Treatment Of STDs Research Articles

Current characteristics of the HIV/syphilis co-infection epidemic

Syphilis, alongside with HIV infection, remains a pressing public health issue due to its widespread prevalence among high-risk groups: men who have sex with men (MSM), transgender women, and female sex workers (FSW). The MSM group shows a disproportionately high prevalence rate of HIV infection, with cases of syphilis/HIV co-infection also on the rise in this population. The increase in these co-infection cases deserves special attention. According to the literature, the rate of HIV infection among syphilis patients averages 15.7%. In addition, it varies significantly, going from 3% in the general population to 90% among MSM. Epidemiological surveillance data showed an increase in cases of HIV/syphilis co-infection in the MSM group, with the proportion of co-infection patients varying from 30 to 60% depending on the region. This syndemia can be explained by the fact that syphilis can contribute to HIV transmission and acquisition. The risk of HIV infection is 2 to 5 times higher among people with syphilis. At the same time, STDs are more and more difficult to control as the Internet and dating applications have made it easier to find potential sex partners. Given the high prevalence rate of syphilis among MSM, screening, diagnosis and treatment of STDs in this population should be a health care priority. Early detection and timely treatment of these socially significant diseases play an important role in epidemic prevention measures.

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium among Patients with Urogenital Symptoms in Istanbul

Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium are the three most commonly reported sexually transmitted bacteria. The present study aimed to investigate the presence of C. trachomatis, N. gonorrhoeae, and M. genitalium in urogenital samples collected from 18-68-year-old Turkish patients who were admitted to the hospital with various urogenital symptoms. A total of 360 patients with symptoms of STD were included in the study. Following DNA extraction by QIAamp Mini Kit, the presence of C. trachomatis, N. gonorrhoeae, and M. genitalium were investigated using multiplex real-time PCR. Causative organisms were identified in 68 (18.9%) of 360 patients. C. trachomatis, N. gonorrhoeae, and M. genitalium were detected in 40 (11.1%), 14 (3.9%), and 28 (7.8%) of the patients, respectively. Patients 21-30 years of age represented more than one-third (37.8%) of positive patients. Of all patients, dual infections of C. trachomatis-M. genitalium, N. gonorrhoeae-C. trachomatis, N. gonorrhoeae-M. genitalium, and triple infection of C. trachomatis-N. gonorrhoeae-M. genitalium were determined in 1.6% (6/360), 1.3% (5/360), 0.2% (1/360), and 0.2% (1/360) of the patients, respectively. In CT-, NG-, and MG-positive patients, different STI agents were also found such as HIV, HBV, HPV, HSV2, T. pallidum, and T. vaginalis. In conclusion, among C. trachomatis, N. gonorrhoeae, and M. genitalium, CT was the most frequently detected bacterial cause of STDs in our hospital at Istanbul. Co-infections, which comprise more than one-fifth of the cases, should not be underestimated. Regular screening and following up of STD agents using multiplex real-time PCR-based diagnostic methods enabling the immediate detection of co-infections are essential for the treatment and primary prevention of STDs.

Анализ распространенности гинекологических заболеваний в гинекологическом отделении ТОГБУЗ «Городская клиническая больница имени Архиепископа Луки г. Тамбова»

Currently, improving the life quality and the state of women's health is an importnant issue, however, somatic comorbidity in combination with various gynecological diseases often lead to a significant decrease in the life quality, possible disability and premature mortality. Gynecological health of women is closely related to the normal functioning of their reproductive function, which directly affects demographic indicators. According to the latest statistics, recently there has been a significant increase in the incidence of inflammatory diseases of the pelvic organs, infertility, various menstrual disorders, which requires their detailed study. The purpose of the study: to analyze the prevalence of gynecological diseases among patients of the daytime and round-the-clock inpatient facility of the Gynecology Department of the Archbishop Luke Tambov City Clinical Hospital in 2020. Materials and methods. We conduct a survey of 500 women in 2 age groups of 18–25 years and 26–35 years old. Results. Analyzing the data obtained, we can talk about a confident increase in pelvic inflammatory diseases, abortions complications, frequency of ectopic pregnancies and operations performed for infertility with increasing age of the studied groups. Conclusion. To prevent the development of inflammatory diseases of the pelvis, it is necessary to carry out preventive measures for the sexual education of girls, explanatory conversations about modern methods of contraception, promotion of a healthy lifestyle, prevention of abortions, medical examinations. Also important is an interdisciplinary approach to the prevention and treatment of STDs, the development and improvement of clinical recommendations, various sanitary and educational activities, lectures conducted by obstetricians and gynecologists.

