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PubMedDate not supplied

The contribution of cytolethal distending toxin to bacterial pathogenesis.

Cytolethal distending toxin (CDT) is a bacterial toxin that initiates a eukaryotic cell cycle block at the G2 stage prior to mitosis. CDT is produced by a number of bacterial pathogens including: Campylobacter species, Escherichia coli, Salmonella enterica serovar Typhi, Shigella dystenteriae, enterohepatic Helicobacter species, Actinobacillus actinomycetemcomitans (the cause of aggressive periodontitis), and Haemophilus ducreyi (the cause of chancroid). The functional toxin is composed of three proteins; CdtB potentiates a cascade leading to cell cycle block, and CdtA and CdtC function as dimeric subunits, which bind CdtB and delivers it to the mammalian cell interior. Once inside the cell, CdtB enters the nucleus and exhibits a DNase I-like activity that results in DNA double-strand breaks. The eukaryotic cell responds to the DNA double-strand breaks by initiating a regulatory cascade that results in cell cycle arrest, cellular distension, and cell death. Mutations in CdtABC that cause any of the three subunits to lose function prevent the bacterial cell from inducing cytotoxicity. The result of CDT activity can differ somewhat depending on the eukaryotic cell types affected. Epithelial cells, endothelial cells, and keratinocytes undergo G2 cell cycle arrest, cellular distension, and death; fibroblasts undergo G1 and G2 arrest, cellular distension, and death; and immune cells undergo G2 arrest followed by apoptosis. CDT contributes to pathogenesis by inhibiting both cellular and humoral immunity via apoptosis of immune response cells, and by generating necrosis of epithelial-type cells and fibroblasts involved in the repair of lesions produced by pathogens resulting in slow healing and production of disease symptoms. Thus, CDT may function as a virulence factor in pathogens that produce the toxin.

Animals↗
PubMed1994

Limitations of and indications for the use of co-trimoxazole.

Co-trimoxazole is still widely used for indications where trimethoprim alone is equally effective. Microbiological and pharmacokinetic considerations reveal that trimethoprim alone provides adequate anti-microbial activity for treatment of conditions for which co-trimoxazole is often given. Synergy may be shown in vitro, but in clinical practice is an unusual occurrence. There is no evidence from clinical studies that the sulphonamide moiety fo co-trimoxazole prevents the development of resistance to trimethoprim. The adverse event profile of co-trimoxazole is a summation of that of sulphonamide and of trimethoprim. Thus, using trimethoprim alone should reduce both the incidence and potential severity of adverse events seen when co-trimoxazole is used. Clinical trials have shown trimethoprim to be as effective as co-trimoxazole in many of the common bacterial infections of the urinary and respiratory tracts. However, there are a few specific varieties of infection for which co-trimoxazole can be shown to be superior to trimethoprim: these include toxoplasmosis, brucellosis, nocardiosis, chancroid and pneumonia caused by Pneumocystis carinii. For many common infections, scientific, rational, economic and clinical reasons dictate that trimethoprim is preferable to co-trimoxazole.

Clinical Trials as Topic↗
PubMed1991

Recent developments in STDs: I. Bacterial diseases.

Bacterial pathogens account for a significant portion of the current STD epidemic in the United States. Gonorrhea, syphilis, and chancroid are especially rife in the nation's poverty pockets. Chlamydial infection, the most common bacterial STD, is prevalent at all socioeconomic levels. A recurrent theme in these diseases is coexisting infection, sometimes involving HIV.

Anti-Bacterial Agents↗
PubMed1998

Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group.

To determine the etiology of genital ulcers and to assess the prevalence of human immunodeficiency virus (HIV) infection in ulcer patients in 10 US cities, ulcer and serum specimens were collected from approximately 50 ulcer patients at a sexually transmitted disease clinic in each city. Ulcer specimens were tested using a multiplex polymerase chain reaction assay to detect Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus (HSV); sera were tested for antibody to HIV. H. ducreyi was detected in ulcer specimens from patients in Memphis (20% of specimens) and Chicago (12%). T. pallidum was detected in ulcer specimens from every city except Los Angeles (median, 9% of specimens; range, 0%-46%). HSV was detected in >/=50% of specimens from all cities except Memphis (42%). HIV seroprevalence in ulcer patients was 6% (range by city, 0%-18%). These data suggest that chancroid is prevalent in some US cities and that persons with genital ulcers should be a focus of HIV prevention activities.

