Sexually Transmitted Diseases Infection Research Articles

Low HIV and high STD among commercial sex workers in a brothel in Bangladesh: scope for prevention of larger epidemic.

The present study documents the first systematic assessment of a brothel in Bangladesh in terms of sexually transmitted disease (STD) and human immunodeficiency virus (HIV). A cross sectional study was undertaken on brothel-based commercial sex workers (CSWs) selected systematic random sampling to assess the prevalence of STDs and HIV among CSWs in a brothel setting. Two hundred and ninety-six CSWs were selected from a brothel with a population of 593 women. Following informed consent, endocervical and blood samples were obtained for the diagnosis of genital chlamydia, gonorrhoea, HIV and syphilis respectively. In addition, another 170 consecutive blood samples were collected from the total CSW population for HIV tests. All blood samples for HIV testing were made anonymous by removing patient identifiers before testing. Endocervical specimens were tested by polymerase chain reaction (PCR) for the diagnosis of genital chlamydia and gonorrhoea. Syphilis and HIV infections were diagnosed by serology. One hundred and sixty-nine (57.1%) of the women were Treponema pallidum haemagglutination (TPHA)-positive, 20 (6.8%) of the women were Venereal Disease Research Laboratory (VDRL)-positive at a greater than 1:8 dilution. Eighty-two (28%) of the women were found to be infected either by gonorrhoea or chlamydia. No HIV antibody was found in any of the 466 blood samples. A high prevalence of STDs and low prevalence of HIV in the CSWs in Bangladesh suggest potential for the rapid spread of HIV once it is introduced in this high-risk population. The opportunity to control STD and HIV infection in this population should not be missed, in order to prevent a large epidemic in the future.

THE CONTEXT OF SEXUALLY TRANSMITTED DISEASE: LIFE HISTORIES OF WOMAN ABUSE

Approximately 25%-50% of women with sexually transmitted diseases (STDs), including AIDS, are involved in abusive relationships. Numerous characteristics associated with a past history of abuse are also risk factors for STD infection, including multiple partner relationships, substance abuse, early age at first coitus, and partner control of the relationship. Research has identified psychological effects of previous abuse, including depression, minimal control in relationships, and decreased self-efficacy. These effects may prevent abused women with STDs from making behavioral changes to prevent recurrence and transmission of disease. Life history methodology was used to understand the context of the interrelationships between STD and woman abuse in 30 Mexican American and African American women's lives. A focus on the context of abused women's partner relationships and aspects of personal control within these relationships may facilitate effective behavioral change, risk reduction, and subsequent decrease in incidence of STDs and woman abuse.

Chlamydial and gonococcal cervicitis in HIV-seropositive and HIV-seronegative pregnant women in Bangkok: prevalence, risk factors, and relation to perinatal HIV transmission.

To determine the prevalence and risk factors associated with cervicitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae in human immunodeficiency virus (HIV) type 1-seropositive and HIV-seronegative pregnant women in Bangkok, and the relation to perinatal HIV transmission. As part of a multicenter perinatal HIV transmission study in an antenatal population with 2% HIV seroprevalence, endocervical swabs obtained at mid-pregnancy from a consecutive sample of 222 HIV-seropositive and 219 HIV-seronegative pregnant women at two large hospitals in Bangkok were tested for the presence of C. trachomatis and N. gonorrhoeae by DNA hybridization probe (Gen-Probe). Clinical risk factors and DNA probe results were analyzed in relation to the women's and newborns' HIV infection status. The prevalence of C. trachomatis was 16.2% in HIV-seropositive pregnant women and 9.1% in HIV-seronegative pregnant women (P = 0.03). The prevalence of N. gonorrhoeae was 2.7% in HIV-seropositive pregnant women and 1.4% in HIV-seronegative pregnant women (P = 0.5). The overall population prevalence estimate was 9.2% for C. trachomatis and 1.4% for N. gonorrhoeae. Women with gonococcal infection were more likely to be positive for C. trachomatis (RR(MH) = 5.2, P < 0.01). Young age (<21 years) and primigravid status were associated with C. trachomatis infection among HIV-seropositive women; history of multiple sex partners (>1) were associated with C. trachomatis infection among HIV-seronegative women. For HIV-seropositive women, primigravida status also was associated with C. trachomatis infection. The perinatal HIV transmission rates were similar for those with and without C. trachomatis (24.1% and 23.2%, P = 0.9) and among those with and without N. gonorrhoeae (20% and 23.5%, P = 1.0). Among pregnant women in Bangkok, C. trachomatis infection was considerably more common than N. gonorrhoeae infection and was associated with HIV infection, young age and first pregnancy (HIV-seropositive women), and multiple partners (HIV-seronegative women). Our data do not suggest an association between perinatal HIV transmission and maternal C. trachomatis or N. gonorrhoeae infection identified and treated during pregnancy. The high prevalence of C. trachomatis found using a test not readily available in Thailand emphasizes the need for improved, inexpensive ways to screen for and diagnose these sexually transmitted infections in developing countries.

