Sexually Transmitted Disease Clinic Research Articles

Molecular epidemiology of genital Chlamydia trachomatis infection in Shenzhen, China

ObjectiveTo investigate molecular epidemiology of Chlamydia trachomatis infection among patients recruited from different clinic settings in Shenzhen, China.MethodsA total of 2534 patients from the sexually transmitted disease (STD) clinics, obstetrics...

Human Immunodeficiency Virus Seroprevalence among Patients Attending a Sexually Transmitted Disease Clinic in West Bengal, India

Sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV) infection have become a major public health problem globally as well as in India. Prevalence of STIs varies across different high risk groups including the population with sexually transmitted diseases (STDs). Individuals with STDs are at a higher risk of acquisition of HIV through the sexual route than the other routes. The tendency of HIV infection was studied in attendees aged 15-49 years in an STD clinic in West Bengal from 2004 to 2008. Blood samples were collected consecutively from 250 attendees per year (a total of 1,250 samples over 5 years) from an STD clinic during 12 weeks (October-December) every year. HIV sero-status was screened using ELISA, and positive samples were subjected to rapid assay and confirmed by Western blot. Overall HIV seropositivity in STD patients was 1.28% (women, 1.04%; men, 1.48%). Data from 5 consecutive years showed a prominent decline from 2.40% (2004) to 0.0% (2007) and a minor increase (1.6%) in 2008, which was not statistically significant (χ(2) = 4.6, df = 4, P > 0.05). The highest seroprevalence (1.66%) was observed in the 25-29 age group, and the lowest (0.87%) was observed in the 40-44 age group. The overall decreasing tendency of HIV infections signifies the efficiency of current interventions. Focused intervention for the 25-29 age group may help in decreasing HIV infections further.

Serum HSV-1 and 2 IgM in sexually transmitted diseases - more for screening less for diagnosis: An evaluation of clinical manifestation

Background:Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes. Now, HSV-1 has become an important cause and represents even about 30% of genital herpes in some countries. So, study related to genital herpes should consider both HSV-1 and HSV-2.Aim:To examine trends in HSV-1 and 2 seroprevalence by Serum HSV-1 and 2 IgM in all type of sexually transmitted disease (STD) patients and also to evaluate correlation of serum HSV-1 and 2 IgM in STD.Materials and Methods:150 patients attending the STD clinic attached to a tertiary care hospital of Ahmedabad were included in the study. Serum HSV-1 and 2 IgM correlations with clinical manifestations of recurrent and non-recurrent type of genital herpes patients and other non-herpetic STD patients were studied.Results:The overall serum HSV-1 and 2 IgM in STD seroprevalence were 15.66%. Female has significant higher prevalence (P < 0.05). STD cases and HSV seroprevalence were specially concentrated in persons aged 21 to 30 years. Among those positive with HSV, the distribution of STD are wide spread and found in non-herpetic group at high frequency. Out of total 23 serum HSV-1 and 2 IgM positive, 12 and 11 are distributed in herpetic and non-herpetic STDs, respectively.Discussion and Conclusion:Though serum HSV-1 and 2 IgM in STDs are less diagnostic, they help to see the iceberg part of the infection among the population concerned in recent scenario or in another words, it provides recent infective burden.

Behavioural risk factors of men associated with transmission of sexually transmitted infections (STIs) in Sri Lanka.

Unprotected sex is a major risk factor for transmission of sexually transmitted infections (STIs). We explored the behavioural risk factors for STIs among men who presented with STI-related symptoms. A systematic sample of 112 males presenting with STI symptoms at district sexually transmitted disease (STD) clinic located in Kandy, Sri Lanka were enrolled during 2009. They were interviewed using a semi-structured questionnaire. Selected sexual behaviours were discussed with them in greater detail. The chi-square and difference-in-two-proportion tests were used for testing the statistical significance for quantitative data, and qualitative methods were used for the analysis of responses to open-ended questions and in-depth discussion. The median age of the respondents was 28 years. The majority of them (56%) had never been married. The median age at the first sexual intercourse was 22 years. The majority (87%) of respondents had their first intercourse before marriage; mostly with older females. Most (103, 92%) men reported having sexual intercourse during the past six months; of them, 40.8% had sex with multiple partners. Only 18.5% used condoms at the first premarital intercourse. The consistent use of condoms with non-marital partners during the past six months was only 13.7%. Common reasons for non-use of condoms were: belief that partner was faithful; poor knowledge about risk of unprotected sex; view that condoms reduce pleasure and negatively affect intimacy; and inhibition in accessing condoms in public. Sexual behaviours were found to be risky among men attending STD clinics in Sri Lanka. Strategies of sexual health promotion among vulnarable groups should be evaluated for planning proper interventions.

