Sexually Transmitted Disease Symptoms Research Articles

Medication use by female sex workers for treatment and prevention of sexually transmitted diseases, Chiang Rai, Thailand.

Female sex workers (FSWs) in Thailand are at high risk for sexually transmitted diseases (STDs). Although regular attendance at public STD clinics is required, FSWs may frequently use medications obtained in the community for STDs. To determine the frequency of use of medications for STDs from sources other than public STD clinics among FSWs in Thailand and to describe factors associated with such medication use. A cross-sectional survey of FSWs attending the public STD clinic in Chiang Rai, Thailand, was performed. Of the 200 FSWs interviewed, 55% had ever used medications to treat or prevent STDs from a source other than a public STD Clinic, and 36% had done so in the prior year. Most use (79%) was to treat STD symptoms, and medication was most frequently obtained directly from a pharmacy (54%). This use of community medication for STDs was associated with younger age, non-Thai ethnicity, seeking STD treatment during the current clinic visit, and brothel-based sex work. Use of medications from various sources in the community was common among these FSWs. Further research is needed to determine the appropriateness of this treatment. Innovative methods to ensure adequate quality STD care by community providers and to improve the health-care-seeking behaviors of these high-risk women are needed.

Multiple condom use in commercial sex in Lamphun Province, Thailand: a community-generated STD/HIV prevention strategy.

In an investigation of condom breakage in commercial sex, we found a high proportion of multiple condoms use. This study sought to ascertain the characteristics of brothel-based commercial sex workers (CSWs) and their clients; to identify the decision makers (clients and/or CSWs) active in choosing multiple condom use; and to determine whether there is an implicit hierarchy of condom use negotiation. To identify factors associated with multiple condom use in commercial sex and to provide an understanding of how this innovation developed in this setting. Sixty-seven brothel-based CSWs in Lamphun Province who participated in a study of condom breakage participated in a case-control study of multiple versus single condom use, which determined CSW and client characteristics for evidence of multiple condom use. Interviews and focus groups were used to determine decision making for condom use and the contexts for multiple use. Association between characteristics of CSWs/clients and multiple condom use was analyzed using X2 for trend. No official program encouraged multiple condom use; this appeared to be a community-devised strategy to increase protection from human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). CSWs working in daytime brothels had significantly greater multiple condom use than those working in nighttime brothels; mean percentages + SD of multiple simultaneous use were 57.5% + 28.6 and 35.5% + 22.4, respectively (p < 0.001). Day CSWs were older, had more pregnancies, reported higher frequency of STD symptoms and history of pelvic inflammatory disease, and had more clients per day but had a lower number of sex acts per client than night CSWs. Among factors associated with multiple condoms, only age was significant. The decision to use single or multiple condoms for a sex act was primarily (78.2% in single and 79.3% in multiple) made by the CSW herself. The main reason given for multiple condom use was protection from HIV/STD. There is high compliance between CSWs in Lamphun province and the Ministry of Public Health-sponsored 100% condom use campaign, and CSWs are attempting to further reduce their risks of HIV/STD exposure by using multiple condoms for sex with their clients.

Delayed presentation to clinics for sexually transmitted diseases by symptomatic patients. A potential contributor to continuing STD morbidity.

To determine the proportion of symptomatic patients attending public sexually transmitted disease (STD) clinics who fail to seek care within 7 days of the onset of STD symptoms and their self-reported reasons for delays in obtaining care. Interviewers administered 23-item questionnaire to a cross section of STD clinic clients between April and September 1995. Five urban STD clinics in the United States (Birmingham, AL; St Paul, MN; San Francisco CA; Seattle, WA; and Raleigh, NC). Of 1,621 patients with genitourinary symptoms, over one third (35% of men, 37% of women) presented to STD clinics only after 1 week or more of symptoms. Men with genital warts (73%) or with nongonococcal urethritis (23.1%) or symptomatic men who were recent contacts to sex partners with STDs were significantly more likely to delay clinic attendance more than a week than men with gonorrhea (6.5%, p < 0.001 for each). Overall 43.8% of women receiving specific clinical diagnoses other than genital warts delayed clinic attendance for more than 1 week. When asked why they delayed clinic attendance, respondents were most likely to respond that they had hoped their symptoms would "go away" (48.5% of men and 49.4% of women who waited a week or more before seeking care). A substantial proportion of patients with genitourinary symptoms attending public STD clinics delay seeking care for a week or more, increasing their likelihood of complications and of transmission of infection to others. Interventions to promote more timely clinic attendance may help reduce STD morbidity in the United States.

