bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipid abnormalities in a healthcare worker receiving HIV prophylaxis
Authors: Allan David A. , Behrman Amy J.
Published: October 2002

Healthcare workers (HCWs) worldwide risk occupational exposure to HIV and other blood-borne pathogens. Post-exposure prophylaxis (PEP) may decrease the risk of seroconversion after occupational or sexual exposure. Current guidelines recommend immediate PEP with at least 2 drugs following HIV exposure. In high-risk exposures, the guidelines recommend the use of a protease inhibitor (PI) as well as 2 reverse transcriptase inhibitors. Protease inhibitors have been associated with dyslipidaemias, other metabolic abnormalities and lipodystrophy syndromes in AIDS patients. We report a case of new transient lipid abnormalities in a HCW receiving PEP after HIV exposure. HIV medications may produce occult metabolic abnormalities in HIV-negative individuals receiving PEP. This risk should be considered during follow-up evaluation for PEP.
Genital schistosomiasis
Authors: Carey F M , Quah S P , Hedderwick S , Finnegan D , Dinsmore W W , Maw R D
Published: October 2002

Schistosomiasis is the most serious helminthic infection in the United Kingdom. Female genital schistosomiasis affects 9-13 million women worldwide, mainly in areas where Schistosoma haematobium is endemic. With increasing tourism to these areas, this diagnosis is being encountered more frequently in the West. We present 2 cases of vulval schistosomiasis that were presented to our department in 1999 and 2000.
New patient-applied therapy for anogenital warts is rated favourably by patients
Authors: O'Mahony C , Law C , Gollnick H P M , Marini M
Published: October 2002

Our objective was to determine patient attitudes to having genital warts, and their perceptions of their treatment with imiquimod and other therapies. As an adjunct to a clinical trial in which patients with external genital warts were treated with imiquimod 5% cream until their warts cleared or for up to 16 weeks, quantitative questionnaires consisting of multiple choice questions and 5-point rating scales were completed prior to, and at the end, of the study period. Pre-study and post-study questionnaires were completed by 902 and 629 patients, respectively. Patients expressed a definite concern about genital warts. The majority of patients (70%) had been previously treated for genital warts, and expressed dissatisfaction with their previous therapies. Of patients treated with imiquimod in this study, 82% reported that their warts decreased in size; this occurred within the first 4 weeks for 78% of patients. Sixty-one per cent of patients perceived that their warts completely cleared within the 16-week treatment period. Patients rated imiquimod 5% cream as better than other genital wart therapies in terms of overall satisfaction, time to clearance, convenience and lack of associated pain. In conclusion, patients rated imiquimod 5% cream as an effective treatment which clears warts in an acceptable length of time causing minimal pain and is convenient to use.
Long-term clinical benefit after highly active antiretroviral therapy in advanced HIV-1 infection, even in patients without immune reconstitution
Authors: Arici Claudio , Ripamonti Diego , Ravasio Veronica , Maggiolo Franco , Rizzi Marco , Finazzi Maria Grazia , Suter Fredy
Published: October 2002

Our objective was to assess, in the clinical setting, the predictors of immune reconstitution (IR) and its relation with long-term clinical benefit, in HIV patients with advanced disease after highly active antiretroviral therapy (HAART) through an observational study. A retrospective cohort study in a clinical setting of 383 consecutive adult patients with advanced HIV infection (CD4+ cells <200/mm3 at baseline), starting their first protease inhibitor (PI)-containing regimen was observed. Immune reconstitution was defined as CD4 count >200 cells/mm3 and an increase ≥100 cells from baseline, anytime since starting HAART. Clinical benefit was defined as decreased mortality and reduction in AIDS-defining events, AIDS-related complex (ARC) events, major infections and hospitalization (days spent in hospital). During a mean follow-up of 808 days, 261 patients (68.1%) achieved IR. About 50% of these patients reached this result within one year after starting HAART. In multivariate analysis, predictors of immune recovery were sex (female) and baseline CD4 count higher than 50 cells/mm3. The group of patients with IR had greater clinical benefit with lower mortality, fewer AIDS-defining events, shorter lengths of stay in hospital, fewer ARC events and fewer major infections during all the follow-up ( P < 0.0001, tests for trends). However, although they did less remarkably than the first group of patients, even those patients who did not achieve IR experienced a significant decrease in the incidence of all the above events, as compared with the first and sometimes the second trimester after starting their HIV therapy. About 70% of HIV patients with advanced disease achieved IR after starting HAART. Such a benefit is a time-dependent effect and may even take more than 2 years to occur. Predictors of IR were sex (female) and higher baseline CD4 count (>50 cells/mm3). The patients who achieved immune recovery performed clinically better than patients who did not. Also the patients who failed to gain such a strong immunological recovery experienced a long-term clinical benefit. This suggests that PI-containing regimens, in advanced HIV disease, may produce a significant clinical benefit, at least temporary, even for patients who do not achieve a substantial immune response.
Male clients of female commercial sex workers: HIV, STDs and risk behaviour
Authors: Coughlan E , Mindel A , Estcourt C S
Published: October 2002

