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Biomedical subjects

P Piot

Publications and source records attributed to P Piot.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

The etiology of genital ulceration in Rwanda.

The etiology of genital ulcer disease was determined in 210 consecutive patients (110 men and 100 women) who presented at a clinic in Kigali, Rwanda, because of genital ulcers. When mixed infections are included, syphilis (21%), chancroid (24%), and genital herpes (17%) were about equally frequent in men. Lymphogranuloma venereum with ulceration was found in 11% of patients. Syphilis (40%) was the most common diagnosis in women; genital herpes (20%), lymphogranuloma venereum with ulceration (19%) and chancroid (12%) also were frequent diagnoses. Microscopic examination for treponemes after silver-impregnation staining had a poor sensitivity and specificity for the diagnosis of primary syphilis. Overall, 59% of the patients (43% of the men and 77% of the women) had IgG antibodies to the human immunodeficiency virus.

Adolescent↗
PubMedDate not supplied

Evaluation of the rapid plasma reagin "teardrop" card test for screening of syphilis in field conditions.

BACKGROUND AND OBJECTIVES: The availability of simple diagnostic methods may contribute to more efficient control of sexually transmitted diseases (STDs) in developing countries. For the detection of syphilis, a simple rapid plasma reagin (RPR) "teardrop" assay for finger-prick blood samples was developed in 1962. The reliability of this test is compared with RPR, Treponema pallidum hemagglutination assay (TPHA), and fluorescent treponemal antibody absorption (FTA-Abs) assays performed on venous blood samples. GOAL OF THIS STUDY: To evaluate the potential usefulness of the finger-stick RPR teardrop assay for diagnosis of syphilis in settings with poor medical resources. STUDY DESIGN: Pregnant women evaluated at two health centers in Pikine, Senegal were tested for STDs. The RPR teardrop assay was performed on plasma from blood samples obtained by finger prick, and standard RPR, TPHA, and FTA-Abs procedures were performed on serum obtained by vein puncture. RESULTS: The sensitivity and specificity of the finger-prick RPR teardrop assay were 69.7% and 96.5%, respectively, and its reactivity was correlated with RPR serum antibody titer. CONCLUSION: The finger-prick RPR teardrop assay is not a reliable alternative to the classic serum RPR test.

Evaluation Studies as Topic↗
PubMedDate not supplied

Enzyme immunoassays (EIAs) for the detection of anti-Haemophilus ducreyi serum IgA, IgG, and IgM antibodies.

BACKGROUND AND OBJECTIVES: Chancroid is a risk factor for heterosexually acquiring HIV. Controlling its spread may reduce HIV transmission. GOAL OF THE STUDY: To develop EIAs for assessing antibody levels and for seroepidemiologic studies. STUDY DESIGN: Anti-Haemophilus ducreyi IgA, IgG and IgM EIAs were standardized using a crude cocktail antigen. Evaluation was on sera from Kenya, Rwanda, Thailand and The Gambia. The two-tailed student's t test was used to compare results. RESULTS: The specificity of IgA was 97% (95% confidence interval (CI): 95-99%), of IgG was 92% (95% CI: 89-95%), and of IgM was 99% (95% CI: 98-100%). The sensitivity of IgA was 88% (95% CI: 83-93%), of IgG was 93% (95% CI:89-97%), and of IgM was 78% (95% CI:71-85%) in patients having an ulceration for more than eight days. Thus, 95% (95% CI:92-98%) of the chancroid patients were seropositive for at least one antibody type. The IgG and IgA EIAs were more sensitive in patients older than 24 years of age. Higher IgG rates were found in HIV infected chancroid patients. CONCLUSION: The EIAs should be useful for studying the kinetics of antibody levels and the epidemiology of H. ducreyi infection.

Adolescent↗
PubMedDate not supplied

Seroepidemiological studies of Haemophilus ducreyi infection in Ethiopian women.

