bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of diarrhoea in HIV-infected patients
Authors: Mitra Amal K , Hernandez Charles D , Hernandez Charlene A , Siddiq Zubair
Published: October 2002

Human immunodeficiency virus (HIV) infection can weaken the immune system causing its inability to combat opportunistic infections. Managing the complexity of these opportunistic infections has created a challenge for healthcare professionals. Our knowledge on the aetiological agents causing opportunistic infections in immunocompromised hosts has increased over the last decade. Diarrhoeal diseases are frequent complications associated with HIV-infected patients. For most of the causes of diarrhoea, the clinical signs are non-specific, and the laboratory diagnostic workup is neither easy nor fast. This review provides data on aetiological approaches of common diarrhoeal diseases including viral, microbacterial, parasitic, bacterial and fungal infections, and HIV enteropathy; diagnostic evaluation; and treatment of diarrhoea in HIV-infected patients. This article will be helpful for those who are in the practice of managing diarrhoea in such patients.
Clinical manifestations of influenza in HIV-infected individuals
Authors: Skiest Daniel J , Kaplan Peter , Machala Timothy , Boney Linda , Luby James
Published: October 2002

Although influenza vaccination is recommended for individuals with HIV infection, there are no data indicating an increased incidence or severity of influenza in this population. We sought to describe the clinical manifestations and morbidity of influenza in HIV-infected patients. All cases of influenza occurring in HIV-infected individuals over 3 years at a large county hospital were reviewed. Forty-three cases of influenza were diagnosed. Most patients presented with typical signs and symptoms of influenza, including cough (90%), myalgias (64%), and fever (52%). Sore throat and headache occurred in less than half of patients. The mean CD4 cell count and HIV viral load in patients with influenza was 340 cells/mm3 and 3.34 log copies/ml, respectively. No significant differences in CD4 counts or viral loads were noted in patients with pneumonia ( n=7) compared with patients without pneumonia ( n=36), P>0.5. Six patients were hospitalized. One patient each had encephalitis and renal failure, although the relationship to influenza was not clear. No new or unusual clinical manifestations were observed. The rate of pulmonary complications was similar to other studies in HIV-negative patients; however, the hospitalization rate was higher than commonly seen in HIV-negative individuals.
A Review of Physical and Psychological Factors in Vulvar Vestibulitis Syndrome
Authors: Green John , Christmas Paula , Goldmeier David , Byrne Michelline , Kocsis Agnes
Published: October 2002

This review is based on a MEDLINE search of all papers on vulvar vestibulitis syndrome (VVS) published 1995–2000. The causation, natural history and prevalence of VVS are unknown. There is no convincing evidence that VVS is the result of an infection or of an allergy. It has been proposed that it is an atypical pain syndrome but there is currently no clear evidence that this is so. The usual diagnostic criteria used in VVS are of doubtful discriminative value. Findings from biopsies of women with VVS are inconsistent. While there is some evidence to suggest that women with VVS attending clinics differ psychologically from normal controls, it is not clear whether these differences reflect the effects of VVS, are the result of patient selection or influence the development of the disease. Several treatments, including biofeedback, psychosexual treatment and surgery have been reported to be successful in some patients but there is a lack of proper placebo-controlled trials on which to base estimates of efficacy. There is a vital need for further, high-quality, research in this area.
Vaginal Shedding of Hepatitis C Virus
Authors: Gameiro R , Venneno T , Prieto E , Castro R , Carnall V , Canas-Ferreira W , Exposto F
Published: October 2002

A group of 14 women infected with hepatitis C virus (HCV) was evaluated for vaginal shedding of the virus. The HCV-RNA detection was performed in plasma, peripheral blood mononuclear cells (PBMC) and in supernatant and pellet of vaginal washings. HCV-RNA positive results were obtained in all plasma samples, in 57% of the PBMC samples, in 36% pellets obtained following centrifugation of vaginal washings and in 36% of the supernatants. In 21% of the women a positive result was found, at the same time, in every analysed product. The HCV genotypes identified in the plasma samples (1a: 38%; 1b: 36%; 3a: 13% and 1b+3a: 14%) matched with those in PBMC and vaginal washings in every sample, with the exception of cases where mixed infection (1b+3a) was detected. In these, genotype 1b was only detected in plasma. HCV viral load was not associated with the presence of HCV–RNA in PBMC or in vaginal washings (either cells or supernatant).
Acceptance of Syphilis Screening among Residents of high-STD-Risk Houston Communities
Authors: Baseman Janet , Leonard Lori , Ross Michael , Hwang Lu-Yu
Published: October 2002

The purpose of this study was to assess the rate of acceptance of street-intercept syphilis screening and to identify barriers to screening among residents of 2 Houston communities with high rates of syphilis. Each of 691 people who participated in a street-intercept survey about syphilis was offered a free syphilis test immediately after completion of the survey. Acceptors of screening had blood drawn at the site of the interview, and blood samples were tested by rapid plasma reagin (RPR) and a confirmatory microhaemagglutination–Treponema pallidum (MHA–TP) for those with a positive antibody reaction on the RPR. On-street syphilis screening was accepted by 26% of the sample. The most common reason for refusal was not wanting to have blood drawn (19.5%). Among those screened for syphilis (n=148), seroprevalence was 19%, with 33% of women testing positive and 10% of men. The results of this study point to a need for increased case-finding, standard screening recommendations, and interventions targeting specific barriers to syphilis screening.
Childhood sexual abuse and sexually transmitted diseases in adults: a review of and implications for STD/HIV programmes
Authors: Greenberg J B
Published: October 2002

