bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial infections in adult patients hospitalized with AIDS: case-control study of prophylactic efficacy of trimethoprim-sulfamethoxazole versus aerosolized pentamidine
Authors: Tabet Stephen R , Krone Melissa R , Hooton Thomas M , Koutsky Laura A , Holmes King K
Published: October 2002

To determine the association between trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis for Pneumocystis carinii pneumonia and risk of bacterial infections in persons with AIDS, we abstracted hospital records from 6496 adult admissions to 42 hospitals in western Washington state. Of these admissions, 570 involved 637 bacterial infections diagnosed among patients who had been prescribed prophylactic TMP-SMX or aerosolized pentamidine. Cases [admissions with bacteraemia, bacterial pneumonia, acute or chronic sinusitis, or urinary tract infection (UTI)] were compared to controls (admissions not associated with any of the 5 bacterial infections). After adjusting for CD4 lymphocyte count and presence of P. carinii pneumonia, TMP-SMX prophylaxis, relative to aerosolized pentamidine prophylaxis, was associated with a reduced risk of bacteraemia (adjusted OR=0.5; 95% CI, 0.2-1.0; P =0.04), bacterial pneumonia (adjusted OR=0.5; 95% CI, 0.3-0.8; P =0.01), acute sinusitis (adjusted OR=0.5; 95% CI, 0.2-1.3; P =0.2), chronic sinusitis (adjusted OR=0.3; 95% CI, 0.1-0.7; P =0.01), and UTI (adjusted OR=0.5; 95% CI, 0.2-1.2; P =0.1), and all 5 bacterial infections combined (adjusted OR=0.6; 95% CI, 0.5-0.8; P 0.001). <
Patterns of sexually transmitted diseases in female sex workers in Surabaya, Indonesia
Authors: Joesoef M R , Linnan M , Barakbah Y , Idajadi A , Kambodji A , Schulz K
Published: October 2002

Sex workers and their clients as core groups of high frequency transmitters play a dominant role in the transmission of HIV and other sexually transmitted diseases (STDs). In Surabaya, Indonesia, little is known about the prevalence of STDs in various sex establishments. We conducted an STD prevalence survey of 1873 female sex workers in Surabaya, Indonesia. We did not find any sex workers with HIV infection. Prevalence rates of other STDs (chlamydia, gonorrhoea, serological test for syphilis positive, and/or trichomoniasis) in female sex workers were 48% in brothels ( n =696), 42% on the streets ( n =192), 16% in massage parlours ( n =344), 25% in barber shops ( n =150), 17% at call-girl houses ( n =73), and 10% in nightclubs ( n =418). Sex workers from the brothels had the highest prevalence rates of gonorrhoea (24%) and trichomoniasis (8%), while sex workers from the streets and the barber shop had the highest rates of serological test for syphilis (STS) positive (30%) and chlamydia (18%). STD rates decreased with an increase in age (except for STS positive), an increase in education, a decrease in the number of sex partners, and condom use in the previous week. Condom use in the previous week was universally low among sex workers, especially among sex workers from the brothels (14%). Sex workers from the brothels had STD rates about 4 times higher than sex workers from the nightclubs (adjusted odds ratio of 4.4). Although the HIV seroprevalence rate is currently low, widespread prostitution and high rates of STDs in sex workers warrant programmes to avert a potential explosion of HIV transmission. Because sex workers from the brothels in Surabaya have high rates of STDs and low use of condoms but good cooperation with local authorities, STD preventive measures should focus on this group.
Immunohistochemical investigations of genital ulcers caused by Haemophilus ducreyi
Authors: Abeck D , Freinkel A L , Korting H C , Szeimis R-M , Ballard R C
Published: October 2002

To gain information on the specific composition of the inflammatory infiltrate of genital ulcers caused by Haemophilus ducreyi , biopsies of 6 genital ulcers which were diagnosed as chancroid on clinical and microbiological grounds were subjected to immunohistochemical investigations after conventional haematoxylineosin staining. A variety of antibodies reactive against B- and T-cells, plasma cells and granulocytes were used with each tissue sections. The lymphocytic infiltrate of chancroid ulcers consisted of both B- and T-lymphocytes and showed a cluster-like formation. B-lymphocytes were preferentially localized perivascularly in the middle layer, T-lymphocytes mainly in the deep layer of the inflamed oedematous tissue. Results stress the importance of both B- and T-cell mediated immune responses in Haemophilus ducreyi infection.
An audit of emergency contraception: a look at patient characteristics and the effects of a consultation proforma
Authors: Nanthakumaran H , Sullivan A K , Boag F C
Published: October 2002

Summary: The aim of this study was to examine the characteristics of patients requesting emergency postcoital contraception at a genitourinary medicine (GUM) clinic. We also compared the quality of information obtained during the consultation, before and after a proforma was introduced. A retrospective review of all clinical notes of patients who attended for postcoital contraception between January and December 1994 and April to June 1995 was performed. Eighty-three per cent of patients were aged 17-29 years, 68.8% were in relationship, 41.3% were not using regular contraception, 33.8% accepted a sexual health screen and of these, 14.8% had a concurrent sexually transmitted disease (STD). The introduction of a consultation proforma significantly improved certain areas of the consultation. The results suggest that sexual health screens should be encouraged in women attending GUM clinics for postcoital contraception and that the use of a proforma improves the quality of information obtained.
Seroprevalence of four sexually transmitted diseases in a semi-urban population of Gabon
Authors: Md E Bertherat , Md M C Georges-Courbot , Phd R Nabias , Md A J Georges , Md A Renaut
Published: October 2002