Female↗
PubMed2005

Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease.

BACKGROUND: In recent years, increasing evidence has accumulated that suggests the majority of cases of genital ulcer disease in sub-Saharan Africa are due to viral and not bacterial infections. Although many cross-sectional studies support such a trend, few serial cross-sectional data are available to show the evolution of genital ulcer disease over time. METHODS: We surveyed the prevalence of sexually transmitted diseases (STDs) among patients with STD symptoms and women recruited from family planning clinics in 3 cities in Botswana in 2002 and compared our findings with those from a survey of a similar population conducted in 1993. RESULTS: The observed proportion of cases of genital ulcer disease due to chancroid decreased from 25% in 1993 to 1% in 2002, whereas the proportion of ulcers due to herpes simplex virus increased from 23% in 1993 to 58% in 2002. Although the proportion of ulcers due to syphilis was similar for both surveys, the rate of positive serologic test results for syphilis among patients with genital ulcer disease decreased from 52% in 1993 to 5% in 2002. During this period, decreases in the prevalence of gonorrhea, syphilis-reactive serologic findings, chlamydial infection, and trichomoniasis were also detected among patients with STDs and women from family planning clinics. These changes remained significant after estimates were adjusted for the sensitivity and specificity of diagnostic tests. CONCLUSIONS: Our findings suggest a decrease in the prevalence of bacterial STDs and trichomoniasis, a reduction in the proportion of ulcers due to bacterial causes, and an increase in the proportion of ulcers due to herpes simplex virus during the period 1993-2002. These changes should be taken into consideration when defining new guidelines for the syndromic management of genital ulcer disease.

Adult↗
PubMed2003

Candida infection as a risk factor for HIV transmission.

BACKGROUND: Numerous epidemiological studies have documented that ulcerative sexually transmitted diseases (STDs), such as syphilis, chancroid, and genital herpes, promote heterosexual human immunodeficiency virus (HIV) transmission. However, the role of vaginal inflammations, such as Candida infection, in HIV acquisition has not been well established, even though, like Trichomona vaginalis infection, it is rapidly emerging as a significant co-factor in HIV transmission. METHODS: This study was conducted among a high-risk population of heterosexual women, cohabitating with their HIV-positive male partners, to determine if an association exists between vaginal infections, primarily Candida, and HIV seroconversion. These serodiscordant couples (i.e., one of the persons is HIV positive, and the other is HIV negative) are currently enrolled in an ongoing longitudinal heterosexual discordant couple cohort that is being prospectively followed at Project Sans Francisco (PSF), an HIV Prevention and Research Center in Lusaka, Zambia. A nested case-control study that used retrospective laboratory analyses data obtained from medical, clinical, and laboratory records at PSF was employed. RESULTS: The findings from this study clearly document that women who seroconverted from HIV-negative status during baseline to HIV-positive status at follow-up were significantly more likely to have vaginal Candida infections than were the correspondingly matched seronegative control women. CONCLUSIONS: These findings suggest that high-risk heterosexual HIV-negative women could benefit from appropriate gynecological management and care regarding the prevention and treatment of vaginal Candida infections, especially in resource-poor environments.

Adult↗
PubMed1987

Retrospective seroepidemiology of AIDS virus infection in Nairobi populations.

Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Lymphogranuloma venereum: 27 cases in Paris.