An Equilibrium Model of the African HIV/AIDS Epidemic

Twelve percent of the Malawian population is HIV infected. Eighteen percent of sexual encounters are casual. A condom is used a third of the time. To analyze the Malawian epidemic, a choice‐theoretic general equilibrium search model is constructed. In the developed framework, people select between different sexual practices while knowing the inherent risk. The calibrated model is used to study several policy interventions, namely, ART, circumcision, better condoms, and the treatment of other STDs. The efficacy of public policy depends upon the induced behavioral changes and equilibrium effects. The framework complements the insights from epidemiological studies and small‐scale field experiments.

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OBJECTIVES/SPECIFIC AIMS: The prevention, management, and treatment of HIV, STDs, and HCV requires continuous training that reflects contemporary best-practice and innovative care models. In order to improve the NYS AIDS Institute’s comprehensive web-enabled training program, which enhances the capacity of a diverse healthcare workforce, a needs assessment (NA) of our community of practice (CoP) is needed to better understand their training needs, circumstances, and instructional modalities preferences. The goal of the assessment was to better understand our CoP’s preferences of online trainings, and as a result to develop a “responsive design” system that will enhance user’s learning experience thus improving patient care. METHODS/STUDY POPULATION: We developed and deployed an NA survey using REDCap. The instrument consisted in 27 questions related to providers’ preferences on receiving continuing educational training and their use of technologies, including mobile platforms, online modules, webinars, and telehealth. As part of the recruitment strategy, several resources were deployed over a 1-month recruitment period including sequential email blasts, website promotion, and assessment links included in newsletters and social media. Weekly reminders were also used to promote the participation from our CoP. RESULTS/ANTICIPATED RESULTS: A total of 310 respondents participated in the NA, with 85.8% from NYS. 177 were clinicians (20.5% MD, 2.9% PA, 17.3% NP, and 16.3% RN) and 133 nonclinical providers (case/care managers, social workers, public health professionals, coordinators/administrators, and other). The participants worked in hospitals, community health centers, substance use centers, private practices, and state/local health departments. More than 90% of respondents indicated that they preferred both live/in-person and online training, and participants most strongly indicated that they stayed up-to-date on current developments through CDC, the AIDS Institute, and conferences. More than 60% of respondents considered that receiving CE credit for the training was very important and 28% indicated they would use training materials in Spanish if offered. In terms of technology, over 80% of the respondents preferred computers, but more 50% also used mobile devices (computer at home 61.8%, computer at work 85%, tablet 29.9%, iPhone 20.9%, Android 16.6%, other device 2.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: Accessing an online CoP provided a useful opportunity to assess training needs and preferences of clinical and nonclinical providers. Most providers indicated that they were primarily likely to use a work computer to complete online training or secondarily a home computer. With a significant portion of respondents indicating use of tablets, smartphones, and other devices, online training opportunities should be developed with responsive design to assure flexibility and access. In addition to online training, participants indicated that they also strongly valued live, in-person training. Offering training with CDC and the NYS AIDS Institute branding, in Spanish, together with offering continuing education credit, were all seen as desirable training elements. Accessing this online CoP helped streamline and target training priorities and logistics.

After Rape: Mexican Women’s Help-Seeking and Access to Emergency Health Care in Public Prosecutor’s Offices

Using a mixed-methods design, this study examines the prevalence of women’s rape by someone other than an intimate partner in Mexico, women’s formal help-seeking strategies and their access to emergency healthcare in state attorney agencies. 18 out of every 10,000 Mexican women were raped during 2011. Only 8.37% of them sought help in law-enforcement agencies and less than 1% in public health services. Specialized agencies in sexual crimes tend to lack attention protocols (70%), and medical examiners (26.7%). Emergency medical care for victims is not guaranteed nor are referrals to public healthcare services for emergency contraception, treatment for STDs and pregnancy interruption.

