia, is growing. To date there has only been one report of C. dubliniensis candidaemia in an HIV-infected patient, in this case from the USA. In the present study, 2 Candida isolates recovered from blood samples were presumptively identified as C. dubliniensis on the basis of their dark green coloration on CHROMagar Candida medium and lack of growth at 45°C. This identification was confirmed by carbohydrate assimilation profile analysis and by polymerase chain reaction (PCR) analysis with C. dubliniensis-specific PCR primers. Both isolates were susceptible to fluconazole. The isolates were found retrospectively to be from a single HIV-infected patient who was receiving broad-spectrum antibacterials at the time of isolation of C. dubliniensis from blood. This study represents the first documented case of C. dubliniensis bloodstream infection in Ireland and is only the second case of C. dubliniensis bloodstream infection identified in an HIV-infected individual anywhere in the world.
Validation of the Medical Outcomes Study HIV Health Survey as a measure of quality of life in HIV-infected patients in Singapore
Authors: Paton Nicholas I , Chapman Chere A T , Chan Siew-Pang , Tan Karen M , Leo Yee-Sin , Aboulhab Jamila , Soh Chang-Heok
Published: October 2002

Measurement of quality of life is crucial to assess the full impact of antiretroviral therapy on patient morbidity. No quality of life instruments have been validated in an Asian HIV-infected patient population, but it is important to do so given the increasing involvement of the region in clinical trials. We set out to validate the Medical Outcomes Study HIV Health Survey (MOS-HIV) in HIV infected patients in Singapore. Clinically stable outpatients were asked to complete the 30-item MOS-HIV (English or Chinese translation). Patients were also asked about the frequency of selected disease symptoms, and clinical and demographic data were recorded from the case sheet. 163 patients (90% Chinese, 96% male, mean age 38 years, mean CD4 count 159 cells/mm3) participated in the study and completed the questionnaire to a satisfactory standard. The questionnaire showed good internal consistency (Cronbach's alpha >0.7 in all cases). There were significant differences in quality of life scores between Centers for Disease Control disease stages, and significant correlations with CD4 count and symptom score, confirming the discriminant validity of the MOS-HIV. Factor analysis revealed two components corresponding to physical and mental health which were similar to those of studies in Western countries except that pain was more closely related to mental than physical health. Linear regression analysis identified symptom burden as the major predictor of physical and mental health. We concluded that the MOS-HIV is a valid measure of quality of life in this HIV patient population in Singapore, and is therefore likely to be useful in future clinical trials in the region. In the era of chronic HIV disease, close attention to symptoms (disease or drug-related) is warranted due to their major adverse influence on mental and physical aspects of quality of life.
Self-reported signs of lipodystrophy by persons living with HIV infection
Authors: Dreezen C , Schrooten W , de Mey I , Goebel F D , Dedes N , Florence E , Colebunders R
Published: October 2002

Objective: To identify risk factors for the development of lipodystrophy in HIV infected patients on highly active antiretroviral therapy. Methods: A survey among patients with HIV infection using an anonymous questionnaire was conducted in 10 European countries between December 1998 and December 1999. Nine hundred and four people receiving antiretrovirals, were included in the analyses. Results: 368 (41%) people reported an increase in abdominal girth since commencing current antiretroviral treatment. Breast enlargement was reported by 106 people (12%). Lipoatrophy signs were reported by approximately one-third of the people: 291 (32%) complained about decrease in facial fat and 300 (33%) reported decrease in buttock fat. One hundred and thirty-one (15%) people reported both lipoatrophy signs and an increase in abdominal girth (mixed lipodystrophy syndrome). In multivariate analysis, the development of the mixed lipodystrophy syndrome was associated with a longer use of indinavir (OR=1.03, 95% CI: 1.00–1.06), ritonavir (OR=1.06, 1.02–1.09) and stavudine (OR=1.05, 1.02–1.08) and also with age, a longer duration of HIV seropositivity and an advanced stage of HIV infection. Conclusions: This study suggests that multiple factors are associated with the occurrence of lipodystrophy, including the prolonged use of protease inhibitors.
Low prevalence of antiretroviral resistance among persons recently infected with human immunodeficiency virus in two US cities
Authors: Sullivan P S , Buskin S E , Turner J H , Cheingsong R , Saekhou A , Kalish M L , Jones J L , Respess R , Kovacs A , Heneine W
Published: October 2002