Twenty-seven men with laboratory-confirmed lymphogranuloma venereum (LGV) were identified among 211 patients tested for LGV or chancroid during a 6-y period. The patients with LGV ranged in age from 17 to 73 y; most were from countries other than France. Twenty-five sought care because of inguinal adenopathy (with spontaneous draining fistulae in two patients) and two because of proctitis. Chlamydia trachomatis was isolated from nine patients; all isolates were the LGV biovar as demonstrated by biologic characterization and monoclonal antibody reactivity. In patients without isolation of C. trachomatis, the diagnosis was based on chlamydial complement fixation antibody titers greater than or equal to 1:32 (mean titer, 1:128). Genital herpes was an associated diagnosis in one patient and syphilis in two patients. Serologic evidence of exposure to human immunodeficiency virus (HIV) type 1 was present in five patients and to HIV-2 in one patient.

Adolescent↗
PubMed1992

Association between HIV-2 infection and genital ulcer diseases among male sexually transmitted disease patients in The Gambia.

OBJECTIVE: To investigate whether genital ulcer diseases are cofactors which enhance the transmission of HIV-2 in West Africa. DESIGN: A cross-sectional study of 435 men presenting with a sexually transmitted disease (STD). SETTING: The outpatient clinic of the Medical Research Council Laboratories, a primary care facility in Fajara, a suburb of Banjul, the capital city of The Gambia (West Africa). PATIENTS, PARTICIPANTS: Six hundred and twenty-four men presenting with a genital complaint, of whom 443 had an STD. Eight of the men with an STD were excluded from further analysis because they were HIV-1-infected (five patients) or had indeterminate Western blot patterns (three patients). The remaining 21 HIV-2-infected and 414 seronegative men constituted our study-group. MAIN OUTCOME MEASURES: Participants were questioned about previous STD and behavioural and demographic characteristics. A physical examination was performed and serum collected for measurement of antibodies against Haemophilus ducreyi and Treponema pallidum. RESULTS: HIV-2-infected men were more likely than HIV-seronegative participants to have previously had a genital ulcer [odds ratio (OR), 3.00; 95% confidence interval (Cl), 1.18-7.60] and to have antibodies against T. pallidum (OR, 5.95; 95% Cl, 2.10-16.91), or H. ducreyi (OR, 4.59; 95% Cl, 1.71-12.33). Circumcised patients with residual foreskin were more likely to be HIV-2 infected than patients with complete circumcision. HIV-2-seropositive patients were six times more likely to have generalized lymphadenopathy than their seronegative counterparts. CONCLUSIONS: Our data suggest that genital ulcerative diseases, such as syphilis and chancroid, are probably cofactors that increase the transmission of HIV-2 in West Africa, and that HIV-2 infection frequently results in generalized lymphadenopathy.

Adolescent↗
PubMed1996

Trends in HIV seroprevalence in men who have sex with men: New York City Department of Health sexually transmitted disease clinics, 1988-1993.

OBJECTIVE: To measure HIV seroprevalence trends in a primarily non-white sample (n = 1618) of men who have sex with men (MSM). The MSM were sampled at New York City Department of Health (NYC-DOH) sexually transmitted disease (STD) clinics during 1988-1993. DESIGN: Unlinked HIV-1 serosurvey using remnant serum originally drawn for routine syphilis screening. METHOD: Demographic, clinical and risk exposure data were abstracted from clinic charts. No other sources of data were used, and patients were not interviewed. RESULTS: HIV seroprevalence in the overall sample declined from 53 to 34% between 1988 and 1993. The most dramatic decline was observed in white MSM (from 47 to 17%; n = 457). Seroprevalence in black MSM also fell (from 60 to 45%; n = 691). Seroprevalence in Hispanic men (n = 332) showed no decline, starting and ending the 5-year period at 39%. Bisexual MSM, who comprised one-quarter of the sample, experienced a shallower decline than other MSM (from 41 to 33%). The magnitude of the decline decreased with increasing age--for example, seroprevalence in MSM aged 20-24 years dropped by 62% (from 39 to 15%), whereas seroprevalence in MSM aged 40-44 years dropped by 10% (from 48 to 43%)--up through age 45 years, at which point another dramatic decline (from 53 to 21%) was observed. There was no decline in the high seroprevalence associated with a discharge diagnosis of gonorrhea (58%) or any genital ulcer disease (GUD; e.g., primary or secondary syphilis, chancroid or genital herpes, 52%). The proportion of STD diagnoses attributed to GUD rose from 8 to 14%. CONCLUSION: A small number of MSM continued to present to NYC-DOH STD clinics and to leave with a diagnosed STD at a time when safe sex was aggressively promoted. The biological and behavioral associations between GUD and gonorrhea and HIV seroprevalence warrant continued investigation. Prevention programs targeted to young, minority and bisexual MSM are needed.