Serum HSV-1 and 2 IgM in patients of sexually transmitted diseases

Background: Herpes simplex virus type1 & 2 (HSV 1 &2) are the causative agent for genital herpes. Aim: To examine Serum HSV-1 and 2 IgM in all type of STD (sexually transmitted disease) patients including Human immunodeficiency virus (HIV) infection and also to evaluate correlation of Serum HSV-1 and 2 IgM in these patients. Materials and Methods: 150 patients attending the STD clinic attached to a tertiary care hospital of Ahmedabad were included in the study. These all patients were screened for HIV-1 and 2 antibodies. Serum HSV-1 and 2 IgM correlations with HIV infection and clinical manifestations of genital herpes patients and other non herpetic STD patients were studied. Results: The overall Serum HSV-1 and 2 IgM in STD seroprevalence was 15.66%. Female have significant higher prevalence ( p Discussion and Conclusion: Though Serum HSV-1 and 2 IgM in sexually transmitted diseases is less diagnostic, it helps to see the iceberg part of the infection among the population concerned recently. Putting STD surveillance systems in place specially in areas with high prevalence of HIV will be crucial in monitoring changes so that appropriate adjustments can be made to treatment schedules to make them more cost effective.

Early Awareness and Uptake of an Effective Waiting Room Video Intervention by STD Clinics

Successful diffusion and adoption is critical for the effectiveness and impact of a new intervention. The objective of this research was to evaluate the uptake and implementation of a newly released educational waiting room video in US sexually transmitted diseases (STD) Clinics. A telephone survey was administered to a random sample of 73 clinic directors representing 76 US STD clinics 3 to 5 months following the availability of the intervention. A qualitative analysis was used to categorize survey responses and detect associations among them. Of the 76 clinics, 22% were aware of the intervention and 17% had ordered the intervention kit. The most frequently reported sources for hearing about the video were interpersonal communication/word of mouth, national conferences, and the STDPreventionOnline.org Website. The majority (74%) of clinic directors reported using state or local entities as primary sources of new information; however, reporting these channels was associated with unawareness of the new intervention. Facilitators to adoption included having adequate video/DVD equipment (55%) and a separate, nonshared waiting room for STD services in which to show the video (47%). The data from this sample suggest that making greater use of prominent thought leaders and interpersonal communication, including social networking, and professional groups may improve awareness of new interventions. Some barriers to adoption, such as lack of equipment, have relatively inexpensive solutions yet bureaucratic or technical support issues may still play a role. However, some structural barriers, such as shared waiting areas, will require innovative alternatives to conventional practice.

Syphilis Seroprevalence among Patients Attending a Sexually Transmitted Disease Clinic in West Bengal, India

Syphilis is a sexually transmitted disease (STD) and is a major public health concern in India. The trend of syphilis infection was studied in attendees aged 15-49 years in an STD clinic in West Bengal from 2004 to 2008. Blood samples were collected from 250 consecutive patients per year (a total of 1,250 samples over 5 years); the patients attended the STD clinic for 12 weeks (October-December) each year, and the serostatus of syphilis was determined qualitatively with the Venereal Disease Research Laboratory (VDRL) test using serum samples. A quantitative VDRL test was then performed at a dilution of 1:8 using serum samples that yielded positive results in the qualitative VDRL test. Finally, serum samples that yielded positive results in the quantitative VDRL test were also subjected to the Treponema pallidum hemagglutination assay (TPHA). The serum samples that yielded positive results in both the tests were considered syphilis seropositive. All seropositive serum samples from the quantitative VDRL test were also found to be positive results in TPHA. The total seropositivity for syphilis in the STD patients was 8.2% (women, 8.9%; men, 7.7%). Review of the data from 5 consecutive years showed a statistically significant (χ(2) = 9.968, df = 4, P < 0.05) decrease in syphilis positivity from 10.8% (2004) to 3.6% (2008). The results of the study also revealed that the highest seroprevalence was in the 20-24 age group (16.3%), and the lowest seroprevalence was in the 45-49 age group (3.3%). The study indicates the effectiveness of current interventions with a need to focus further on reducing the burden in the 20-24 age group.