Self-treatment patterns among clients attending sexually transmitted disease clinics and the effects of self-treatment on STD symptom duration. The Study Group.

To assess patterns of self-treatment and its effects on the duration of sexually transmitted disease (STD) symptoms before medical care. A cross-sectional interview survey in public STD clinics (7 U.S. cities). Patients, seeking treatment for STD symptoms or having a known infected sexual contact, reported self-treatment behaviors and symptom duration. Additional data were abstracted from medical charts. Self-treatment, primarily over-the-counter topical medications (54.8%), was reported by 21.8% of 2,508 symptomatic patients. Self-treaters were significantly more likely to be African-American (odds ratio [OR] = 1.8), female (OR = 1.7), over age 30 (OR = 1.3), report > 1 symptom (OR = 1.4), and report a genital lesion (OR = 2.1). Symptom duration was 2 days longer among self-treaters (p < 0.01). African-Americans (OR = 1.5), men (OR = 1.2), and self-treaters of symptoms other than genital lesions (OR = 1.4) had a significantly longer time from symptom onset to receiving medical care. Self-treatment is common among patients with STDs. Self-treatment of a genital lesion, unlike certain demographic factors and self-treatment of other STD symptoms, did not prolong the time to medical treatment.

A Risk-Assessment Tool for Integrated Reproductive Health Services

In response to the global AIDS epidemic and the contributions of other sexually transmitted diseases (STDs) to the spread of HIV the 1994 Cairo International Conference on Population and Development developed an STD risk assessment tool. This paper discusses the importance of the STD risk assessment tool in providing a unified pathway for integrated reproductive health services. The STD risk assessment tool uses a variety of demographic behavioral and clinical information (other than laboratory test results) to assess the likelihood that persons are currently infected with an STD or at high risk of future infection. Providers of reproductive health services can use this tool in counseling clients about behavioral and contraceptive choices that will help them achieve future childbearing goals. Moreover it can be used as a guide to treat STD symptoms in settings where appropriate laboratory services are not available. Thus STD risk assessment serves as a bridge for integrating reproductive health programs.

STD rapid assessment in Rwandan refugee camps in Tanzania.

OBJECTIVE: To obtain baseline information on sexually transmitted diseases (STDs) in the Rwandan refugees camps in Tanzania, prior to establishment of STD services. SETTING: The largest camps of Rwandan refugees...

A Risk-Assessment Tool for Integrated Reproductive Health Services

In response to the global AIDS epidemic and the contributions of other sexually transmitted diseases (STDs) to the spread of HIV the 1994 Cairo International Conference on Population and Development developed an STD risk assessment tool. This paper discusses the importance of the STD risk assessment tool in providing a unified pathway for integrated reproductive health services. The STD risk assessment tool uses a variety of demographic behavioral and clinical information (other than laboratory test results) to assess the likelihood that persons are currently infected with an STD or at high risk of future infection. Providers of reproductive health services can use this tool in counseling clients about behavioral and contraceptive choices that will help them achieve future childbearing goals. Moreover it can be used as a guide to treat STD symptoms in settings where appropriate laboratory services are not available. Thus STD risk assessment serves as a bridge for integrating reproductive health programs.

Sexually transmitted diseases: Experience and risk factors among urban, low income, African American and Hispanic youth

The objectives of this study were to assess: (1) ethnic and gender differences in reporting of diagnoses of sexually transmitted diseases (STDs), symptoms related to STDs and sexual behavior and (2) behavioral risk factors for STDs in a probability sample of low income African American and Hispanic youth. Data were analyzed from a household probability sample of youth. The study collected data on self reported STDs, symptoms of STDs and sexual behavior. The sample was drawn from households in low income areas of urban Detroit: 1435 African American and Hispanic low income youth age 15-24 living in Detroit were interviewed face to face in 1991. Patterns of sexual activity as well as experience with STDs differ by ethnicity and gender. Within ethnic groups, women report more symptoms of STDs. Risk factors for diagnosed STDs included age, a young age at first intercourse, numbers of sexual partners, oral intercourse and anal intercourse. The data underscore the importance of development of effective safer sex intervention programs for these youth as well as careful assessment of STD risks in medical clinics serving these youth.

Partner referral as a component of integrated sexually transmitted disease services in two Rwandan towns.

