Sexually Transmitted Diseases Treatment Research Articles

Health Issues in Prisons and Jails

Health Issues in Prisons and Jails

Health-Seeking Behaviors and Sexually Transmitted Diseases Among Adolescents Attending An Urban Pediatric Emergency Department

Adolescents are often seen in Emergency departments (ED) for urgent care. Rates of treatable sexually transmitted diseases (Neisseria gonorrhoeae and Chlamydia trachomatis) are highest in this age group. This study examines the prevalence of these sexually transmitted diseases (STDs) and the health seeking characteristics of adolescents presenting to an urban pediatric ED. Participants were enrolled between January 2000 and July 2004. Urine specimens (tested for the STDs) and a questionnaire data form (demographics and health seeking behaviors) were collected and scanned into a computer database, and results were merged for analysis. Prevalence rates were calculated for gonorrheal and chlamydial infections. A total of 1,621 participants were enrolled. Prevalence rates for C. trachomatis and N. gonorrhoeae were 9.8% (95% CI 8.6, 11.1) and 3.4% (95% CI 2.6,4.2), respectively. Test results did not differ significantly by race (p= 0.29). Reporting of a regular health care provider vs no regular provider did not significantly impact the likelihood of having a positive test result, 10.7% (95% CI 9.1, 12.4) vs 12.1% (95% CI 5.4, 18.8) (p=0.69). The prevalence of STDs was higher among uninsured (16.3, 95% CI 12.3, 20.3) and those participants covered by Medicaid (13.3, 95% CI 10.6, 16.1) compared to those reporting private insurance (6.0, 95% CI 4.2, 7.7). This study confirms a high prevalence of treatable STDs among adolescents in an urban ED setting and provides information on frequency of ED usage and health-seeking behaviors among adolescents.

Estimating dissemination of Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines from a survey of physicians

Periodically, the Centers for Disease Control and Prevention (CDC) produce guidelines for the treatment of sexually transmitted diseases (STDs) in the USA. To date, few evaluations of the dissemination of these guidelines exist. A paper and pencil survey was distributed via priority mail to a sample of Atlanta-area physicians, 416 (34%) of whom responded with complete data. Physicians were drawn from private practice, managed-care settings and public settings. In all, 85% of respondents treated STD, with a further 10% referring cases. Of those treating STD, 56% owned a copy of the 2002 CDC Treatment Guidelines, and 26% knew how to access them. The corresponding figures for physicians not treating STD were 25% and 30%. Of the physicians who did have copies, half had accessed the internet for their copies. Acquisition of, or the knowledge of how to acquire, the CDC STD Treatment Guidelines was widespread. The internet may be an effective and cost-saving means of disseminating the guidelines, although the continued need for print distribution should not be discounted.

Services for men at publicly funded family planning agencies, 1998-1999.

Men's reproductive health needs are receiving increased attention, but most family planning clinic clients are female, and clinics have reported barriers to serving men. A 1999 survey of publicly funded agencies that administer family planning clinics asked several questions about current policies and services and the number of men served in 1998. Data on 17 services were collected, as well as the proportion of clients who were male and agencies' barriers to serving men. The services most commonly offered to men in 1999 were condom provision and sexually transmitted disease (STD) counseling (95% of all agencies), contraceptive counseling (93%), and STD treatment (90%) and testing (89%). The proportions offering various male reproductive health services were lowest among hospital-based clinics. Eighty-seven percent of agencies served some male contraceptive or STD clients in 1998; those that did served a mean of 255 men and a median of 50. The male client caseload increased between 1995 and 1998 at 53% of agencies, and four out of five agencies were interested in serving more men in the future. The most commonly reported barriers to serving men were men's unawareness that services were available (58%) and inadequate agency funding (55%). Although most clients of publicly funded family planning agencies are women, a nonnegligible number are men. Additional efforts are needed to determine the best way to deliver reproductive health services to men.

100 Jahre Hautklinik Gießen: Von der Lupusheilstätte zum Zentrum für Dermatologie und Andrologie

For one hundred years the skin hospital at the clinical center of Giessen University has been an important institution for patients with skin diseases. The hospital has not only been an address for patients to turn to but also a place of work and training for health personnel. Its profile has been especially established, formed and developed by the chairs of dermatology. Its development was strongly influenced by the treatment of lupus and STDs (sexually transmitted diseases). This is exemplary for the development of other German dermatology clinics.