Cervical Cancer Screening Among Women Who Attend Sexually Transmitted Diseases (STD) Clinics: Background Paper for 2010 STD Treatment Guidelines

In April 2008, experts reviewed updates on sexually transmitted disease (STD) prevention and treatment in preparation for the revision of the Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines. This included a review of cervical cancer screening in the STD clinical setting. Key questions were identified with assistance from an expert panel. Reviews of the literature were conducted using the PubMed computerized database and shared with the panel. Updated information was incorporated in the 2010 CDC STD Treatment Guidelines. We recommend that STD clinics offering cervical screening services screen and treat women according to guidelines by the American College of Obstetrics and Gynecology, the American Cancer Society, the US Preventive Services Task Force, and the American Society for Colposcopists and Cervical Pathologists. New to the 2010 guidelines are higher age for initiating cervical screening (age ≥ 21 years) and less frequent intervals of screening (at least every 3 years). New recommendations include new technologies, such as liquid-based cytology and high-risk human papillomavirus (HPV) DNA tests. Liquid-based technologies are not recommended over conventional testing. HPV DNA tests are recommended as adjunct tests and with new indications for use in cervical screening and management. Stronger recommendations were issued for STD clinics offering cervical screening services to have protocols in place for follow-up of test results and referral (eg, colposcopy). Important additions to the 2010 STD Treatment Guidelines include information on updated algorithms for screening and management of women and recommendations for use of liquid-based cytology and high-risk HPV testing.

Ureaplasma urealyticum Is Associated With Nongonococcal Urethritis Among Men With Fewer Lifetime Sexual Partners: A Case-Control Study

Ureaplasmas have been inconsistently associated with nongonococcal urethritis (NGU). We evaluated the association of the newly differentiated species Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) with NGU using 2 separate control groups. Case patients were men who attended a sexually transmitted disease (STD) clinic in Seattle, Washington, during the period 2007-2009 with NGU (defined as visible urethral discharge and/or ≥5 polymorphonuclear neutrophils per high-powered field; n = 329). Control subjects were STD clinic attendees (n = 191) and emergency department (ED) attendees (n = 193) without NGU. Polymerase chain reaction assays detected UU and UP in ureaplasma culture-positive urine. Multivariable logistic regression was used to assess the associations of UU and UP with NGU. UU was only marginally associated with NGU in aggregate multivariable analyses, irrespective of control group (adjusted odds ratio [aOR](STD-control), 1.6 [95% confidence interval {CI}, 0.9-2.8]; aOR(ED-control), 1.7 [95% CI, 0.97-3.0]). This association was significantly stronger when analyses were restricted to men with fewer lifetime sex partners (<10 vaginal partners: aOR(STD-control), 2.9 [95% CI, 1.2-6.7]; aOR(ED-control), 3.2 [95% CI, 1.3-7.6]; <5 vaginal partners: aOR(STD-control), 6.2 [95% CI, 1.8-21.0]; aOR(ED-control), 5.2 [95% CI, 1.3-20.2]). UP was not positively associated with NGU overall or among subgroups. The absence of an association of UU with NGU among men with more lifetime sex partners suggests that adaptive immunity may attenuate the clinical manifestation of UU infection. Similar relationships were not observed with UP, which suggests that it is not a urethral pathogen.

County-Level Sexually Transmitted Disease Detection and Control in Texas: Do Sexually Transmitted Diseases and Family Planning Clinics Matter?