To document partner referral rates at health centres with improved STD services, and to determine factors contributing to successful referral. Partner referral was initiated as part of the upgrading of STD services in primary care health facilities in two semi-urban Rwanda towns. After syndromic management of the presenting complaint, index patients received prevention education and condom demonstration, and were urged to refer sexual partners to the health centre for a free examination. Partner referral coupons linked by code number to the symptomatic index patient were given to facilitate referral; no identifying information was collected on partners from the index patients. Three quarters of the symptomatic patients seen at the two primary health care facilities were women. Overall, the ratio of referred partners to index patients was 26%. Only 58% of index patients accepted partner referral coupons. The referral rate for those who did accept coupons was 45%. Partner referral worked best for regular partners. Most index patients and partners were married and only four index patients referred more than one partner. Women index patients, especially when pregnant, were more successful in referring partners than men. Index patients who referred partners tended to be older than those who did not. Awareness of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of STD symptoms in the partner, and diagnosis of cervicitis were associated with a higher rate of partner referral. Efforts to improve rates of partner referral should begin at the clinic level with improved counselling to convince more index patients of the importance of partner referral. Partner symptom recognition may be useful for increasing rates of partner referral. Supplementary strategies are needed to reach non-regular partners. When syndromic management is used, counselling should take into account the lower predictive values of identifying STD in women in order to avoid partner accusation. Despite limitations, patient referral of sexual partners can be an effective strategy for reaching a population at high risk for STD with minimal additional investment in health worker staff time.

In Response: Condom Use to Prevent Incident STDs

In Response: Condom Use to Prevent Incident STDs

Association of HIV and STDs in Haiti

Mellon, Ralph L.*; Liautaud, Bernard*; Pape, Jean W.*†; Johnson, Warren D. Jr†; Port-au-Prince, ; Haiti, Author Information

STD knowledge and behaviours among clients of female sex workers in Bali, Indonesia.

This study investigated knowledge, beliefs, and practices related to STDs and AIDS among clients of low price sex workers in Bali, Indonesia. These men are at high risk of STD and HIV transmission. They have poor knowledge of the basic concepts of STD and HIV transmission and prevention, and they practice a variety of ineffective prevention strategies including partner selection and the prophylactic use of antibiotics. They report a mean of 1.9 paid sexual partners in the previous week and very low frequencies of condom use. Over 25% had experienced an STD symptom in the previous 6 months, with self treatment with antibiotics reported by a third. Recent experience of an STD was related to the number of sex worker partners in the previous month and to ever having used a condom with a sex worker. The implications of the study findings for the development of comprehensive STD control programs including educational campaigns, condom promotion, and the strengthening of STD case management by health care providers are discussed.

HIV-1 infection in young men in northern Thailand

To determine risk factors for HIV-1 infection in young men in northern Thailand. At enrollment into a prospective study, data were collected from a self-administered questionnaire and serologic testing on a cohort of 1115 young men selected by lottery for conscription. The overall HIV-1 infection rate was 6.9%; however, the rate was 15.3% among the 387 (34.7%) men who had been living in the upper north subregion of Thailand compared with 2.5% for the remaining 728 men (P < 0.001). A history of sex with female prostitutes was reported by 74.7% of men and increased frequency of this type of sex was highly associated with HIV-1 infection and a history of sexually transmitted disease (STD) symptoms (chi 2 for trend, P < 0.001). In stratified and multivariate analyses, however, history of STD symptoms, reported by 42.5% of the cohort, was most strongly associated with HIV-1 infection. Only 42.8% of men who reported sex with prostitutes had used condoms more than half the time. Young men in the general population in northern Thailand are at high risk for HIV-1 infection via sex with female prostitutes; STD are highly associated with HIV-1 infection. Increasing condom use and controlling STD should be immediate goals of HIV control programs.

AIDS and STDs: risk behaviour patterns among female sex workers in Bali, Indonesia.

This study investigated AIDS and STD knowledge, risk behaviour patterns and condom use among three distinct groups of female commercial sex workers (CSWs) in Bali, Indonesia. Individual in-depth interviews were conducted with 71 female CSWs. These CSW groups differ in the prices they charge, their places and modes of employment, educational backgrounds, levels of AIDS and STD knowledge, number of clients served and levels of condom use. Knowledge of the routes of transmission and appropriate prevention practices is low among all groups, and despite significant differences in their number of clients and their condom use, all groups report high levels of STD symptoms. Although HIV seroprevalence rates are currently low in Indonesia, high risk sexual behaviour patterns place all three groups of CSWs and their clients at great risk of infection. Interventions targeted to specific groups of CSWs and clients should be undertaken as soon as possible, including educational activities utilizing peer educators, condom promotion and distribution, together with improved STD diagnosis and treatment for CSWs and their clients.