Childhood sexual abuse (CSA) has been linked to a variety of health problems in adolescence and adulthood, including risky sexual behaviour and sexually transmitted diseases (STDs). This article reviews the literature, including findings from a recent intervention study of high-risk, adult women and offers suggestions for professionals working in STD/HIV prevention.
Mycoplasma genitalium - an up-date
Authors: Taylor-Robinson David
Published: October 2002

Mycoplasma genitalium was first isolated from men with non-gonococcal urethritis (NGU) more than 20 years ago. Use of polymerase chain reaction technology has shown it to be a cause of acute NGU and probably chronic NGU, almost independently of Chlamydia trachomatis, but there is no substantial evidence that it causes acute or chronic prostatitis. In women, M. genitalium is not associated with bacterial vaginosis, but it is strongly associated with cervicitis and endometritis and serologically with salpingitis and tubal factor infertility. Further studies may show M. genitalium to be associated, perhaps causally, with epididymoorchitis, neonatal disease and reactive arthritis. Furthermore, its potential for enhancing HIV transmission needs to be explored. M. genitalium is susceptible to various broad-spectrum antibiotics, but M. genitalium-associated diseases are probably best treated with azithromycin.
Evaluation of a rapid test for the detection of antibodies to human immunodeficiency virus type 1 and 2 in the setting of multiple transmitted viral subtypes
Authors: Reynolds Steven J , Ndongala Lubaki M , Luo Chi-Cheng , Mwandagalirwa Kashamuka , Losoma Atibu J , Mwamba Kasali J , Bazepeyo Edidi , Nzilambi Nzila E , Quinn Thomas C , Bollinger Robert C
Published: October 2002

Rapid HIV testing is an appealing strategy in the approach to HIV diagnosis in developing countries. Concern has been raised about the use of these tests in the setting of multiply transmitted HIV subtypes. We sought to compare the OraQuickTM HIV-1/2 Test, a qualitative immunochromatographic test for the detection of antibodies to HIV-1 and HIV-2 using stored sera, with a conventional enzyme immunoassay (EIA)/Western blot (WB) algorithm. The study design used was a blinded retrospective study. Samples were collected on patients attending sexually transmitted disease clinics and tuberculosis clinics in Kinshasa, the Democratic Republic of Congo and included 72 known HIV seropositive and 131 known HIV seronegative subjects. All 72 known HIV seropositive samples were positive by OraQuick and all 131 known HIV seronegative samples were negative by OraQuick resulting in 100% sensitivity and specificity. We conclude that the OraQuick rapid HIV-1/2 test performs well in the setting of diverse HIV viral subtypes.
Factors associated with adherence to antiretroviral medication in HIV-infected patients
Authors: Molassiotis Alexander , Nahas-Lopez Violeta , Chung W Y Rita , Lam S W Charlotte , Li C K Patrick , Lau T F Joseph
Published: October 2002

The aim of the study was to assess adherence with antiretroviral medication in a sample of HIV patients in Hong Kong and identify predictors of adherence. The study used a cross-sectional correlational design. Adherence behaviour was assessed with the use of self-reports. Other scales assessed knowledge with HIV medication, coping, health locus of control, anxiety, depression and fatigue. A blood sample was also obtained to assess CD4+ counts and viral load. Sociodemographic characteristics and medical information were obtained from the medical records. A high adherence rate was found in this sample of 136 predominantly Chinese patients. There were only 13.7% of the patients being classified as non-adherent. Predictors of adherence included high self-efficacy in terms of being certain that the medication schedule will be followed all or most of the time as directed, low tension-anxiety scores, and low intensity of nausea and vomiting (R2=0.304). An expanded regression model revealed additional factors influencing adherence, including coping variables, pain and numbness in the hands and feet, age, disease stage, internal locus of control, fatigue, family support and taking medication twice daily. This model explained 49% of the variance in adherence. The results suggest that adherence is a multidimensional concept. Every effort should be made to assess in individuals those variables found to affect adherence and alter them whenever possible. Continuous support of patients and individualized medication programmes that will help patients adjust their treatment to their lifestyle are recommended.
Are we getting the point? Needlestick injuries—an ongoing problem
Authors: McAdam T K , McLaughlin R E , McNicholl B
Published: October 2002

The pattern of glove perforation using hollow needles is unknown and the incidence, using sensitive electronic methods has not been described. We wished to identify the glove perforation rate following the use of hollow needles in our Emergency Department. Two hundred and eighty-nine gloves were collected over three months. These gloves were electronically tested and compared with one hundred unused control gloves. There were 28/298 perforations (9.7%) vs 1/100 in the control group ( P<0.01 Fisher's exact probability). Most perforations were located on the thumb and index fingers. There were no needlestick injuries reported during this period. The glove perforation rate following hollow needle use in our Emergency Department is higher than previously reported. The pattern of perforation suggests injury by the needle held in the dominant hand.
The effects of mood states on the AIDS-related judgements of gay men
Authors: Gold R S
Published: October 2002