Summary: Using the cluster-sampling method, the authors estimated the seroprevalence of 4 sexually transmitted diseases (STDs) among the sexually active general population in a city of 30,000 inhabitants in the east of Gabon. The seroprevalences were 2% for HIV-1, 13.8% for hepatitis B, 8.6% for Treponema pallidum and 59.6% for Chlamydia trachomatis . The seroprevalences of hepatitis B and chlamydia were stable over time and similar to those registered in other countries of central Africa. On the other hand, the seroprevalence of T. pallidum is notably low in comparison with these countries and seems to be decreasing. The seroprevalence of HIV-1 is also low but has doubled in 8 years in the city. Immigrant women from west Africa were a high-risk group for STDs but more generally, cohabiting was a risk factor for women.
A UK centre's experience of mycobacterial infections in HIV-infected patients
Authors: Clark J E , Ong E L C
Published: October 2002

A descriptive retrospective review of 26 patients with mycobacterial infection; 7 Mycobacterium tuberculosis (MTB), 17 Mycobacterium avium complex (MAC), one M. xenopei and one M. kansasii . Diagnosis of non-tuberculous mycobacteria (NTM) was made mainly from blood in 68%, with biopsy material initially useful in 68%. All MTB were fully sensitive. No patients received MAC chemoprophylaxis, yet resistance to rifabutin, ciprofloxacin and ethambutol was noted. It is important to examine the UK experience of mycobacterial infection; individual centres may find it useful to review infecting organisms and resistance patterns.
The clinical load of HIV and AIDS for genitourinary physicians
Authors: Shahmanesh Mohsen , Lacey Charles
Published: October 2002

We aimed to investigate the extent of genitourinary medicine (GUM) involvement in the clinical management of HIV. A questionnaire survey was conducted on GUM consultants in the UK and the Irish Republic. Clinics were divided into teaching hospitals (THs) undertaking both undergraduate and postgraduate training in GUM, non-teaching training (NTT) centres undertaking specialist training only and non-teaching (NT) centres. Information was obtained on 241 of the 250 consultants on the Royal College of Physician's GUM Committee's records from 117 GUM clinics (including all THs and NTT centres). Four (1 TH and 2 NTT centres) GUM clinics did not see HIV-positive patients, 62 saw 10-99 patients, 18 reported 100-999 and 4 with over 1000 patients attending in 1996. Thirty-five per cent of the 55 THs and NTT centres had over 100 HIV patients. Consultants were involved in the outpatient care of HIV patients in 99.5% and GUM trainees in 85.5% clinics. Overall 47 clinics have their own inpatient HIV beds and 176 consultants (73%) had full (100) or significant (76) input to inpatient HIV management. Only 29% of THs and 12.5% of NTT centres had none or minor input into HIV care. HIV inpatient on-call commitment by the GUM trainees was reported by 64% of training centres. GUM services provide a major input into outpatient and inpatient care of HIV-infected patients in the UK.
ulcers in a primary health clinic in Rwanda: impact of HIV infection on diagnosis and ulcer healing (1986-1992)
Authors: Bogaerts Jos , Kestens Luc , Dyck Eddy Van , Martinez Waldina , Akingeneye Tello Jeannette , Mukantabana Veronique
Published: October 2002

During 1986-88 and 1990-92, 1025 (97%) out of 1057 genital ulcer patients in Kigali, Rwanda, were tested for HIV antibodies and for infection with Treponema pallidum, Haemophilus ducreyi and herpes simplex virus. Overall, 57% of men and 80% of women had antibodies to HIV-1. The most frequent laboratory diagnoses were chancroid (27%), syphilis (19%) and genital herpes (19%) among men and syphilis (35%), genital herpes (23%) and chancroid (20%) among women. HIV-1 seroprevalence increased sharply over time among men but not among women. The clinical presentation of ulcers as well as laboratory diagnoses were similar in the HIV-1 seropositive and seronegative groups. The relative frequency of all laboratory diagnoses remained unchanged over time. HIV-1 seropositivity had no impact on ulcer healing. Advanced immunodeficiency was diagnosed among 12% of the HIV-1 seropositive patients and was significantly associated with increasing age and genital herpes.
The outcome of contact tracing for gonorrhoea in the United Kingdom
Authors: Fitzgerald M R , Thirlby D , Bedford C A
Published: October 2002

Tracing and treating contacts (partner notification, PN) is a crucial part of the control of sexually transmitted infections but few studies have quantified its outcome. A retrospective national study obtained information from 155 clinics on 1308 patients with gonorrhoea, 59% of all UK patients attending in January to March 1995. These gave 1887 contacts (1 : 1.5) of whom 621 attended, 75% being found to be infected. The ratio of contacts attending to index patients was 0.5 (621/ 1260). The ratio was not influenced by gender or ethnicity, but was affected by orientation, being 0.5 for contacts of male heterosexuals, 0.3 for contacts of male < homosexuals (P 0.001). PN outcome was less good in metropolitan (0.3) than provincial clinics (0.5), suggesting that further research is necessary on the reasons for this difference. Reliable ongoing outcome audit will require good communication between clinics to verify that contacts have attended. The contact:index ratio is suitable for evaluation of PN as it relates to actual outcome rather than to the patient's account of contact numbers. Local work can be assessed against these national figures.
Sexual histories, partnerships and networks associated with the transmission of gonorrhoea
Authors: Ward H , Goan U , Parker M , Kinghorn G , Claydon E , Weber J , Ghani A , Bell G , Ison C
Published: October 2002