Social stigma and taboo limit current understanding of sexual behaviours and epidemiology of sexually transmitted infections (STIs) in clients of commercial sex workers/prostitutes. We designed a study to determine risk behaviours and prevalence of STIs in a group of sexual health clinic attending male clients of female commercial sex workers (FCSWs) in Sydney, and to compare these characteristics with men who denied any commercial sexual contact. Eight hundred and ninety cases and 2670 controls were included. Clients of FCSWs were older, more likely to be married and of non-English speaking background than controls. Clients had more sexual partners but reported more condom usage than controls. Prevalence of STIs at presentation was lower in clients than controls but clients were more likely to report STIs in the past than controls. HIV prevalence was low in both groups.
A multi-district audit against national guidelines for the management of uncomplicated genital Chlamydia trachomatis infection
Authors: Clarke Janette , Preston Andrew D
Published: October 2002

A regional audit group in genitourinary medicine (GUM) developed a method to assess their practice using peripatetic audit workers. An audit using 2 audit proformas recorded information relating to an agreed selection of standards contained within the national guidelines for the management of uncomplicated genital chlamydial infection. An audit worker (ADP) reviewed patient records of a sample of cases. Nine GUM clinics throughout the Yorkshire region participated in the audit; 489 cases out of a total annual workload of 2358 cases positively diagnosed as uncomplicated chlamydial infection were reviewed. Variations in compliance with the standards for confirmation of test results and the time from diagnosis to treatment were seen. Recording of discussions, advice and contact tracing activity were limited or separated from the main patient record, making assessment of practice difficult. Post-audit meetings of the group led to action on these areas and commitment to re-audit with the same standards and methods.
An Audit of Baseline Assessment of Patients with HIV Infection
Authors: Piyadigamage Anura , Monteiro Eric F ,   Yorkshire Audit Group for HIV-related diseases, Fairley Ian , Stanley Philip , Valentine Chris , Joshi Uday , Gupta P , de Silva A , Monteiro Eric , Waugh Michael , Wilson Janet , Morgan Emile
Published: October 2002

A multicentre retrospective medical audit was conducted on the baseline investigations of new patients with HIV infection. A total of 20 investigations were audited for men and 21 for women. Data were received on 49 newly diagnosed patients infected with HIV from 8 centres in the Yorkshire region. The audit demonstrated that half of the patients were not screened for sexually transmitted infections. However, the majority of baseline assessment considered as standard of care, had been performed.
Variability of the Symptoms of Chronic Abacterial Prostatitis/Chronic Pelvic Pain Syndrome during Intermittent Therapy with Rectal Prednisolone Foam for Ulcerative Colitis
Authors: Talbot Martin , Bates Sylvia
Published: October 2002

We describe the response of symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/PPS) in a man treated with rectal prednisolone for concomitant ulcerative colitis. The temporal relationship of the symptoms of CAP/PPS to starting and stopping the topical corticosteroid over 2 treatment cycles lends further anecdotal support to our hypothesis that treatment of the immune-mediated response in this chronic condition has a beneficial effect upon symptomatic outcome.
Syphilitic Panuveitis and Asymptomatic Neurosyphilis: A Marker of HIV Infection
Authors: Thami Gurvinder P , Kaur Sukhjot , Gupta Rajeev , Kanwar Amrinder J , Sood Sunandan
Published: October 2002

Co-existing human immunodeficiency virus (HIV) infection can alter the course and presentation of syphilis. Severe ocular manifestations and accelerated natural course of syphilis along with neurosyphilis may be associated with HIV infection. A 30-year-old man is described in whom syphilitic panuveitis and asymptomatic neurosyphilis served as a marker for HIV infection.
Efficacy of preventive human papillomavirus vaccination
Authors: Lehtinen M , Paavonen J
Published: October 2002

Interplay between host immune system and expression of human papillomavirus (HPV) early (E) and late (L) genes during infection has a central role in the surveillance of virus-induced neoplastic cervical lesions. Recently, new features of this interplay have been discovered. However, not enough is yet known of the relative roles of different E and L proteins, human lymphocyte antigens (HLAs) and specific co-factors in the natural history of these lesions in order to guarantee efficacy of preventive HPV vaccination. The ultimate knowledge can only be provided by phase III/IV vaccination trials which are starting in the near future. The present review attempts to answer one fundamental question: which of the vaccine candidates is likely to be most successful.
Care of sexually transmitted infections in the Nordic countries
Authors: Moi Harald
Published: October 2002

This article presents an overview of the epidemiology and control of sexually transmitted infections (STIs) in the Nordic countries. These countries have succeeded in controlling gonorrhoea and syphilis, and the incidence of HIV infection is low. However, during the last few years the incidence of all STIs has increased, although from very low levels. Genital chlamydial infection is still prevalent, and is also increasing. Dermatovenereologists are responsible for the specialized care of STIs, but family doctors and gynaecologists are responsible for the management of a great portion of STIs.
Sexually transmitted infections in Italy: an overview
Authors: Dal Conte Ivano , Lucchini Anna , Contuzzi Enza , Di Perri Giovanni , Bingham James
Published: October 2002

