Attending STD Clinics Research Articles

Seroepidemiological study of herpes simplex virus types 1 and 2 in Brazil, Estonia, India, Morocco, and Sri Lanka

Background: The association between herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus (HIV) and the development of HSV vaccines have increased interest in the study of HSV epidemiology....

Use of psychometric techniques in the analysis of epidemiologic data.

This article demonstrates techniques for developing reliable multi-item scales for analysis of complex public health data. Information from a questionnaire designed to evaluate the acceptability and efficacy of the female condom as a method for STD/HIV prevention was summarized using psychometric analysis. 1159 high-risk women attending STD clinics participated in this study. Questionnaire items were designed to measure nine domains of predictors of condom use. Principal components analysis was employed to reduce the number of potential predictors. Reliability of the multiple-item scales was assessed using Cronbach's alpha. Pearson's correlation coefficients were calculated to evaluate collinearity among multi-item scales. Approximately half (51%) of the questionnaire items that were analyzed were retained in the final scales. Data reduction procedures identified several multi-item scales with acceptable reliability (Cronbach's alpha >0.70). The correlation coefficients between scales was never >.5, suggesting that there was little collinearity among the scales. When focused on multiple partially interdependent determinants of an outcome, data reduction decreases the number of independent variables to be evaluated, ensures they have adequate reliability, maximizes strength of their association with outcomes, and reduces collinearity among predictors.

Gonorrhoea reinfection in heterosexual STD clinic attendees: longitudinal analysis of risks for first reinfection

Objectives: Gonorrhoea is associated with adverse reproductive health outcomes, including pelvic inflammatory disease and increased HIV transmission. Our objective was to determine the association of demographic factors, sexual risk behaviours,...

Genital herpes serotesting: a study of the epidemiology and patients’ knowledge and attitude among STD clinic attenders in Coventry, UK

Objectives: To examine the seroprevalence and correlates of antibodies to herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2), and to assess patients’ knowledge and attitude towards genital herpes...

#86 Changes in hiv prevalence among emnt who have sex with men (Msm) Who attend public sexually transmitted disease clinics in the western region of the us (1989–1999)

Abstract PURPOSE: To compare the distribution and trends in HIV infection among MSM STD clinic attendees in four Western urban counties. METHODS: As part of CDC's national HIV seroprevalence surveys, unlinked HIV testing was performed on sera routinely collected for syphilis screening between 1989 and 1999 from public STD clinics in Denver, Los Angeles, San Francisco, and Seattle. HIV test results were linked to demographic and risk information abstracted from clinic records. RESULTS: Greater than 70% of MSM attendees were between the ages of 20 and 39. The majority in 3 of 4 counties was white. HIV prevalence over the study period ranged from 13% in Seattle to 30% in San Francisco. In all counties, prevalence was highest among blacks, lowest among Asian/Pacific Islanders, and similar between whites and Hispanics. The 30–39 year-old age group was most likely to be infected. After adjustment for age, race, and injection drug use, mean annual declines in HIV prevalence from 1989 to 1999 ranged from 2.1% (95% CL 1.6, 2.6) in Seattle to 2.8% (95% CL 2.6, 3.1) in San Francisco. All counties except San Francisco saw larger adjusted declines among whites and Hispanics than among blacks. CONCLUSION: Despite variations in the severity of the HIV epidemic across the Western region counties, relative differences in prevalence by race and age were similar. Moreover, all four counties saw temporal declines in HIV prevalence. Trends in HIV prevalence among the MSM STD clinic attendees may not, however, reflect population trends in HIV incidence or prevalence. This may be due to more HIV-positive MSM becoming aware of their status and seeking STD treatment in other settings, thus biasing downward the HIV prevalence observed in public STD clinics, compared with prevalence in the general population.

Prevalence and incidence of hepatitis B virus infection in STD clinic attendees in Pune, India

Objectives: To estimate the prevalence and incidence of hepatitis B virus (HBV) infection among patients attending three STD clinics in Pune, India, and to identify associated risk factors. Methods: Of...