Sexually transmitted disease clinics in the era of the affordable care act: is it time to tear down the walls?

Sexually transmitted disease clinics in the era of the affordable care act: is it time to tear down the walls?

P6.025 The Brazilian Experience in the Joint Construction of Action Plans For the Prevention, Control, Surveillance, Diagnosis and Treatment of STDs, AIDS and Viral Hepatitis Among Indigenous Populations

BackgroundWithin the Brazilian context, it is possible to say that indigenous populations are among the groups at highest risk and vulnerability to HIV, AIDS and viral hepatitis (VH). With the...

The cost-effectiveness of intervening in low and high HIV prevalence areas in South Africa

This research compared the cost-effectiveness of a set of HIV/AIDS interventions in a low HIV prevalence area (LPA) and in a high HIV prevalence area (HPA) in South Africa. The rationale for this analysis was to assess the interaction dynamics between a specific HIV/AIDS intervention and an area of implementation and the effects of these dynamics on the cost-effectiveness of such an HIV/AIDS intervention. A pair of Markov models was evaluated for each intervention; one model for a HPA and another for an LPA and the cost-effectiveness of that intervention was compared across an LPA and a HPA. The baseline costs and health outcomes in each area were collected from the literature. To depict interaction dynamics between an HIV/AIDS intervention and an area of implementation, baseline health outcomes collected in each area, were adjusted over time based on the patterns of the projections observed in the AIDS model of the Actuarial Society of South Africa (ASSA2008). The study found that the VCT and treatment of STDs were equally cost-effective in an LPA and in a HPA while PMTCT and HAART were more cost-effective in an LPA than in a HPA. As a policy proposal, resources earmarked to non-ARV based interventions (VCT and treatment of STDs) should be equally shared across an LPA and a HPA while more of the resources reserved for ARV-based interventions (PMTCT and HAART) should go in an LPA in order to increase efficiency.

130 Treatment of Gonorrhea and Chlamydia in Emergency Department Patients

Study Objective: To describe the frequency of effective antibiotic treatment both in the emergency department (ED) and at follow-up, among ED patients who test positive for Chlamydia trachomatis or Neisseria gonorrheae. Methods: A retrospective case control chart review was performed in which a random sample of 500 cases and 500 controls were selected from all patients who had a test for Neisseria gonorrheae or Chlamydia trachomatis sent from the ED of an urban, academic, level 1 trauma center from 1/1/10-6/30/11. Exclusion criteria were: age <15, victims of sexual assault, patients who eloped or left against medical advice, or repeat visits within 3 weeks of testing positive. Data abstracted from the ED medical record by trained research assistants included demographics, history and physical exam findings, ED antibiotic prescribed, successful contact by the follow-up nurse, and follow-up treatment. The CDC 2010 STD Treatment Guidelines were used to define effective antibiotic for each infection. Descriptive statistics, frequencies and logistic regression modeling using generalized estimating equations to account for repeat visits, were used for analysis. Double data abstraction on a 10% random sample was completed to calculate interrater reliability. Results: In 18 months, a total of 631 tests were positive for Chlamydia trachomatis and 213 were positive for Neisseria gonorrheae among 6997 specimens sent. Interrater reliability was excellent with a Kappa of 0.92. Among the 500 randomly selected cases, the demographics were: mean age 25, 51% female, 93% English, 73% Black, 17% Hispanic, 6% White, and 4% other. Of the 500 cases, 374 were positive for Chlamydia trachomatis only, 93 for Neisseria gonorrheae only, and 33 for both Chlamydia trachomatis and Neisseria gonorrheae. Of the 374 Chlamydia trachomatis only cases, 312 (83%) received effective treatment; 174 were treated in the ED and 138 treated on follow up. Of the 93 Neisseria gonorrheae only cases, 80 (86%) received effective treatment; 66 were treated in the ED and 14 were treated on follow up. For those who tested positive for both Chlamydia trachomatis and Neisseria gonorrheae, 30/33 (91%) were treated effectively; 25 were treated in the ED and 5 were treated on follow up. Overall 422/500 (84%) cases ultimately received effective antibiotic treatment for their STD, 265/422 (63%) in the ED and 157/422 (37%) on follow-up. Among the 235 cases who were not treated in the ED, 78 (33%) did not get effective antibiotics at our medical center at follow-up; 11(14%) reported treatment elsewhere, 18 (23%) were unable to be reached, 48 (62%) were reached but did not return to our medical center for appropriate antibiotics, and 1 had no documentation of call back. Among controls, 86/500 (17%) received presumptive antibiotic for either Neisseria gonorrheae, Chlamydia trachomatis, or both in the ED and none were called back for follow up treatment. Conclusion: In this ED that has a dedicated callback nurse, eventual treatment of STDs occurred in only 84% of patients who tested positive for Neisseria gonorrheae or Chlamydia trachomatis. Providers should consider presumptive treatment at time of initial ED visit more frequently when follow-up can not be assured, as follow up often did not lead to successful treatment in this population.