In Italy more than 240,000 and 500,000 cases of gonorrhoea and syphilis, respectively, were reported in 1936 but the incidence progressively fell to about 200-300/year by the early 1990s; data available now are probably 100-150% underestimated. An inefficient notification system, diversion of public funding to other fields, and the progressive decline in importance of dermatovenereological centres are responsible for this decline. The advent of the HIV epidemic (with more than 47,000 AIDS reported cases) has drained most public health resources away from the very limited interventions for the control of traditional sexually transmitted infections (STIs). This has led some groups to attempt alternative approaches to the HIV/STI prevention and treatment policies; the potential of these new experiences need to be assessed. A change in culture of the medical body politic is now essential in order to support medical professionals, administrators and programme managers seeking to implement proper STI control programmes.
Sexual transmission of Helicobacter pylori via oral-anal intercourse
Authors: Eslick Guy D
Published: October 2002

Helicobacter infection may be transmitted sexually, during the act of oral-anal intercourse. A literature search was performed using MEDLINE and Current Contents (January 1983 to September 2001). Combinations of relevant keywords were used and additional manual searches were made using the reference lists from the selected articles to retrieve other papers relevant to the topic. Helicobacter infection may be transmitted via faeces during the sexual act of oral-anal intercourse with an infected individual.
Estimating HIV-1 transmission efficiency through unsafe medical injections
Authors: Gisselquist David P
Published: October 2002

The transmission efficiency of HIV-1 through unsafe medical injections can be estimated from seroconversions among health care workers (HCWs) after percutaneous exposures and documented iatrogenic outbreaks. Data from a case-control study of seroconversion after percutaneous exposures among US and European HCWs shows an average rate of seroconversion after deep injuries - arguably comparable to unsafe injections - of 2.3%. Information from an iatrogenic HIV outbreak in a Romanian orphanage suggests a transmission efficiency of 2-7%. Even these estimates may be too low to explain the rapid spread of HIV among Russian and Libyan children in iatrogenic outbreaks discovered in 1988 and 1998, respectively. In countries in sub-Saharan Africa and elsewhere with high HIV prevalence and large numbers of unsafe injections, personal risk as well as the share of the HIV epidemic associated with unsafe injections may be an order of magnitude higher that many experts have supposed.
A multidistrict audit of the management of chlamydial PID in genitourinary medicine clinics in Yorkshire
Authors: Kuchimanchi Usha , McClean Hugo
Published: October 2002

In response to recent reviews of practice of pelvic inflammatory disease (PID) management, a multidistrict audit involving eight genitourinary clinics within the Yorkshire region was carried out. This audit reports the referral patterns of patients, physical signs and microscopy findings at the first genitourinary medicine (GUM) clinic attendance, antibiotic treatment and follow-up data as well as health adviser involvement and partner participation for 68 patients diagnosed with chlamydial PID. Twenty-eight (41.2%) patients presented with symptoms of less than or equal to four weeks duration, partner notification was recorded as being carried out for all patients and at least one partner was documented as having been treated in 57 (83.8%) patients. There is, however, a wide variation in the antibiotic regimens used for treatment and their duration.
The male genital skin burning syndrome (Dysaesthetic Peno/Scroto-dynia)
Authors: Markos A R
Published: October 2002

Men may complain of penile and/or scrotal skin burning with no evidence of positive physical signs or investigations. The condition is cumbersome and leads to stress and disruption in social and sexual relationships. The patients report no response to previous medications (including antibiotics, antifungals and topical corticosteroids); and identify improvement in symptoms and quality of life on selective serotonin re-uptake inhibitors (SSRI). A similar condition has been recognized in the female patients (dysaesthetic vulvodynia). We report the occurrence of this condition in three men and suggest it being recognized as 'the male genital skin burning syndrome' (Dysaesthetic Peno/Scroto-dynia).
Subcutaneous granulomatous lesions related to ritonavir therapy in a HIV infected patient
Authors: Kawsar M , El-Gadi S
Published: October 2002

We report a case of subcutaneous granulomatous lesions developed in a HIV seropositive man, related to ritonavir therapy. The importance of close monitoring and investigations of patients developing unusual side effects during highly active antiretroviral therapy (HAART) is demonstrated.
To cut a long story short - the use of imiquimod in resistant warts
Authors: Murray Carolyn
Published: October 2002

Persistent anogenital warts are frustrating and expensive to manage, both for the patient and the clinic. This case report illustrates prolonged and varied management, and eventual success with imiquimod.
Information-giving to patients with genital warts at a genitourinary medicine clinic: a baseline assessment
Authors: McClean Hugo , Weaver Susan
Published: October 2002