Routine HIV screening of sexually transmitted disease clinic attenders has favourable cost-effectiveness ratio in low HIV prevalence settings.

HIV screening for attenders of clinics for sexually transmitted disease (STD) may identify individuals with high-risk sexual behaviour and avert HIV infections in partners. Extending our previous analysis in AIDS, we performed an economic evaluation of HIV screening of STD-clinic attenders in Rotterdam, the Netherlands. The results, at euro 2987 per life-year gained, display a favourable economic profile. Routine HIV screening in STD clinics should be considered as a highly cost-effective prevention measure even in countries with a low HIV prevalence.

Determinants of gonorrhoea infection among STD clinic attenders in Trinidad-II: Sexual behavioural factors

Sexual behavioural factors associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI) were determined by univariate and stepwise multiple logistic regression analysis. Casual sex (odds ratios [OR] 1.6) was the only predictor of gonorrhoea. Among males, significant associations were identified by univariate analysis between concurrent partnerships, > or =one sexual partner(s) in the past 6 months, and drug use prior to engaging in casual and/or oral sex. No significant associations were identified between gonorrhoea and sexual behaviour factors among females. This study is the first to describe sexual behaviours associated with gonococcal infection in Trinidad and to evaluate risk behaviours by gender.

Low HBV vaccine uptake in patients attending STD clinics

Low HBV vaccine uptake in patients attending STD clinics

The determinants of health care seeking behaviour of adolescents attending STD clinics in South Africa

The study investigated the determinants of delay behaviour in health care seeking in a sample of 292 adolescent patients (20 years and younger) with STD symptoms. Fifty six percent (56%) of the adolescents sought health care within the first 6 days of noticing symptoms, 23% waited between 7 to 10 days and 21% waited longer than 10 days before seeking health care. Early health care seeking was determined by perceived seriousness of STDs, an absence of self treatment prior to seeking care and positive attitudes regarding personal autonomy in condom use behaviour. Facilitation of early health care seeking remain critical in curbing the threat of AIDS among the South African youth.

Misconceptions about STD-protective behavior

Context: Misconceptions about STD-protective behaviors have not been studied before and after STD counseling. Further, to the best of our knowledge, the relationship of these misconceptions to condom use and STD incidence has not previously been described in published reports. Objectives: The main purpose of the study was to determine the prevalence of misconceptions about STD prevention among STD clinic attendees ( N=3498) in five large cities, as well as whether misconceptions decreased after STD diagnosis, STD counseling, or both. The study also identified predictors of persistent misconceptions and determined the relationship of STD incidence and unprotected sex to persistent misconceptions. Methods: Data from a randomized controlled trial evaluating HIV/STD counseling interventions (Project RESPECT) were used for the present analyses. Participants completed an interview upon study enrollment and every 3 months following enrollment for a 1-year period. A portion of the interview assessed participants’ misconceptions about STD-protective behaviors. Results: At baseline, 16.3% believed that washing the genitals after sex protected from STDs. Likewise, urinating after sex (38.7%), douching (45.7%), and use of oral contraceptives (19.9%) were believed to prevent STDs. Prevalence of misconceptions was significantly diminished at a 3-month follow-up ( p<.001). Those continuing to have misconceptions were more likely to be aged ≥24 and African American. Those continuing to have these misconceptions did not have higher STD incidence. Conclusions: Misconceptions about STD-protective behaviors are common, and the event of an STD or STD counseling or both generally reduces these misconceptions. Although these misconceptions may not directly translate into risky behavior, they may preclude movement toward safer sex.

Determinants of condom-use behaviour among STD clinic attenders in South Africa.

