bluuebunny/crossref_metadata_2025 huggingface dataset:
The management of chronic hepatitis B infection
Authors: Matthews G. V. , Nelson M. R.
Published: October 2002

Chronic hepatitis B infection is frequently diagnosed within the genitourinary clinic setting with sexual transmission the commonest route of acquisition in the United Kingdom. Only 3-5% of adults who contract acute hepatitis B will progress to chronic infection, and these individuals can be identified by the presence of hepatitis B surface antigen (HBsAg) in the bloodstream 6 months after infection. Individuals at highest risk of long-term complications such as cirrhosis and hepatocellular carcinoma, carry HBeAg and have high levels of circulating hepatitis B virus (HBV) deoxyribonucleic acid (DNA). Therapy should be targeted towards this group of patients. Two forms of therapy are now licensed for use in chronic hepatitis B infection: interferon-alpha and lamivudine. Seroconversion occurs in 30-40% of patients treated with interferon and treatment is often limited by toxicity. Lamivudine is well tolerated with seroconversion rates of 15-20% at one year, rising with increasing duration of therapy. Long-term monotherapy is limited however by the development of resistance mutations and combination nucleoside therapy is likely to become the treatment of choice in the future. Patients with chronic hepatitis B should be counselled regarding transmission, partner vaccination and alcohol intake and co-infection with other hepatitis viruses should be excluded.
Donovanosis: an update
Authors: O'Farrell Nigel
Published: October 2002

Donovanosis has been ignored for many years until recently. The condition still has a limited geographical distribution. A significant epidemic of donovanosis has been identified in KwaZulu/Natal, South Africa where it may be a risk factor for acquiring HIV in men. After a gap of more than 30 years, the organism was cultured by researchers in Durban, South Africa and Darwin, Australia. Polymerase chain reaction (PCR) techniques for donovanosis were developed soon after, most recently using a colorimetric detection system. Similarities between the causative organism, Calymmatobacterium granulomatis and Klebsiella spp. were confirmed. A proposal that the organism be reclassified under the genus Klebsiella has been put forward. Azithromycin has been confirmed as the drug of choice but is yet to be accepted universally because of cost issues. Treatment in patients with significant HIV induced immune deficiency may need to be prolonged. A donovanosis eradication programme is underway amongst the aboriginal community in Australia. Elsewhere, management through current syndromic guidelines for genital ulcers are yet to be validated in areas where donovanosis is endemic. PCR testing should enable further recognition of donovanosis and lead to more concerted efforts in disease control and possible eradication.
Characteristics of homosexually-active men with gonorrhoea during an epidemic in Sydney, Australia
Authors: Donovan Basil , Bodsworth Neil J , Rohrsheim Richard , McNulty Anna , Tapsall John W
Published: October 2002

Our objective was to investigate an epidemic of gonorrhoea among homosexually-active men in Sydney. Demographic and behavioural data on all homosexually-active men diagnosed with gonorrhoea (any site) at the Sydney Sexual Health Centre (SSHC) from 1992 through 1998 were reviewed. The men diagnosed with anal gonorrhoea were then compared with all homosexually-active men who tested negative for anal gonorrhoea or who were not tested for anal gonorrhoea at the SSHC between 1996 and 1998. Data on HIV status and country of birth of men diagnosed with anal gonorrhoea during 1998 at the Taylor Square Private Clinic were also reviewed. Over the period 1992 to 1998, homosexually-active men diagnosed with gonorrhoea at SSHC tended to become older at the time of diagnosis (median age 26.5 years in 1992 up to 31.0 years in 1998), indicating a cohort effect in the clinic population due to service reductions. When compared with men who tested negative for anal gonorrhoea at SSHC between 1996 and 1998, those with anal gonorrhoea were more likely to have anogenital symptoms (adjusted odds ratio [OR] 2.3), to have had a past history of gonorrhoea (OR 3.1), to present as a contact of gonorrhoea (OR 8.6), to have used condoms less consistently (OR 2.3), to be HIV positive or of unknown HIV status (OR 3.2), and to have been born in an English-speaking country other than Australia (OR 2.9). The last feature was not observed at the private clinic. In conclusion, the gonorrhoea epidemic was linked to public health service reductions, though it seems unlikely to be the only factor. Homosexually-active men with anal gonorrhoea had well established behavioural risk factors while men with concurrent HIV infection were over-represented. Given the role of gonorrhoea in promoting the spread of HIV infection, a National Sexual Health Strategy – closely linked to the National HIV/AIDS Strategy – is due.
Screening for sexually transmitted infections in children and adolescents in the United Kingdom: British Co-operative Clinical Group
Authors: Williams Olwen , Forster Greta , Robinson Angela
Published: October 2002

Our objectives were (1) to assess the number of young people aged under 16 years attending genitourinary medicine (GUM) departments in the UK in 1998; (2) to identify clinical activity and policy; (3) to determine the knowledge and training needs of healthcare professionals within GUM providing care for this client group.