BACKGROUND AND OBJECTIVES: To measure prevalence of anti-Haemophilus ducreyi antibodies in sera from Ethiopian female attendees, and to determine significant socioeconomic associations. STUDY DESIGN: A modified ELISA immunoassay was used to test sera of 1,831 Ethiopian women attending gynecological, obstetric, and family planning clinics in Addis Ababa. RESULTS: Overall seropositivity was 19.4%. Prevalence rates for seropositivity for antibodies to H. ducreyi were significantly associated with ethnic group and religion, older age (> or = 50 years: 28%), early age at first coitus (< 13 years: 28%) and first coitus before the menarche (25%), being divorced (27%) or a prostitute (24%), longer duration of marriage (> 20 years: 27%) and sexual life (> 20 years: 24%), number of lifetime sexual partners (2 to 5 partners: 27%) and self-reported history of both syphilis and gonorrhea (31%). Of these factors, the two most significant were first coitus before the menarche (P < 0.0001) and not being still married to the first husband/sexual partner (P < 0.001). Differences in seropositivity according to ethnic group and religion may be explained by the number of women within each group who had only one lifetime sexual partner. Women with serological evidence of exposure to another sexually transmitted disease (STD) had a greater risk of exposure to H. ducreyi. The odds ratio for H. ducreyi seropositivity in women with syphilis or gonorrhea was 3.6, for women with genital chlamydial infection, 2.3, and for those with HBV or HSV-2, 1.4 and 1.3 respectively. CONCLUSIONS: This study illustrates the usefulness of the modified ELISA immunoassay for measuring exposure to H. ducreyi, and the usefulness of H. ducreyi as a marker for cumulative sexual exposure. Further studies on the association of HIV transmission and H. ducreyi in Ethiopia are now indicated.

Adolescent↗
PubMedDate not supplied

The role of maternal syphilis, gonorrhoea and HIV-1 infections in spontaneous abortion.

The role of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) as risk factor for spontaneous abortion was investigated in a case-control study in Nairobi, Kenya. Cases (n = 195) were women admitted with clinical signs and symptoms of spontaneous abortion, before 20 weeks of gestation. Patients with induced or clinically septic abortion were excluded. Controls were unselected pregnant women in their second or third trimester (n = 195). Spontaneous abortion was independently associated with maternal HIV-1 antibody (14.4% versus 6.2%; adjusted odds ratio, 2.3; 95% confidence interval, 1.1-4.8), with maternal syphilis seroreactivity (6.8% vs 2.1%, adjusted odds ratio, 4.3; 95% confidence interval 1.2-15.6), and with vaginal colonization with group B streptococci (15.6% vs 5.2%; adjusted odds ratio, 3.2; 95% confidence interval, 1.5-6.7). No significant association was found between maternal infections with gonococci and genital mycoplasmas, and spontaneous abortion.

Abortion, Spontaneous↗
PubMedDate not supplied

Epidemic spread of plasmid-mediated tetracycline resistant Neisseria gonorrhoeae in Zaire.

A cohort of 650 prostitutes from Kinshasa, Zaire, was followed at monthly intervals for sexually transmitted diseases as part of an HIV intervention project. Neisseria gonorrhoeae isolates, obtained during a period of 30 months, were auxotyped, serotyped and tested for antimicrobial susceptibility. Among 1085 gonococcal isolates tested, 725 (67%) produced beta-lactamase (PPNG) and 323 (30%) showed plasmid-mediated resistance to tetracyline (TRNG). Over time, the prevalence of PPNG varied between 60 and 73%, while the level of TRNG increased from 11 to 45%.

Democratic Republic of the Congo↗
PubMedDate not supplied

All about STDs.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Incidence of uncomplicated genital infections in women using oral contraception or an intrauterine device: a prospective study.

Over a period of 2 years, the authors prospectively followed a cohort of 123 women using an intrauterine device (IUD) and 108 women using oral contraception (OC) in one family practice. They found nine new episodes of cervical chlamydial infection in OC users (7/100 woman years (WY] as compared to 1 new episode in IUD users (0.8/100 WY), yielding a relative risk (RR) for OC users of 8.8 (95% confidence interval (CI): 1.3-59.0). During the 24 months of observation, 15% of OC and 2% of IUD users acquired at least one episode of Chlamydia trachomatis infection (P = .01). Bacterial vaginosis occurred more frequently in IUD users (25/100 WY) than in OC users (9/100 WY) (RR = 2.8; 95% CI: 1.5-5.1). During the 24-month period, 50% of women using an IUD had at least one episode of bacterial vaginosis, compared with 20% of the OC users (P = .001). Symptomatic bacterial vaginosis was associated with the use of an IUD (RR for IUD users was 7.7; 95% CI: 2.1-28.4), whereas asymptomatic bacterial vaginosis was associated with sexual promiscuity.

Cohort Studies↗
PubMedDate not supplied

Antimicrobial therapy of chancroid: an evaluation of five treatment regimens correlated with in vitro sensitivity.

