Biomedical subjects
Publications and source records attributed to A M Worm.
We have prospectively determined the frequency of asymptomatic sexually transmitted diseases (STD) among patients seeking an HIV-test. In 246 patients, we observed 32 cases (13%) of asymptomatic STD, predominantly infections caused by Chlamydia trachomatis or human Papillomavirus. STD screening is of significance among patients seeking an HIV-test.
Consecutive female patients attending the Copenhagen Venereal Disease Clinic were interviewed about sexual behaviour in 1984 (981 women) and in 1988 (684 women). Details of symptoms, age at coitarche, number of sexual partners, contraceptive methods, and obstetric history were recorded together with the results of the venereological examination. A substantially higher proportion of women used condoms in 1988 (51%) than in 1984 (11%), but otherwise the safe sex campaigns had had a limited effect on the sexual behaviour in this group of women until 1988. The prevalence of gonorrhea decreased significantly (from 22% to 6%, p < 0.01), whereas an increase in the prevalence of genital warts was observed (from 4% to 10%, p < 0.01).
The results of contact tracing in two male and one female HIV antibody positive index cases are described. Altogether 19 sexual partners were reported, of whom 13 were traced. In one case previously unknown HIV infection was diagnosed. Contact tracing for HIV infection in Denmark depends solely upon the cooperation of the index case and upon the willingness of notified partners to appear for counselling and testing. The efficacy of partner notification for HIV infection in Denmark based on the current strategy should be further evaluated.
BACKGROUND: Male urethritis may be caused by mycoplasmas. Since Mycoplasma genitalium has previously been isolated from the urethra of two men with non-gonococcal urethritis (NGU), it was the aim of the study further to elucidate its role by measuring the prevalence of this organism in men with NGU. MATERIAL AND METHODS: The polymerase chain reaction was used. Two different sequences of the gene coding for the main adhesin MgPa were amplified. Urethral, rectal, and throat samples from 99 male sexually transmitted disease (STD) patients with and without urethritis were studied. RESULTS: M genitalium DNA was demonstrated in 17/99 (17%) of the urethral swabs, but in none of the rectal and throat swabs. Significantly more patients with urethritis (13/52) were positive for M genitalium DNA than were patients without urethritis (4/47) (p < 0.03). In those with urethritis M genitalium DNA was found more often in Chlamydia trachomatis negative NGU (12/34) than in those with chlamydial NGU (1/14) (p = 0.05). Attempts to culture M genitalium from the PCR positive specimens were unsuccessful. CONCLUSION: M genitalium DNA was found significantly more often in male STD patients with non-chlamydial NGU than in men with chlamydial urethritis (p = 0.05) and in men without urethritis (p = 0.003), suggesting that M genitalium may be a cause of NGU. M genitalium DNA was not demonstrated in any of the throat or rectal swabsindicating that the urogenital tract is probably the primary site of infection or colonisation of this species.
Markers of hepatitis B virus (HBV) infection were measured in 465 non-drug-abusing heterosexually transmitted disease (STD) patients. HBV markers were found in altogether 70 persons, of whom 7 were HBsAg carriers. Those chronically infected were all born in HBV intermediate/high endemic areas. Gonorrhoea was the only STD that was correlated to an increased risk of HBV markers. Number of sexual partners, sex and age was not correlated with HBV infection, irrespective of country of origin. The risk of having HBV markers in an STD clientele in Copenhagen was highly dependent on the country of birth, as the prevalences were 7% (21/307) in persons born in Denmark, 19% (9/47) in those born in other low endemic areas and 36% (40/111) in those born in intermediate/high endemic areas. Falling incidence of gonorrhoea and other STD may render it difficult to point out risk factors indicative of HBV immunization in heterosexual STD patients. In low-risk countries, screening for HBV markers should however be offered to all immigrants and refugees as a part of an HBV immunization program.