We aimed to describe and compare sexual links among people with gonorrhoea, by studying patients in 2 UK departments of genitourinary medicine. Interviews were completed for 510 and 235 cases in London and Sheffield respectively. There was a greater proportion of cases in men, homosexual men, non-white and non-British people and fewer female sex workers in London. Total networks of 1738 people in London and 570 people in Sheffield were described. Large linked heterosexual networks identified in Sheffield were associated with local contact, including men with higher numbers of sexual partners. Condom use for vaginal sex was reported for 11% of heterosexual partnerships in Sheffield, and 27% in London, with little difference between regular and casual partners. It was more difficult to define networks in London due to a high proportion of relatively anonymous contacts. These difficulties suggest that research and interventions may profitably focus upon venues for meeting partners as well as partner notification.
Diagnostic accuracy of HIV-associated central nervous system toxoplasmosis
Authors: Marra C M , Krone M R , Holmes K K , Koutsky L A
Published: October 2002

Our objective was to examine the accuracy of diagnosis of HIV-associated central nervous system (CNS) toxoplasmosis. Individuals diagnosed with HIV-associated CNS toxoplasmosis and controls were ascertained from a population-based database. Diagnosis was confirmed by response to therapy or by histology. Symptoms, results of anti-Toxoplasma serology and use of Pneumocystis carinii pneumonia (PCP) prophylaxis were recorded. Central nervous system toxoplasmosis was confirmed in 54 (76%) of 75 patients. Reactive anti-Toxoplasma serology was associated with CNS toxoplasmosis (OR=20.4, 95% CI 3.1-175.8). Adjusting for CD4 and use of dapsone or aerosolized pentamidine, trimethoprim-sulphamethoxazole (TMP-SMX) for PCP prophylaxis was associated with lower likelihood of CNS toxoplasmosis (OR 0.3, 95% CI 0.1-0.7). Diagnosis of CNS toxoplasmosis is often incorrect. Another diagnosis is most likely in patients who are anti-Toxoplasma seronegative or who are receiving prophylactic TMP-SMX.
HIV infection among patients with sexually transmitted diseases in rural South Africa
Authors: Wilkinson David , Wilkinson Nomsa
Published: October 2002

A cross-sectional study of 360 patients presenting with sexually transmitted diseases (STDs) to a primary care clinic in KwaZulu/Natal, South Africa was done. Prevalence of HIV infection was 42.5%. HIV-infected patients were of similar age to uninfected patients (mean age 25.1 vs 26.1 years), but were less likely to be married (9.2% vs 18.8%; P = 0.02). HIV prevalence was highest among young women (47.9% among women aged 15-34 years compared with 33.1% among men of the same age; P = 0.03). History of a previous STD in the preceding 3 months was high (40.1% in HIV-infected patients). Similar proportions of the HIV-infected and HIVuninfected had sought care for the previous illness at private practitioners (16.9%), and primary care clinics (50.0%), and traditional healers (14.6%) or had treated themselves (18.5%). Patients with an STD are at very high risk of HIV infection in this setting. Repeat STDs are frequent and opportunities exist to improve treatment seeking behaviour, to reduce the risk of recurrent STDs, and hence to reduce the incidence of HIV infection.
Activity of thalidomide in AIDS-related Kaposi's sarcoma and correlation with HHV8 titre
Authors: Fife Kathryn , Phillips Robert H , Howard Mark R , Bower Mark , Gracie Fiona
Published: October 2002

A phase II study of thalidomide was conducted to evaluate its efficacy and toxicity in the treatment of cutaneous AIDS-related Kaposi's sarcoma (AIDSKS). To evaluate whether clinical response is correlated with titre of human herpesvirus 8 (HHV8) DNA in peripheral blood, levels were determined by serial end-point dilution at enrolment and 4-6 weeks later. Seventeen male HIVseropositive patients with histopathologically diagnosed KS were treated with thalidomide 100 mg orally once nightly for 8 weeks. Response evaluation was performed using AIDS Clinical Trials Group (ACTG) criteria and analysis was by intention to treat. Six of 17 patients achieved a partial response (35%: 95% confidence interval 10-61%). Eight patients withdrew (6 owing to toxicity, one to early progression and one to non-compliance). HHV8 DNA load decreased by at least 3log10 to undetectable levels in 3 of the 5 virologically assessable partial responders. This preliminary study demonstrates that thalidomide has activity in the treatment of AIDS-KS and that clinical response is associated with a reduction of HHV8 DNA titre in peripheral blood.
Clinical predictors of azole resistance, outcome and survival from oesophageal candidiasis in AIDS patients
Authors: Laing R B S , Brettle R P , Leen C L S
Published: October 2002

A retrospective review of AIDS-related oesophageal candidiasis was undertaken to identify clinical features helpful in predicting response to azole therapy and patient survival. Patients who had received daily azole prophylaxis against candidiasis were significantly less likely to respond to azole therapy than those who had not (P < 0.001). Patients who had lost >5% of their body weight in the 2 months before oesophageal candidiasis were less likely to respond to azoles than the others (P < 0.001). Amongst those who had not received daily azoles, patients with a CD4+ cell count <25/mm3 were less likely to respond to azole treatment (P = 0.05). The median survival beyond oesophageal candidiasis was 18 months. Survival from oesophageal candidiasis was significantly poorer for patients who did not respond to azole therapy but AIDS survival did not differ between azole responders and non-responders. Non-responders who had been taking daily azole prophylaxis had the poorest survival (median = 4 months).
Detection of male genital infection with Chlamydia trachomatis and Neisseria gonorrhoeae using an automated multiplex PCR system (Cobas®Amplicor™)
Authors: Higgins Stephen P , Klapper Paul E , Struthers J Keith , Bailey Andrew S , Gough Alison P , Moore Rita , Corbitt Gerald , Bhattacharyya Mukti N
Published: October 2002