Resistance testing for treatment-naïve, recently HIV-infected persons is not currently recommended; its clinical value will depend on the prevalence of resistance-associated mutations among recently infected persons. To estimate this prevalence, specimens were collected during 1997-1999 in Seattle and Los Angeles from drug-naïve, recently HIV-infected persons. HIV-1 protease and reverse transcriptase (RT) RNA sequences were amplified from plasma by RT-polymerase chain reaction (RT-PCR), sequenced, and analysed. Of 69 patients, five (7%) had resistance-associated mutations: three (4%) had primary mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) or non-nucleoside-RTIs, and three patients (4%) had secondary NRTI mutations. No primary mutation associated with resistance to protease inhibitors was observed. Mean age of the five persons with resistance-associated mutations (38 years) was higher than that of the 64 persons without resistance-associated mutations (31 years, P=0.04). The findings suggest that the prevalence of resistance-associated mutations among persons recently infected with HIV in these cities is low.
An audit of outpatient management of pelvic inflammatory disease
Authors: Piyadigamage Anura , Wilson Janet D
Published: October 2002

Pelvic inflammatory disease (PID) is a common condition presenting to Genitourinary Medicine clinics in the UK. It is unclear what is the best therapeutic option in the outpatient setting. A clinical audit of current standard of care in women presenting with PID was conducted. A total of 150 women were diagnosed clinically during a six-month period. Chlamydia and gonorrhoea were identified in 30% and 4% of patients respectively. The clinical and microbiological cure rates of oral doxycycline and metronidazole were assessed. In 57% of patients their symptoms resolved, but 18% had persistent signs and symptoms; 25% did not attend for follow up visit. Partner notification was discussed in 87% of patients. With a treatment failure rate of 18% we felt it appropriate to change the antibiotic regimen of PID in our department.
Judging a book by its cover: gay men's use of perceptible characteristics to infer antibody status
Authors: Gold Ron S , Skinner Michael J
Published: October 2002

This study investigated gay men's use of perceptible characteristics to infer antibody status. Participants (n =66) read brief descriptions of men they did not know and estimated the likelihood that they were HIV-infected. Each description highlighted one of 6 characteristics: physical attractiveness, intelligence/education level, healthy appearance and lifestyle, personality, a combination of the preceding, and wealth. Three versions of each sketch were used; they depicted the man in positive, neutral, and negative terms respectively. There were significant differences in the ratings for the 3 versions in the case of every characteristic except wealth. In general, the negative version elicited higher ratings (corresponding to a greater likelihood that the man was HIV-positive) than either the positive or neutral versions; in the case of physical attractiveness, the positive version elicited higher ratings than the neutral version. Results are discussed in relation to earlier findings regarding gay men's inferences, during sexual encounters, of antibody status from perceptible characteristics; to possible differences between AIDS-related thinking during sexual encounters and in the cold light of day; and to educational techniques that might be used to counter inferences of this type.
Idiopathic ulcerations of the oesophagus in HIV-infected patients: a review
Authors: Ehrenpreis Eli D , Bober Daniel I
Published: October 2002

A clinical syndrome of large ulcerations of the oesophagus has been well described in the literature in HIV-infected patients. These patients are markedly symptomatic with odynophagia and substernal chest pain as their most common presenting symptoms. Weight loss often accompanies this disorder. Despite biopsy evaluation for patients with idiopathic oesophageal ulcerations, no identifiable cause of this lesion is found. Although some authors suggest that these ulcerations represent a primary HIV infection of the oesophagus, others question the role of HIV itself in the development of these lesions. Patients with this disorder appear to respond to corticosteroid therapy in the oral, intravenous or intralesional form . This therapy could possibly predispose to infectious com plications. Acute HIV infection has also been described presenting with lesions of the oesophagus which may be single or multiple. It has again been suggested that HIV is the prim ary aetiology of the oesophageal ulcerations. Endoscopic evaluation is mandatory for the diagnosis of idiopathic oesophageal ulcerations of the oesophagus in HIV-infected patients. It is important to rule out the many other causes of oesophageal ulcerations in these patients, as treatment modalities are determined by proper diagnosis of the underlying disorder.
Practical models for the care of HIV and AIDS patients
Authors: Brailsford S. C. , Roy R. Basu , Shahani A. K. , Sivapalan S.
Published: October 2002