In July 1999 a questionnaire was circulated via the 18 regional British Co-operative Clinical Group (BCCG) representatives to the consultants in charge of all 197 main GUM departments in the UK. One hundred and sixty out of 197 (81%) completed questionnaires were returned and analysed. The reported number of under-16-year-olds attending in 1998 varied considerably between clinics; for females ranging from 0 to 256 and for males between 0 and 50, with a male to female ratio of 1:4.4. The majority of responding clinics, 139/160 (87%) had been involved in the screening of abused children/adolescents for sexually transmitted infections (STIs). Most clinics were prepared to screen for STI (86%), HIV test (79%) and assess contraceptive needs (50%) in this age group. Staff involved in care included health advisers (74), nurses (59), and doctors (138) in the responding clinics. Only 31/160 clinics (19%) had a written policy for the management of children/adolescents attending their clinic. The majority of respondents were aware of their child protection policy [122/154 (79%)] and designated child sexual abuse doctor, [125/157 (80%)] in their district. When questioned on previous and current training needs, 134/160 (84%) respondents identified their need for further training in the area of adolescent sexual health and 124/160 (78%) in child sex abuse. The publication Physical Signs of Sexual Abuse in Children, was known to 112/160 (70%) respondents, of whom 58/112 (52%) who answered this question had read the publication. Genitourinary physicians in the UK are aware of the increasing number of children and adolescents accessing their services, and recognize the need to identify those in abusive situations. Written policies dealing with children and adolescents in GUM clinics in the UK are lacking. This needs to be rectified urgently. This survey identifies that further training in the field of child sexual abuse and adolescent sexual health would be welcomed by the respondents.
Qualitative and quantitative aspects of the ligase chain reaction assay for Chlamydia trachomatis in genital tract samples and urines
Authors: Thomas B J , Pierpoint T , Taylor-Robinson D , Renton A M
Published: October 2002

The performance of the ligase chain reaction (LCR) assay for Chlamydia trachomatis was evaluated in a genitourinary medicine (GUM) clinic population. Its sensitivity was 100%, 91% and 95%, respectively, for cervical, vaginal and urine samples from 417 women, when compared with direct fluorescent antibody (DFA) staining of cervical samples, and 100% and 91%, respectively, for urethral and urine samples from 317 men, when compared with DFA staining of urethral smears. An enzyme immunoassay (EIA) was only 65% sensitive for cervical samples. Urethral swabs from a number of treated men remained LCR-positive when antigen was no longer detectable by DFA staining. An association between quantitative data from the LCR assay (i.e. the optical density of samples, measured in relation to internal controls and calibrators) and the antigen load of the samples, measured by DFA staining, indicated a lack of significant inhibition in the LCR assay in this study. This was probably due to freezing of the samples before testing. Diluting 20 LCR-positive urines with a range of antigen loads resulted in loss of positivity in 3, and a reduction in the signal in 13. The implications of the antigen load on the performance of detection assays for chlamydia-positive patients are discussed.
Patients' perspectives on the burden of recurrent genital herpes
Authors: Patel R , Boselli F , Cairo I , Barnett G , Price M , Wulf H C
Published: October 2002

The purpose of this study was to quantify the impact of recurrent genital herpes (RGH) on health-related quality of life, healthcare resource and workplace productivity. This was a cross-sectional survey conducted in 5 countries (Australia, Denmark, Italy, The Netherlands and UK). Patients with a confirmed history of RGH completed the MOS 36-Item Short Form Health Survey (SF-36) and the Recurrent Genital Herpes Quality of Life questionnaire (RGHQoL). Questionnaires addressing frequency of access to healthcare services and workplace productivity were also completed and patients' medical history was obtained. Scores for 6 of the 8 domains of the SF-36 were significantly lower ( P<0.001) i.e. worse, compared with scores for the normal population. The RGHQoL score was significantly lower in patients experiencing more frequent or more severe recurrences. Forty-five per cent of patients estimated that their work effectiveness was reduced by between 25% and 50% due to genital herpes symptoms.
More cautious, more optimistic: Australian people living with HIV/AIDS, 1997–1999
Authors: Grierson Jeffrey , de Visser Richard , Bartos Michael
Published: October 2002

The aim of this study was to assess whether the lives of Australian people living with HIV/AIDS (PLWHA) have improved to the extent hoped for following the introduction of new antiretroviral (ARV) drugs for HIV. In 1997, 925 Australian PLWHA completed the first national survey of the social impacts of HIV/AIDS. In 1999, 924 Australian PLWHA were recruited for a repeat of the survey. Study participants completed an anonymous self-administered questionnaire. The data revealed that although new ARV drugs have improved the clinical profiles of many PLWHA, there have not been corresponding improvements in the physical well-being, levels of employment, or financial circumstances of many PLWHA. Nevertheless, PLWHA express favourable attitudes toward ARV drugs. Australian PLWHA have a complex relationship with their ARV medication that is likely to change over time as their HIV disease progresses and new treatments become available.
Clinical uses of herpes simplex virus type-specific serology
Authors: Munday P E , Mullan H M
Published: October 2002

Type-specific serological tests to distinguish between infection with herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) have largely been used for studies which have contributed to our knowledge of the epidemiology and natural history of these infections. Such tests could be used as diagnostic tools in clinical situations provided that clinician and patient are aware of the test characteristics, which may result in false negative and false positive results. The use of serological tests in the screening of populations or sub-populations, such as pregnant women, has been advocated to attempt to halt the worldwide spread of the infection. However, there is little evidence currently to support this strategy.
Determinants of gonorrhoea infection among STD clinic attenders in Trinidad-II: Sexual behavioural factors
Authors: Castor D , Jolly P E , Furlonge C , Rao A , Brown A , Camara B , Weiss H , Prabhakar P
Published: October 2002