Aspects of information-giving to patients with a first episode of genital warts attending a large UK genitourinary medicine clinic on three or more occasions were assessed using a questionnaire survey employing correlational and between-groups analyses. The main outcomes measured were levels of, and interrelationships between, patients' perceptions of information received about genital warts, accuracy of knowledge, quality of interaction with clinic personnel, written information, patients' level of anxiety and demographic variables. Patients with genital warts have good basic knowledge about this condition, although understanding about several complex issues is poor. Educational level was positively correlated with accuracy of knowledge about genital warts. Although ease of communicative interaction with information-givers was positively correlated with perceived information given, no relationship was found between the latter and actual knowledge about genital warts. Anxiety levels and receiving written information were largely uncorrelated with accuracy of knowledge about genital warts. This study suggests that while patients' perception of information received may relate to more satisfactory interaction with information-givers, actual knowledge may be a more important measurable outcome. More interventional work is needed to determine how the information-giving process for genital warts can be optimized.
Sexual health provision and the Sexual Health and HIV Strategy for England: a questionnaire survey of general practitioners' views
Authors: Hope S C , Theobald J A , McOwan A
Published: October 2002

An anonymous postal survey was used to assess the views of general practitioners (GPs) on the expected contents of the Department of Health National Sexual Health and HIV Strategy for England prior to release. One hundred and seventeen GPs in four London Primary Care Groups took part (response rate=50%). The majority felt they currently have about the right amount of involvement in patient care (HIV 70%: GUM 66%); 88% of GPs felt they offer general sexual health care (Level one), and most wished to continue with this (85%). However, a sizeable minority of GPs wanted to be involved in the development of care guidelines (HIV 17%; GUM 22%), and 10% considered that they might wish to offer more specialist services (Level two). To achieve a Strategy goal to integrate sexual healthcare services in England, it is likely that there will need to be local consultation and support for GPs.
HIV risk factors among patients with tuberculosis — Botswana 1999
Authors: Talbot Elizabeth A , Kenyon Thomas A , Moeti Themba L , Hsin Gary , Dooley Laura , El-Halabi Shenaaz , Binkin Nancy J
Published: October 2002

To identify factors associated with HIV in Botswana, a standardized questionnaire was administered to 135 tuberculosis patients with known HIV status. HIV-positive patients were more likely than HIV-negative patients to: be female (45% vs 26% (adjusted prevalence odds ratio (aPOR)=3.8, 95% confidence interval (CI)=1.1-12.7)); be 26-35 years old (50% vs 19% (aPOR=2.7, CI=0.7-10.7)); be unmarried (91% vs 71% (aPOR=13.3, CI=2.5-72.7)); have higher income (24% vs 10% (aPOR=8.2, CI=1.6-42.9)); report separation from spouse/partner for work (63% vs 52% (aPOR=1.8, CI=0.5-6.2)); have 2 sex partners other than their regular partner (82% vs 67% (aPOR=1.8, CI=0.5-7.5)); and state that they or their partner drank alcohol before sex (77% vs 55% (aPOR=6.8, CI=1.9-24.1)). Only 22% of respondents used condoms during all of their past 10 sexual encounters. These data provide information for HIV prevention strategies.
Microscopy of stained smears of vaginal secretion in the diagnosis of recurrent vulvovaginal candidosis
Authors: Novikova Natalia , Yassievich Elena , Mårdh Per-Anders
Published: October 2002

This study was undertaken to determine the value of stained smears from the vaginal introitus and the posterior vaginal fornix for detection of candida morphotypes in the diagnosis of recurrent vulvovaginal candidosis (RVVC) in cases with an assumed novel attack of the condition, and to compare the value of microscopy of such smears in relation to candida culture, vaginal pH-determinations and leucocyte esterase tests (LE). One hundred and thirteen women with a history and a current assumed attack of RVVC were studied by means of culture of samples from the vaginal introitus and posterior vaginal fornix on Sabouraud and CHROMagar. Microscopy of methylene blue- and Gram-stained smears from these sites was performed. The pH of vaginal secretion and the LE activity in vaginal flushing fluid was measured. Candida morphotypes were found significantly more often in the smears from candida culture-positive than culture-negative women. There was no difference in this respect between the findings in the methylene blue- and Gram-stained smears. Differences were found in candida morphotypes among Candida albicans and non- albicans-positive cases, as blastoconidia were detected only in the latter cases. The leukocyte esterase activity score was higher in the candida-positive than in candida-negative cases. The study showed that microscopy of fixed, stained genital smears can play a role in attempts to distinguish cases infected and not infected by candida among patients consulting with an assumed novel attack of RVVC. Study of methylene blue-stained smears is recommended as they represent an easier means than Gram-stained smears to diagnose genital candida infections in assumed RVVC cases.
Observations on the microbiology of urethritis in black South African men
Authors: Taylor-Robinson D , Jensen J S , Fehler G , Radebe F , Ballard R C
Published: October 2002