Mathematical models for infectious diseases are of lim ited use in providing practical help to health professionals. In this paper we discuss computer models developed jointly by operational research mathematicians and clinicians to meet this need. W e use the term 'operational modelling' to describe this pragm atic approach. The models can aid decision-making at a resource planning level and can also be used by clinicians to monitor and im prove patient care. The models incorporate uncertainty and variability and are therefore mathematically complex, but are easy to use and provide a great deal of useful information about morbidity and resource use.
Recurrent bacterial vaginosis-an old approach to a new problem
Authors: Winceslaus S J , Calver G
Published: October 2002

Bacterial vaginosis (BV) is a common cause of abnormal malodorous vaginal discharge and can be frustrating to manage in its recurrent form. Metronidazole is the standard treatment, but is unacceptable to many women when given repeatedly. Results of treating recurrent BV using a single vaginal washout with 3% hydrogen peroxide are analysed. A total of 30 symptomatic women with clinically confirmed recurrent BV in the absence of other genital infections were recruited after informed consent. Hydrogen peroxide (3%) was instilled into the vagina, left for 3 minutes and drained. Reassessment was at 3 weeks after treatment. A total of 23 women completed the study. Symptoms cleared completely in 78% (18/ 23), improved in 13% (3/23) and remained unchanged in 9% (2/23). All the 3 women with improved symptoms had a mild vaginal discharge, but only one of them was still able to perceive the malodour. The amine test was negative in all 23 women including the 2 (9%) who felt no change in their symptoms following treatment. Mixed anaerobes isolated in all women before treatment were not re-isolated, and microscopy did not show 'clue cells' in the vaginal discharge following treatment. Vaginal acidity was restored to normal in all but one (96%). No side-effects were observed in the treated women. Hydrogen peroxide (3%) used as a single vaginal wash was as effective as any other agent in current use in clearing the vaginal malodour of bacterial vaginosis at 3 weeks after treatment.
Determination of T-lymphocyte subsets on site in rural Tanzania: results in HIV-1 infected and non-infected individuals
Authors: Levin A , Brubaker G , Shao J S , Kumby D , O'Brien T R , Goedert J J , Strauss K W , Blattner W A , Hannet I
Published: October 2002

With the FACSCount TM flow cytometer, counts of CD4, CD8 and CD3 lymphocytes and CD4/CD8 ratios were performed in a rural hospital in Tanzania. A total of 168 subjects (21 HIV-1 seropositive and 147 HIV-1 seronegative) were tested as part of a population-based serosurvey and AIDS education programme; 134 other subjects were hospitalized patients who had signs and symptoms suggestive of AIDS (69 HIV-1 seropositive and 65 HIV-seronegative). Mean values for the 147 HIV-1 seronegative subjects from the local population were 980 CD4 cells (95% CI 930, 1031), 598 CD8 cells (560, 635) and CD4/CD8 ratio 1.78 (1.68, 1.89). Seropositive subjects from the local population had significantly lower CD4 cell counts, higher CD8 counts and a lower CD4/CD8 ratio. CD4 cells were significantly lower and CD8 cells significantly higher in HIV-1 seropositive hospital patients compared to HIV-1 seronegative patients. However, 23 (35%) seronegative hospital patients had CD4 counts lower than 600. These results establish baseline values for the lymphocyte subsets in this population and indicate that this technique can be used in remote areas to monitor progress of HIV-infected individuals.
HIV infection among pregnant women in Lindi, Tanzania, 1989-1993
Authors: Petry K. Ulrich , Kingu Howard
Published: October 2002

One obstacle to contain the HIV-1 epidemic in the general population in Africa is a lack of knowledge about how it is spread in rural areas. We examined 683 pregnant women in 1989 and 484 in 1993 who attended antenatal clinics in Lindi district, Tanzania to determine changes in the prevalence of HIV-1 in a remote area in East Africa. The prevalence rose from 0.44% in 1989 to 8.7% in 1993. Women with more than 1 partner (17.25% vs 2.78%), STD patients (42.4% vs 6.2%), women from urban areas (10.2% vs 3.57%) and patients younger than 21 years were more likely to have HIV antibodies. By logistic regression analysis, 1993 as year of testing was associated with the greatest risk for HIV seropositivity (P < 0.00002) followed by clinical signs of STD (P < 0.00005) and urban residence (P =0.0275). Teaching of all women attending antenatal care how to minimize their future risk of acquiring HIV is urgently needed as one tool to prevent a fast spread of HIV throughout the continent.
Forty years on-contact tracing in Wakefield
Authors: King D. , Chown R. , Clarke J.
Published: October 2002