Short-Term Effect of a Cultural Adaptation of Voluntary Counseling and Testing Among Female Sex Workers In China: A Quasi-Experimental Trial

This study evaluates the efficacy of cultural adaptation of a voluntary counseling and testing (VCT) intervention, in increasing condom use and decreasing rates of sexually transmitted diseases (STDs) among a group of female sex workers (FSWs) in Guangxi, China. This intervention is modeled after the "state-of-the-science" VCT program that was developed and evaluated by the Center for Disease Control and Prevention's Project RESPECT. Four hundred FSWs were assigned to either an intervention group receiving the VCT intervention or a control group receiving standard of care STD testing and treatment. Data were collected at baseline and 6 months postintervention. Outcome measures included HIV/STD related knowledge and perceptions, condom use, and history of STDs. Five common STDs were screened and tested through clinical examination and laboratory testing to serve as biomarkers. After controlling for potential confounders and baseline differences, the VCT intervention group was significantly higher than the control group in HIV/STD related knowledge (p < .0001) and consistent condom use with clients (odds ration [OR] = 2.23; 95% confidence interval [CI] = 1.26-3.96) at 6 months follow-up. In addition, the intervention group had a significantly lower infection rate of STDs than the control group at follow-up (OR = 0.44; 95% CI = 0.24-0.80). This quasi-experimental trial provides evidence that the brief VCT intervention, through appropriate cultural adaptation, can be efficacious in increasing condom use and reducing STD infection rate among FSWs in China.

113: Empiric Treatment of STDs in the Emergency Department: Are We Treating Too Much or Not Enough?

Sexually transmitted diseases (STDs) represent a serious and ongoing public health concern. In the US, 15 million cases of STDs occur annually and include four million cases of Chlamydia trachomatis (CT) and one million cases of Neisseria gonorrhea (GC). Judicious empiric treatment is important, as follow up may be difficult, and serious potential morbidity may result from untreated GC and CT.

Empirical Observations Underestimate the Proportion of Human Immunodeficiency Virus Infections Attributable to Sexually Transmitted Diseases in the Mwanza and Rakai Sexually Transmitted Disease Treatment Trials: Simulation Results

Population attributable fractions (PAF) from observational studies may under- or overestimate the contribution of cofactor sexually transmitted disease (STD) to human immunodeficiency virus (HIV) spread. Empirical PAF estimates from the Mwanza and Rakai trials indicated the proportion of HIV infections attributable to STDs was higher in Mwanza than Rakai. Estimate the "true" proportion (PAFM) of HIV infections attributable to STDs in the Mwanza and Rakai STD trial populations and explore how the evaluated interventions prevented HIV infections. The STDSIM model was used to simulate the 2 populations at the baseline of the trials (with no STD treatment interventions) and counterfactual scenarios in which STD cofactor effects on HIV spread were removed either at the start of the trials or 2, 10, and 20 years into the HIV epidemics. Similar methods were used to quantify the contribution of the cure of each STD to overall HIV impact in each site. : In Mwanza, the highest PAFM for the effect of any single STD over the 2 years of the trial was due to chancroid (40%). The PAFM for all curable STD was 65%. In Rakai, herpes simplex virus type 2 (HSV-2) was the most important STD (PAFM = 23%); the PAFM for curable STD was 20%. In both sites, the proportion of new infections due to treatable STD decreased over time. The decrease was greater for Rakai, where a behavioral risk reduction that preceded the trial reduced STD prevalence. In both sites, the importance of HSV-2 increased later in the HIV epidemics and STD increased transmission of HIV more than acquisition of HIV. In the Mwanza trial, treatment of chancroid contributed most to preventing new HIV infections. PAFs calculated from empirical data underestimated the contribution of STD to HIV spread in the Mwanza and Rakai trial populations because STD effects on HIV transmission (as opposed to acquisition) were not captured in the observationally based studies.

Updated guidelines for treatment of STDs.

The CDC has issued a new set of sexually transmitted disease (STD) treatment guidelines that replace those issued in 2002. The updated guidelines

STD Treatment: How Can It Improve HIV Prevention in the South?

Rates of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs) are disproportionately high in the Southern United States. A high percentage of the population is black, and STD/HIV rates are particularly high among this group. Control and treatment of STDs offers promise as an HIV prevention strategy, and nowhere more than in the South. Identify those specific recommendations for control and treatment of STDs that available evidence indicates can reduce HIV transmission. Review of published literature. Community trials produced inconsistent results but still suggest that STD treatment can reduce HIV transmission in the United States. Treatment of symptomatic STDs among those with HIV-infection should reduce HIV infectivity. There is as yet only limited evidence that STD treatment can reduce HIV susceptibility, although promising studies addressing herpes simplex virus are under way. The unacceptably large racial disparities in STD rates must be addressed, symptomatic STDs among HIV-infected individuals treated, and syphilis prevention activities continued. Detection of unrecognized HIV infections among those seeking STD services should be a priority; identification of those with STDs and acute HIV infection may provide unique HIV prevention opportunities.