The occurrence of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium was determined by molecular techniques in urine specimens from 182 black South African men who had symptoms and/or overt signs of urethritis. Eighty-six (47.3%) of these men were infected with N. gonorrhoeae. There were 185 men without overt evidence of urethritis, 16 (8.6%) of whom were also infected with N. gonorrhoeae. Of the 96 men who had non-gonococcal urethritis, 14 (14.6%) were infected with C. trachomatis, 16 (16.7%) with M. genitalium and only one with both microorganisms. In comparison, 15 (8.9%) of 169 men without overt urethritis and without N. gonorrhoeae were infected with C. trachomatis and 15 (8.9%) with M. genitalium, proportions that were about half the size of those in the group with overt urethritis.
Relative risk of HIV infection among young men and women in a South African township
Authors: MacPhail C , Williams B G , Campbell C
Published: October 2002

The prevalence of HIV infection in Africa is substantially higher among young women than it is among young men. Biological explanations of this difference have been presented but there has been little exploration of social factors. In this paper we use data from Carletonville, South Africa to explore various social explanations for greater female infection rates. This paper reports on data from a random sample of 507 people between 13 and 24 years old. Subjects were tested for HIV, as well as other sexually transmitted infections (STIs), and answered a behavioural questionnaire. The age-prevalence of HIV infection differs between men and women with considerably higher rates of increase with age among young women. The age of sexual debut did not differ significantly between men and women (15.9 and 16.3 years, respectively) and below the age of 20 years there was no difference in the number or distribution of the number of sexual partners reported by men or women. The risk of infection per partnership was substantially higher among women than among men. Women have sexual partners who are, on average, about five years older than they are with some variation with age. Scaling the age-prevalence curve for men by the age of their sexual partners gives a curve whose shape is indistinguishable from that for women but is about 30% lower for men than for women. In terms of social explanations for HIV rates among women, the data indicates that this difference can be explained by the relative age of sexual partners, but not by other factors explored. In addressing the epidemic among young women it will be essential to deal with the social factors that lead young women to select their partners from older-age cohorts and that shape their sexual networking patterns.
Topical imiquimod cream 5% for resistant perianal warts in a renal transplant patient
Authors: Gayed S L
Published: October 2002

Renal transplant recipients represent a patient subgroup for whom the effective treatment of genital warts poses a significant problem in genitourinary medicine. This case demonstrates the safe and effective treatment of resistant perianal warts in a male renal transplant recipient using imiquimod.
Bacterial vaginosis in climacteric and menopausal women
Authors: Taylor-Robinson D , McCaffrey M , Pitkin J , Lamont R F
Published: October 2002

The objective was to determine how frequently an abnormal vaginal flora occurred in women attending a menopause clinic and whether any abnormality might be related to a particular risk factor. Women completed a questionnaire on their gynaecological, sexual and medical history. Whether they were perimenopausal or postmenopausal was determined on the basis of symptomatology, duration of amenorrhoea and on a follicle-stimulating hormone (FSH) assay when clinically indicated. A speculum examination of the vagina was undertaken, at which time a smear of vaginal secretion was Gram stained and the bacterial flora graded as follows: grade 1, normal; grade 2, intermediate, and grade 3, bacterial vaginosis (BV). Of 100 women examined, 44 had grade 1 flora, 17 had grade 2 flora and 18 had BV. An apparent absence of, or very scanty, vaginal bacteria in which grading was not possible was found in 21 women. Women with BV had had more sexual partners than the others, but otherwise there were no discernible factors associated with the occurrence of BV. Women with vaginal atrophy were more likely to have an apparent absence of vaginal bacteria, but a few had BV.
Contraceptive use, protected sexual intercourse and incidence of pregnancies among African HIV-infected women. DITRAME ANRS 049 Project, Abidjan 1995–2000
Authors: Desgrées-du-Loû Annabel , Msellati Philippe , Viho Ida , Yao Angèle , Yapi Delphine , Kassi Pierrette , Welffens-Ekra Christiane , Mandelbrot Laurent , Dabis François
Published: October 2002

The aim of this paper is to describe the adherence of African HIV+ women to the counselling provided after announcement of the result of the HIV test during pregnancy, focusing on early weaning to reduce post-natal transmission, protected sexual intercourse to avoid sexual transmission, and contraceptive use to avoid unexpected pregnancies. In 1999-2000, a questionnaire on sexual and reproductive behaviours was administered to 149 HIV+ women followed in post-partum, informed and counselled in the ANRS 049 DITRAME project in Abidjan. Côte d'Ivoire. Duration of breastfeeding, post-partum amenorrhea and abstinence, contraceptive use and condom use were measured. Incidence of pregnancies during the first 24 months post partum was estimated and modelled by a Cox regression model. Average duration of breastfeeding was 7.9 months, average duration of post partum abstinence was 12.0 months, and 39% of women used contraceptives at the time of the survey. Frequency of condom use was 13%. Incidence of pregnancies was 16.5 per 100 women-years at risk. Half of these pregnancies were not desired and a third were terminated by induced abortion. The significant determinants of the pregnancy occurrence were the death of the previous child, the cessation of breastfeeding, the cessation of the post partum abstinence, and higher education. In conclusion, if counselling on early weaning can be followed by the HIV+ women, it is not easily the case for condom and contraceptive use. Hence, pregnancy incidence in the post-partum follow-up was high. The main strategy of these HIV+ women to avoid unexpected pregnancies as well as sexual transmission of HIV seems to be an increase of the duration of post-partum abstinence. The most educated women who cannot easily adopt this strategy are particularly exposed to unwanted pregnancies.
Validation of syndromic algorithm for the management of genital ulcer diseases in China
Authors: Wang Qian-Qiu , Mabey David , Peeling Rosanna W , Tan Mei-Li , Jian Da-Ming , Yang Ping , Zhong Ming-Ying , Wang Guang-Ju
Published: October 2002

Objectives 1. To determine the aetiologies of genital ulcers in China. 2. To evaluate a modified WHO syndromic management algorithm for genital ulcer disease (GUD).