Sexual behavioural factors associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI) were determined by univariate and stepwise multiple logistic regression analysis. Casual sex (odds ratios [OR] 1.6) was the only predictor of gonorrhoea. Among males, significant associations were identified by univariate analysis between concurrent partnerships, ≥one sexual partner(s) in the past 6 months, and drug use prior to engaging in casual and/or oral sex. No significant associations were identified between gonorrhoea and sexual behaviour factors among females. This study is the first to describe sexual behaviours associated with gonococcal infection in Trinidad and to evaluate risk behaviours by gender.
STD treatment for men in rural and urban Zimbabwe: choice of practitioner, perceptions of access and quality of care
Authors: Gibney L , Chikukwa P , Seidenberg P , Mukherjee S , Mbizvo M
Published: October 2002

STD treatment choices and perceptions of treatment services (access, quality of care) by Zimbabwean men are examined in 2 settings: Mbare, a district within the capital city Harare, and Gutu, a rural town. Data collection included a survey of 457 men 18 years of age or older (from a stratified systematic sample), focus groups and key informant interviews. Of 220 cases of self-reported genital symptoms, 81.4% were treated by allopathic practitioners, 9% by traditional/faith healers, 8.6% by the subject, a friend or another person; 1.4% were not treated. Traditional/faith healers were consulted primarily for symptoms involving pain or discomfort rather than ulcers or exudation. Disrespect by the health care provider and consultations that were not private were cited as problems by a small minority of subjects. Significantly more respondents in Mbare than in Gutu had been prevented from obtaining the STD treatment they desired at some point in their life because of cost of treatment ( χ2=5.23, P=0.02). Given the current deteriorating economic situation in Zimbabwe, cost of treatment may become an even more important impediment in the future.
Treatment of genital warts — what's the evidence?
Authors: Wilson Janet
Published: October 2002

Genital warts are usually asymptomatic, and rarely cause discomfort. Once the patient is aware of them the main symptom is their cosmetic appearance and resultant psychological consequences. The ideal treatment outcome would be complete viral eradication, but this is not possible. Treatments focus on the removal of exophytic warts, leaving the surrounding subclinical and latent human papillomavirus (HPV) infection as areas of possible transmission and recurrence. Effective treatment does reduce HPV viral load, so the infection is reduced if not completely eradicated. Treatment is often painful, inconvenient, and may produce poor clearance rates and frequent recurrences. The treatment chosen should be no worse or more dangerous than the disease itself, and should be tailored to the patients' disease and needs as well as to the available resources. Genital warts are highly infectious and sexual partners may well already be infected when a patient presents for treatment. There are no published studies showing that condom use reduces transmission of HPV from people with genital warts. However, if the sexual partner is uninfected; using a condom may protect against HPV lesions and genital warts. Condom use should be encouraged in new relationships.
Medical Workforce Speciality Review for Genitourinary Medicine 2001/2002—England, Wales, Northern Ireland and Scotland
Authors: Rogstad K E
Published: October 2002

This document addresses medical workforce needs for the speciality of Genitourinary Medicine (GUM) for the next 10 years. Data on current consultant numbers, working patterns and retirement are based on information from the Royal College of Physicians (RCP) Workforce Unit annual census undertaken on 30 September 2000. Information on specialist registrars is from the JCHMT. Senior house officers (SHO) data are from the RCP's General Professional Training department. Data on Non-Consultant Career Grade Doctors is from the Association of Genitourinary Medicine Survey. Data on incidence of Sexually Transmitted Infections (STIs) are from KC60 returns on STIs collected from GUM clinics by CDSC. There is considerable movement of doctors in GUM between countries in the UK both during progression from SpR to consultant and at consultant level. Data are therefore presented as amalgamated UK data and also by country. It is essential that workforce planning takes this lateral movement into consideration when undertaking calculations for future workforce requirements.
Standards for comprehensive sexual health services for young people under 25 years
Authors: Rogstad K E , Ahmed-Jushuf I H , Robinson A J
Published: October 2002