Differences in biologic maturation, sexual behavior, and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia

Because several cofactors may influence the development of cervical intraepithelial neoplasia (CIN) in young women, we compared differences in behaviors (sexual activity, contraception, and cigarette use), sexually transmitted disease (STD) infection rates (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus), and cervical maturation (age of menarche and percentage of cervical ectopy) in groups of sexually active female adolescents with and without CIN. Those with CIN were compared with three non-CIN groups: (1) teenagers who were referred to a teen colposcopy clinic but had no evidence of CIN (high-risk group), (2) teenagers seen at a gynecology clinic without STD symptoms (asymptomatic group), and (3) teenagers seen at the gynecology clinic with STD symptoms (symptomatic group). The percentage of cervical ectopy was measured by colpophotography. Subjects with CIN had more lifetime sexual partners than the asymptomatic group (p less than 0.001) and were more likely to smoke cigarettes than either gynecology clinic group (p less than 0.01). No differences in behaviors existed between the CIN and high-risk groups. The mean age of menarche in those with CIN was 1 year older than all three non-CIN groups (p less than 0.05), and those with CIN had a greater area of ectopy than those without CIN (p less than 0.02). Those with CIN were more likely to have a past or present history of C. trachomatis infection than the two gynecology clinic groups; no difference was found between the CIN and high-risk groups. We conclude that cofactors such as smoking, sexual promiscuity, and C. trachomatis infection may influence cervical vulnerability. However, cervical biologic immaturity is an important risk factor for development of CIN in adolescent girls.

STD Patients' Knowledge About AIDS and Attitudes Toward Condom Use

Patients (N = 71) from a sexually transmitted disease (STD) clinic in an urban setting were surveyed to determine their knowledge about acquired immune deficiency syndrome (AIDS) and attitudes toward condom use. Overall knowledge scores were high with a mean score of 22 on the 28-item true-false questionnaire. No statistical significance was found between AIDS-knowledge scores and condom-use behavior. The majority of subjects or their partners had STD symptoms and multiple partners within a 6-month period. Thirty percent of the respondents reported using condoms at least 25% of the time. In response to open-ended statements about condoms, 10 beliefs were mentioned most frequently. The majority of subjects reported protection against sexually transmitted disease and preventing pregnancy as the most important reasons for condom use. "Avoids getting AIDS" only ranked as the eighth most salient belief and few subjects with multiple partners in the previous 6-month period even cited this belief. Other significant beliefs about condom use included decreased feeling, worry about breakage, decreased pleasure for partner, uncomfortable, feeling safe, inconvenient, and not romantic. The most significant referent (normative belief) influencing condom-use decision making was "mother" in younger subjects and "sexual partner" for older subjects. The sexual partner had unfavorable attitudes toward condom use. These results indicate the need to incorporate attitudes and normative beliefs to change condom-use behavior.

Water and electrolyte absorption by the colon in tropical sprue.

A defect in colonic absorption of electrolytes and water was demonstrated in patients with tropical sprue by perfusing the colon with normal saline containing a non-absorbable marker. Colonic water absorption correlated negatively with stool weight and was abnormal in patients with steatorrhoea. The possible mechanisms producing this defect are discussed. This defect may be related to colonocyte damage produced by unabsorbed unsaturated fatty acids in patients with steatorrhoea.

The Management of Sexually Transmitted Diseases.

Patients with sexually transmitted diseases (STDs) in developing countries are often untreated for long periods of time or receive ineffective treatment, producing complications that can lead to infertility, blindness, and even death. In addition, there is growing research evidence that people with bacterial or viral STDs are more likely to acquire--and perhaps transmit--the human immunodeficiency virus (HIV). STD control programs in developing countries must be reorganized to include: 1) good management of patients with STDs and their contacts, 2) case finding for syphilis in the antenatal population, 3) screenings and case findings for gonorrhea in high-risk groups, and 4) systematic prophylaxis for ophthalmia neonatorum in newborns. Since diagnosis before treatment is problematic in rural areas, the World Health Organization recommends simple treatment protocols based on the most common STD symptoms--urethral discharge; gynecological complaints such as vaginal discharge, low abdominal pain, or dysuria; genital ulceration; and inguinal bubo, a swelling of the lymph nodes in the groin. Other components of this approach include standardized treatment, contact tracing and treatment, health education targeted at high-risk groups, follow-up and case referral where necessary, and the collection of simple statistics on treatment efficacy and STD epidemiology. The incidence of STDs in developing countries is steadily increasing as a result of urbanization, increased numbers of young people, and delayed age at marriage. However, this situation can be combatted through application of treatment protocols, technological advances, improvements in the health care delivery system, and awareness on the part of policy makers of the seriousness of the STD problem.