In two studies, the effects of induced mood on the AIDS-related judgements of gay men were investigated. Participants were induced into a positive, neutral, or negative mood by recall of affect-laden autobiographical memories; they then made AIDS-related judgements. In Study 1 ( n=30), the men indicated their level of agreement with statements expressing optimism about the efficacy of antiretroviral treatments for HIV/AIDS. Those induced into a positive mood indicated stronger agreement than did those induced into a neutral or negative mood. In Study 2 ( n=83), participants read brief descriptions of men they did not know and estimated the likelihood that they were HIV-infected. Each sketch highlighted one characteristic of the man described. There were two versions of each sketch (e.g., the versions of the sketch highlighting intelligence described the man either as very intelligent or as very unintelligent), given to different participants. Stereotype use was inferred if significantly different estimates were given for the two versions of a sketch. Reliance on stereotypes was found most often in the positive mood condition and least often in the negative mood condition. The findings are consistent with, and suggest explanations for, earlier correlational evidence that, in gay men of the age group studied, sexual risk-taking is associated with a positive mood. Suggestions are made for how AIDS educators might address the contributions of mood states to sexual risk-taking.
Chronic prostatitis/chronic pelvic pain syndrome: national survey of genitourinary medicine clinics
Authors: Luzzi G A , Bignell C , Mandal D , Maw R D
Published: October 2002

We sought to determine current practice in the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CPPS) in genitourinary medicine departments in the UK, using a detailed questionnaire survey. Evaluable responses were received from 147 (69%) clinics. Seventy-nine (54%) clinics reported seeing >10 new CPPS patients per year. A broad range of investigations was reported to be used in the diagnosis of CPPS. Whilst 89 (61%) clinics reported using the four-glass test in diagnosis, 46 (32%) reported using the test in >90% of patients with CPPS, and 42 (29%) reported never using the test. In the treatment, doxycycline or ciprofloxacin were reported to be first line treatment by 98% clinics, mostly in 4–6 week courses; however, great variation was recorded in second-line choices and use of non-antibiotic approaches. This survey demonstrates that patients with CPPS are regularly diagnosed and managed in genitourinary clinics in the UK, with wide variations in diagnostic and treatment practices.
Genital elephantiasis
Authors: Sarkar Rashmi , Kaur Charandeep , Thami Gurvinder P , Kanwar Amrinder J
Published: October 2002

Genital elephantiasis (esthiomene), which is the dramatic end-result of lymphatic obstruction, is rather rare. Although mainly associated with filariasis and sexually transmitted diseases, such as lymphogranuloma venereum and donovanosis, it could also be an uncommon complication of tubercular lymphadenitis, a common infection in tropical countries. We report a rare case of a 32-year-old Indian female in whom genital elephantiasis occurred as a complication of tubercular lymphadenitis.
Availability of dental services for patients with blood-borne viruses
Authors: Kellock D J , Carlin E M
Published: October 2002

Dental practitioners were surveyed, using a self-completed postal questionnaire, to assess their attitudes to managing patients with blood-borne viruses (BBV) and to identify dental services available for such patients in North Nottinghamshire. Questionnaires were completed by 79 (65.3%) of the 121 practitioners from 43 (82.7%) of the 52 study practices. Previous BBV experience was reported by 44 (55.7%), 31 (39.2%), 20 (25.3%) respondents for hepatitis B (HBV), hepatitis C (HCV), HIV, respectively. Over two-thirds would maintain existing patients with subsequently diagnosed BBV on their lists, approximately one-third would accept new BBV patients. Risk factors for BBV of homo/bisexuality and injecting drug use were not asked by 71 (89.9%) and 49 (62.0%) practitioners, respectively. Universal precautions were employed by 67 (84.8%) practitioners regardless of the patient's status and by seven practitioners for known BBV patients. The advice of the General Dental Council, British Dental Association, and the use of universal precautions are discussed.
Frequency of herpes simplex virus, cytomegalovirus and human papillomavirus DNA in semen
Authors: Aynaud Olivier , Poveda Jean-Dominique , Huynh Bernard , Guillemotonia Aline , Barrasso Renzo
Published: October 2002

Herpes simplex virus (HSV-2) and cytomegalovirus (CMV) infections produce brain damage in the newborn, and human papillomavirus (HPV) plays a role in cervical carcinogenesis. To assess the frequency of herpes virus and HPV in semen and its role in transmission, semen from 111 male partners of women with histologically-detected genital HPV infection was analysed for HSV, CMV and HPV infection. We used cell culture to detect HSV and CMV, and polymerase chain reaction (PCR) for HPV. Virological findings in the sperm were correlated to the presence or absence of HPV-associated genital lesions and to the viral type. Viral cultures yielded HSV-2 DNA in 9% and CMV DNA in 6.3% of cases. No correlation was established with a history of clinically apparent infection for HSV. HPV-DNA was detected in 23.4% of semen by PCR techniques: in 48% of subjects with urethral lesions, in 22% of patients with penile lesions, in 2% of patients without HPV-associated lesions. HPV-DNA type 16 was detected in 3.6% of cases. Patients with a positive HPV semen sample and penile or urethral lesions had the same HPV type detected in the two specimens. The study shows a high detection of clinically inapparent HSV and CMV, but does not confirm high HPV prevalence in semen from men without detectable lesions. Our study also suggests that the mechanism for semen contamination by HPV is the exfoliation of infected cells from urethral lesions during semen ejaculation, and probably, by abrasion from penile lesions. This could result in the contamination of semen used in assisted reproductive technology.
Unusual malignant tumours in patients with HIV infection
Authors: Santos J , Palacios R , Ruiz J , González M , Márquez M
Published: October 2002