An audit of contact tracing activity for a range of common sexually transmitted diseases (STD) was performed prospectively on 100 consecutive referrals to the health advisers at the Genitourinary Medicine (GUM) clinic in Wakefield. Targets for contact attendance were set according to the initial index patient diagnosis. Health adviser contact tracing methods (telephone, letter, visit) were logged. A total of 119 contacts were identified; of these, 86 (73%) were seen and examined. Attendance within the target time of one working week was not achieved in gonorrhoea contacts, but 61% warts contacts attended within the target of 4 weeks. Tracing by patient-carried contact slips after interview with the health adviser was effective in the majority (68%) of notifications.
Contraceptive and sexually transmitted diseases protection among adult and adolescent women infected with human immunodeficiency virus
Authors: Clark Rebecca A , Kissinger Patricia , Williams Troylynn
Published: October 2002

The goal of this study was to describe contraceptive and sexually transmitted disease STD prevention practices in human immunodeficiency virus HIV infected adult and adolescent women, and to determine if hormonal contraception has unique adverse effects in this population. A retrospective review of 241 HIV-infected women age 15-45 years was performed. The associations between contraceptive methods and selected characteristics were determined by chisquare methods and logistic regression modelling. African American race RR 8.6, 95 CI 3.3, 22.5 , injection drug use history RR 5.0, 95 CI 2.2, 11.2 , age 25 years RR 1.9, 95 CI 1.1, 3.5 and progestin only contraceptive use RR 3.0, 95 CI 1.4, 6.6 were significantly associated with incident STDs. The only potential adverse effect of hormonal contraception noted in this retrospective study was the significant association between STDs and progestin-only contraception. Prospective studies to better delineate the true association between STDs and progestin-only agents after adjustment for behaviour patterns are warranted.
Hormonal factors and the laboratory detection of Chlamydia trachomatis in women: implications for screening?
Authors: Crowley Tessa , Horner Patrick , Hughes Anthony , Berry Judith , Paul Ian , Caul Owen
Published: October 2002

One thousand and fifty-six new and re-registered consecutive women attending a genitourinary medicine clinic requiring speculum examination were screened for Chlamydia trachomatis by enzyme immunoassay (IDEIA, Dako Diagnostics Ltd). Of 1022 women who had results available for both cervix and urethra C. trachomatis was detected in 8.8% (89/1022) in any site, 2.3% (23/1022) in both sites, 4.9% (51/1022) at the cervix alone and 1.5% (15/1022) at the urethra alone. Thus sampling at the urethra increased detection by 17% (15/89). Analysis of 808 women with a regular menstrual cycle showed a significant association of combined oral contraceptive use, age and ectropion with the detection of C. trachomatis. The detection of C. trachomatis showed a significant variation with the menstrual cycle (P=0.023) (relative risk (rr) 1.7 (95% confidence intervals (CI) 1.0-2.8)). It was detected significantly more often in the latter part. Stepwise logistic regression analysis revealed that ectropion and age were the stronger determinants of C. trachomatis detection and not oral contraceptive use or menstrual cycle. The variation in detection of C. trachomatis with the menstrual cycle was independently associated with combined oral contraceptive use and the lack of a cervical ectropion. The increased detection at the cervix was present after the second week in combined oral contraceptive users (P=0.008) (rr=2.3 (1.2-4.5)) but only after the 3rd week in women without an ectropion (P=0.004) (rr=2.7 (1.3-5.5)). Combined oral contraceptives, ectropion and youth are markers for the carriage of C. trachomatis in the lower gential tract of women. It is also detected significantly more often in the latter part of the menstrual cycle in women who are oral contraceptive users.
The last sexual encounter: the contextualization of sexual risk behaviour
Authors: Leonard Lori , Ross Michael W
Published: October 2002