One hundred fifty-one men with genital ulcer disease were assigned randomly to treatment with one of five oral antimicrobial regimens: (1) sulfadimidine (1 g four times daily for seven days); (2) tetracycline (500 mg four times daily for seven days); (3) trimethoprim-sulfamethoxazole (TMP-SMZ; 160 mg of TMP and 800 mg of SMZ twice daily for seven days); (4) doxycycline (300 mg as a single dose); or (5) TMP-sulfametrole (640 mg of TMP and 3,200 mg of sulfametrole once as a single dose). Haemophilus ducreyi was isolated from 81 (54%) of the men, and 35 strains were available for testing of antimicrobial susceptibility. The TMP-SMZ and TMP-sulfametrole regimens were more effective than sulfadimidine, tetracycline, or single-dose doxycycline in curing ulcers. Only one of 35 strains tested was susceptible to tetracycline (less than or equal to 8 mg/liter), and only ten of 35 strains were susceptible to doxycycline (less than or equal to 4 mg/liter), whereas all were susceptible to trimethoprim (less than or equal to 2 mg/liter). The correlation between in vitro susceptibility and bacteriologic response to the antimicrobial agents requires further investigation. In particular, sulfonamide resistance did not always identify failure to respond to sulfadimidine.

Chancroid↗
PubMedDate not supplied

Isolation of Mycoplasma hominis from genital ulcerations of patients in Eastern and Southern Africa.

In three separate surveys involving 413 patients in Mbabane (Swaziland), Nairobi (Kenya), and Carletonville (South Africa), Mycoplasma hominis was isolated from the base of ulcers in 41 (16%) of 251 men with genital ulcer disease. Antibodies to M. hominis were detected by indirect hemagglutination in 89 (51%) of 176 such patients. Of these male patients, 15% and 6% had indirect hemagglutinating antibodies at titers of greater than or equal to 160 and greater than or equal to 640, respectively. The rate of isolation of M. hominis and the results of serologic tests for antibodies to this organism were the same whether or not a cause of genital ulcer disease was identified.

Antibodies, Bacterial↗
PubMedDate not supplied

Sexually transmitted diseases in the 1990s. Global epidemiology and challenges for control.

Epidemiologic trends of STD are strikingly different in various parts of the world. In Northern and Western Europe there has been a spectacular decline in the incidence of STD, particularly gonorrhea and syphilis. It is probably due to a combination of an early initiation of sex education at school, behavior change, condom promotion, and the wide availability of STD treatment. The situation in North America is far more complex, with geographic areas and large population groups having low levels of STD and others continuing to experience an epidemic of STD, particularly inner-city minority populations in the United States. In developing countries both the prevalence and incidence of STD are still very high and STDs are a major public health problem making up the second cause of healthy life lost in women of 15 and 45 years of age after maternal morbidity and mortality. "Business as usual" is clearly not acceptable any longer. A better understanding of the determinants of STD epidemiology is essential for a more effective approach to STD control as well as recognizing the limitations of each single intervention, be it medical or behavioral. The major challenges are to mobilize political commitment and funds, and to transfer small scale interventions into large scale public health programs, and to apply the right mix of approaches, including medical, behavioral, societal interventions.

Adolescent↗
PubMedDate not supplied

Development of sexually transmitted diseases treatment guidelines, 1993. New methods, recommendations, and research priorities. STD Treatment Guidelines Project Team and Consultants.

To develop the 1993 Sexually Transmitted Diseases Treatment Guidelines, experts from the Centers for Disease Control and Prevention reviewed the literature on sexually transmitted disease treatment, assembled tables of evidence, and listed key questions on therapeutic outcome: microbiologic cure, alleviation of symptoms, and prevention of sequelae and transmission. At a meeting with external experts, evidence was systematically assessed and guidelines developed. Quality of evidence for microbiologic cure was generally good for gonorrhea and chlamydia, poor for syphilis, and fair for most other diseases. Evidence on preventing sequelae and transmission was limited. The Guidelines include new recommendations for single-dose oral therapy of gonorrhea (cefixime, ciprofloxacin, and ofloxacin), chlamydia (azithromycin), and chancroid (azithromycin); outpatient therapy of pelvic inflammatory disease (ofloxacin and either clindamycin or metronidazole); and patient-applied therapy of genital warts (podofilox). Syphilis therapy did not change substantially. Several global issues that emerged during the development of the World Health Organization Recommendations for the Management of Sexually Transmitted Diseases also are discussed. This evidence-based approach clarified important treatment issues and the rationale for recommendations, and identified research priorities.

Anti-Infective Agents↗