The clinical charts of 2560 HIV-infected patients seen in our Unit between 01/89 and 08/01 were reviewed. All patients with a neoplasm were analysed to study the prevalence of tumours other than Kaposi's sarcoma (KS), non-Hodgkin's lymphoma (NHL) or cancer of the cervix. There were 43 unusual malignant tumours: 13 lung cancers, six leukaemias, six skin cancers, two carcinomas of the conjunctiva, two cancers of the penis, three of the anus, three of the larynx, one sarcoma of the ureter, one gastric carcinoid, one non-differentiated thyroid carcinoma, one non-differentiated prostate carcinoma, one cancer of the tongue, one cancer of the bladder, one adenocarcinoma of the rectum and one multiple IgM myeloma. Thirteen (43.3%) of the patients died, 10 (76.9%) from causes related to the tumour itself. These results suggest that HIV-infected patients have a higher prevalence of some neoplasms than the general population.
Case-control study of sexually transmitted diseases as cofactors for HIV-1 transmission
Authors: Beck E J , Mandalia S , Leonard K , Griffith R J , Harris J R W , Miller D L
Published: October 2002

The aim of the study was to investigate the association between infection with HIV-1 infection and a history of other sexually transmitted diseases (STD). We were able to match 1295 HIV-1 infected patients who attended St Mary's Hospital between 1985 and 1991 with 1273 seronegative controls on gender, sexual orientation, injecting drug use and age at time of test. The cases were 3 times more likely to have a history of ever having had another STD than the controls: multivariate conditional logistic regression showed that, after controlling for sexual behaviour, for known sexual contact with an HIV infected individual or AIDS patient or with a resident from a high HIV prevalence area, area of residence and for year of test, a history of gonorrhoea, syphilis, hepatitis B, genital herpes or genital warts were all significantly associated with HIV-1 seropositive status. These findings reinforce the need for HIV containment strategies to be promoted in conjunction with containment programmes for other STDs.
Azithromycin in the management of Chlamydia trachomatis infections
Authors: Ridgway G L
Published: October 2002

The unique pharmacological profile of the azalide macrolide azithromycin, coupled with its in vitro activity against both Chlamydia trachomatis and the ureaplasmas, suggested that genital infections caused by these bacteria could be successfully treated with a single dose of the antibiotic. This has now been confirmed in worldwide clinical studies. A single oral dose of azithromycin 1 g eradicates C. trachomatis in almost 100% of cases of non-gonococcal urethritis and cervicitis. Unfortunately, there are no specific clinical signs for genital chlamydial infection. It is therefore necessary to use therapy effective against known and unknown pathogens for treating lower genital tract infection. Clinical cure rates for both chlamydial and non-chlamydial, non-gonococcal infections compare favourably with standard 7-day doxycycline therapy, being in excess of 85%. Side-effects are few (<20%) and essentially minor.
Treatment of syphilis with azithromycin
Authors: Mashkilleyson A L , Gomberg M A , Mashkilleyson N , Kutin S A
Published: October 2002

The efficacy of oral azithromycin (500 mg daily for 10 days or 500 mg on alternate days for 11 days) in 100 patients with seropositive syphilis was studied. Clinical manifestations regressed more rapidly in azithromycin-treated patients compared with patients who received erythromycin or penicillin, and there was also a more rapid reduction in serum antibody levels. In 90.3% of patients, the complete resolution of classic serological tests was observed within 4 months of completion of the azithromycin treatment. The immobilization (TPI) test and absorbed fluorescent treponema antibody tests became negative 12 months after treatment in 40% of patients. After 4 years of follow-up, no symptoms of neurosyphilis or syphilitic changes of visceral organs were observed.
An evaluation of percutaneous endoscopic gastrostomy feeding in AIDS
Authors: Dowling S , Kane D , Chua A , Keating S , Flood P , Keeling P W N , Mulcahy F M
Published: October 2002

Between October 1991 and October 1993, 17 AIDS patients (14 intravenous drug users, 3 sexually acquired) were com menced on percutaneous endoscopic gastrostomy (PEG) feeding in St James's Hospital. Indications were progressive weight loss related to severe anorexia (11), persistent oesophageal candidiasis (5) and absence of gag reflex (1). Two patients requested PEG tube rem oval after one week because of cram py abdom inal pain without peritonitis. Five patients died from AIDS related infections within 6 weeks of PEG insertion. Ten patients were followed up for > 2 months (mean 5.2 months, range 2.5-15.5 months). In these 10 patients, 1 patient developed a PEG site infection which responded to topical antibiotics. There were no other complications. There was a significant ( P < 0.001) increase in energy and protein intake at 2 months. Variant degrees of weight gain occurred in all patients (mean 2.6 kg) (P < 0.01). Small but significant increases in other anthropometric variables occurred. Patients who died within 6 weeks of PEG insertion were older, and had a lower serum album in than the group who survived > 2 months (P < 0.01). A self-administered questionnaire demonstrated that the majority of patients found PEG feeding acceptable and preferable to nasogastric (NG) feeding.
Azithromycin as the first-line treatment of non-gonococcal urethritis (NGU): a study of follow-up rates, contact attendance and patients' treatment preference
Authors: Carlin E M , Barton S E
Published: October 2002