We evaluated Cobas® Amplicor™, a highly automated polymerase chain reaction (PCR) system, to test first-void urine (FVU) and urethral swab specimens for Chlamydia trachomatis and Neisseria gonorrhoeae in men attending a sexually transmitted infection (STI) clinic. Results were compared against an in-house radioimmune dot blot (DB) test for C. trachomatis and selective culture for N. gonorrhoeae. Three hundred and ninety sets of specimens were obtained from 378 consecutive new and returned-new patients. Gonorrhoea prevalence was 9.49%, with no significant difference in sensitivity or specificity between culture and PCR. Chlamydia prevalence was 15.4%, with sensitivities of: DB 55%, PCR of FVU 86.7%, urethral swab PCR 90%. The specificity of PCR on FVU and urethral swabs was 100%. We have shown that Cobas®Amplicor™ PCR is highly sensitive and specific in the diagnosis of chlamydia and gonorrhoea in men attending an STI clinic. Further economic and scientific studies are needed to determine the cost-effectiveness of this technique for screening in primary care settings.
The management of Chlamydia trachomatis genital infection in genitourinary medicine clinics in the Wessex region
Authors: Priestley C J F
Published: October 2002

Summary: The management of cases of Chlamydia trachomatis genital infection diagnosed in clinics in Wessex in the last quarter of 1996 was surveyed, and the results compared with those obtained in the national gonorrhoea audit. Treatment regimens were extremely varied both between and within clinics. Overall, 71% of patients saw a health adviser, 74% returned for follow-up, and 96% of these were cured. Compared with the national gonorrhoea audit, fewer contacts were reported (1.2 vs 1.5), but more contacts were seen per index case (0.7 vs 0.5), and a higher proportion of contacts were seen (59% vs 33%). The figures were higher in those who returned for a test of cure. Little data were available for contacts attending elsewhere for treament; communication networks among genitourinary medicine (GUM) clinics are essential for effective contact tracing. Variations between clinics may reflect differences between the populations served as well as in diagnostic methods and management policies.
Prevalence, causes and outcome of vulval pain in a genitourinary medicine clinic population
Authors: Denbow M L , Byrne M A
Published: October 2002

Summary: A detailed assessment was completed on 150 consecutive new female patients attending a walk-in genitourinary medicine clinic, in order to elicit the features of vulval pain. Twenty patients (13.3%) experienced vulval pain, and of these, 15 (75%) had an infective cause demonstrated. Candidiasis was demonstrated in more than half (55%) of them and one-fifth had genital herpes. Of the 5 patients in whom no infection was present, 2 were diagnosed with the vulvar vestibulitis syndrome (VVS) following their referral to the dedicated vulval clinic.
Collaborative approach to improve the detection and management of trichomoniasis in a low prevalence district
Authors: Waghorn D J , Tucker P K , Chia Y , Spencer S , Luzzi G A
Published: October 2002

We describe a simple collaborative approach developed by the departments of cytology, microbiology and genitourinary (GU) medicine for the detection, diagnosis and management of microbiologically confirmed Trichomonas vaginalis (TV) infection. Over a 2-year period, 54 (0.1%) of 52,440 cervical smears were reported to show TV, but microbiological confirmation was made in only 76% of 34 patients from whom a vaginal swab was subsequently taken. Trichomoniasis should not be diagnosed by cytology alone and clinicians need further education on the role of cytology in diagnosing sexually transmitted diseases (STDs). Over the same period, from a total of 96 cases of TV identified in the district, only 12 (13%) were first diagnosed in the department of GU medicine. Forty per cent of the other 84 patients were subsequently seen in the GU clinic for test of cure, contact tracing and screening for other STDs. Collaborations between departments may improve the management of trichomoniasis and other conditions in the community and their development should be encouraged.
Evaluation of an HIV saliva test for the detection of HIV-1 and HIV-2 antibodies in high-risk populations in Abidjan, Cote d'Ivoire
Authors: Ettiegne-Traore V , Ghys P D , Maurice C , Hoyi-Adonsou Y M , Soroh D , Adom M-L , Teurquetil M-J , Diallo M O , Laga M , Greenberg A E
Published: October 2002

Summary: To evaluate saliva testing in a West African field situation where both HIV-1 and HIV-2 are present, a cross-sectional study was conducted among female sex workers (FSWs) and their stable male partners (SMPs) at a STD/HIV clinic in Abidjan, Cote d'Ivoire. Saliva samples were collected with the Omni-SAL device and tested for antibodies to HIV-1 or HIV-2 by GACELISA. The HIV seroprevalence was 71% among 468 FSWs and 61% among 31 SMPs. Salivary HIV antibodies were detected in all 227 HIV-1-seropositive, in all 6 HIV-2-seropositive and in 115 of 117 dually seroreactive participants, while no salivary HIV anitbodies were detected in 148 of 149 seronegative participants. The sensitivity and specificity of the saliva test were 99.4% and 99.3% respectively, and the positive and negative predictive values were 99.7% and 98.7% respectively. In this West African field situation saliva testing has a high validity compared to serum testing. The Omni-SAL and GACELISA combination is an alternative strategy to serological testing because of its high sensitivity and specificity, the ease and safety of sample collection and its relatively low cost.
Xanthomonas maltophilia : an emerging pathogen in patients with HIV disease
Authors: Manfredi Roberto , Nanetti Anna , Ferri Morena , Chiodo Francesco
Published: October 2002