Street-based STD testing and treatment of homeless youth are feasible, acceptable and effective

Purpose Current Centers for Disease Control (CDC) guidelines recommend that sexually transmitted disease (STD) screening measures for high-risk populations such as homeless youth prioritize testing in out-of-clinic settings and incorporate new approaches to STD eradication, such as field-delivered testing and treatment and patient-delivered partner therapy (PDPT). Our non-medically trained research staff offered field-based STI testing, field-delivered therapy, and PDPT to homeless youth in the context of a longitudinal study. Methods A total of 218 ethnically diverse (34% female) 15–24-year-old homeless youth recruited from street sites in San Francisco completed an audio computer-administered self-interview survey and provided a first-void urine sample for testing for chlamydia (CT) and gonorrhea (GC). Youth testing positive were offered field-delivered therapy and PDPT. A random subset of 157 youth was followed prospectively, of whom 110 (70%) were interviewed and 87 (55%) retested at six months. Results At baseline, 99% of youth in the study consented to STI testing, of whom 6.9% and .9% tested positive for CT and GC, respectively. Ninety-four percent of positive youth were treated, 50% within one week. The incidence rate for CT was 6.3 per 100 person-years (95% confidence interval [CI]: 1.3–18.4) and for GC was 4.2 per 100 person-years (95% CI: .5–15.2). None of the youth treated by study staff and tested six months later (n = 6) had CT or GC on follow-up testing (95% CI: 0–131.3). Conclusions Field-delivered testing and field-delivered therapy are feasible, acceptable and effective interventions for the diagnosis and treatment of STDs in homeless youth. These measures along with PDPT may decrease rates of subsequent reinfection.

Reducing HIV-1 transmission through prevention strategies targeting HIV-1-seropositive individuals

Prevention efforts for HIV-1 have traditionally focused on those at risk for acquiring the virus. Recently, there has been growing interest in directing prevention efforts towards HIV-1-seropositive individuals, who are seeking care in increasing numbers as a result of improving access to antiretroviral therapy in resource-limited countries. Biomedical interventions aimed at reducing the spread of HIV-1 by targeting those at risk for transmitting the virus will be guided in part by an understanding of the bidirectional interactions between HIV-1 and other sexually transmitted diseases (STDs). Among those who are infected with HIV-1, STDs are common, and immunosuppression may further increase STD risk. In turn, the presence of an STD increases the concentration of HIV-1 in genital mucosal secretions. Both antiretroviral therapy and treatment of STDs can lower genital HIV-1 concentrations, suggesting that these approaches may reduce infectivity. Thus, the growing availability of HIV-1 and STD treatment in the countries most affected by the HIV-1 epidemic provides a unique and important opportunity to develop prevention strategies that target HIV-1/STD interactions at multiple levels. Further work is urgently needed to develop, test and implement comprehensive strategies for prevention in positives.

Knowledge About Sexually Transmitted Diseases in Women Among Primary Care Physicians

Little is known about sexually transmitted disease (STD) knowledge of primary care providers. The objectives of this study were to determine the knowledge about the management of STDs among primary care physicians and to identify physician characteristics associated with possession of STD knowledge. A self-administered questionnaire was mailed to a random sample of 1600 obstetrician/gynecologists, pediatricians, family physicians, and internists practicing in Pennsylvania. Information on physician and patient demographics was gathered, and we assessed knowledge and practice patterns concerning the management of STDs in young women. Physician knowledge regarding the evaluation and management of women with or at risk for STDs was associated with female gender (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.2), age < or =40 (OR: 2.3; 95% CI: 1.4-3.6), and metropolitan practice location (OR: 1.7; 95% CI: 1.1-2.6). Familiarity with the Center for Disease Control and Prevention's (CDC's) STD treatment guidelines was independently associated with STD knowledge (OR: 2.0; 95% CI: 1.2, 3.3). Physicians with good STD knowledge were more likely to report routinely screening at-risk women for Chlamydia trachomatis (OR: 3.9; 95% CI: 2.3-6.8). Inadequacies in physician knowledge may serve as a barrier to the appropriate diagnosis and treatment of STDs. Interventions to improve STD management practices should include continuing medical education and distribution of CDC's STD treatment guidelines to primary care providers.