During the years 1984 to 1990, 1,029 intravenous drug users (IVDU), equalling approximately one-third of the estimated total IVDU population in the study area, attended the outpatient venereal disease clinic of Copenhagen for an HIV antibody test. Neglecting samples on HIV-positive persons after the first positive test, 665 IVDU were only tested once, whereas 364 IVDU had 613 tests performed after their first HIV antibody negative result. HIV prevalences calculated for each year showed that the prevalence of 20% in 1985 was significantly higher than those of the following years, varying between 9% and 12% without any statistical differences between these years or evidence of an increase or a decrease. HIV incidence was calculated from the results of the 364 IVDU with an initially negative HIV test, from whom 613 subsequent test results were available and of which 20 showed HIV antibodies. The total risk period was 837 years, and the overall incidence 2.4 per 100 person years without any difference between male and female IVDU, but with a tendency of a decreasing incidence with increasing age. The incidence rates per 100 person years were 2.82 in 1984-1987 and 2.38 in 1988-1990, which is not significantly different. A seroconversion rate of 2.42 (1.51-3.65) per 100 IVDU per year was calculated. With an estimated IVDU population of 3,000 persons in Copenhagen, the yearly number of new HIV infected IVDU can then be estimated to 72 persons (45-110), a figure that is 100% higher than that known from the anonymous national HIV reporting system.(ABSTRACT TRUNCATED AT 250 WORDS)
The object of this investigation was to evaluate the suitability of unlinked anonymous HIV screening of persons visiting one of eight out of the nine Danish clinics for venereal diseases in the national HIV surveillance. Data were collected during the period July 1, 1990-March 31, 1991 and included: gender, sexual orientation, history of intravenous drug use (IVDU), syphilis testing and HIV testing. A total of 7,455 persons participated of whom 75% were tested for HIV antibodies. The HIV test activity was significantly higher among male IVDUs than homo/bisexuals, and higher among female IVDUs than heterosexuals. The overall HIV prevalence among tested individuals was 0.6%, ranging from 0.1% among heterosexual women to 5.3% among female IVDUs. A total of 81% were tested for syphilis with an overall HIV prevalence of at least 1.1%, ranging from 0.2% among heterosexuals to 9.3% among homo/bisexual men. Since the non-participation is great and the venereological clientele is very heterogeneous, using blood taken for syphilis serology from this group for unlinked anonymous HIV screening, would not be particularly important as a supplement to the Danish HIV surveillance.
In 1989 and 1990, newly-acquired sexually transmitted bacterial disease was found in 41 HIV-antibody-positive men seen at a sexually transmitted disease (STD) clinic in Copenhagen. In 38 homo/bisexual men, the new STD was transmitted from a male contact in 36 cases and from a female contact in two cases. In three male intravenous drug users, the new STD was transmitted from a female contact. In two men, the HIV-infection was first diagnosed together with the new STD, the other men had been aware of their HIV-infection for a mean period of 38 months. Gonococcal infections were diagnosed in 33 men, Chlamydial infections in ten men and syphilis in three men. Anorectal gonococcal infections were found in 13 men, corresponding to 43% and 30% of the total number of anorectal gonococcal infections in 1989 and 1990 respectively. The data presented might indicate a relapse to unsafe sexual practices among homosexual men in Copenhagen. This could influence the HIV prevalence as at least 12% of the contacts were known to be HIV-antibody-negative.
OBJECTIVES: To examine the sexual behaviour and the prevalence of sexually transmitted diseases (STD) among females attending an inner-city STD clinic before and after safer sex campaigns. SUBJECTS: In 1984 981 women and in 1988 684 women were interviewed immediately after the venerological examination. SETTING: Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark. METHODS: In a face to face interview, details of symptoms, age at coitarche, number of sexual partners (lifetime and during the last year), obstetric history, and contraceptive methods were recorded. RESULTS: A substantially higher proportion of women used condoms in 1988 than in 1984. A dramatic decrease in the prevalence of gonorrhoea occurred (from 22% in 1984 to 6% in 1988, p < 0.01), whereas an increase in the number of patients with genital warts was observed (from 4% in 1984 to 10% in 1988, p < 0.05). The prevalence of chlamydia, genital herpes, and cervical dysplasia remained unchanged. No significant changes in the number of sexual partners, or the frequency of sexual intercourse or unplanned pregnancy could be detected from 1984 to 1988. CONCLUSIONS: The safer sex campaigns have only been partly successful, as a general reduction in all sexually transmitted diseases should be expected as a result of the increased use of condoms. Future campaigns should focus on the correct use of condoms, and encourage a lifestyle with stable sexual relationship.
A collection of 3019 selected serum samples (ss), comprising 329 ss from intravenous drug abusers, 558 ss from homosexual men, 682 samples from persons attending a STD clinic, 100 ss from individuals of African origin, 300 ss from sexual contacts to Africans, 650 ss from Danish blood donors who resided in Africa greater than 2 years prior to donating the ss, and 400 ss with equivocal antibody reactions in an HIV-1 Western blot was tested for antibodies against HIV-2 by in-house HIV-2 ELISA and Western blot. Four ss were positive for antibodies against HIV-2. Three of the ss originated from West African men, the fourth belonged to the spouse of one of these men. Three of the samples presented with an uncharacteristic reaction in a HIV-1 Western blot. The study indicates that HIV-2 infection is not yet widespread in Denmark and that it remains closely related to West Africa.