Methods: Patients with genital ulcers were enrolled at their first visit to STD clinics in the cities of Shanghai and Chengdu. They were managed according to a modified WHO algorithm for GUD, in which no treatment was given for chancroid. A multiplex polymerase chain reaction was used to detect Treponema pallidum, Herpes simplex and Haemophilus ducreyi. Dark field examination and serology (rapid plasma reagin and Treponema pallidum particle agglutination assay (TPPA) were also used to diagnose syphilis.

Results: A total of 227 male and female patients were enrolled. Syphilis alone was diagnosed in 78 (35%), genital herpes alone in 43 (19%), and both infections were present in 28 (12%). No diagnosis was made in 76 (34%). No case of chancroid was identified. The sensitivity of the algorithm for syphilis and herpes was 88.7% and 69.0% respectively, the specificity 95.0% and 50.0%. 12/106 cases of syphilis were incorrectly classified as herpes (11%), and did not receive treatment. More than 97% of patients followed up responded clinically to treatment.

Conclusion: Further validation and revision of the WHO flowchart for GUD are needed.
Emergency contraceptive pill (ECP) and sexual risk behaviour
Authors: Dupont Simon , Webber Jessica , Dass Kavita , Thornton Susan
Published: October 2002

The study describes a cross-section of women using the emergency contraceptive pill (ECP), with regard to demographics, ECP use, sexual health, sexually transmitted infection (STI)/HIV risk perception and attitudes to condom use. All women attending a London hospital for the ECP over a four-month period were invited to complete a 30-item questionnaire anonymously. Of the 150 women attending, 88 (59%) took part. Over 60% needed the ECP because of unprotected sexual intercourse (UPSI). A third had had UPSI in the previous three months, 70% had used ECP previously. The vast majority (>95%) did not think they were at high risk of STIs or HIV infection, and though the most likely explanations for UPSI were that it is more enjoyable and that people get 'carried away'. There are concerns that women are using the ECP as a form of contraception and are putting themselves at risk of STIs and HIV infection. Information regarding risk behaviour needs to be routinely given with the ECP in order to avoid further large increases in infection.
A life-long antiretroviral treatment of congenital HIV disease, associated with a mixed fat redistribution syndrome and osteopenia already occurred during pre-pubertal age
Authors: Manfredi Roberto , Calza Leonardo , Chiodo Francesco
Published: October 2002

An extraordinarily rare case report of mixed fat redistribution syndrome associated with osteopenia but not with relevant metabolic abnormalities is documented in a prepubertal child with congenital HIV infection treated with antiretroviral therapy since the age of six months, up to the present age of 12 years and two months. The possible relationship with prior and present antiretroviral treatment, and with the most recent literature evidences published in both adults and children with HIV disease are discussed, in order to focus these emerging adverse effects of long-term antiretroviral therapy in the paediatric population, and stimulate further investigation in this field.
'Skin popping' ulceration in an HIV patient. Successful treatment with antiretroviral drugs and stanozolol
Authors: Redondo Pedro , Molano Elvira , Lloret Pedro , Bauza Ana
Published: October 2002

Skin popping refers to the practice of injecting drugs beneath the skin without concern for vascular access. We describe a male HIV seropositive injecting-drug user with chronic cutaneous ulcerations on the legs at sites of skin popping. Treatment with antiretroviral drugs and stanozolol was associated with a striking clinical improvement of the ulcer in two weeks. The mechanism of action, improvement of immune function by the antiretroviral treatment or activity of stanozolol on collagen and transforming growth factor-β1 synthesis, remains unknown.
Salivary IgA and serum IgA and IgG antibodies to Candida albicans in HIV-infected subjects
Authors: Belazi M , Fleva A , Drakoulakos D , Panayiotidou D
Published: October 2002

This study sought to determine IgA, IgG antibodies to Candida albicans in whole saliva and serum from HIV-infected patients and to compare them to a group of healthy controls. The study population consisted of 34 HIV-infected individuals free of any other systemic diseases and thirty healthy controls. IgA concentrations in saliva and IgA and IgG concentrations in serum were measured by a micro enzyme-linked immunosorbent assay. No significant differences were observed in salivary and serum IgA antibodies to C. albicans between the two study groups. Serum IgG antibodies were found to be significantly lower in the HIV-infected ( P < 0.05). No significant changes were observed in the specific activity of anti-Candida IgA and IgG antibodies in saliva and serum, in both the study groups. The undifferentiated levels of secretory-IgA antibodies to C. albicans in the patients' and the controls' saliva could be an indicator of the high immune response to opportunistic infections of the HIV-infected subjects, a fact that is verified by the lack of oral candidiasis in the patients' group. The low levels of IgG antibodies in the serum of the HIV-infected patients confirm the high immune response of them.
An evaluation of the applicability of quantitative clinical standards for the management of genital chlamydial infection using an electronic database
Authors: McClean H L , Joshi U Y , Clark A
Published: October 2002