Antiretroviral Therapy and Sexual Behavior: A Comparative Study between Antiretroviral- Naive and -Experienced Patients at an Urban HIV/AIDS Care and Research Center in Kampala, Uganda

We examined whether use of antiretroviral (ARV) therapy is associated with increased sexual risk behavior in a cross-sectional study of patients undergoing ARV therapy (ARV experienced) compared to patients not undergoing ARV therapy (ARV-naïve) attending an urban HIV clinic in Kampala, Uganda. Sexual behavior during the prior 6 months and sexually transmitted disease (STD) treatment was determined by face-to-face structured interviews. Multiple logistic regression was used to identify independent correlates of sexual activity, multiple sexual partners, inconsistent condom use, and STD treatment during the prior 6 months. Three hundred forty-seven (48%) of the 723 respondents reported a history of sexual intercourse in the 6 months prior to the interview (sexually active). Receipt of ARV therapy was not associated with a significantly higher likelihood of being sexually active (adjusted odds ratio [AOR], 2.0 95% confidence interval [CI], 0.3-9.9). Among both ARV-experienced and ARV-naïve persons who were sexually active, 35% (120) reported one or more casual sexual partners in addition to a main partner (no difference by ARV status). Consistent condom use with spouse, regular, casual, and commercial partners was reported by 57%, 65%, 85%, and 85% of the sexually active respondents, respectively. The ARV-experienced respondents were more likely to report consistent condom use with their spouses than were ARV-naïve respondents (OR 2.82 95% CI 1.74-4.6). ARV-experienced respondents were more likely than ARV-naïve respondents to have disclosed their HIV status to their spouses (OR 1.57 95% CI 1.07-2.30).The ARV-experienced group was more likely to report STD treatment in the prior 6 months (AOR 2.62 95% CI 1.8-3.83) than the ARV-naïve group. The findings suggest that in this population, use of ARV therapy was not associated with risky sexual behavior in the prior 6 months. Still, recall and social desirability biases remain important limitations in interpreting these conclusions.

Human immunodeficiency virus and other sexually transmitted diseases in Cuban women

A cross-sectional study was performed in 60 Cuban women of child-bearing age who were seropositive for human immunodeficiency virus (HIV) and 60 controls. Human papillomavirus (HPV) was identified most frequently, with oncogenic HPV serotypes 16, 33 and 58 detected in HIV-positive patients, and serotypes 11, 33 and 51 in the controls (relative risk 4.41; 95% CI 2.21-8.29). Syphilis and hepatitis B and C viruses were detected exclusively in HIV-seropositive women (p<0.05). Sexually transmitted diseases (STDs) appeared to pose a substantial health problem, especially for HIV-positive women. Clinics should consider screening and treatment for STDs as part of their HIV prevention programmes.

Sustainable development, health and STDs: A study of tribal society of Rajasthan

Sustainable development is a three-fold concept including economic sustainability, social sustainability and environmental sustainability. Sustainable development belongs to the social and cultural avenues of life, too, and health is an indispensable component in it. Human beings are at the centre of concerns for sustainable development, and they are entitled to a healthy and productive life in harmony with nature. The goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating diseases and proper management of health activities at the grassroots level. This study reveals that a good proportion of the tribal population is suffering from problems of sexually transmitted diseases (STDs). These STDs are causing severe damage to them, not only physiologically but also socially and economically. The consequences related to STDs are endless. The HIV/AIDS phenomenon has made it more dreadful. The situation is more horrible in the tribal context because of their comparative unawareness about health and related activities. Findings reveal that a complete treatment of such STDs among the tribal persons is not a regular phenomenon; hence, an untreated STD not only keeps on multiplying the symptoms and the complications within the carrier but also results in spreading the disease fast within the community. Thus, the relation between disease and health is simple-when disease sustains, health suffers. Sustainable development aims at just the opposite situation, in which health sustains and disease suffers (gets eradicated).

Risk and protective behaviours of bisexual minority women: a qualitative analysis

Public health messages urging women to seek health care services such as sexually transmitted diseases (STD) and cervical cancer screening or family planning services fail to address women who have sex with women (WSW). This negligence may have led to a false sense of security amongst WSW concerning sexual risk behaviour. Research has shown that WSW engaged in more high-risk sexual behaviours than heterosexual women. WSW has been identified as an important vector in the spread of STDs in all populations because of bisexuality. To prevent and reduce transmission of STDs amongst WSW, perceptions of risk for STD amongst WSW need to be understood so that effective interventions may be developed. To describe the relationship between sexual risk and protective behaviour and STD transmission amongst bisexual minority women with a history of STD. Life history methods were used to interview 23 African-American bisexual women with a history of STD. Various themes unfolded during analysis of the patient interviews, including bisexual women's perceptions of STD risk, the context of sexual relationships with women and STD prevention, screening, and treatment practices. The contexts of sexual relationships including multiple or concurrent partner relationships with both men and women placed these women at high risk for STD. Regardless of the type of relationship or belief it is possible to get an STD, protection was often not used. These circumstances identify an extremely high-risk population of women with need for more extensive research to identify strategies for health care interventions.