Men's Behavior Change Following Infection With a Sexually Transmitted Disease

An analysis of data on 20-39-year-old men participating in the 1991 National Survey of Men finds that of 466 respondents who had ever had a sexually transmitted disease (STD), 25% had sex while infected. However, 85% of these men informed their partner of their infection before having intercourse. Black men were significantly less likely than whites to have had sex while infected. Overall, 29% of men with an STD did not modify their sexual behavior or condom use. Blacks, married men and men who were affiliated with a religious group were less likely than whites, single men and those with no religious affiliation to maintain the same behavior subsequent to the diagnosis of an STD infection as before. Black men were more likely than whites to start using condoms; blacks, religious men, less-educated men and those who were older when they had their first sexual experience were the most likely to stop having sex with casual partners once they learned that they were infected with an STD.

Consistency of Condom Use Among Users of Injectable Contraceptives

Use of condoms for protection against sexually transmitted diseases (STDs) was examined over a nine-month period among 536 women from 17 clinics in southeastern Texas who had selected the injectable depot-medroxyprogesterone acetate (DMPA) as a contraceptive. Among women who were using condoms prior to receiving DMPA, nearly half said they never or rarely did so after initiating DMPA use; only 18% of all women in the study used condoms consistently while relying on DMPA. Factors associated with consistent condom use were being black (odds ratio of 2.0), being unmarried (odds ratio of 2.2), having a history of STD infection (odds ratio of 1.8), having previously used condoms (odds ratio of 2.7) and having no interest in future childbearing (odds ratio of 1.8). Our data suggest that the majority of users of injectables may not be protected from exposure to the human immunodeficiency virus and other STDs.

Increased Risk of STD Infection Among Peruvian Women Linked to Their Partners' Sexual Practices

This study using the block-randomization procedure was conducted to examine the risk among Peruvian women for sexually transmitted diseases (STDs). A total of 300 men and 300 women with a mean age 25 and 26 respectively completed a questionnaire about their social and demographic status medical history sexual behavior contraceptive history and perception of risk of sexually transmitted infection. Blood samples were drawn and tested for antibodies to Treponema pallidum (syphilis) Chlamydia trachomatis herpes simplex virus type 2 and HIV. Overall women were 3 times more likely than men to test positive for past or current infection with chlamydia genital herpes or syphilis although at any given age men were more likely than women to be sexually experienced and have had more sexual partners. It is noted that 59% of the men had had sex with a female sex worker and only 30% of them used a condom during such encounters. Among men the presence of antibodies to STDs was associated with having unprotected sex with commercial sex workers while among women such presence was associated with having had intercourse before age 18. The authors recommend that STD prevention programs stress delayed onset of sexual activity and the promotion of condom use.

Sexually transmitted disease control in the era of managed care: "magic bullet" or "shadow on the land"?

Sexually transmitted diseases (STDs) are a major public health problem. In the United States, nearly 12 million STD infections occur annually, generating estimated direct annual health care costs exceeding $12 billion. Lifetime costs may total $88 billion. Meanwhile, inflation-adjusted public funding for STD clinical care and control decreased over the past two decades. Previous STD control officials warned that declining support for STD control programs would result in program elimination and increased rates of STDs ("Brown's Law"). Effective public health and primary prevention efforts have been difficult to implement because of societal sensitivities about sexuality, and the curative rather than preventive focus of our health care system. Proven cost-effective medical interventions, such as chlamydia screening, have not been universally implemented because of health care system inefficiencies, whereby public STD clinical services generate private sector savings not reinvested into these public prevention programs. However, the dramatic growth in managed care presents opportunities, as well as risks, for better STD management.

Sexually transmitted diseases in South Africa.