This document is a first response to the need to develop sexual health services for young people on a single site whilst awaiting research from pilot studies of 'one stop shops' suggested in the Sexual Health and HIV strategy. It is a document which is intended to be a tool to use for those wishing to set up a service providing testing for sexually transmitted infections and provision of contraceptive services for those under 25 years. It is not intended that such a service would replace existing specialist or general practice care but complement it, allowing clients to choose the service most appropriate and acceptable to them, with close links and clear pathways of care for referral between services. This paper should be used as a template when initiating and monitoring a clinic but some of the standards may not be achievable without significant financial input. However, economic limitations should not detract from striving to achieve the best possible care for those most at risk from sexually transmitted infections and unwanted pregnancies. For example, not all clinics will be able to provide the recommended tests for the diagnosis for gonorrhoea and chlamydia immediately, but should work towards achieving them. Although the upper age limit in this document is defined as 25 years, some providers may wish to limit clinics to those under 20 depending on local needs. Detailed information on specific issues such as consent and confidentiality, provision of contraception, investigation of non-sexually transmitted vaginal infections and sexually transmitted infection management and diagnosis are referenced and we recommend these are accessed by the users of this document. Many of the references themselves are live documents available on the worldwide web, and are constantly updated. The Sexual Health and HIV Strategy has now been published and these standards are aimed at those who wish to provide a level 2 sexual health service for young people wherever the setting e.g. genitourinary outreach clinic, contraceptive services, general practice. This document is a starting point to be reviewed and updated as new research becomes available, as the Sexual Health Strategy is implemented and with further input from providers of care (family planning, general practice, genitourinary medicine, gynaecology and paediatrics) and service users. All service providers must maintain a high quality of care and have networks both with those who provide more specialized services (Level 3) and Level 1 services. This document is an initial attempt to ensure that there is equity of clinical provision wherever a Level 2 sexual health service is provided and should be a useful tool for those setting up or monitoring services.
Haematospermia: in the context of a genitourinary medicine setting
Authors: Narouz N , Wallace D M A
Published: October 2002

Haematospermia should be taken more seriously. Although it is usually benign and self-limiting, it provokes great anxiety in patients. Malignancy is generally rare, but it should particularly be considered in older patients (40 years old or above). Recent investigative modalities, especially non-invasive, have made diagnosis feasible in most cases. What will constitute a reasonable approach to the problem of haematospermia in the context of a genitourinary medicine setting? A detailed history and physical examination, including genital and rectal examination, would be necessary. Initial investigations could include screening for STIs, urine examination and full blood count. Few patients will need further investigations, which will depend on the findings in patients' history and examination as well as the nature of the bleeding. Patients should be given a detailed explanation of their condition, and a plan of management and follow up should be made clear to them. Treatment depends on the underlying cause but often simply involves reassurance. Referral to a urologist may include patients with recurrent or persistent haematospermia, those with associated symptoms and patients who are 40 years old or above.
Diagnosis of bacterial vaginosis on self-collected vaginal tampon specimens
Authors: Sturm P D J , Moodley P , Nzimande G , Balkistan R , Connolly C , Sturm A W
Published: October 2002

A vaginal tampon specimen was previously shown to be suitable for the molecular diagnosis of non-ulcerative sexually transmitted infections (STIs). Different tampon fluid preparations were evaluated for the diagnosis of bacterial vaginosis (BV). Women with pregnancy related problems were enrolled. Two observers evaluated the different tampon fluid preparations and vaginal smears collected during speculum examination using the Nugent score. Using the Amsel criteria, 21% of the 84 women enrolled were diagnosed with BV. Results of the tampon fluid preparations and vaginal smears showed excellent agreement for both observers (Spearman >0.80). The overall sensitivity and specificity was 91.7% (95% CI: 81.6-96.5) and 79.3% (95% CI: 67.2-87.8), respectively, using the Amsel criteria as reference standard. The tampon provides a specimen for the combined diagnosis of non-ulcerative STIs and BV. This non-invasively collected specimen may facilitate self-initiated testing and population-based studies as well as longitudinal studies that are necessary to gain insight in the epidemiology of BV related to STIs and HIV.
High incidence of treatment failure of Neisseria gonorrhoeae isolates to ciprofloxacin in male gonococcal urethritis in Delhi
Authors: Chowdhry S , Pandhi D , Vidhani S , Bhalla P , Reddy B S N
Published: October 2002

Several treatment failures and widespread antimicrobial resistance to ciprofloxacin have been documented, subsequent to its initial recommendation in 1989 as a single dose alternative therapy for gonorrhoea. Still, it continues to be part of various treatment schedules in National STD control guidelines including India. This prompted us to study the current status of this drug in the treatment of gonorrhoea. Thirty-five male patients with gonococcal urethritis were included in the study. The susceptibility to penicillin, tetracycline, ciprofloxacin and ceftriaxone was determined by Kirby-Bauer disc diffusion method and minimum inhibitory concentration (MIC) of ciprofloxacin by agar plate dilution method. The clinical and bacteriological response was assessed on day 5 after treatment with single dose ciprofloxacin, 500 mg. The sensitivity pattern of Neisseria gonorrhoeae was observed to be: ceftriaxone 100%, azithromycin 100%, tetracycline 65.7%, penicillin 40% and ciprofloxacin 5.7% by disc diffusion method. The MIC for ciprofloxacin was below 0.06 µg/mL (sensitive) in one (2.5%) isolate only. On the fifth day a large number of treatment failures (88.5%) were seen with ciprofloxacin while none was noted one week after re-treatment with ceftriaxone. The location of endemic quinolone-resistant N. gonorrhoeae (QRNG) in New Delhi has increased alarmingly, resulting in an extremely high proportion of therapeutic failures, and thus requiring appropriate alterations in the presently recommended treatment regimens.
Sexually transmissible agent and African Kaposi's sarcoma
Authors: Matondo Patrick , Sivapalan S
Published: October 2002