Aims: To identify any differences in follow-up rates or sexual contact attendance rates in men presenting with non-gonococcal urethritis (NGU) after treatment by single dose azithromycin rather than longer standard duration therapies and to identify patients' treatment preferences. Methods: A prospective study was performed on 200 consecutive men attending a genito-urinary medicine (GUM) clinic with new episode, microscopically confirmed NGU. The first 100 patients were treated with standard duration therapy (Group S) whilst the second 100 patients received a single 1 g oral dose of azithromycin (Group A). Patient-led contact tracing was arranged and patients were asked to return for review when a test of cure was performed, contact attendance noted and the patient's treatment preference ascertained. Results: Both groups were predominantly heterosexual and over 60% gave a history of previous sexually transmitted disease (STD). There were no significant differences in efficacy between Groups S and A. However, the index follow-up rate and percentage of traceable sexual contacts attending was higher in Group A. In both groups contacts of homosexual men were more likely to attend the GUM clinic. More additional visits were made by Group S due to mislaid medication or compliance problems. Over 70% of patients questioned expressed a preference for single dose therapy. Conclusion: Single dose therapy with 1 g of azithromycin is as efficacious as longer duration therapies with advantages in patient follow-up rates and contact attendance and for the majority of patients would be their treatment of choice. A cost analysis supports the practical application of this regimen.
AIDS defining diseases in the UK: the impact of PCP prophylaxis and twelve years of change
Authors: Porter Kholoud , Fairley Christopher K. , Wall Patrick G. , Evans Barry G. , Goldberg David J. , Weerasuriya Melanie , Noone Ahilya
Published: October 2002

We examined all reports of adult AIDS cases made to the 2 national surveillance centres in the UK for changes in AIDS defining conditions between January 1982 and September 1994. Differences and changes among persons diagnosed since January 1988 who had and had not been aware of their HIV infection prior to their AIDS diagnosis were of particular interest. Pneumocystis carinii pneumonia (PCP) is the AIDS defining disease most often reported at the initial AIDS diagnosis. Its proportion of all AIDS cases has increased significantly between January 1982 and December 1987 and decreased markedly thereafter. Since January 1988 a significant decrease in the proportion of cases diagnosed with cryptosporidial infection was also observed while increases were observed in the proportion of cases diagnosed with: HIV wasting (chi21=5.56), PML (chi21=19.47), mycobacterium avium complex (chi21=35.76) and pulmonary tuberculosis (chi21=144.0). For cases diagnosed between January 1988 and September 1994, PCP was more likely to be diagnosed in patients previously unaware of their HIV infection (P < 0.01) as was extrapulmonary TB (P < 0.01). In contrast, the following diseases were more likely to be diagnosed in patients already aware of their HIV infection prior to the diagnosis of AIDS: oesophageal candidiasis (P < 0.001), HIV wasting (P =0.07), mycobacterium avium complex ( P =0.0001), cytomegalovirus disease (P < 0.001), HIV encephalopathy (P =0.0009) and cryptosporidial infection (P =0.02). Prophylaxis and anti-retroviral therapy appear to have had a significant impact on the temporal changes of the most frequently diagnosed AIDS diseases. While PCP prophylaxis has substantially reduced the likelihood of a PCP diagnosis at AIDS, the corresponding increase in other opportunistic infections suggests that there may be a need for improved prophylaxis for these conditions.
Efficacy of inosine pranobex oral therapy in subclinical human papillomavirus infection of the vulva: a randomized double-blinded placebo controlled study
Authors: Tay Sun Kuie
Published: October 2002

A randomized double-blind placebo controlled study was carried out to assess the efficacy of inosine pranobex (1 g orally 3 times a day for 6 weeks) in the treatment of symptomatic subclinical human papillomavirus infection of the vulva. In a series of 55 women, 22 patients in the inosine pranobex group and 24 patients in the placebo group were suitable for analysis. A total of 14 (63.5%) of the inosine pranobex treated patients and 4 (16.7%) of the placebo treated patients showed significant vulval epithelial morphological improvement (P =0.005) at 2 months after initiation of treatment. Whereas 13 (59.1%) and 9 (37.5%) patients in the respective groups showed significant improvement in the severity of pruritus vulvae (P =0.435). Twelve (66.7%) of 18 patients with morphological improvement compared to 10 (35.7%) of 28 patients with no morphological improvement experienced significant symptomatic alleviation of pruritus vulvae (P =0.041). Similar results were seen at the second assessment 4 months after the initiation of treatment. Adverse drug reactions were reported by 2 patients in the treatment group and by 2 patients (skin rash) in the placebo group. These adverse reactions were mild and self limiting. It is concluded that inosine pranobex demonstrated a significant pharmacological activity in subclinical HPV infection of the vulva and should be considered an alternative treatment for the condition.
The prevalence of serological markers for syphilis amongst a sample of Spanish prostitutes
Authors: Estebanez P , Zunzunegui Ma V , Grant J , Fitch K , Aguilar Ma D , Colomo C , Pueyo  , Lorenzo M
Published: October 2002