Fifty-four episodes of Xanthomonas maltophilia infection were observed in 52 HIV-infected patients out of 2062 assessed (2.52%) over a 6-year period: sepsis/ bacteraemia in 44 cases, lower airways infection in 5 cases, urinary tract infection and pharyngitis in 2 cases each, and lymph node involvement in one patient. X. maltophilia represented the fourth most common non-mycobacterial bacterial pathogen responsible for bacteraemia in HIV-infected patients: 44 cases out of 721 diagnosed (6.1%). When compared with non-typhoid Salmonella spp. bacteraemia, an increased risk to develop X. maltophilia disseminated infection was seen according to the progression of HIV-related immunodeficiency, the occurrence of leukopenia-neutropenia, central venous catheterization, previous antibiotic and/or corticosteroid treatment, and hospitalization. In 3 patients suffering from concurrent AIDS-related disorders, X. maltophilia infection contributed to death, while a recurrence occurred in 2 cases only. Due to the poor antimicrobial susceptibility of this pathogen (also confirmed in our series), X. maltophilia bacteraemia associated with advanced HIV infection and concurrent risk factors, may represent a potentially severe disease.
HIV, hepatitis B and sexual practices in the street-recruited injecting drug users of Calcutta: risk perception versus observed risks
Authors: Panda S , Chatterjee A , Bhattacharjee S , Saha M K , Bhattacharya S K
Published: October 2002

Injecting drug users (IDUs) were recruited from the streets of Calcutta to obtain a baseline biological and behavioural data on risk practices. One-fifth of them (mostly using buprenorphine) tested positive for hepatitis B surface antigen (HBsAg); 4% were reactive to serologic test for syphilis (VDRL: Venereal Disease Research Laboratory). Condom use was insignificant while 74% reported sex with female sex workers and 15% of male IDUs also reported having sex with men. Although, sharing of injecting equipment ('works') was perceived as dangerous by the IDUs, majority of them (90/103) reportedly shared it; cleaning of works before sharing was a concern for intravenous but not for intramuscular drug injecting. Half of the IDUs reported suffering ever from abscess; a proportion (12%) of which had had superadded attack of maggots in it. They were also found to be infected with HIV (1%, 95% CI 0.028-5.97%) at a low prevalence that prompted subsequent launching of needle syringe exchange programme, establishment of cleaning norms before sharing of works, cleaning of injecting site on the body and condom promotion.
Measuring condom use among sex workers in the Dominican Republic
Authors: Weir Sharon S , Fox Laurie J , Bayardo Antonio Demoya , Guerrero Gomez Ernesto , Hassig Susan E
Published: October 2002

The purpose of this paper is to assess the internal consistency of selfreported condom use among sex workers in Puerto Plata and Santo Domingo, Dominican Republic. We examined the responses to questions about condom use among 4 crosssectional samples of sex workers. We compared measures based on: (1) questions using always-to-never scales; (2) questions about use with the past 5 clients; and (3) questions about use in the past week obtained from a retrospective coital log. In each sample, more women reported 'always' using condoms with clients than with each of the past 5 clients. In 3 of the 4 samples, only about half of the women who reported 'always' using condoms used condoms with the most recent 5 clients and with all clients in the past week. Internal consistency was significantly higher when the comparison was limited to use with the most recent 5 clients and use in the past week. Self-reported measures of condom use can be difficult to interpret. Assessing the internal consistency of several measures of use provides insight into the strengths and weaknesses of each measure.
Intravitreal sustained-release ganciclovir implantation to control cytomegalovirus retinitis in AIDS
Authors: Dhillon B , Kamal A , Leen C
Published: October 2002

A novel form of therapy, the intravitreal ganciclovir implant (Vitrasert), was used to treat cytomegalovirus (CMV) retinitis in AIDS, when it was not possible to continue systemic therapy or disease progression was evident despite conventional intravenous treatment. A review of the ophthalmic and general health data, operative records and fundus photographs of 9 individuals who had Vitrasert implantation surgery in Edinburgh. Two patients received bilateral replacement implant procedures. Visual acuity, concomitant anti-CMV therapy, complications of implantation and control of retinitis were documented until final follow-up. Control of CMV retinitis was achieved in all individuals at one month postoperatively and remained controlled for a mean period of 5.8 months. Postoperative complications were mild and transient in all but 2 eyes of 2 patients who developed non-progressive macula oedema. Blinding complications as a result of surgery were not encountered and retinal detachment was not observed in this series. Vitrasert implantation is an acceptable and well tolerated treatment for CMV retinitis when systemic therapy fails to control disease progression.
Attitudes to HIV testing in general practice
Authors: Kellock D J , Rogstad K E
Published: October 2002

Summary: Newer therapies for the treatment of HIV infection and the effectiveness of zidovudine in reducing vertical transmission mean that it is becoming increasingly important to diagnose HIV infection earlier. General practitioners (GPs) attending a local study day on sexually transmitted diseases (STDs) were asked about their likelihood of raising the subject of HIV antibody testing, and their anxiety when doing so, for different patient groups. A high level of anxiety was found when raising this topic in certain patient groups, and a proportion of GPs would never discuss HIV testing, even in very high-risk groups. No respondents were aware that vertical transmission could be reduced by antiretroviral drug therapy. These data advocate that the barriers to raising the issue of HIV testing and the methods of reducing GPs' anxiety associated with it, need to be addressed.
improving survival of AIDS patients St Mary's Hospital, London, 1982-1991 Hospital service interventions and
Authors: Beck Eduard J , Mandalia Sundhiya , Miller David L , Harris John R W
Published: October 2002