Adult↗
PubMed1997

HIV-1 infection among female commercial sex workers in rural Thailand.

OBJECTIVE: To reconstruct past HIV-1 incidence and identify risk factors for HIV-1 seroconversion among female commercial sex workers in a semi-rural setting in northern Thailand. DESIGN: Retrospective cohort of sex workers attending a sexually transmitted disease (STD) clinic at Mae Chan District Hospital, Chiang Rai Province, Thailand. METHODS: Information included demographic data, HIV-1 antibody testing and STD diagnosis was collected in 821 sex workers attending the STD clinic from 1989 through 1993. HIV-1 incidence among initially HIV-1-seronegative sex workers who underwent repeat HIV-1 antibody testing during follow-up was determined and possible predictive factors for seroconversion including diagnosis of other STD were examined. RESULTS: HIV-1 seroprevalence among 556 sex workers who underwent antibody testing was 52%, rising from 29% at initial test in 1989 to 53-63% for 1990-1993. Among 96 initially HIV-1-negative sex workers who underwent repeat testing, 64 HIV-1 seroconversions occurred, giving an incidence rate of 12.6/100 person months (PM). Incidence increased from 12.0/100 PM for 1989 and 1990 to 17.0/100 PM for 1991, with a subsequent decline to 9.3/100 PM for 1992-1993. The cumulative risk of seroconversion 6 months following initial negative HIV-1 antibody test was 57%. There were higher rates among younger sex workers (14-19 years old) and those from Hilltribes, but only a diagnosis of chancroid was significantly associated with HIV-1 seroconversion (P = 0.014). CONCLUSION: An explosive epidemic of HIV-1 occurred among sex workers in a semi-rural area of northern Thailand from 1989. These HIV-1 incidence estimates, which are among the highest rates of sexual transmission ever reported, highlight the extreme vulnerability of female sex workers to HIV infection, even in a non-urban setting.

Adolescent↗
PubMed1999

Relative risks and population attributable fraction of incident HIV associated with symptoms of sexually transmitted diseases and treatable symptomatic sexually transmitted diseases in Rakai District, Uganda. Rakai Project Team.

OBJECTIVES: To assess the linkage of sexually transmitted disease (STD) symptoms and treatable STD to HIV incidence. DESIGN: Analysis of a randomized trial of STD control for HIV prevention, Rakai, Uganda. METHODS: Consenting adults 15-59 years of age were seen at 10-monthly home visits, interviewed regarding STD symptoms, and asked to provide samples for HIV and STD diagnoses. HIV incidence was determined in 8089 HIV-negative subjects over 10 457 person years. Adjusted rate ratios (RR) and 95% confidence intervals (CI) of HIV acquisition associated with genital ulcer disease (GUD) and discharge/dysuria were used to estimate the population attributable fraction (PAF) of HIV acquisition. HIV transmission risks associated with STD symptoms in HIV-positive partners of 167 HIV discordant couples and the numbers of sexual partners reported by HIV-positive subjects were used to estimate the PAF of HIV transmission attributable to STD. RESULTS: HIV prevalence was 16%. The risk of HIV acquisition was increased with GUD (RR 3.14; CI 1.98-4.98) and in males with discharge/dysuria (RR 2.44; CI 1.17-5.12), but not in females with discharge/dysuria. The PAF of HIV acquisition was 9.5% (CI 2.8-15.8%) with any of the three STD symptoms. The PAF for GUD was 8.8% (CI 3.7-13.8), but only 8.2% of reported GUD was caused by treatable syphilis or chancroid . The PAF for discharge/dysuria in males was 6.7% (CI 1.1-13.8), but only 25% of symptomatic males had concurrent gonorrhea or chlamydial infection. No significant differences were seen in PAF between study treatment arms. The PAF of HIV transmission associated with STD symptoms in HIV-positive persons was indirectly estimated to be 10.4%. CONCLUSION: In this mature, generalized HIV epidemic setting, most HIV seroconversion occurs without recognized STD symptoms or curable STD detected by screening. Therefore, syndromic management or other strategies of STD treatment are unlikely to substantially reduce HIV incidence in this population. However, STD is associated with significant HIV risk at the individual level, and STD management is needed to protect individuals.