Sexually transmitted disease (STD) detection and control have traditionally been performed by STD and family planning (FP) clinics. However, the magnitude of their impact (or the lack thereof) has not been examined. We examine the association between having STD and/or FP clinics and county-level STD detection and control in the state of Texas. We used county-level STD (chlamydia, gonorrhea, and primary and secondary syphilis) morbidity data from the National Electronic Telecommunications System for Surveillance for 2000 and 2007. We applied spatial regression techniques to examine the impact of the presence of STD/FP clinic(s) (included as dichotomous variables) on STD detection (i.e., morbidity) and control. We included county-level demographic characteristics as control variables. Our results indicated that counties with STD or FP clinics were associated with at least 8% (P < 0.05) increase in the transformed chlamydia and gonorrhea rates, 20% (P < 0.01) increase in transformed syphilis rates in 2000, and at least 6% (P < 0.05) increase in transformed gonorrhea and Chlamydia rates in 2007. From 2000 to 2007, the transformed incidence rates of chlamydia declined by 4% (P < 0.10), 8% (P < 0.01) for gonorrhea, and 8% (P < 0.05) for primary and secondary syphilis for the counties that had at least 1 STD or FP clinic. The results from this ecological study are associations and do not establish a causal relationship between having an STD/FP clinic and improved STD detection and control. Finer level analyses (such as census block or cities) may be able to provide more detail information.

Screening of Oropharynx and Anorectum Increases Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Female STD Clinic Visitors

The relevance of screening of oropharynx and anorectum in addition to endocervical tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae infection is unclear in women, while there is a documented benefit of this approach in men who have sex with men. Female visitors to the sexually transmitted disease (STD) clinic were asked about their sexual practice as a part of the routine electronic patient file. In addition to tests for endocervical infection, swabs were taken from the oropharynx and anorectum to test for C. trachomatis and N. gonorrhoeae based on the history of sexual contact. Routinely, all electronic patient files are anonymously included in a database for surveillance purposes. In this observational study, we analyzed all consultations in the database over an 18 months period. A total of 4299 consultations were registered; 10% of women had endocervical chlamydia and 1.1% had gonorrhea. The detection rates for C. trachomatis and N. gonorrhoeae from oropharyngeal samples were 1.9% and 0.8%, and from anorectal samples 8.7% and 1.7%, respectively. Except for 2 cases of pharyngeal gonorrhea, all oropharyngeal and anorectal infections were asymptomatic. Inclusion of oropharyngeal and anorectal tests in the screening protocol was associated with a percentage increase in prevalence of chlamydia by 9.5% and gonorrhea by 31%, relative to tests for endocervical tests alone. The percentage increase in prevalence was higher than that for the symptom-based approach (3.7% and 10.4%, respectively). Inclusion of oropharyngeal and anorectal tests in the STD screening protocol increases the prevalence of chlamydia and gonorrhea in women. Screening of anatomical sites based on sexual history is preferred over a symptom-based protocol.

NYC Condom Use and Satisfaction and Demand for Alternative Condom Products in New York City Sexually Transmitted Disease Clinics

In 2007, via a high-profile media campaign, the New York City Department of Health and Mental Hygiene (NYC DOHMH) introduced the "NYC Condom," the first specially packaged condom unique to a municipality. We conducted a survey to measure NYC Condom awareness of and experience with NYC Condoms and demand for alternative male condoms to be distributed by the DOHMH. Trained interviewers administered short, in-person surveys at five DOHMH-operated sexually transmitted disease (STD) clinics in Spring 2008. We systematically sampled eligible patients: NYC residents aged ≥18 years waiting to see a physician. We approached 539; 532 agreed to be screened (98.7% response rate); 462 completed the survey and provided NYC zip codes. Most respondents were male (56%), non-Hispanic black (64%), aged 18-24 years (43%) or 25-44 years (45%), employed (65%), and had a high school degree/general equivalency diploma or less (53%). Of those surveyed, 86% were aware of the NYC Condom, and 81% of those who obtained the condoms used them. NYC Condom users were more likely to have four or more sexual partners in the past 12 months (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.0-3.8), use condoms frequently (AOR = 2.1, 95% CI = 1.3-3.6), and name an alternative condom for distribution (AOR = 2.2, 95% CI = 1.3-3.9). The most frequently requested condom types respondents wanted DOHMH to provide were larger size (28%), ultra thin/extra sensitive (21%), and extra strength (16%). We found high rates of NYC Condom use. NYC Condom users reported more sexual partners than others, suggesting the condom initiative successfully reached higher-risk persons within the STD clinic population. Study results document the condom social marketing campaign's success.