Summary: The relationship between changes in hospital service interventions at St Mary's Hospital, London, reduced case fatality for patients with their first episode of Pneumocystis carinii pneumonia (PCP) and improved survival from diagnosis of AIDS was investigated for the period 1982-1991. Multivariate logistic regression models identified factors independently associated with episode survival; for those patients who survived their first episode of PCP, survival from time of diagnosis of AIDS was analysed using multivariate Cox's proportional hazards models. The case-fatality rate after 1987 was significantly lower for the 159 subjects. Median survival from diagnosis of AIDS increased significantly from 142 days to 554 days ( P =0.01). Improved survival of first episode of PCP was associated with it being the index diagnosis and having a haemoglobin at diagnosis of PCP greater than 12 g/dl. The presence of a concurrent AIDS-defining condition in patients who presented with an A-a gradient equal to or greater than 40 mmHg was associated with reduced episode survival, especially before 1987. For the 126 individuals who survived their first episode of PCP, death rates were lowest in patients treated with primary or secondary PCP prophylaxis and those who received zidovudine since their first episode of PCP. Survival in patients with HIV disease is better in patients who receive appropriate antiretroviral treatment of HIV infection and timely treatment of opportunistic illnesses. Early diagnosis of HIV-1 infection with early diagnosis and treatment of first episode of PCP was associated with improved episode survival. Subsequent medical follow up combined with PCP prophylaxis and zidovudine were significantly associated with long-term survival.
Sexually transmitted disease rates before and after HIV testing
Authors: George Nigel , Green John , Murphy Siobhan
Published: October 2002

Summary: The aim of the study was to evaluate the effect of having an HIV-positive or negative test result on sexual risk behaviour before and after the test. Longitudinal retrospective case-note survey identifying new episodes of sexually transmitted disease (STD) infections in 114 subjects testing HIV positive and 114 matched negatives were examined at the Genitourinary Medicine Department, St Mary's Hospital, Paddington, London. Across the whole sample in the year after HIV testing the number of cases of new STD infections was 40% of the number of cases in the year prior to HIV testing. There was no association between serostatus and incidence of STD infections before and after HIV testing. Of those testing negative, 5.3% were identified as having a new infection in the year after the HIV test, while amongst those testing positive there was a rate of new STDs of 2.6%. In conclusion, there was no evidence that having a negative test result increased the risk of acquisition of new STDs. Rates of new STD infections amongst seropositives in the year after HIV testing were low.
Urinary neopterin as a prognostic index of survival time in HIV-1 infection
Authors: Rogstad Karen E , Morgan Linda , Hughes James
Published: October 2002

Summary: A prospective semi-longitudinal study was undertaken to determine if urinary neopterin was a predictor for survival in HIV-positive patients. One hundred and one HIV-positive subjects attending a department of genitourinary medicine over a 41-month period were included. Survival data were analysed 6 months after the end of recruitment. Ninety-two subjects were followed up for a minimum of 6 months. Survival figures at 1 and 2 years were 93% (SE 3%) and 79% (SE 5%). There was an inverse relationship between urinary neopterin excretion and 1 and 2-year survival. Two-year survival fell from 70% (SE 6%) for neopterin levels 300 mmol/mol creatinine to 25% (SE 9%) for levels 700 mmol/mol < creatinine ( P 0.001). Urinary neopterin may be a useful non-invasive technique in predicting survival in HIV-positive patients.
Does additional lubrication affect condom slippage and breakage?
Authors: Smith Anthony M A , Jolley Damien , Hocking Jane , Benton Kim , Gerofi John
Published: October 2002

Summary: The risk of condom slippage (1.94%) and breakage (0.89%) among 3607 condoms was analysed with respect to the use of additional lubricant. Whether or not lubricant was used, the site at which it was applied and the type of lubricant used were all found to vary significantly with the type of sexual act(s) for which the condoms were used. Little evidence was found for differing effects of type of additional lubricant (water-based, saliva or other) or site of lubricant use (on penis/ inside condom, on condom, in vagina/anus). The use of lubricant more than doubles the risk of slippage for vaginal sex. While anal sex is associated with much higher risks of slippage the use of lubricant for this practice actually reduces the risk of slippage to that similar for vaginal sex where lubricant is used. No significant effect of additional lubricant on condom breakage was observed. It is recommended that education messages concerning the use of additional lubricant may need to change to take into account the varied nature of lubricant use practices and the differential effects of lubricant with respect to sexual practices. Specifically, if the use of additional lubricant has little or no impact on condom breakage but increases condom slippage then encouraging its use may be counterproductive if condom users consider slippage to be a reason not to use condoms.
Factors associated with HIV testing among Canadians: results of a population-based survey
Authors: Houston Sandra , Archibald Chris P , Strike Carol , Sutherland Donald
Published: October 2002