The results of a multicentre study of 1668 Spanish prostitutes are described with regard to syphilis infection. For those women who permitted serological tests ( n =1095), 30.59% (confidence interval (CI): 30.55%-30.63%) were positive for markers indicating current or prior infection. After adjustment was made for other variables, a significant association with syphilis infection was observed for periods of exposure (i.e. age and years working as a prostitute). No significant associations were detected for either intravenous drug use, or educational attainment. The results of this study are similar to those of some other investigations into the prevalence of syphilis amongst prostitutes.
Infection by hepatitis B and C virus in female and transsexual Greek prostitutes with serological evidence of active syphilis
Authors: Tsakris A , Kyriakis K P , Chryssou S , Papoutsakis G
Published: October 2002

Two hundred and thirty female and 43 male-to-female transsexual Greek prostitutes were screened for serological evidence of active syphilis as judged by positivity in both rapid plasma reagin (RPR) test and treponemal (FTA-ABS and TPHA) tests. The rate of active syphilis was 20.9% in the male-to-female transsexual prostitutes and 4.3% in the female ones ( P 0.001, odds ratio=5.82). In the former group 65.1% had evidence of hepatitis B virus (HBV) infection, and 4.7% of hepatitis C virus (HCV) infection while the respective rates among the latter group were 50.4% and 3.9%. There was no correlation of viral hepatitis marker prevalence with positive syphilis serology. <
Cross-national HIV infection control practices and fear of AIDS: a comparison between Nigeria and the USA
Authors: Essien Ekere James , Ross Michael W , Meremikwu Martins
Published: October 2002

Summary: Fears about occupational transmission of HIV may have a significant impact on the behaviour of health care workers and on infection control practices. We investigated the relationships between fear of AIDS and infection control practices in health care workers in major university teaching hospitals in Nigeria and the USA. Data from the fear of AIDS scale and on a measure of infection control practices and beliefs showed that knowledge of whether the patient was HIVinfected determined infection control practices in Calabar but not Texas. Where the patient was known to be infected, there were no differences between the 2 countries. Fears of AIDS were related to infection control practices significantly more in the USA than in Nigeria where there was almost no relationship. These data may be influenced by the greater availability of disposable equipment in the USA compared with Nigeria.
Demonstration of Epstein-Barr virus DNA and human papillomavirus DNA in acetowhite lesions of the penile skin and the oral mucosa
Authors: Voog Ewa , Ricksten Anne , Olofsson Sigvard , Ternesten Annika , Ryd Walter , Kjellstrom Christer , Forslund  , Lowhagen Gun-Britt
Published: October 2002

Summary: Oral hairy leukoplakia (OHL), thought to be caused by Epstein-Barr virus (EBV), shows similar histological and clinical features to human papillomavirus (HPV)-related acetowhite lesions of the vulva. We thus aimed to investigate the role of both HPV and EBV in men with acetowhite lesions of the penis. HPV but not EBV was significantly associated with penile acetowhite lesions showing koilocytosis compared with normal penile skin (12/20 versus 5/20, P 0.02). HPV (5/20) and EBV (6/20) was detected in oral mucosa of some of these individuals. These results confirm an aetiological association between HPV and acetowhite penile lesions showing koilocytosis. HPV and EBV carriage in the oral mucosa is relatively common in young sexually active men. <
Use of GUM services and information and views held by first time service users in a large UK city: implications for information provision
Authors: McClean H. L. , Reid M.
Published: October 2002

The aim of this study was to examine the relationship between and views held by service users before obtaining help from a medicine (GUM) service and the accessibility and use of the service, to determine potential intervention measures for change. A structured was completed by 292 first-time GUM service users in a large UK in 1994. Overall 94 (57.7%) of 163 male service users and 59 (48.4%) of 122 service users had some information about the service before seeking help, this difference was not significant. Only 92 (31.5%) knew the service was The main source of information was through general practitioners with personal contact as the second most common information source. Two and fifteen (73.6%) used the service within 2 weeks of needing help and (35.6%) of these felt there was delay, but reporting delay was not associated having information about the service. The majority indicated feeling nervous embarrassed about using the service. Female service users were more likely to feel nervous or embarrassed than male service users 0.05). Service users were significantly more likely to feel nervous when they no information about the service than if they knew something about the service 0.01). Most service users regarded the service as dealing with sexually infections (STIs), and most intended to use the service for this reason. whilst many service users indicated knowledge about non-STI services, HIV counselling and testing, relatively few intended to use these services. service users (269, 92.1%) were in favour of increased availability information GUM clinics mainly through written media but also through GPs. The results this study show a clear need to project increased awareness and information this GUM service so as to encourage use of the range of services available and more positive feelings about using the service. Information in written as well as through other health professionals may be of benefit. Further work needed to study the effect of information provision in influencing the large of potential service users to make use of sexual health services.
Silent upper genital tract chlamydial infection and disease in women
Authors: Tait S J , Duthie I A , Taylor-Robinson D
Published: October 2002