We aim to apply critical incident methodology to details of respondents' last sexual encounter to provide contextualized data on sexual behaviour and alleviate the problem of recall bias. In areas of Houston, Texas, registering high prevalence rates of syphilis, we elicited information from 400 men and women about the last time they had sex. Details of time, place, partner, activities, and situational circumstances were collected in street intercept interviews. Nearly 50% of men and 30% of women were drunk or high the last time they had sex, and more than one-quarter of last encounters occurred in hotel or motel rooms. Drug use was not related to condom use. Both men and women were more likely to use condoms with new than with more familiar sex partners; however, women were less likely than men to report condom use across all types of sexual activity, and particularly for anal sex. The findings are being used to design a syphilis prevention intervention in the study communities.
Sexually transmitted diseases and human immunodeficiency virus infections in women attending an antenatal clinic in Abidjan, Cote d'Ivoire
Authors: Diallo M O , Ettiegne-Traore V , Maran M , Kouadio J , Brattegaard K , Makke A , Van Dyck E , Laga M , De Cock K M
Published: October 2002

A cross-sectional survey was conducted among women attending an antenatal clinic in Abidjan to determine the prevalence of sexually transmitted diseases (STDs) and HIV infection, and to identify factors associated with the presence of gonococcal and/or chlamydial cervical infection. Among 546 women, 3.7% had a gonococcal infection and 5.5% had a chlamydial infection. The seroprevalence of syphilis and HIV was 1.1% and 16.2% respectively. Gonococcal and/or chlamydial cervical infection was associated with young age, the presence of endocervical mucopus and with more than 10 polymorphonuclear leucocytes per high power field in a vaginal smear. None of these associated factors had a large enough predictive value to allow its use as a diagnostic criterion. Sexually transmitted diseases are common in pregnant women in Abidjan. The development of rapid, inexpensive diagnostic tests for STD is a priority to improve the care of women attending antenatal clinics in the developing world.
Pilot studies of azithromycin, letrazuril and paromomycin in the treatment of cryptosporidiosis
Authors: Blanshard Christine , Shanson David C , Gazzard Brian G
Published: October 2002

Summary: Pilot studies of the safety and efficacy of 3 drugs thought to have anticryptosporidial activity were carried out to determine whether any of them are suitable for large-scale clinical trials. Open studies of the use of azithromycin, letrazuril and paromomycin in patients with acquired immunodeficiency syndrome (AIDS) and confirmed cryptosporidial diarrhoea for at least a month. Azithromycin 500 mg daily was ineffective. Letrazuril 150-200 mg daily was associated with an improvement in symptoms in 40% of patients treated and cessation of excretion of cryptosporidial oocysts in the stool in 70%; however biopsies remained positive. Paromomycin therapy was associated with a complete resolution of diarrhoea in 60% of patients treated and some improvement in symptoms in a further 5% but it did not eliminate the infection. None of the drugs had any major toxicities. Dose escalation studies of azithromycin should be performed. Letrazuril should be further investigated for efficacy in double-blind placebo-controlled trials. Paromomycin appears to result in prolonged symptomatic remission of cryptosporidial diarrhoea, but has no effect on cryptosporidial cholangitis.
Sexual behaviour and sex education in Irish school-going teenagers
Authors: Machale E. , Newell J.
Published: October 2002

Summary: The sexual behaviour and factors which affect such behaviour, source of knowledge and education about sex was assessed by means of an anonymous selfadministered questionnaire among 2754 pupils (15-18 years) attending 40 (85%) second level schools in Galway City and County. The purpose of the study was to make recommendations in relation to a school sexual health education programme. Overall 21% of pupils had had sexual intercourse, with boys more than twice as likely as girls to have experienced this. The mean age of first sexual intercourse was 15.5 years, 72% reported having used a condom at first intercourse but of 475 pupils who had sexual intercourse regularly only 67% used condoms all the time with 33% using them sometimes or never. Over half reported that first intercourse was with a 'casual' partner and 35% and 9% respectively claimed that alcohol and nonprescribed drugs were a contributory factor. In relation to sexual risk beliefs, 72% believed that condoms used properly reduced the risk of sexually transmitted diseases (STDs) and 78% knew that the contraceptive pill is not protective against human immunodeficiency virus (HIV) infections. While the level of knowledge regarding sex education was generally high over one-third of sexually active respondents had been involved in high-risk behaviour. A need for health education programmes which focus on behaviour change and assertiveness has been identified.
Satisfaction with care of patients attending a dedicated dental clinic: comparisons between 1989 and 1994
Authors: Croucher Ray , Robinson Peter , Zakrzewska M. , Cooper Heiko , Greenwood Ian
Published: October 2002