Unexpectedly high prevalence of sexually transmitted diseases in married women attending family planning clinics in Yaounde, Cameroon

The increased number of sexually transmitted diseases (STD) and HIV screening and counselling centres in major cities in sub-Saharan Africa facilitates epidemic investigations elucidating the extent method of transmission and clinical consequences of STD. The aim of the present study was to evaluate the prevalence of STD and HIV/ AIDS among women attending family planning clinics in Yaounde Cameroon and presenting with clinical signs and symptoms related to these infections. From December 1997 to December 1998 783 women of reproductive age attending the three main family planning clinics in Yaounde were prospectively enrolled. These centres offered multipurpose reproductive health services including provision of STD services as well as operating as voluntary HIV testing and counselling centres in Yaounde. Written informed consent was obtained from all women. Reasons for attendance sociodemographic and behavioural data obstetric and STD histories were elicited in a structured interview. Women underwent general genital and pelvic examination during which serum vaginal and cervical samples were collected. Clinical immunosuppression or AIDS-related symptoms were assessed using the World Health Organization Bangui clinical case definition for AIDS in Africa. A seven-day follow-up appointment was arranged for all women and appropriate treatment was provided for any treatable STD syndrome or genital pathogen diagnosed. (excerpt)

Prevention of sexually transmitted diseases

Sexually transmitted diseases (STDs) represent a serious and ongoing public health concern in the developing and developed world. In the United States between 10 million to 20 million new STD cases occur every year [1]. In 2002 this included 834555 cases of chlamydia a 6.5% increase in prevalence from 2001 [2]. Forty-five million people in the United States are infected with genital herpes and one million new cases occur every year [3]. Five million people worldwide became infected with HIV in 2003 [4] and over 281000 people in the United States are living with HIV [5]. Because most STDs are initially asymptomatic and several are incurable the best hope for decreasing the personal and social costs of these infections is prevention. A National Institute of Medicine report in 1997 recognized that “although the barriers to STD prevention are formidable STDs can be prevented” but lamented the lack of an effective national system for STD prevention [6]. It is debatable as to how much progress has been made over the last 7 years. The current Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines state “The prevention and control of STDs is based on the following five major concepts: a) education and counseling of persons at risk on ways to adopt safer sexual behavior; b) identification of asymptomatically infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services; c) effective diagnosis and treatment of infected persons; d) evaluation treatment and counseling of sex partners of persons who are infected with an STD; and e) pre-exposure vaccination of persons at risk for vaccine-preventable STDs” [7]. With the exception of diagnosis and treatment this article reviews each of these and their underlying evidence of effectiveness. (authors)

Attitudes, beliefs and practices of the Vhavenda in sexually transmitted diseases

Sexually transmitted diseases (STDs) are not foreign to African cultures. Like other nationalities, Africans also had their own diagnosis, treatment and prevention methods for these types of diseases. In addition, there are norms for sexual behaviour that are unique to each culture and that are different for women and men. Such gendered patterns of sexual behaviours may contribute to the understanding of many aspects of people\'s ways of living, including their perception of diseases such as those transmitted sexually. This article is based on a qualitative descriptive study conducted to explore the participants\' attitudes, beliefs and practices on promotive, preventive and curative measures of sexually transmitted diseases. Data were collected by means of in-depth interviews held with key informants in the communities. Key informants identified one another, which facilitated snowball. In the process, traditional healers specialising in the treatment of STDs were also identified as key informants. The findings indicated that good social behaviour such as listening to the elders and fulfilling the moral expectations of a society based on cultural values such as sexual education, initiation schools, premarital counselling, polygamy and widow inheritance are believed to be the main strategies for combating sexually transmitted diseases. It was recommended that cultural practices and beliefs that have proved to be reliable and effective be integrated into health education and that awareness be created regarding the dangers of cultural practices that are detrimental to women\'s health, especially those that put them at risk of HIV/AIDS. It was further recommended that traditional leaders, healers, civic organisations and student representative councils be engaged to provide health education on issues relating to sexually transmitted diseases as well as to recognise and address traditional practices that perpetuate women\'s vulnerability. Keywords : sexually transmitted diseases, HIV/AIDS, Indigenous knowledge, Vhavenda, cultural beliefs, traditional healers Indilinga: African Journal of Indigenous Knowledge Systems (IAJIKS) Vol. 4(1) 2005: 323-339