A prototype electronic database was designed for use as a retrospective audit tool to provide data that allowed comparison of genital chlamydial infection management performance with a series of quantitative operational consensus standards. However, some of the terms used by the standards require further definition for translation into database fields to improve accuracy and general application as an audit tool. Construction of the database involved differentiation between prior and clinic diagnostic points, as well as a forward contact trail of specific quantitative indicators of contact tracing. More definition is needed of the meaning of diagnosis and contact in the standards. For clinic-diagnosed patients, the time to treatment was mainly dependent on clinical factors, not on the availability of a chlamydial test result. For about one-third of patients (with prior management), several standards cannot be applied because data are not available, and this raises the issue of data sharing between various agencies involved in chlamydial testing. More data from other clinics may help both to test the appropriateness of, and inform, some of the operational standards. The database could be developed as a real-time audit tool for use with electronic patient records.
Chlamydia trachomatis infection and non-gonococcal urethritis in homosexual and heterosexual men in Edinburgh
Authors: Dixon L , Pearson S , Clutterbuck D J
Published: October 2002

In 1998, when ligase chain reaction testing for chlamydial infection was introduced in our clinic in Edinburgh, routine clinic protocol included the testing of all heterosexual, but not homosexual, men for urethral chlamydial infection. We audited all new homosexual and bisexual male attendees with a diagnosis of chlamydial infection or non-gonococcal urethritis (NGU) in 1999, together with heterosexual men with the same diagnoses attending in alternate months of the same year. Urethral Chlamydia trachomatis infection was detected in 14.6% (350/2402) of heterosexual men and 2.4% (11/465) of homosexual men tested. Fifty percent of chlamydial infections were asymptomatic. In this population 44% (84/190) of NGU in heterosexual men is attributable to C. trachomatis as opposed to only 10% (6/59) of that in homosexual men. These rates of chlamydial infection differ from previous reports in Scotland and recent studies from the USA. Our clinic protocol has been revised to include routine testing for chlamydial infection in all men.
Mother to child human immunodeficiency virus (HIV) transmission: what HIV-infected women think. Our experience in Rome, Italy
Authors: Visconti E , Celentano Lucia Pastore , Marinaci Salvatore , Scoppettuolo Giancarlo , Tamburrini Enrica
Published: October 2002

Objectives: To investigate the knowledge of the risk of HIV vertical transmission as well as the feeling about the new therapy in reducing that rate.

Methods: We included 152 HIV-infected women. A self reported questionnaire was administered from September to December 2000.

Results: About the risk rate of transmitting HIV to their baby, 21 (13.8%) women indicated 100%; 67 (44.1%) 50-80%; 35 (23%) 10-50% and only 22 women (14.5%) answered the correct value of less than 5%. Regarding the effect of highly active antiretroviral therapy, 82 women (53.9%) considered therapy effective in reducing vertical HIV transmission, while 63 women (41.4%) considered therapy powerless in preventing mother to child HIV transmission. Any statistically significant difference in sociodemographic, clinical, viroimmunological characteristics and antiretroviral therapy emerged between the groups.

Conclusions: Our data highlight the importance of providing appropriate counselling about perinatal HIV transmission to all childbearing age HIV infected women.
HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission
Authors: Gisselquist David , Rothenberg Richard , Potterat John , Drucker Ernest
Published: October 2002

An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%–40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.
Do all men attending departments of genitourinary medicine need to be screened for non-gonococcal urethritis?
Authors: Horner P J , Thomas B , Gilroy C B , Egger M , Taylor-Robinson D
Published: October 2002