Kaposi's sarcoma (KS) has a higher incidence in some parts of Africa than anywhere else in the world. Recent studies in western homosexual men with AIDSKS suggest that KS may be caused by a putative sexually transmissible agent. Our analytical review of studies on KS in Africa before and during the AIDS era reveals a disparate epidemiological picture. Its occurrence in sexually inexperienced children; overwhelming male preponderance in an almost exclusively heterosexual population; rarity of concordant couples in areas of very high incidence; sequestration of high incidence to Eastern and Central Africa; and regional variations in incidence even in high-incidence countries are all difficult to reconcile with a conventional sexually transmissible aetiology. There is a need for prospective studies specifically designed to test the hypothesis in Africa. Also, we recommend that studies pursuing the aetiology of KS in western countries be linked with studies in high incidence areas in Africa.
The potential role of azithromycin in the treatment or prophylaxis of toxoplasmosis
Authors: Chang H R
Published: October 2002

Infection with Toxoplasma gondii is the most common parasitic infection worldwide with an estimated prevalence of 1–2 billion people. The risk of developing severe toxoplasmosis is higher for immunocompromised individuals and fetuses of mothers who have acquired a primo-infection. The current therapy of choice for toxoplasmosis is the synergistic combination of pyrimethamine and sulphadiazine. This therapy is highly effective but its use is complicated in immunocompromised individuals due to adverse secondary effects. In addition, since pyrimethamine is potentially teratogenic, its use is not recommended during early pregnancy. Clindamycin, a lincosaminide, in combination with pyrimethamine has been shown to be an acceptable therapeutic alternative in patients who are unable to tolerate pyrimethamine plus sulphadiazine. In the search for new, effective compounds with less adverse or toxic effects, recent efforts have focused on the new macrolides and the azalides. Here, the results of the investigations and, in particular, the theoretical considerations for the potential use of azithromycin in the therapy of toxoplasmosis in immunocompromised individuals are reviewed.
Is Trichomonas vaginalis still a marker for other sexually transmitted infections in women?
Authors: Reynolds M , Wilson J
Published: October 2002

Trichomonas vaginalis (TV) has, in the past, been regarded as a useful marker for other asymptomatic sexually transmitted infections such as gonorrhoea and chlamydia in women. The aim of this study was to determ ine whether TV is still such a m arker. All wom en attending the Department of Genito-urinary Medicine at the Leeds General Infirmary with a diagnosis of TV during 1983 and 1993 were identified and concurrent infections were tabulated. In 1993 approximately 30% of women with TV had at least one other sexually transm itted infection. The prevalence of gonorrhoea in women with trichomoniasis fell from 20% in 1983 to 10% in 1993 whilst the prevalence of chlamydia in these wom en remained unchanged at 15%. Thus trichomoniasis is still frequently associated with other pathogens in women and screening of these women for other infections rem ains essential.
AIDS in rural Africa: a paradigm for HIV-1 prevention
Authors: Hudson Christopher P
Published: October 2002

Networks of concurrent sexual partnerships may be the primary cause of epidemic spread of HIV-1 in parts of sub-Saharan Africa. This pattern of sexual behaviour increases the likelihood that individuals experiencing primary HIV-1 infection transmit the virus to other persons. Networks of concurrent partnerships are likely to be important in both the early ('epidemic') and late ('endemic') phases of HIV-1 transmission. Interventions should aim to break the sexual networks, whatever the stage of the epidemic. However, prevention of transmission in the endemic phase also requires a greater awareness of early clinical manifestations of HIV-1 infection in the general population. Such awareness, coupled with the availability of condoms and access to HIV-1 testing facilities, may reduce transmission in discordant couples.
Sexually transmitted diseases: a survey of case management in Malawi
Authors: Chilongozi D. A. , Costello C. , Franco Daly L. , Liomba N. G. , Dallabetta G.
Published: October 2002

A national survey of sexually transmitted disease (STD) case management was carried out at 39 health care facilities in Malawi in 1994. Fifty-four health care providers were observed managing 150 patients presenting with selected STD syndromes and 103 providers were interviewed. STD case management was assessed by calculation of WHO/GPA prevention indicators (PIs) from observation data. The overall rate for PI-6, which measures correct assessment and treatment of STD patients was 11% (81% for history taking, 46% in physical examination, and 13% correct antibiotic treatment according to national guidelines). The score for PI-7, which measures overall patient counselling was 29% (65% for partner notification and 40% for condom advice). Although Haemophilus ducreyi is at least as common as Treponema pallidum as the causative agent for genital ulcers, only 16% of patients with genital ulcers were treated effectively for chancroid vs 56% for syphilis. Female patients received less comprehensive care than male STD patients. Only 20% of STD patients were offered condoms. Overall, the survey results support the policy decision to adopt syndromic management of STDs, and provide baseline information for planning and evaluation of a national control programme.
Prevalence of HIV-1, HIV-2 and HTLV antibody, in Fortaleza, Ceara, Brazil, 1993-1994
Authors: Broutet N. , de Queiroz Sousa A. , Basilio F. Placido , Sa H. Luis , Simon F.
Published: October 2002