P1-S6.28 Integrated HIV, syphilis, and other STI testing in North Carolina county jails

BackgroundIn 1999 North Carolina initiated STI screening programs in seven county jails as part of the CDC Syphilis Elimination Effort (SEE). All jails were willing to permit screening programs for...

Emergency Physicians' Patterns of Treatment for Presumed Gonorrhea and Chlamydia in Women: One Center's Practice

No indicator reliably predicts if a woman has gonorrhea or chlamydia (sexually transmitted diseases [STDs]) during an Emergency Department (ED) visit. Before culture results return, emergency physicians (EPs) must choose whom to treat. We evaluated EP treatment of STDs within our institution. EPs voluntarily completed anonymous surveys while evaluating women requiring both a pelvic examination and STD cultures, except for sexual assault victims. The questionnaires asked for patients' demographics, history, physical examination, and in-ED laboratory tests, and whether any particular section of the encounter caused treatment. The treated and untreated groups' characteristics, as reported by the examining physicians, were compared. There were 145 questionnaires returned over a 6-month period; 41/145 patients (28%) were treated for presumed STD—28 (68%) based on physical examination, 8 (19.5%) on history, and 5 (12.5%) on in-ED laboratory tests. Comparison of treated vs. untreated groups revealed no difference in patient demographics. The treated group had more historical positives (3.92 vs. 2.84, respectively; p < 0.001) and physical examination findings (3.39 vs. 1.24, respectively; p < 0.001) compared to the untreated group. Eleven patients (7.58%) had positive STD cultures, 4 (9.75%) in the treated group and 7 (6.73%) in the untreated group ( p > 0.05). In our institution, EPs chose to treat patients with more historical and physical examination findings, not based on demographics. Our EPs' presumptive STD treatment paradigms do not accurately distinguish patients with positive pelvic culture results from those with negative results, supporting the available literature that describes the difficulty of this diagnosis. Individual EDs must recognize this infection identification problem and, after assessment of their treatment population, institute either a liberal presumptive STD treatment regimen for all comers, or establish reliable and timely follow-up for women left untreated.

Urine-Based Asymptomatic Urethral Gonorrhea and Chlamydia Screening and Sexual Risk-Taking Behavior in Men Who Have Sex with Men in Greater Boston