We investigated the influence of symptoms and signs on the detection of Chlamydia trachomatis, Mycoplasma genitalium and Ureaplasma urealyticum organisms (ureaplasmas) in men with non-gonococcal urethritis (NGU). Two hundred and forty-two men attending the Jefferiss Wing at St Mary's Hospital for a sexual health assessment were evaluated, of whom 169 had NGU. Urethral inflammation was diagnosed if there were either ≥5 polymorphonuclear leucocytes (PMNLs) per high-power field (HPF) in five or more microscope fields of a Gram-stained urethral smear, or ≥10 PMNLs per HPF in five or more fields of a Gram-stained thread from 15-20 mL of a first-passed urine (FPU) specimen. C. trachomatis was diagnosed by direct immunofluoresence, M. genitalium by a polymerase chain reaction assay and ureaplasmas by culture. On multivariate analysis, to control for potential confounding by age, ethnicity, sexual lifestyle and co-infection, an urethral discharge remained significantly associated with the detection of C. trachomatis and M. genitalium in men with acute urethritis [OR 12.3, 95% CI (2.39-63.5) and OR 35.2, 95% CI (3.9-319.6), respectively], but dysuria or penile irritation did not. The detection of ureaplasmas was not associated with any clinical feature. In addition, on multivariate analysis men with NGU who were either symptomatic or had an observable discharge were more likely to have C. trachomatis or M. genitalium detected [(OR 6.92, 95% CI 1.41-33.9) and (OR 5.18, 95% CI 0.99-27.1), respectively], but not ureaplasmas (OR 1.19, 95% CI 0.33-4.35). The findings suggest that in men with acute NGU, symptoms or signs, and in particular a urethral discharge, are associated with the detection of C. trachomatis and M. genitalium, but not ureaplasmas. Currently, there is no precise answer to the question of whether all men attending a GUM clinic need to be screened for NGU, but if clinically asymptomatic NGU is found not to be associated with a sexually transmitted pathogen, the UK clinical guidelines requiring the preparation of a urethral smear from such men would need to be revised.
HIV transmission risk behaviours among HIV-positive persons in serodiscordant relationships
Authors: Kalichman Seth C , Rompa David , Luke Webster , Austin James
Published: October 2002

As many as one in three persons living with HIV-AIDS continue to practise unprotected sexual intercourse and these practices often occur with HIV-negative or unknown HIV serostatus (serodiscordant) partners. The current study examined the rates of HIV transmission risk behaviours in non-regular (e.g. casual) and regular (e.g. steady) serodiscordant relationships.

HIV positive men ( n = 269) and women ( n = 114) responded to measures of demographic characteristics, health and mental health status, and sexual behaviours assessed in partner-by-partner interviews.

257 (67%) participants were sexually active in the preceding three months and 182 (71%) of the sexually active persons had engaged in vaginal or anal intercourse with serodiscordant partners. Comparisons of persons with non-regular ( n = 97) and regular ( n = 85) serodiscordant partners showed that overall rates of unprotected and protected intercourse were greater with regular partners than non-regular partners. Disclosure of HIV status to regular and non-regular serodiscordant partners did not appear to influence the pattern of results. Mathematical modelling showed that HIV transmission estimates over a one-year horizon were significantly greater for male regular partners of HIV-positive men than non-regular partners and there was a trend toward greater HIV transmission rates from HIV-positive men to their regular serodiscordant female partners compared to non-regular partners.

Results suggest an urgent need for HIV transmission risk reduction interventions for HIV serodiscordant couples, particularly for couples in established, regular relationships.
A comparison of the lymphoproliferative capacity of pokeweed mitogen (PWM) and phytohaemagglutinin (PHA) in CCR-5 wild-type and heterozygous HIV-infected and uninfected subjects
Authors: Barabás É , Kemény B , González R , Várkonyi V , Nagy K , Horváth A
Published: October 2002

Effect of CCR-5 delta 32 heterozygosity in immunological protection was studied by a lymphocyte proliferation assay. Twenty of 86 HIV+ and eight of 32 healthy subjects showed heterozygous mutation (wt/mut) of the CCR-5 gene. Lymphocyte proliferation to pokeweed mitogen was found significantly higher ( P < 0.005) in wt/mut versus wild type homozygous (wt/wt) HIV+ subjects in groups with CD4 > 500 and CD4 < 200 cell/ µL. Phytohaemagglutinin induced stronger proliferation of cells from wt/mut HIV+ subjects with CD4 < 200 cell/ µL ( P = 0.03). Decline of lymphocyte response was more significant among wt/wt groups with different CD4+ cell counts than that between wt/mut groups to both mitogens. Reduced number of CCR-5 receptors on CD4+ cells may decrease the ability of HIV-1 envelope glycoproteins to transduce intracellular signals through CCR-5. Mutation in CCR-5 gene seems to have a benefit in preventing T-cells from HIV envelope-mediated immunopathogenic effects and maintain a relatively normal response to lectins.
Financial situation of people living with HIV in Europe
Authors: Schrooten W , Dreezen C , Borleffs J , Dijkgraaf M , Borchert M , De Graeve D , Hemmer R , Fleerackers Y , Colebunders R
Published: October 2002

The objective was to investigate the financial situation of people living with HIV in Europe. Two surveys using an anonymous questionnaire were organized in Europe among people living with HIV, the first in 1996-97 and the second in 1998-99. One thousand one hundred and sixty-one people from the 1996-97 survey and 899 from the 1998-99 survey were included. Four hundred and fifty-seven (42%) of the 1996-97 participants reported that their income had decreased since HIV diagnosis. The latter participants reported significantly more often difficulties in paying for housing (27% vs 20%), food (18% vs 12%) and transport (17% vs 12%) compared to 1998-99 participants. In multiple regression analysis, severity of HIV disease, not being on highly active antiretroviral therapy (HAART), younger age, lower education level and living in the South of Europe were associated with having financial difficulties. We concluded that since the introduction of HAART, the financial situation of persons living with HIV in Europe has improved, but a relatively large percentage of them still have financial difficulties.