This cross-sectional study analyses determinants of condom-use behaviour among patients attending dedicated STD clinics in South Africa. A structured interviewer-administered survey was conducted among 1473 patients. Patients' beliefs and attitudes towards condom use in general, as well as their personal condom-use behaviour were measured. Their perceptions, regarding the social influence of their partners and friends on their condom use, and of their self-efficacy in using condoms, while infected with an STD were also measured. Condom use, as a dependent variable, was examined and patients were placed in a pre-contemplation stage if they had never used a condom, contemplation if they had seriously thought of using a condom, some action stage if they sometimes used a condom and regular action stage if they used a condom every time. The relationships between the stages of change, as dependent variables, and the independent variables were investigated for both those patients with steady partners and those with outside partners. This was performed by stepwise multiple regression analyses. The variables that significantly explained stages of change were similar for patients with steady partners and those with outside partners. In both partner groups communication was the variable most strongly associated with the use of condoms. General self-efficacy in condom use, self-efficacy in condom use with a partner and attitudes towards the use of condoms played a role in determining patients' different stages of change.

HIV/STD: the women to blame? Knowledge and attitudes among STD clinic attendees in the second decade of HIV/AIDS

We aimed to determine the knowledge and attitudes towards HIV/STDs among women attending an STD clinic by interviewing 520 randomly selected women. Nearly all had heard of HIV/AIDS/STDs, with posters, pamphlets and the radio being the main source of their information. The years of schooling was the only predictive factor of knowing a preventive measure of HIV. Two-thirds thought they were at risk of contracting HIV from their regular partner. Knowledge of the sexual habits of their male partners was low with 260 (50%) of the women distrusting their partner. Only 52 (10%) of respondents admitted to sex in exchange for gifts or money. In the event of a positive HIV test result, the perceived partner response would be to blame the woman for introducing the infection into the relationship. After a positive HIV test result, only 3.5% would resort to using condoms while another 3.7% would try to pass on the disease to other people. The quality of their knowledge of the transmission of HIV was low in spite of the fact that most respondents have heard of HIV/AIDS/STDs. Violence against women was expected in relation to a positive test result. There is a need for better educative effort on the modes of transmission and prevention of HIV, also in 'low risk' populations.

HIV/STD: the women to blame? Knowledge and attitudes among STD clinic attendees in the second decade of HIV/AIDS

HIV/STD: the women to blame? Knowledge and attitudes among STD clinic attendees in the second decade of HIV/AIDS

Current estimates of and future projections for adult deaths attributed to HIV infection in Zimbabwe.

Estimates of HIV prevalence in 1995 among all adults in Zimbabwe range between about 18% and 24%. The objective of this study was to estimate, for Zimbabwe, the impact of HIV infection on adult mortality, by age and gender, between 1995 and the year 2000. For this analysis, we used 1992 census data to estimate the number of non-HIV-related deaths, and a short-term projection model to estimate the number of deaths attributed to HIV infection in 1995 and the year 2000. It was estimated that between 52% and 60% of all adult deaths in 1995 were attributed to HIV infection, and between 69% and 76% in both males and females in the group between 20 and 39 years of age. The estimated adult mortality rate per 1000 increased from 9.8 in 1987 (based on census data) to between 20.6 and 24.3 in 1995. For the year 2000, it was projected that between 66% and 73% of all adult deaths would be attributed to HIV infection, and between 81% and 86% in those aged 20 to 39 years. The estimated adult mortality rate in the year 2000 increased to between 29.1/1000 and 36.6/1000. Even if all transmission was assumed to cease after 1995, it was projected that >60% of adult deaths would be attributed to HIV in the year 2000. Adult population growth is projected to decrease to between 0.3% and 1.0% in the year 2000. Results suggest that the impact of HIV infection on mortality in Zimbabwe is already severe and will continue to increase. Efforts to reduce numbers of new HIV infections today will serve to reduce the future burden of mortality, particularly in the longer term.

Urinary Symptoms, Sexual Intercourse and Significant Bacteriuria in Male Patients Attending STD Clinics

OBJECTIVE: To assess the relationship between sexual behaviour, urinary symptoms, urinalysis and bacteriuria in men attending STD clinics. DESIGN: A prospective study recording sexual behaviour, urinary symptoms and collecting mid-stream urine specimens. SETTING: Two West Midlands STD clinics, UK. SUBJECTS: 1086 new male patients. RESULTS: 704 patients had had sexual intercourse (SI) within 14 days of testing, 424 had urinary symptoms and 122 had pyuria. All 13 patients with positive culture had SI < 14 days before testing, urinary symptoms and pyuria. No association was found between sexual orientation, type of SI, number of sexual partners, condom usage and bacteriuria. CONCLUSION: Bacteriuria does not behave as an STD but SI may be a factor in acquiring bacteriuria. Dysuria with or without urethral discharge is the most predictive symptom of bacteriuria. Pyuria has a high sensitivity for predicting bacteriuria among males.