To assess the prevalence of asymptomatic urethral gonorrhea and chlamydia men who have sex with men (MSM) living in greater Boston, 206 men attending routine medical appointments consented to urine-based chlamydia and gonorrhea screening using urine LCR amplification. Of those screened, 201 patients also completed a seven-question survey to assess sexual risk behaviors associated with urethral sexually transmitted infections. Less than 1% of the asymptomatic patients screened tested positive for urethral chlamydia; none tested positive for urethral gonorrhea. Forty-eight percent reported multiple sexual partners in the 30 days prior to screening, with HIV-infected patients reporting fewer partners and less unprotected insertive anal sex than HIV-uninfected patients. Almost 25% of patients screened used the Internet in the 30 days prior to screening to find a sexual partner. Internet use was associated with increased numbers of sexual partners in the 30 days prior to screening. Findings suggest that asymptomatic urethral chlamydia and gonorrhea may be uncommon in MSM living in the greater Boston area and that the recent rise in the prevalence of sexually transmitted infections may not be due to untreated asymptomatic infections. Increased awareness of STD symptoms among patients and medical providers is critical to timely diagnosis and treatment of STDs in MSM.

Youth United Through Health Education: Building Capacity Through a Community Collaborative Intervention to Prevent HIV/STD in Adolescents Residing in a High STD Prevalent Neighborhood

The early detection and treatment of STDs is an effective strategy for slowing the sexual transmission of HIV. The goal of the YUTHE (Youth United Through Health Education) program, a collaborative effort between the San Francisco Department of Public Health (SFDPH) and the University of California, San Francisco, is to increase sexually transmitted disease screening and treatment among adolescents in a neighborhood with a high incidence of STDs in San Francisco. Youth health educators residing in the intervention neighborhood recruited sexually active youth between the ages of 12 and 22 years to participate in the YUTHE program's intervention between January 2001 and May 2002. Sixty-three percent had two or more sexual partners, 47% did not use condoms consistently, and 18% had a history of STDs. When the intervention neighborhood was contrasted with a sociodemographically matched comparison neighborhood results indicate that both females and males in the YUTHE intervention neighborhood were significantly less likely to have Chlamydia trachomatis infection than their counterparts in the comparison neighborhood.

Pharmacy clerks' prescribing practices for STD patients in Porto Alegre, Brazil: missed opportunities for improving STD control.

STDs are a significant public health problem in Brazil. A primary control strategy is the immediate treatment of symptomatic individuals. When services are unavailable, STD patients seek care in alternative settings. Probably the most frequently used settings are commercial pharmacies, where pharmacy clerks provide treatment, although Brazilian law prohibits selling antibiotics without prescription. Our objective was to evaluate prescribing practices by pharmacy clerks for STDs. We performed a cross-sectional study. Trained medical students visited 62 pharmacies in the city of Porto Alegre during March 2002. These were randomly chosen from a list of 863 registered pharmacies. The students presented to the pharmacy complaining of dysuria and urethral discharge. After obtaining a prescription, or not, they asked for additional instructions to be followed. Immediately after leaving the premises, the instructions were anonymously recorded. Of the 62 pharmacies visited, a clerk in 56 (90.3%, 95% confidence interval [CI]: 80.1%-96.4%) provided a prescription. Most frequently prescribed drugs were ampicillin with probenecide (29/51.8%) and rosoxacin (11/19.6%). Ministry of Health-recommended treatment was not suggested by any of the clerks. Forty-six additional recommendations were given. The use of condoms was the most frequent additional advice (42/46). Prescribing by pharmacy clerks is very prevalent in Porto Alegre. This may represent a lost opportunity for more comprehensive prevention effort (counselling, partner management, and diagnosing other STDs). Additionally, the most frequently prescribed drugs are not recommended by international or national health authorities for treatment of STDs, and none of these drugs covers chlamydia. We conclude that pharmacy clerks are a potentially important source of STD treatment and control but that their practices are in need of vast improvement.

Contemporary Obstetrics and Gynaecology for Developing Countries

Contemporary Obstetrics and Gynaecology for Developing Countries

To Change or Not to Change: Obstacles and Resistance to Sexual Behavioural Change among the Youth in Ghana in the Era of AIDS