To find what proportion of women with endocervical Chlamydia trachomatis infection had asymptomatic infection of the upper genital tract, 10 women with neither gonorrhoea nor signs, symptoms or a past history of pelvic inflammatory disease were laparoscoped. Swabs from the fimbriae and pouch of Douglas were tested for C. trachomatis by tissue culture, enzyme immunoassay, direct fluorescent antibody and polymerase chain reaction techniques. Four of the women had an upper genital tract chlamydial infection. Neither laparoscopic appearances, menstrual phase, interval since last intercourse, partner change nor other coincidental genital infection was associated with the upper genital tract spread. These findings suggest that careful investigation, immediate treatment and contact tracing are mandatory when asymptomatic endocervical chlamydial infection is discovered.
A longitudinal study of the vaginal flora over a menstrual cycle
Authors: Keane F E A , Ison C A , Taylor-Robinson D
Published: October 2002

Healthy female volunteers participated in an anonymous study to monitor vaginal flora by taking daily vaginal samples and making a smear for later Gram-staining, as well as recording information on genital symptoms, sexual activity, contraceptive and bathing practices. A modification of Spiegel's criteria was used to categorize the Gram-stained smears, an intermediate category between normal flora and bacterial vaginosis (BV) being recognized. Of the 22 volunteers who completed the study, one was excluded because of pregnancy. Of the remaining 21 women, 10 (48%) had a normal flora throughout the study, 4 (19%) had an abnormal flora throughout and 7 (33%) had a basically normal flora which underwent a change to either an intermediate flora in 5 women or fully developed BV in 2 of them. In 5 (71%) of these women the change occurred within the first 9 days of the cycle. Transient changes in the vaginal microbial flora occurred predominantly in the first part of the menstrual cycle which suggests that in some women hormonal changes could have a role in the pathogenesis of bacterial vaginosis.
Antiretroviral uptake in Australia: medical, attitudinal and cultural correlates
Authors: Ezzy Douglas M , Bartos Michael R , Visser Richard O De , Rosenthal Doreen A
Published: October 2002

The objective of this study was to describe the medical, attitudinal and cultural correlates of antiretroviral uptake amongst people living with HIV/AIDS (PLWHA) in Australia. Stratified purposive sampling produced a sample of 925 PLWHA, which represents 8.3% of the current population of PLWHA in Australia. Respondents completed a self-administered questionnaire which revealed that 78% of respondents were using antiretroviral drugs for HIV/AIDS. Logistic regression revealed that PLWHA were more likely to use antiretroviral drugs if they had more favourable attitudes toward antiretroviral drugs, if they had been diagnosed with an AIDS-defining illness, and if they had ever had a CD4/T-cell count below 400 copies/ml blood. Women were less likely than men to use antiretroviral drugs, and logistic regression revealed different predictors of antiretroviral drug use amongst men and women. Given the importance of attitudes toward antiretroviral drugs, it is likely that if the current confidence in antiretroviral drugs were to change, this would be reflected in an equally rapid cessation of treatment amongst many PLWHA.
Disorders of fat distribution in HIV infection
Authors: Shaw Andrew J , Mclean Ken A , Evans Brian A
Published: October 2002

Alterations in body shape due to fat loss and/or redistribution have been described in HIV-infected individuals and associated with the use of antiretroviral (ARV) combination therapy. Certain of these changes have been referred to as peripheral lipodystrophy (LD) and we describe 12 patients who were recognized with this condition between September 1997 and February 1998. It occurred in 12.5% of patients on ARV combination therapy that included a protease inhibitor (PI). In early descriptions the emphasis was on the abdomen, which may be grossly enlarged. In our patients this feature was much less marked. Patients with LD were significantly older than those on PI therapy who did not develop this condition ( P =0.016). Although all had raised triglyceride (TG) levels, the elevations were not severe (maximum=6.3 mmol/l). CD4 lymphocyte and viral load levels suggested an optimal response to ARV therapy at the time LD developed. Appearances may be disfiguring but no serious systemic consequences of LD have been observed. Most individuals have chosen to remain on their present ARV combinations. When LD occurs, it appears to be a marker of effective response to anti-HIV therapy.
A comparison audit of a genitourinary medicine colposcopy service against nationally agreed quality standards
Authors: Kellock J , Hicks D A
Published: October 2002

The National Health Service Cervical Screening Programme (NHSCSP) recently published their document Standards and Quality in Colposcopy outlining recommendations for standards in the service provided by colposcopists. In this first audit of colposcopic practice measured against these agreed UK national guidelines, the authors discuss the standards, their attainability, and their relevance to genitourinary medicine (GUM) colposcopy services.
Audit of service to a minority client group: male to female transsexuals
Authors: Moriarty H J , Thiagalingam A
Published: October 2002

Male to female transsexual clients are a group of clients for whom there are few dedicated services in New Zealand. To examine service utilization in Wellington, New Zealand, 70 male to female transsexual clients were identified and their medical records audited for selected aspects of sexual health service delivery. Audit revealed that sexual health history is recorded incompletely and behavioural risk factors are not fully explored, sexual health examination and testing is incomplete. We conclude opportunities to expose relevant behavioural factors and to educate for sexual safety and health promotion are lost with this infrequently attending minority client group.
Condom use among Aboriginal people in Ontario, Canada
Authors: Calzavara L M , Burchell A N , Myers T , Bullock S L , Escobar M , Cockerill R
Published: October 2002