Adolescent↗
PubMed2000

Model-based evaluation of single-round mass treatment of sexually transmitted diseases for HIV control in a rural African population.

OBJECTIVES: To compare the impact of single-round mass treatment of sexually transmitted diseases (STD), sustained syndromic treatment and their combination on the incidence of HIV in rural Africa. METHODS: We studied the effects of STD interventions by stochastic simulation using the model STDSIM. Parameters were fitted using data from a trial of improved STD treatment services in Mwanza, Tanzania. Effectiveness was assessed by comparing the prevalences of gonorrhoea, chlamydia, syphilis and chancroid, and the incidence of HIV, in the general adult population in simulations with and without intervention. RESULTS: Single-round mass treatment was projected to achieve an immediate, substantial reduction in STD prevalences, which would return to baseline levels over 5-10 years. The effect on syphilis was somewhat larger if participants cured of latent syphilis were not immediately susceptible to re-infection. At 80% coverage, the model projected a reduction in cumulative HIV incidence over 2 years of 36%. A similar impact was achieved if treatment of syphilis was excluded from the intervention or confined to those in the infectious stages. In comparison with sustained syndromic treatment, single-round mass treatment had a greater short-term impact on HIV (36 versus 30% over 2 years), but a smaller long-term impact (24 versus 62% over 10 years). Mass treatment combined with improved treatment services led to a rapid and sustained fall in HIV incidence (57% over 2 years; 70% over 10 years). CONCLUSIONS: In populations in which STD control can reduce HIV incidence, mass treatment may, in the short run, have an impact comparable to sustained syndromic treatment. Mass treatment combined with sustained syndromic treatment may be particularly effective.

Adolescent↗
PubMed2002

Transmission of human herpesvirus 8 by sexual activity among adults in Lagos, Nigeria.

BACKGROUND: Human herpesvirus 8 (HHV-8) infection is common in Africa, but prevalence varies geographically. Studies in Europe and America suggest spread through homosexual contact, but evidence of heterosexual spread is inconsistent. We examined the association between HHV-8 and markers of risky sexual activity in Nigeria. METHODS: The study subjects included an adult referent population at relatively low risk of HIV infection, patients attending a sexually transmitted disease (STD) clinic, and female commercial sex workers (CSW). Sera were collected between 1991 and 1994 to study the epidemiology of retroviruses and STD in Lagos, Nigeria. Residual samples were tested for HHV-8 antibodies using a K8.1 enzyme immunoassay and for antibodies to syphilis, chancroid, herpes simplex virus 2, HIV-1/2, and HTLV-1. Associations were sought using chi square tests and logistic regression. RESULTS: Overall, HHV-8 prevalence was 26.5% in 2002 study subjects, being higher among CSW and STD patients (31% in each) than in the referent population (19%). HHV-8 prevalence in women was approximately half that in men in both the referent and the STD populations. Increasing age and STD were each associated with HHV-8-seropositivity in men and women, and among women being a CSW was also a risk factor. HHV-8 antibodies were more frequently detected in those with laboratory evidence of STD in each group. Having at least one STD was associated with having HHV-8 antibodies. CONCLUSION: The higher prevalence of HHV-8 antibody in groups with multiple sexual partners and the association with STD among individuals both support the sexual transmission of HHV-8 in African adults.