To review the epidemiology of and data collection for sexually transmitted diseases (STDs) in South Africa. Literature published since 1980 on STDs in South Africa were complied and evaluated. Historical reports and salient unpublished literature were also used in the literature review. Studies were critically reviewed in the light of sample populations and study methods, and a baseline picture of the patterns of STD burden was developed. The STD burden in apparently asymptomatic study populations is significant. Ulcerative infections, primarily caused by syphilis and chancroid, are present in 5-15% of asymptomatic clinic attenders; prevalence rates of gonorrhoea average 8%, with up to 13% of gonococcal isolates resistant to penicillin antibiotics. In addition, on average, chlamydia and vaginal infections are detected in 16% and 20-49%, respectively, of antenatal and family planning clinic attenders. HIV seroprevalence rates have reached 7.6% in antenatal clinic attenders. Most South African STD data are derived from ad hoc surveys which have traditionally focused only on several major infections and particular urban centres. Almost all STD studies have been facility-based, with many studies based at STD clinics, thus reporting only relative frequencies and not population-based prevalences of STDs. With the possible exception of HIV, systematic surveillance data for STDs are conspicuously lacking. The disease burden of classic sexually transmitted infections has historically been heavy, and continues to be a serious public health problem in South Africa. Morbidity from both ulcerative and non-ulcerative infections, particularly in women, is significant. The body of STD data, although mostly sound, remains incomplete, and with the rapid emergence of HIV in South Africa, surveillance of STDs and focused STD policies will be critical.

Sexually transmitted diseases control in developing countries.

Sexually transmitted diseases (STDs) are a major public health problem now compounded by the advent of AIDS and HIV infection. The size of the problem represented by STDs and HIV is unknown however it is estimated that there are 333 million new cases of STD per annum and currently 15-20 million people infected worldwide with HIV. Control programmes for STDs must prevent the acquisition of STDs, their complications and sequelae and interrupt and reduce transmission. They can also reduce the incidence of HIV infection. Such programmes must place emphasis on health education, condom usage, altering health seeking behaviour and providing case management. The syndromic approach currently offers the most realistic, and cost effective, way in which to treat patients.

In Early 1990s, U.S. Men and Women Were Just as Likely to Initiate Risky Behavior as to Halt it

National AIDS Behavioral Survey data indicate that heterosexual men and women seem to have done little between 1991 and 1992 to reduce their risk of contracting AIDS and other sexually transmitted diseases (STD). The National AIDS Behavioral Surveys consisted of two surveys each conducted in two waves. The baseline survey was conducted from June 1990 to February 1991 with follow-up interviews conducted one year later from January to August 1992. Among respondents aged 18-49 1553 men and women were interviewed at baseline and 1062 of them could be reinterviewed. The majority sampled were not at risk of HIV or STD infection either at wave one or wave two. Both nationally and in cities where the risk of AIDS is believed to be high 6-8% of respondents aged 18-49 reported that they had discontinued risky behavior between the 1991 baseline and the 1992 follow-up surveys. Over the same period 7-11% of those who had not engaged in risky behavior previously began to do so.

STD Treatment Program Lowers Risk of HIV Infection in Tanzania

From November 1991 through December 1994 six communities in the Mwanza region of Tanzania participated in a program designed to improve the local treatment of sexually transmitted disease (STD). The program involved improving the management of STD cases at rural health visits through training health center staff providing a regular supply of drugs with which to treat STDs conducting periodic supervision visits and holding community health education sessions on seeking treatment for STDs. The intervention communities were matched with six control communities. A total of 12537 men and women aged 15-54 from all 12 communities were surveyed at baseline and 8825 were seen at follow-up two years later. At baseline the rates of HIV prevalence in the intervention and comparison communities were 3.8% and 4.4% respectively. 11362 cases of STD were treated in local health clinics participating in the program during the two years of follow-up. The intervention seems to have reduced the risk of STD infection as well as the risk of HIV infection. At the two-year follow-up HIV infection rates were found to be 42% lower in the intervention communities than in the control communities with the impact of the intervention particularly pronounced among women aged 15-24 years and men aged 25-34. Since there appears to have been no change in sex behavior over the period the one may conclude that the STD intervention which shortened the duration of infection most likely lowered the incidence of HIV.

Chlamydia infection in street youth: Need for more aggressive screening programs.