Ghana has one of the highest levels of reported cases of HIV/AIDS in the West African sub-region. The majority of infected persons are in their twenties. Young people are particularly vulnerable to STD/HIV infection for a number of reasons. They are confronted with complex and interlinked bio-social, economic and political structures and community factors. Although they are aware of STD/HIV, they do not practice safe sex or do not use condom consistently. They are more reluctant than older ones to seek treatment for STDs partly because of the attitudes of the older people, the health care providers and the general society to adolescent sexuality or may not be able to afford services. The paper is based on data collected from in- and out-of-school youth at the national and regional levels on their perceptions and reactions to the epidemic. Field work was done in five out of ten regions in Ghana using both qualitative and quantitative instruments. The issues covered included their current attitudes and behaviours related to HIV/AIDS, their reaction to the need for change and their perceived constraints/barriers to behaviour change. HIV/AIDS education messages have not taken the specific concerns of the young people into consideration. Most out-of-school youth are cut off from the mainstream educational and health care facilities. Young people are receptive to AIDS-related messages when they are made part of the planning and implementation of programmes. Attempts at initiating behavioural change in the youth must take into consideration all the complex factors. The source of, and the agents for change, must be seen to be credible and the effort must be reinforced and sustained. The problem may be of barriers than just resistance/refusal of change on the part of the youth. (Institute of African Studies Research Review: 2003 19(1): 27-46)

MANAGEMENT OF SEXUAL ASSAULT

The incidence of sexual assault continues to escalate, and it is under-reported. Victim care requires special attention in the emergency department because the history and physical examination are unique and frequently time consuming. The victim should receive counseling and treatment for potential STDs, HIV, and hepatitis exposure, while stressing the importance of follow-up care. The emergency department physician must fulfill obligations not only to the patient but also to law enforcement. To be done well, documentation of findings and the completion of the evidentiary portion of the exam require a familiarity with the process.

Risk perception and HIV-1 prevalence in 15,000 adults in rural south-west Uganda.

Few studies have described levels and determinants of perceived risk of HIV-1 among African adults for whom the sero-status is known. This study describes HIV risk perception obtained from a large rural population in south-west Uganda which also underwent serological testing for HIV. Cross-sectional survey. Information on risk perception and sexual behaviour was collected by interview. Sera were obtained from all consenting adults (13 years and above) in order to assess HIV-1 prevalence. Of 14,818 adults with a definitive sero-status, 9.7% were HIV-1 positive and 51% considered themselves to be at risk of infection. Risk perception showed similar patterns as age- and sex-specific sero-prevalence and there was correspondence between risk factors for perceived risk and known HIV risk factors. Partner's sexual behaviour was the commonest reason for risk perception in women whereas men cited their own sexual behaviour. Abstinence from sex was much more commonly mentioned as a protective practice than condom use in men and women. Half of the adults we have studied already see infection with HIV as a real possibility in their lives and are aware of HIV risk behaviours. More efforts should be made to implement sustainable control measures rather than simply raising awareness. In addition to recommending abstinence, these include mutual faithfulness, condom use and better treatment for STDs.

Can audiovisual presentations be used to provide health education at primary health care facilities in South Africa?

This study assessed the feasibility and potential effectiveness of using audiovisual presentations in the waiting rooms of busy South African primary health care clinics, to educate patients about STD prevention and treatment. A 24-minute episode of South Africa's popular soap opera, Soul City was played continuously during three consecutive days in the clinic waiting areas. The storyline of the episode chosen was intended to convey key health messages regarding the prevention and treatment of STDs. The research was conducted at four primary health care clinics serving large, poor peri-urban townships in South Africa. Observations of patient behaviour were made, and a random selection of patients were interviewed on exit. A focus-group discussion was held with all of the clinic staff at each clinic site, to assess staff atti tudes towards the use of such audiovisual presentations as part of their future routine duties. The mean proportion of patients who were observed watching the video at any one time varied from 34 to 64 per cent at all four clinics. Based on exit inter views, the presentation was seen by 88.2 per cent of patients attending all four clinics, and its STD content was recognised by 91.5 per cent of those who had seen it. Over 90 per cent of patients found the presentation helpful and interesting. Clinic staff described the use of video-mediated education as a solution to the problem of inad equate health education, and there was unanimous support for it. In future, it will be important to evaluate whether such audiovisual presentations can be effective in improving patients' knowledge and attitudes, and changing their behaviour, without compromising important interactions between clinicians and patients.