Summary: This investigation aimed to audit patient satisfaction with care at a dedicated dental clinic, using previously developed standards and criteria. A selfcomplete questionnaire was administered to a group of 161 patients assessing the dimensions of care availability, affective behaviour and technical competence. Comparisons with baseline showed a high but slightly decreased level of satisfaction with technical competence, a significantly higher level of satisfaction with the affective behaviour of the clinic staff but a continuing level of dissatisfaction with the availability of care. Respondents with AIDS reported higher levels of satisfaction for all 3 dimensions. Women were less satisfied with the availability of care. The results indicate the inter-related nature of the dimensions of technical competence and care availability. Satisfaction with care availability will only improve if initiatives beyond the clinic are introduced to increase the overall supply of dental services available to this population.
Hospital and hospice resource use of HIV-positive patients in Edinburgh
Authors: Brettle R P , Atkinson F I , Wilcock J , Richardson A , Lewis R , Maccullum L , Bath G
Published: October 2002

A prospective study of health service and hospice resource utilization (average length of stay or ALOS, discharge rate, bed day use, outpatient consultation) analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) for the financial year 1992-93 was undertaken at the Regional Infectious Disease Unit (RIDU), City Hospital, Edinburgh, Scotland where 72% of 513 patients were infected via injection drug use. Not surprising therefore overall, drug users were the heaviest users of the inpatient facilities (74% of the discharges and 65% of the bed days) although homosexuals had the highest discharge rate (114 per 100 person years) and rate of bed day use (1654 days per 100 person years). Immunodeficiency (CD4 count < 200 cells/ul) and a clinical diagnosis of AIDS were both associated with greater inpatient and outpatient resource use compared to those without immunodeficiency (CD4 count 200 CD4 cells/ul) or AIDS. Gender effects were complex; the ALOS for women was increased for all risk groups whatever the CD4 count whilst there was no consistent trend of more resource use for women by risk group. Drug users were the heaviest overall users of the local hospice (84% of all admissions, 83% of the bed days and a discharge rate of 76.4 per 100 person years), more than double the rates experienced by the other risk groups. Thus both clinical and immunological staging (AIDS or a CD4 count < 200 cells/ul) were associated with increased resource use in HIV infection and estimates of resource use for AIDS need to be increased by around one-third to take into account hospice use. Despite the preponderance of drug users in Edinburgh, comparisons with other centres did not reveal increased resource use.
Complementary AIDS therapies: the good, the bad and the ugly
Authors: Ernst E
Published: October 2002

Summary: HIV-infected/AIDS patients seem to frequently use complementary therapies, yet definitive information in this area is difficult to obtain. The aim of this systematic review is therefore to assess the published data on the use of complementary medicine by HIV-infected/AIDS patients. A computerized systematic literature search was carried out. Data on prevalence of complementary medicine (CM) use, effectiveness, risks and costs were extracted. The prevalence of CM use ranges between 27 and 100%. Users perceived complementary therapies as beneficial, however, no data exist to suggest that these treatments are specifically effective. They are generally perceived as 'safe', but there is evidence to suggest that risks do exist. The costs for complementary therapies seem to be high and financial exploitation of patients may not be infrequent. It is concluded that complementary therapies for HIV-infected/AIDS patients are popular. Their potential for doing either harm or good requires more detailed study.
Testosterone treatment of clinical hypogonadism in patients with HIV/AIDS
Authors: Rabkin Judith G , Rabkin Richard , Wagner Glenn J
Published: October 2002

The use of testosterone to treat clinical symptoms of hypogonadism and wasting among patients with HIV/AIDS is a relatively new area of inquiry and clinical application. Outcome measures have included changes in mood, libido, energy, weight and muscle mass1-5. The purpose of this review is to identify the questions most commonly raised about risks of testosterone therapy, to review available data which address these questions, and to discuss issues of clinical management. These include treatment indications, measurement issues, and side effects and their management.