Summary: The purpose of this study was to examine the HIV-testing behaviour of Canadians aged 15 years and older. Questions on HIV testing were asked as part of a Canada-wide random digit dialling telephone survey conducted in December 1995 to January 1996 on health practices and attitudes toward health care in Canada ( n =3123). Including blood donation and insurance testing, 40.4% of men and 30.4% of women had been tested for HIV. Excluding blood donation and life-insurance testing (voluntary testing), 17.8% of men and 15.6% of women had been tested. In multivariate analyses, factors independently associated with voluntary testing among men were: having had sex with a man (OR=16.8), injection drug use (OR=5.8), having had a partner at high risk (OR=2.5), having received blood or clotting factor (OR=2.3), being younger than 45 years of age (OR=1.8), living in a city of over one million (OR=1.7), and making less than $30,000 a year (OR=1.6). For women, factors independently associated with voluntary testing were having received blood or clotting factor (OR=3.9), having had a high-risk partner (OR= 3.5), being younger than 45 years of age (OR=2.4), having had sex with a man (OR=2.3), and being unattached (OR=2.0). Results indicated that those at risk are more likely to be tested. It is of concern, however, that many of those reporting risk factors have not been tested. A better understanding of HIV testing behaviour is needed to improve the planning and evaluation of prevention and counselling services.
Chlamydia trachomatis : probable cause of prostatitis
Authors: Ostaszewska Iwona , Zdrodowska-Stefanow Bozena , Badyda Jerzy , Pucilo Katarzyna , Trybula Jadwiga , Bulhak Violetta
Published: October 2002

Summary: Seventy-eight men with symptoms of chronic or subacute prostatitis were enrolled. Investigations for the presence of Chlamydia trachomatis in urethral swabs were carried out. The expressed prostatic secretions were additionally examined for Mycoplasma hominis , Ureaplasma urealyticum , Gardnerella vaginalis , other Gram-negative and Gram-positive bacteria, Trichomonas vaginalis , yeast-like fungi and leucocyte count. Furthermore, all patients were evaluated for the presence of serum anti-chlamydial IgG antibodies. Signs of inflammation on the basis of the count of leucocytes per hpf in the prostatic secretions were detected in 42 patients (group I). Prostatodynia was found in the remaining 36 men (group II). In group I, chlamydial antigen was detected in the urethra and expressed prostatic secretions (EPS) in 6 (14.3%) and 9 (21.4%) patients, respectively. No evidence of current chlamydial infection was found in group II. The presence of serum anti-chlamydial IgG antibodies was demonstrated in 13/42 (30.9%) patients with prostatitis and in 3/36 (8.3%) patients with prostatodynia ( P 0.01). The results suggest that chlamydia may be one of the causative agents of chronic prostatitis. <
G CSF association with prolonged survival in HIV infected patients with disseminated Mycobacterium avium complex infection
Authors: Keiser Philip , Rademacher Steven , Smith James , Skiest Daniel
Published: October 2002

Summary: Clarithromycin can ameliorate symptoms and improve survival in disseminated Mycobacterium avium complex DMAC infection. Optimal combina tions of this drug with other agents remain unknown. Granulocyte colony stimulating factor G CSF is a cytokine that can improve phagocytosis of M. avium complex in vitro . We aim to determine if G CSF administration is associated with improved survival in patients with DMAC in a retrospective, cohort study. Case records from 1991 to 1995 of 91 patients with DMAC at Parkland Memorial Hospital were reviewed for date of initial DMAC diagnosis, baseline CD4 count, race, sex, antiretroviral use, G CSF use, therapy for DMAC clarithromycin, ethambutol, ciprofloxacin and rifabutin and date of death. Of 91 cases identified, 25 were treated with G CSF and 66 never received this drug. Baseline characteristics were similar in each group including CD4 count 40 cells mm 3 vs 33 cells mm 3, P =0.68 , clarithromycin use 18 patients vs 52 patients, P =0.90 , and antiretroviral use 20 patients vs 42 patients, P =0.21 . Subjects treated with G CSF lived longer than those who did not receive this drug 355 days vs 211 days, P 0.01 . In the subgroup treated with clarithromycin, G CSF was also associated with increased survival 377 days vs 252 days, P 0.01 . Cox proportional hazards model showed a decreased risk of death in patients treated with G CSF RH=0.22, P 0.01 , clarithromycin RH=0.13, P 0.01 and ethambutol RH=0.51, P =0.02 . Ciprofloxacin and rifabutin use did not influence survival. These data support the use of clarithromycin and ethambutol in the treatment of DMAC. Addition of G CSF to a regimen of clarithromycin and ethambutol may increase survival in DMAC and should be studied prospectively.
Prevalence and prediction of sexually transmitted diseases among sex workers in Cameroon
Authors: Ryan K A , Zekeng L , Roddy R E , Weir S S
Published: October 2002

The aim of the study was to determine the prevalence of sexually transmitted diseases STDs , describe the frequency of genitourinary symptoms and signs, and to assess the accuracy of clinical diagnoses of STD in a cohort of Cameroonian sex workers. Physical examinations were conducted on 1233 sex workers in Yaounde and Douala, Cameroon. Symptoms experienced within the 14 days prior to examination were collected. Women were tested for gonorrhoea, chlamydia infection, and trichomoniasis. Doctors clinical impressions were compared with laboratory tests. Prevalence of cervical infection and trichomoniasis was 20 . A high percentage of abnormal signs and symptoms was found in this cohort. Clinical diagnosis for cervicitis and trichomoniasis had low sensitivities 50 while specificity remained high 65 . In conclusion STDs are common among sex workers in Cameroon. Clinical diagnosis was not an accurate predictor of infection at the individual level in this population at risk of STD.
Clinical study of the effectiveness of a dual amplified immunoassay IDEIA PCE Chlamydia for the diagnosis of male urethritis
Authors: Hirose T , Iwasawa A , Satoh T , Itoh N , Tsukamoto T , Gohro T , Miyagishi T , Ikegaki S , Saka T , Nishimura M , Yamazaki K , Hayashi K , Yoshida H , Hagiwara T
Published: October 2002