To evaluate the respective part of HIV-1, HIV-2 and human T lymphotropic virus (HTLV) infection in Fortaleza, the principal city of the Ceara state (Northeast of Brazil), a cross-sectional seroepidemiological survey was conducted from July 1993 to February 1994 in 6 selected groups: pregnant women, tuberculosis (Tb) patients, sexually transmitted disease (STD) patients, female and male commercial sex workers (CSWs) and prisoners. Sera were screened by Mixt HIV-1/HIV-2 commercial enzyme immunoassay and ELISA HTLV I/II. Each serum found positive by ELISA was confirmed by Western blot. A total of 2917 persons were interviewed, of whom 2754 (94.4%) agreed to participate and gave a blood sample. Twenty-eight were found to be HIV-1 antibody positive. The prevalence ranged from 0.25% in pregnant women to 2.9% in male CSWs. The prevalence was 1% in STD patients and 0.44% in Tb patients. None of the sera was found positive for HIV-2. The prevalence of antibodies to HTLV-I varied from 0.12% in pregnant women to 1.21% in female CSWs. Five sera were positive for HTLV-II. These results confirm the hypothesis that the HIV epidemic in Northeastern Brazil is still limited to high risk groups. Repeated cross-sectional surveys of this type should be performed as a surveillance tool to study the dynamics of this epidemic in low prevalence areas. Defining risk factors should allow targeting of intervention strategies.
Genital ulcer disease among STD clinic attenders in Nairobi: association with HIV-1 and circumcision status
Authors: Nasio James M , Nagelkerke Nico J D , Mwatha Anthony , Moses Stephen , Ndinya-Achola Jackoniah O , Plummer Frank A
Published: October 2002

In previous studies, genital ulcers in men have been found to be associated with increased risk of HIV-1 seroconversion. To further explore this association male patients attending a sexually transmitted disease STD clinic in Nairobi for either urethritis controls, n 276 or a genital ulcer cases, n 607 were compared with respect to sexual behaviour, presence of HIV-1 antibody and circumcision status. Patients were followed to study risk factors for incident genital ulcers and HIV-1 seroconversion. At entry, being married was associated with higher prevalence of HIV-1 OR 1.76 and genital ulcers OR 1.42 . Lack of circumcision was associated with both HIV-1 infection OR 4.67 and the presence of a genital ulcer OR 2.23 . Genital ulcers were also associated with HIV-1 infection OR 1.87 independent of circumcision status. On follow-up, HIV-1 seropositivity was associated with incident genital ulcers. It is argued that the association between genital ulcers and HIV-1 infection may be more complex than ulcers simply being a risk factor for HIV-1 infection, and that HIV-1 infection may either increase the risk of acquiring a genital ulcer, or HIV-1 infection and genital ulcers may have some unknown risk factor in common.
Travels with HIV: the compliance and health of HIV-infected adults who travel
Authors: Kemper Carol A , Linett Adam , Kane Carol , Deresinski Stanley C
Published: October 2002

We examined the effects of travel on the health of a group of HIV-infected adults (n=89) cared for in a public hospital HIV clinic. In a period of 2 years, 45% travelled to a median of 3 US destinations for at least one week and 20% travelled to at least one international destination for a mean duration of 20 days. At the time of completion of the survey, the majority of these patients were severely immunosuppressed (median CD4+ count, 120/mm ). A physician was consulted concerning travel before 53% of the trips, but only one person consulted a travel medicine expert. All but one patient (98%) who was receiving medical therapy carried sufficient supplies of medication; 95% estimated their compliance with medication at 75% or better. None of the travellers to developing countries received gamma globulin, but one received yellow fever vaccine. Fifteen travellers (43%) became ill either during their trip or immediately thereafter; 3 required hospitalization. While most illnesses were not severe, 4 patients developed potentially life-threatening infections including coccidioidomycosis, cryptococcosis, PCP, and bacterial pneumonia. This survey provides information by which the clinician can anticipate the health care needs of HIV-infected patients who travel. HIV-infected patients should be more aware of the necessity for medical counsel prior to travel. 3
Measuring outcomes in genitourinary medicine: involving service users in the measurement of outcomes
Authors: Gann Robert
Published: October 2002

Summary: Recently there has been increased emphasis on the user perspective in health care. At the same time the concern with effective health care is making us look more critically at the outcomes of treatment and other interventions, and the evidence available to us to make sense of effectiveness. This paper addresses the involvement of genitourinary medicine service users in outcome measurement through 3 linked questions: (1) What do we mean by outcomes? (2) What do we mean by users? and (3) What do we mean by involving?
Determinants of high-risk sexual behaviour and condom use among adults in the Arusha region, Tanzania
Authors: Mnyika Kagoma S. , Klepp Knut-Inge , Kvale Gunnar , Ole-King'Ori Naphtal
Published: October 2002