To determine, first, the sexual practices among street youth in the Ottawa-Carleton, Ontario region; second, the percentage of street youth who report previous sexually transmitted disease (STD) screening; and third, the rate of previous infection with Chlamydia trachomatis in this population. This prospective street youth pilot study was cross-sectional in design. Street youth aged 15 to 20 years were recruited through a drop-in centre or shelter in Ottawa, Ontario between August and October 1993. Information on demographics, substance use, current sexual practices and STD screening and infection history were obtained through a structured face to face interview and a 75-item questionnaire. Past C trachomatis infection was determined by microimmunofluorescence assay with purified antigens of C trachomatis (serovars A to K), Chlamydia psittaci (avian strain 6BC) and Chlamydia pneumoniae (TW-183 strain). Ninety-eight per cent of the youth approached participated. Of the 100 street youth (61 males, mean age 17.8 years; 39 females, mean age 17.1 years), 94% were sexually active, with 21% of males and 26% of females having had four or more different sexual partners in the previous year. Only 27% of males and 8% of females reported consistent condom use with all partners all of the time. Thirty per cent of males and 50% of females reported previous STD testing. Of the 100 street youth, 22 (16 males and six females) had had previous C trachomatis infection by serotesting, but only three of 16 (19%) of these males and three of six (50%) of these females reported previous STD testing. None of the 22 recalled previous diagnosis or treatment for any STD. These street youth reported a high prevalence of risky sexual behaviour, and this supports the national STD guidelines for targeted screening in this population. The current screening guidelines for C trachomatis in this population do not reach the majority of street youth.

Prevalence of Trichomonas vaginalis in a male sexually transmitted disease clinic population by interview, wet mount microscopy, and the InPouch TV test.

To determine the prevalence of trichomoniasis in male patients from their urine at a Sexually Transmitted Disease (STD) Clinic using the InPouch TV culture system. Two hundred and four patients were examined for STD infections. Their ages ranged between 17 and 72 years. Depending on their clinical symptoms tests were ordered for Neisseria gonorrhoeae, chlamydia, and for syphilis. Each patient submitted a clean catch urine specimen for trichomonas testing. A 15 ml aliquot of urine was centrifuged and a drop of the sediment examined microscopically. The remainder was cultured in the InPouch TV test. Each pouch was examined at 24 h, 48 h, and 5 days. Twenty-four of the 204 patients (12%) were culture positive for Trichomonas vaginalis and only three of these were wet mount positive. The InPouch TV test demonstrated an epidemiological important infected male population that was not indicated by wet mount microscopy.

Bacterial vaginosis and HIV seroprevalence among female commercial sex workers in Chiang Mai, Thailand

To investigate the relationship between HIV seropositivity and bacterial vaginosis (BV) in a population at high risk for sexual acquisition of HIV. A cross-sectional study was conducted among 144 female commercial sex workers in Chiang Mai, Thailand. The participants were tested for cervical gonorrhea and Chlamydia infection, syphilis, Trichomonas vaginitis, Candida vaginitis, BV, and HIV infection. BV was diagnosed by clinical criteria (pH > 4.5, positive amine test, and presence of clue cells) and using Gram stains. Thirty-three per cent of participants had BV, and 43% were HIV-positive. Using clinical criteria, the association of BV and HIV seropositivity was significant [odds ratio (OR), 2.7; 95% confidence interval (CI), 1.3-5.0]. Although the association between BV and HIV prevalence was not significant using Gram stains alone for diagnosis of BV, an association was found between abnormal vaginal flora and HIV (OR, 2.1; 95% CI, 1.0-4.8). In multiple logistic regression analysis, adjusting for age, number of sexual encounters per week, current condom use, and currently having a sexually transmitted disease (STD), both BV and a history of an STD were independently associated with HIV seropositivity (adjusted OR for BV, 4.0 and 95% CI, 1.7-9.4; adjusted OR for history of an STD, 6.9 and 95% CI, 2.1-22.9). When diagnosed clinically, BV is independently associated with HIV seroprevalence. HIV infection may promote abnormal vaginal flora, or BV may increase susceptibility to sexual transmission of HIV. Alternatively, the association seen here may result from intervening variables; in this case BV may be a marker or a cofactor of HIV transmission.

The HIV/AIDS epidemic in Jamaica

To describe the HIV/AIDS epidemic in Jamaica. Data from the national surveillance system for HIV infection and AIDS based in the Epidemiology Unit, Ministry of Health, were reviewed. These include case reports; HIV screening of blood donors, migrant farmworkers and US visa applicants; sentinel surveillance among antenatal clinic (ANC) attenders and sexually transmitted disease (STD) clinic attenders; and various serosurveys. A total of 669 AIDS cases were reported in Jamaica from December 1993 representing a cumulative AIDS case rate of 28 per 100,000 population. Since 1987 the annual AIDS case rate doubled every 2 years with 69% of individuals having died with AIDS. Heterosexual transmission predominates with the cumulative adult AIDS male-to-female case ratio declining from 2.8:1 in 1988 to 1.9:1 in 1993. A total of 55 children with AIDS account for 8.2% of all cases. The HIV infection rate per 1000 in 1993 was 3.8 among blood donors, 1.4 among ANC attenders and significantly higher among STD clinic attenders (men 6%, women 2.7%), homosexuals (9.6%), female prostitutes (12%) and individuals with repeat STD infections (10%). Consistent condom use increased from 27% in 1989 to 47% in 1993. HIV infection was introduced into Jamaica from abroad through several different routes including the Jamaican homosexual community, migrant farmworkers, female prostitutes, and informal commercial importers. HIV transmission is well established locally and is spreading more rapidly in Western Jamaica and along the North Coast, which may reflect increased sexual activity associated with tourism. Although awareness of AIDS and HIV is high and condom use has increased considerably, there are no grounds for complacency concerning the HIV/AIDS epidemic in Jamaica.