Urinary Symptoms, Sexual Intercourse and Significant Bacteriuria in Male Patients Attending STD Clinics

Urinary Symptoms, Sexual Intercourse and Significant Bacteriuria in Male Patients Attending STD Clinics

Changes in sexual behaviour focusing on condom use in STD clinic attenders in Göteborg, Sweden, from 1989 to 1994--a questionnaire survey.

During the 4 years from 1989/1990 to 1994 an increase in the use of condoms was registered. A high frequency of condom failures was reported and probably reflects inappropriate use. More efforts should be made to educate people how to use the condom. The impact of alcohol intake as a risk factor for unsafe sex seems to be significant and should also be stressed in educational safer sex programmes. STD patients are a well-motivated group for information about safer sex and condom use. Health workers in STD clinics have an important task in this context.

HERPES SIMPLEX VIRUS–2 INFECTION: An Emerging Disease?

Genital herpes infections continue to increase in the world. As outlined previously, several factors play a role in the continued transmission of genital herpes worldwide. Reducing the medical consequences of HSV-2 infection will not be easy. It is also sobering to realize that widespread penetration of HSV-2 into the population had preceded the spread of sexually acquired HIV in most countries. The biological rationale for a connection between HIV and HSV continues to be strengthened. Currently, a specific program to decrease the transmission of genital herpes does not exist. Recent studies with antiviral agents indicate the potential of these compounds to reduce shedding in HIV-negative and in HIV-positive persons and potentially may be useful in preventing some aspects of HSV transmission. Advances in laboratory techniques to assist in the diagnosis of genital herpes infections have added to our knowledge of the natural history and epidemiology of infection. Because of imperfect laboratory tests, negative results do not always indicate lack of infection; this has important public health implications. Large numbers of unrecognized symptomatic cases and frequent asymptomatic shedding are the likely source of continued genital HSV-2 transmission. Solutions for reducing the transmission of genital herpes range from simple, such as counseling patients regarding symptoms and signs of genital herpes and the frequency of subclinical shedding, to complex and expensive, such as screening high risk populations (e.g., STD clinic attendees) for HSV-2 infection. Chronic antiviral therapy may be indicated in HSV-2 seropositive persons without monogamous relationships as they are at risk to transmit HSV to multiple persons. The authors' aim in this review is to provoke discussion of such a control program and to raise the consciousness of the feasibility of instituting control measures for selected populations. We hope to elicit pilot programs designed to reduce the morbidity of this old but re-emerging infectious disease.

Mycoplasma genitalium infection and host antibody immune response in patients infected by HIV, patients attending STD clinics and in healthy blood donors

Prevalence of Mycoplasma genitalium in humans is still not clear. We have developed a sensitive and specific serological assay for M. genitalium using lipid-associated membrane proteins (LAMPs) as antigens. Antibodies to LAMPs from M. genitalium showed little cross-reactivity to LAMPs from antigenically similar M. pneumoniae. For validity testing, urines from 104 patients were tested by PCR for M. genitalium. All 15 PCR + patients had M. genitalium-LAMPs antibodies. Moreover, none of 64 antibody-negative patients were PCR +. Serological study of 1800 patients of various diseased groups and healthy blood donors showed M. genitalium was primarily a sexually transmitted microbe that infected patients with AIDS (44.0%), intravenous drugs users with or without HIV infection (42.5%), and also HIV − patients attending STD clinics (42.6%). Only 5.5% HIV − healthy blood donors and 1.3% HIV + hemophiliacs tested positive. M. genitalium has been associated with acute non-gonococcal urethritis in male patients. However, many sexually active men and women appear to be chronically infected or colonized by the microbe without apparent clinical symptoms and may continue to transmit the organism through sexual contacts.