Summary: Determinants of multiple sexual partners and condom use among adults were assessed through a population-based survey in one urban, one semi-urban and one rural community in the Arusha region, northern Tanzania. The study samples were obtained by randomly selecting clusters of 10 households from the 3 communities. Informed verbal consent was sought from each respondent for participation in the study. High-risk sexual behaviours and condom use were assessed using a structured questionnaire. It was observed that significantly more men than women reported having multiple sexual partners (49% vs 25.2%; OR=1.69; 95% CI=1.51-1.90) and urban men were significantly more likely to report having multiple sexual partners than men in rural areas. In both men and women, early sexual debut was associated with having multiple sexual partners while travel, alcohol use, and sex under the influence of alcohol were significantly associated with multiple sexual partners in men only. AIDS-related discussion was significantly associated with having fewer sexual partners in both men and women. Of the 1551 respondents, 320 (20.6%) reported having ever used a condom and of the 320 respondents who had ever used a condom, 34 (10.6%) reported having used it at the last sexual intercourse. Significantly more men than women reported having ever used a condom (34.1% vs 14.1%; OR=1.77; 95% CI=1.56-2.01). In both men and women, early sexual debut and being young, unmarried, travelling out of the Arusha region and having multiple sexual partners were associated with increased condom use. For both men and women, frequent discussion of AIDS with family members or friends was associated with increased condom use. These data suggest that interventions targeting adolescents and young adults may be effective for control of HIV transmission in Tanzania. In particular, creation of opportunities for people to come together and discuss AIDS might be an important strategy.
Inoculation of culture plates: straightforward or is it?
Authors: Carlin E M , Hammond J-A , Boag F C
Published: October 2002

Summary: In view of the recent vogue in some genitourinary medicine (GUM) units towards selective microscopy we aimed to assess the adequacy of culture plate inoculation in our own GUM clinic by the visual examination of 350 consecutively inoculated plates. Seventy-five (21%) plates were inoculated so lightly that no indentation in the agar could be seen whilst in 20 (60%) the agar was shredded. Eighty-five per cent of inadequately plated samples were inoculated by the same staff members who were either relatively inexperienced, or well-distanced from their last in-service training. This has many important implications not only in the identification and control of infection but also with respect to staff training. We have now introduced practical plating instruction for all new members of clinical staff and additional in-service training. We plan to repeat the audit in 6 months' time to assess the effect of these changes.
Suppression of HIV replication in vitro by CD8+ T-cells from HIV-infected and HIV-seronegative individuals
Authors: Ichimura H , Dwyer J M , Tsuchie H , Detorio M A , Hossain M M , Tesfamariam N , Trickett A , Lam-Po-Tang P R , Yamada O , Kurimura T
Published: October 2002

The inhibitory effect of CD8+ T-cells from HIV-infected or HIVseronegative individuals on HIV replication in the naturally-infected CD4+ T-cells in vitro was examined. Not only autologous CD8+ T-cells from HIV-infected individuals but also allogeneic CD8+ T-cells from HIV-seronegative individuals prevented or delayed HIV replication, even in transwell cocultures using a semipermeable 0.45 micron filter. The level of the inhibitory effect of allogeneic CD8+ Tcells from the HIV-seronegative individuals on the HIV replication was varied among CD4+ T-cells obtained from HIV-infected individuals used. The results suggested that CD8+ T-cells from HIV-seronegative individuals as well as HIVinfected individuals could produce some cytokine(s) which suppress HIV replication in vitro . The sensitivity to the cytokine(s) might be variable among HIV strains, depending on differences in the nucleotide sequence of different HIV-1 strains. Further studies of control of HIV replication by CD8+ anti-HIV cytokine(s) should provide new strategies for the therapy of HIV infection.
Determinants of HIV seroconversion in drug users during a period of rising prevalence in Vancouver
Authors: Patrick David M , Strathdee Steffanie A , Archibald Christopher P , Ofner Marianna , Craib Kevin J P , Cornelisse Peter G A , Schechter Martin T , Rekart Michael L , O'Shaughnessy Michael V
Published: October 2002

To identify determinants of HIV seroconversion among injection drug users (IDUs) during a period of rising prevalence, a case-control investigation was conducted. Cases were IDUs with a new positive test after 1 January 1994, and a negative test within the prior 18 months. Controls required 2 negative tests during the same period. Subjects completed a questionnaire on demographic, psychosocial, and behavioural factors. Eighty-nine cases and 192 controls were similar with respect to gender, age, ethnicity and inter-test interval. Multivariate analyses of events during the inter-test interval showed borrowing syringes (adj. OR=2.96; P 0.006), unstable housing (adj. OR=2.01; P =0.03) and injecting 4 times daily (adj. OR=1.71; P =0.06) to be independently associated with seroconversion. Protective associations were demonstrated for sex with opposite gender (adj. OR=0.36; P =0.001) and tetrahydrocannabinol use (adj. OR=0.41; P =0.001). There is a need to evaluate programmes dealing with addiction, housing and the social underpinnings of risk behaviours in this population. <
Sexual networks in Uganda: mixing patterns between a trading town, its rural hinterland and a nearby fishing village
Authors: Pickering H , Okongo M , Ojwiya A , Yirrell D , Whitworth J
Published: October 2002