A clinical study of patients with male urethritis n =316 was undertaken to determine the sensitivity potential for a new dual amplified immunoassay IDEIA PCE ChlamydiaTM . Increased sensitivity 98.8 , 84 85 was obtained for IDEIA PCE ChlamydiaTM compared to a conventional antigen detection test IDEIA ChlamydiaTM, 81.2 , 69 85 when testing urine samples. In a smaller patient population n =104 the positivity rate for the first void urine tested with IDEIA PCE ChlamydiaTM of 30.8 32 104 was similar to the 27.9 29 104 obtained from urethral swabs tested with a DNA probe assay PACE 2TM . The increased sensitivity of the test was confirmed with a commercial PCR kit AmplicorTM and nested PCR. The IDEIA PCE ChlamydiaTM kit has the sensitivity potential to be a clinically reliable alternative for detecting Chlamydia trachomatis .
The role of effective diagnosis for the control of gonorrhoea in high prevalence populations
Authors: Davies P O , Ison C A
Published: October 2002

Gonorrhoea in the UK is now a highly focal problem that is localized to certain inner city areas where it presents a significant public health concern. However, the majority of men and a proportion of women infested with Neisseria gonorrhoeae do not experience symptoms of sufficient intensity to prompt them to seek medical advice and the current strategy of treating symptomatic individuals in specialist clinics with subsequent tracing of sexual partners is therefore failing to control the spread of infection in these areas. One method for addressing this problem would be the extension of effective diagnostic services into the clinical environments most likely to be accessed by these high risk individuals. This paper reviews the scientific literature examining the various methodologies available for the identification of N. gonorrhoeae and assesses their suitability for the diagnosis of gonorrhoea in these alternative clinical settings.
Correlation between history of contact with people living with HIV AIDS PWAs and tolerant attitudes toward HIV AIDS and PWAs in rural Thailand
Authors: Takai Akiko , Wongkhomthong Som Arch , Akabayashi Akira , Kai Ichiro , Ohi Gen , Naka Koichi
Published: October 2002

This study examines the hypothesis that people who have more contact with PWAs people living with AIDS are more tolerant than those who have no contact with them. Four provinces with different incidence of AIDS in 4 different regions of Thailand were selected. Structured questionnaire interviews were conducted with village people, asking about their history of contact with PWAs, and knowledge and attitudes toward HIV AIDS and PWAs n =434 . An lAttitude Score , which indicates an accepting attitude or tolerance toward HIV AIDS and PWAs, was developed using the results of the questionnaire on attitudes. Six factors: sex, education, age, province, knowledge, and history of contact with PWAs were positively correlated with the Attitude Score. After a multiple regression analysis, contact with PWAs was significantly associated with Attitude Score. This study is one of the first analytical studies conducted in a non Western country to show that people s tolerant attitudes towards HIV AIDS and PWAs are positively related to their history of contact with HIV AIDS and PWAs. This finding should have important implications for future educational programmes and preventative intervention.
Herpes zoster ophthalmicus and HIV infection in Nigeria
Authors: Umeh Rich E
Published: October 2002

Eight patients, 3 men and 5 women, aged between 24 and 40 years who had herpes zoster ophthalmicus HZO were seen in the Eye Department of the University of Nigeria Teaching Hospital, Enugu between 1994 and 1997. One of the patients was already on treatment for active pulmonary tuberculosis at the time he was first seen. All had skin eruptions at different stages of development in the area of distribution of the first trigeminal nerve on the affected side of the face and head. Ocular examination revealed impaired vision in the affected eye between 6 12 and hand movement in all the patients. All had lid oedema while 5 had ptosis 3 partial and 2 complete . Various degrees of conjunctival injection were observed in all patients while 6 of them had corneal anaesthesia and keratitis. Uveal inflammation, present in all the patients varied from mild iritis in 4 individuals to severe iridocyclitis in the remaining 4. Pupils reacted to light sluggishly in 2 patients while they were dilated and fixed in 3 others. None had any associated abnormalities in the posterior segment. Six of the patients consented and were screened for human immunodeficiency virus HIV infection. Of these, 4, including the patient with pulmonary tuberculosis, tested seropositive while 2 were seronegative. All 8 were treated with topical acyclovir. This was combined with oral acyclovir in one of the patients. Follow up period was between 2 and 52 weeks. During this period skin eruptions and anterior segment signs improved in 5 patients while remaining stable in 3 others; post herpetic neuralgia persisted on the affected side in 4 patients. Patients who were HIV seropositive did not recover as quickly or to the same extent as the seronegative ones. It is concluded that HZO infection may indicate underlying HIV infection in young Africans as has been found in whites.
The availability and cost of antibiotics for treating PID in the Central Region of Ghana and implications for compliance with national treatment guidelines
Authors: Bosu W K , Mabey D
Published: October 2002

The availability and cost of antibiotics for treating pelvic inflammatory disease PID were assessed in 17 drug dispensing outlets in 5 districts of the Central Region, Ghana. The outlets included the dispensaries of 2 regional and 4 district hospitals, 4 privately owned pharmacies and 7 chemical seller shops. The most common antibiotics available, including co trimoxazole, metronidazole, benzylpenicillin, amoxycillin, chloramphenicol and gentamicin, were also the lowest priced drugs. Conversely, the most expensive antibiotics including ceftriaxone, ciprofloxacin, cefuroxime and spectinomycin, were also the least commonly available. Recommended anti gonococcal antibiotics ciprofloxacin, ceftriaxone may not be prescribed if they are not available in the districts.