Traditional vaginal agents: use and association with HIV infection in Malawian women

To assess the prevalence of traditional vaginal agent use in Malawian women and its association with HIV infection. Consenting, consecutive antenatal women were administered a questionnaire and screened for sexually transmitted diseases (STD) including HIV. Of the 6603 consenting women, 886 (13%) reported using intravaginal agents for tightening and 2222 (34%) for self-treatment of vaginal discharge and itching. A higher proportion of HIV-infected than uninfected women (17% versus 14%) reported use of intravaginal agents for treatment (odds ratio, 1.29; 95% confidence interval, 1.05-1.57), but no difference in HIV status was found when these agents were used for tightening. In multivariate analysis, vaginal agent use for treatment was independently associated with HIV seropositivity. The association of HIV infection with vaginal agents for self-treatment, but not for tightening, suggests that STD may play a role or that vaginal agents are used differently for the two purposes. In addition to a small increased risk of HIV infection associated with vaginal agent use, these agents may interfere with condom effectiveness or acceptability of vaginal microbicides.

Sex, Alcohol and Sexually Transmitted Diseases: A National Survey

The analysis of a representative national survey of households provides strong evidence that alcohol overshadows illicit drug use as a risk factor for sexually transmitted diseases (STDs). Men and women who report a history of STDs are significantly more likely to have a history of problem drinking, independent of high-risk sexual activities and demographic characteristics. However, a high rate of change in sexual partners over the past five years also increases the chance of STD infection. Sexual orientation is a major STD risk factor among men but not among women. Although both black men and black women are at greater risk of STDs than are those in other racial or ethnic groups, results indicate that black women's greater likelihood of having sex with men who have multiple partners, rather than their own rates of partner change, makes the crucial difference between their risk and that of white women.

Contraceptives of the future in the light of HIV infection.

The AIDS and sexually transmissible disease pandemics have helped to focus the world's attention on the need for good protection against transmission of infections during sexual intercourse. Most of the highly effective modern contraceptives provide only limited protection against STD transmission, although recent progress with the development of loose-fitting plastic male condoms and new spermicides gives some hope. Urgent attention must continue to be given to contraceptives with STD protective qualities which are under the woman's control. Refinements of the female condom and vaginal sponges with new spermicides and microbicides may be a step in this direction.

Sexually transmitted disease infection in HIV carriers

Heterosexual transmission of the human immunodeficiency virus (HIV) appears to occur readily all over the world. Recent reports have suggested an association between HIV and sexually transmitted disease (STD). We conducted a case study among foreign female prostitutes who were seropositive to HIV to determine the prevalence of STD. In this study, we checked the prevalence of STD infection in 19 HIV seropositive female prostitutes. Overall, 84 percent were seropositive for Chlamydia trachomatis, 37% for HBs, 32% for Treponema pallidum (Tp) and 6% for hepatitis C virus (HCV). The high frequency of a history of STD may be associated with an increased risk of HIV infection acquired through heterosexual contact. Prevention of heterosexually transmitted HIV infection will require an extensive educational program aimed specifically at the risk associated with the number and selection of sexual partners and at promoting safer sexual practices.

Use of the Cognitive Assessment Method to Evaluate the Adequacy of Sexually Transmitted Disease History Questions

Cognitive assessment is an approach used to evaluate questions in survey interviews. This approach is useful in delineating measurement error due to participants' understanding of terms and interpretation of questions. The purpose of this study was to evaluate the quality of questionnaire items designed to evaluate history of sexually transmitted diseases (STDs) using a cognitive assessment approach. Participants recruited from an STD clinic were asked up to six questions to assess their history of STDs. Verbal probes were used after each question in an attempt to evaluate the participants' understanding of the questions and methods they used to recall episodes of having STDs. The findings revealed that respondents did not understand the medical terms for some STDs, that the wording of one question potentially interfered with respondents' comprehension of the question, and that respondents used an episodic recall method to determine their number of previous STD infections. Cognitive assessment is a useful method for identifying potential sources of respondent-induced measurement error.