O5-S4.03 HIV testing among patients infected with Neisseria gonorrhoeae-STD surveillance network, USA, 2009–2010

BackgroundAn estimated 21% of 1.1 million HIV-infected US residents do not know they are infected and may unknowingly transmit HIV. Because people with sexually transmitted diseases (STDs) are at increased...

P1-S1.23 Trend of sexually transmitted diseases diagnosed by syndromic approach in an institute setting

BackgroundThe paradigm of research in sexually transmitted diseases (STD) has recently shifted to HIV/AIDS. Recent trend of sexually transmitted diseases in India is lacking.ObjectiveTo determine the trend in the syndromic...

P1-S1.25 Trend of sexually transmitted diseases diagnosed by syndromic approach in an institute setting

BackgroundThe paradigm of research in sexually transmitted diseases (STD) has recently shifted to HIV/AIDS. Recent trend of sexually transmitted diseases in India is lacking.ObjectiveTo determine the trend in the syndromic...

O5-S3.02 Implementation of an Expedited Partner Therapy (EPT) Program in an inner-city STD clinic

BackgroundExpedited partner therapy (EPT) is the practice of treating sex partners of persons with sexually transmitted diseases (STD) without an intervening medical evaluation. In 2006, the CDC issued guidelines for...

P3-S6.06 Does the concept of early and late latent syphilis hold well in today's scenario?

BackgroundLatent syphilis refers to the asymptomatic stage in the natural evolution of syphilis in a patient not treated or inadequately/inappropriately treated for syphilis. Latent syphilis has been categorised as early...

P3-S5.05 Rapid point of care testing for ten sexually transmitted diseases

BackgroundDelays in the reporting of STD testing sometimes result in inappropriate patient care where a patient must be called back in for treatment. Some STDs may be missed because not...

Evaluation of VERSANT® CT/GC DNA 1.0 Assay in conjunction with VERSANT® kPCR Molecular system

A total of 463 first void urine specimens were obtained from patients attending the Sexually Transmitted Diseases (STD) Outpatients Clinic of the St. Orsola University Hospital in Bologna, Italy. Samples were tested by the new test VERSANT® CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Inc.), a multiplex Real-Time Polymerase Chain Reaction (PCR) assay, for simultaneous detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC).A total of two specimens were collected from each patient, respectively: one urine sample for VERSANT® CT/GC DNA 1.0 Assay testing and one urethral or endocervical swab for the detection of C. trachomatis by IDEIA™ PCE Chlamydia (Oxoid). In our population, the prevalence of CT in patients was 11.9%, when studied by VERSANT® CT/GC DNA 1.0 Assay, whereas it was only 5.0%, when samples where analyzed by IDEIA™ PCE Chlamydia. In conclusion,VERSANT® CT/GC DNA 1.0 Assay demonstrated to be a highly sensitive and specific technique for the detection of CT in patients attending a STD Clinic. Nucleic acid amplifications tests are the most sensitive assays available to date for CT and GC in clinical specimens and this new Real-Time PCR assay adds to the group of commercially available assays that are available to laboratories as choices for superior diagnostic performance.

Mediators of the relation between partner violence and sexual risk behavior among women attending a sexually transmitted disease clinic.

Intimate partner violence (IPV) is associated with a wide range of negative outcomes, including sexual risk behavior. This cross-sectional study explored mediators of the relationship between IPV and risky sexual behavior in 717 women recruited from a sexually transmitted disease (STD) clinic. Participants were recruited from a public STD clinic in upstate New York as part of a randomized controlled trial that was designed to evaluate several sexual risk reduction interventions. They completed an audio computer-assisted self-interview in a private room. Among these women, 18% reported IPV in the past 3 months and 57% reported lifetime experience of IPV. Recent IPV was associated with greater sexual risk, as measured by more episodes of unprotected sex (overall and with a steady partner). Although IPV was associated with depressive symptoms and drug use before sex, these variables did not mediate the relationship between IPV and sexual risk behavior. The results indicate that IPV is common among women who attend an STD clinic and warrants increased attention. Research is needed to better understand the pathways linking IPV and HIV risk in women, to optimize the design of effective interventions.