The study was based in south-west Uganda where significant differences in HIV prevalence have been found between urban and rural areas. Longitudinal data collected in a diary format was used to determine the extent to which high-risk men and women living in a truck stop/trading town had sexual contact with people from surrounding rural areas and a nearby fishing village. Study participants were 143 men, 75 of whom were resident in the town, 40 in a fishing village and 28 in rural areas, and 81 women, of whom 47 were resident in the town, 25 in the fishing village and 9 in a rural area. During 1687 man weeks the 143 men made 3149 trips and had 5189 sexual contacts. Ninety-two per cent of these sexual contacts occurred in the man's current place of residence and 21% were with a new partner. The 81 women participated for 1280 women weeks during which they recorded 6378 sexual contacts. Women who lived in the fishing village and the rural area had around 90% of their contacts with local men while those who lived in the town fell into 3 categories: women who charged a relatively high price for commercial sex had only 11% of contacts with men living in the town, while those who charged a tenth of the price had 71% of contacts with town men. The small number of women who fell into an intermediate category, in terms of price, had sexual contact with a wide variety of men. These findings show that there is little scope for HIV infection to spread between different residential or occupational groups. This may help to explain how large differences in HIV seropositivity between neighbouring localities can be maintained for long periods, despite considerable social and economic mixing between groups and high levels of sexual partner change within groups.
A pilot study to investigate the treatment of anogenital warts with Topical Lithium Succinate cream (8% lithium succinate, 0.05% zinc sulphate)
Authors: Ward K A , Armstrong K D , Maw R D , Winther M D , Gilburt S J A , Dinsmore W W
Published: October 2002

The incidence of anogenital warts (condyloma acuminatum) is rapidly increasing while there is still no totally satisfactory treatment available. In light of the emphasis of experimental approaches toward the prevention of viral replication and evidence of the antiviral action of lithium salts it was proposed to investigate the efficacy of Topical Lithium Succinate cream (LSC) in the treatment of anogenital warts. A total of 101 patients (42 women, 59 men) were randomized to receive either active or placebo treatment for a period of 4 weeks. Assessment of the number, location, size and area of coverage of the warts was made by the clinician at baseline, weeks 2, 4, 6 and 12. Compliance to the study protocol following cessation of treatment at week 4 was extremely poor. The high drop-out rate after this was felt to invalidate data collected after that point. It was therefore decided that the analysis should concentrate on the treatment period. Of 101 patients entering the trial 51 received active (30 male and 21 female) and 50 received placebo (29 male, 21 female). The primary efficacy variable was percentage change from baseline in the overall coverage of lesions. Over all patients LSC treatment resulted in a reduction of 42% ( P 0.02) in the overall coverage of lesions. Separate analyses for male and female patients showed that for males there was a highly significant reduction in the coverage of lesions of < 65% ( P 0.02). However for females the reduction of 11% was not significant. A possible explanation for this difference between the sexes is that as many of the lesions in the female patients were internal therefore this could lead to difficulty in both application of the cream, and subsequent lesion assessment. <
Detection of Chlamydia trachomatis antibodies by 2 novel tests: rELISA and peptide EIA
Authors:   1 M Paukku,   2 A Narvanen,   3 M Puolakkainen,   4 K Dreesbach,   1 A Tiitinen,   2 W Hao,   5 T I Anttila,   1 J Paavonen
Published: October 2002

The performance of 2 newly developed enzyme immunoassays (EIAs) intended for the routine serological diagnosis of chlamydial infections was evaluated. rELISA is based on a recombinant lipopolysaccharide antigen which detects chlamydia genus-specific antibodies, and Chlamydia trachomatis EIA is based on a peptide derived from major outer membrane protein and is therefore speciesspecific. Both tests distinguished patients with tubal factor infertility (TFI) or pelvic inflammatory disease (PID) from the controls. The prevalence of IgA antibodies was higher for the PID patients than for the TFI patients; the finding indicates a more active state of infections for the PID patients. Furthermore, C. trachomatis EIA detected more IgG antibodies in the TFI patients than in patients with non-tubal factor infertility. In conclusion, rELISA detected chlamydial antibodies in general, and C. trachomatis EIA detected species-specific antibodies. These EIA tests may be useful in the serodiagnosis of chlamydial infection.
Tolerance, compliance and psychological consequences of post-exposure prophylaxis in health-care workers
Authors: Tribonniere X De La , Dufresne M D , Alfandari S , Fontier C , Sobazek A , Valette M , Ajana F , Gerard Y , Maulin L , Bourez J M , Baclet V , Senneville E , Vermersh A , Mouton Y
Published: October 2002

Our objectives were to evaluate tolerance and compliance of postexposure triple therapy in health-care workers (HCWs) by retrospective observational study. Structured telephone interview of HCWs identified through data from antiretroviral prescribing centres. Twenty HCWs who received triple prophylaxis were identified over one year. Sixteen agreed to participate in the study. All but one source patient had documented HIV infection. Half HCWs were not aware of post-exposure therapy. Most HCWs received a zidovudine, lamivudine and indinavir combination. All completed at least 4 weeks of therapy. Only 50% received their first dosage less than 4 h after exposure. Nearly all experienced adverse events, mostly digestive (nausea and abdominal pain n =15) or psychological (anxiety and depression n =15), none resulting in therapy discontinuation. Most events occurred 2 to 7 days after therapy initiation. Most modified their sexual life with abstinence or condom use. Compliance was excellent. Half HCWs did not miss any tablet, 4 forgot one dosing a month and 4 one dosing a week. Follow up is over 6 months in all but one HCW. No HIV seroconversion has been observed to date. In France, post-exposure triple antiretroviral therapy is widely available 24 h a day in every emergency room but further training and development of HCWs is needed to decrease consulting time and increase referral to specialized physicians. Notable moderate adverse events, both physical and psychological are noted, however, compliance is excellent.