Summary: A survey of 658 Aboriginal men and women living in 11 reserve communities in Ontario, Canada, was utilized to collect data on patterns of condom use. Individuals who had sexual intercourse in the previous 12 months were included in the analysis ( n =400). Descriptive statistics and multiple logistic regression were used to analyse condom use in the previous 12 months. Eight per cent always, 31% sometimes, and 61% never used condoms. Rates of condom use differed with the number of sex partners in the last year, age, gender, having a steady sex partner, and marital status. Multiple logistic regression revealed that people most likely to use condoms were under the age of 30, male, did not have a long-term steady sex partner, had more than one sex partner, worried about pregnancy, were knowledgeable about HIV/AIDS, and were not embarrassed to obtain condoms. Condom users who were knowledgeable about HIV/AIDS and who knew someone with HIV/AIDS were more likely to always use condoms. The most common reason for not using a condom was 'I was with my steady sex partner'. These results have implications for STD prevention efforts and for future research of sexual and STD preventive behaviour among Aboriginal people.
HIV, STDs, anal sex and AIDS prevention policy in a northeastern Brazilian city
Authors: Halperin Daniel
Published: October 2002

Summary: Data on HIV/AIDS, other STDs, and related sexual practices and AIDS prevention measures in Sao Luis, capital of Maranhao state, were collected in MayJuly 1995 using participant-observation fieldwork, including a number of face-toface interviews in addition to archival research, and were updated by correspondence in 1996-1997 and a brief visit in February 1998. In contrast to the continuing severe AIDS epidemic in southern Brazil, public health statistics and public HIV testing recently instituted in Sao Luis suggest that HIV infection has remained largely concentrated among men who have sex with men, as well as a few, though growing number of cases of women evidently infected by such men. However, other STDs are endemic to the region, and could provide an increasing portal of entry for HIV infection. AIDS prevention education programmes have commenced in public schools and elsewhere in Sao Luis, but greater emphasis needs to also be placed on the prevention and treatment of other STDs. As in other regions of Brazil and Latin America, the reportedly common practice of anal sex among heterosexuals also represents a significant yet typically underemphasized risk factor for HIV.
Audit of diagnostic criteria for Trichomonas vaginalis in a genitourinary medicine clinic
Authors: Thompson C , Malone J H
Published: October 2002

Summary: A comparison between high vaginal swab (HVS) wet prep examination within the genitourinary medicine (GUM) clinic and that made from an HVS transported in Amies charcoal medium to the laboratory for the diagnosis of Trichomonas vaginalis was made in a prospective study. Clinic wet prep compared with Amies had a sensitivity of 68% and specificity of nearly 100%. Using the clinic wet prep alone, 9/30 (30%) cases would have been missed.
HIV 1 infection and reproductive history: a retrospective study among pregnant women, Abidjan, Cote d Ivoire, 1995-1996
Authors: Desgrees Annabel , Lou Du , Msellat Philippe , Welffens Christiane , Ramon Ekra Rosa , Noba Valentin , Viho Ida , Dabis Francois , Mandelbrot Laurent
Published: October 2002

The aim of this paper is to determine the differences of fertility between HIV 1 infected and uninfected women in Abidjan, Cote d Ivoire, using data available in an observational study conducted in 1995 and 1996 in 2 antenatal care centres in the district of Yopougon, Abidjan, within an intervention programme to reduce mother to child HIV 1 transmission DITRAME project, ANRS 049 . Fertility indicators have been constructed from retrospective data on pregnancies and births, and univariate and multivariate analyses have been performed on these indicators and stratified by age groups to compare HIV 1 positive and HIV negative populations. The main outcome measures were the number of pregnancies, the number of miscarriages, the risk of miscarriage and the proportion of primigravida. Four thousand, three hundred and ninety six women agreed to HIV testing: 12.1 were found to be HIV 1 infected. HIV 1 positive women had significantly fewer pregnancies than HIV negatives in age groups 25-29 P =0.05 and 30-34 P =0.008 . The risk of having had at least one abortion or stillbirth was significantly higher for HIV 1 infected women than for HIV negatives OR=1.28, 95 CI: 1.02-1.60 , when controlling for social and demographic factors. This study suggests that HIV 1 infection has deleterious consequences on female fertility, with lower fertility rates and more frequent adverse pregnancy outcomes. Family planning and antenatal care services should consider antenatal HIV counselling and testing in women in areas of high HIV prevalence.
Difference in susceptibility to CC chemokines among HIV 1 isolates
Authors: Tsuchie H , Jin T Q , Zhang J , Detorio M A , Hossain M M , Taniguchi K , Kurimura T
Published: October 2002

In this study, we examined the difference in susceptibility to anti HIV activity of the CC chemokines RANTES, MIP 1 alpha and MIP 1 beta among HIV 1 isolates and analysed its relation with phenotype syncytium inducibility and V3 domain of gp120 of the HIV 1 isolates. Of 11 cases tested in endogenous assay, at a concentration of 200 ng ml, RANTES, MIP 1 alpha, and MIP 1 beta showed more than 80 suppression of HIV 1 replication in 10, 8, and 7 cases, respectively. HIV 1 isolates sensitive to more than one CC chemokine showed non syncytium inducing phenotype, whereas HIV 1 isolates resistant to all of the 3 CC chemokines showed syncytium inducing phenotype. HIV 1 isolates resistant to all of the 3 CC chemokines contained more positively charged amino acid residues in the V3 domain of the gp120. These results indicated that utilization of the CC chemokine receptors as co receptors for virus entry could vary among HIV 1 isolates.