From October 1985 until the end of December 1986, 439 intravenous drug users (IVDU) presented themselves at the outpatient venereal disease clinic of Copenhagen for an HIV-test. HIV-antibodies were found in 53 out of 272 men (19.5%) and in 25 of 167 women (15.0%), giving an overall prevalence of 17.8%. Risk factors for HIV were the length of drug abuse (p less than 0.05) and having injected drugs within the last six months before testing (p less than 0.005). HIV-antibodies were found in 18 of 90 women (20%) and in three of 20 men (15%), who had a history of a past or ongoing life as a prostitute. The IVDU in this study have been chosen as a cohort and recalled for an ongoing follow-up study focusing on drug and sexual behaviour in relation to the initial HIV-test result.
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During four study periods, each of 3-4 weeks' duration in 1987 and 1988, all patients attending the Copenhagen outpatient Venereal Disease Clinic were encouraged to have a test for human immunodeficiency virus (HIV) antibody. Anonymous testing or testing for research purposes only without any data was also offered. Patients known to be HIV antibody-positive were not re-tested. A total of 1753 patients (1118 men, 635 women) were counselled and testing recommended. Testing was refused by 255 patients, 57 of whom had been tested (all negative) within the previous 3 months. HIV serology was therefore unknown in 11.7% (198 of 1696 persons), including 120 of 922 heterosexual men (13%), 16 of 159 homo/bisexual men (10%) and 62 of 615 women (10%). There was no substantial difference between the four study periods in the numbers refusing the test. Sixteen of the 1498 patients tested were HIV antibody-positive, including one woman and 3 men with a history of intravenous drug abuse and 11 homo/bisexual men; one heterosexual man with HIV antibodies had no known risk behaviour. It is concluded that HIV testing with informed consent at a sexually transmitted disease clinic will not include all persons, and therefore will not exclude a self-selection bias. Surveillance studies using unlinked HIV testing are therefore necessary and it is recommended that they should be performed in Denmark. In this study, unlinked HIV testing of the serum specimens taken for syphilis serology would have decreased the percentage of 'non-attenders' from 12.4% to 0.8% during the final study period.
The clinical efficacy and safety of roxithromycin 300 mg once a day was compared with that of erythromycin 500 mg twice a day in 87 men with chlamydia-negative non-gonococcal urethritis. In the roxithromycin group the clinical efficacy rate was 88% on day 8 and between 78% and 84% on day 21. In the erythromycin group the clinical efficacy rate was 98% on day 8 and 86% on day 21, a non-significant difference. Side effects were mainly gastrointestinal, occurring in about 15% of patients receiving each treatment.
With the object of describing how their own health is experienced, the social circumstances and sexual behaviour in anti-HIV-positive homosexual and bisexual men, an anonymous questionnaire to be completed by the recipient was distributed in 1987 in connection with a placebo controlled investigation to assess the value of isoprinosin (Imunovir) in preventing the development of AIDS. 87% participated. Among the total of 85 participants, 78% considered that their health was good, 29% met family members and 75% friends at least once weekly. Fifty patients (65%) felt stressed in their daily lives which was definitely higher than in the normal population. All of the participants had altered their sexual behaviour in a manner which reduced the risk of HIV-transmission but 18 (21%) had had sexual behaviour known to transmit HIV within the past year. This behaviour occurred more frequently in young persons (p = 0.09) and in smokers (p = 0.03). In addition, no connection could be demonstrated between a series of possible determinants for this, which may, however, be due to the limited extent of the material. It is demonstrated that awareness that one is infected with HIV does not eliminate dangerous sexual behaviour in all cases.
The androgen status was determined in 105 women with hirsutism. Raised values of at least one androgenic hormone was found in 58 women, most frequently free testosterone, dehydroepiandrosterone sulphate and delta-4-androstendion. No significant correlation was found between the androgen level and the degree of hirsutism or the frequency of disturbances of menstruation apart from amenorrhoea. Fifty-three women were examined at least six months after the electroepilation therapy. Significant decrease in the degree of hirsutism and the frequency of self-treatment were found together with great satisfaction with the result of treatment.