Adolescent↗
PubMedDate not supplied

The variability of syphilitic chancres.

Sixty-four patients who had darkfield microscopic evidence of primary syphilis underwent a standardized interview and physical examination. Two or more lesions were observed in 47% of patients, 7.8% of patients had non-indurated ulcers, and the borders of the ulcers of 7.8% were irregular and slightly undermined, suggesting lesions of chancroid. Only 27 patients (42.7%) had single, indurated chancres with regional lymphadenopathy. It is suggested that the "classic" chancre may be the "atypical" lesion.

Adolescent↗
PubMedDate not supplied

Characterization of the cytopathic effect of Haemophilus ducreyi.

BACKGROUND AND OBJECTIVES: Haemophilus ducreyi is the etiologic agent of chancroid, which is a genital ulcer disease that increases the risk of acquiring and transmitting HIV. The pathogenesis of H. ducreyi is not well understood. GOAL OF THIS STUDY: The goal of this study was to use a quantitative tetrazolium-based XTT assay to characterize the cytopathic effect of H. ducreyi on human foreskin fibroblasts. STUDY DESIGN: Haemophilus ducreyi strains 35000, R018, A77 and CIP542 were evaluated using the XTT assay. The role of attachment on resultant CPE was assessed using a wash step 2 hours post-infection. Internalization was evaluated by the gentamicin kill assay. Secreted exotoxin was studied using permeable inserts to separate the bacteria from the HFF monolayer. RESULTS: HFF cell damage did not appear to be mediated by a secreted H. ducreyi cytotoxin. Direct contact of viable H. ducreyi with HFF cells was required for cell damage. H. ducreyi strains that attached poorly could be readily removed by a wash step. This reduced their capacity to damage HFF cells significantly. Although some H. ducreyi strains attach to high levels within 4 hours, no HFF cell damage was detected by the XTT assay. However, once HFF cell damage was detected by 24 hours, it was not easily reversible, despite antibiotic treatment that eradicated H. ducreyi. Internalization of H. ducreyi by HFF cells apparently did not occur to a significant degree. CONCLUSION: This study indicates that classic "soluble exotoxins" are not likely the key component in H. ducreyi pathogenesis. Attachment or direct contact with HFF cells are required for H. ducreyi to cause a CPE.

Bacterial Adhesion↗
PubMedDate not supplied

Pattern of sexually transmitted diseases in a Malagasy population.

BACKGROUND: Data concerning the spectrum and antimicrobial susceptibility of STDs in Madagascar are scarce. OBJECTIVES: Improvement of STD patient management in Madagascar. GOAL OF THE STUDY: Assessment of the spectrum of STDs and improvement of therapy. STUDY DESIGN: Etiologic study of 400 patients (169 men, 231 women) under consultation at the major STD service in Antananarivo for one or more of the STD syndromes, urethral discharge, cervicovaginal discharge, genital ulcers, or condylomata according to a fixed diagnostic schedule. RESULTS: Of genital ulcers, syphilis accounted for 46%, lymphogranuloma venereum for 24%, chancroid for 16%, and herpes for 1%. Of the syphilis cases, 51% presented as condyloma lata. Discharge was found in 124 men and 210 women. Counting concomitant infections separately, gonorrhea occurred in 69% of the men and 20% of the women with discharges, chlamydia infection in 42% and 52%, trichomoniasis in 9% and 31%, candidiasis in 12% and 30%. Bacterial vaginosis was found in 37% of the women with discharges. In 32% of male and 71% of female gonorrhea cases, there was concurrent chlamydia infection. Infection with HIV 1 or 2 was not detected. Determination of the antibiotic susceptibility of Neisseria gonorrhoea revealed high efficacy of ampicillin, ciprofloxacin, and spectinomycin; but frequent resistance to tetracycline and cotrimoxazole. CONCLUSIONS: High priority should be given to the management of infections with chlamydia and with Treponema pallidum as well as to educational measures to increase awareness of genital ulcer disease.

Adolescent↗
PubMedDate not supplied

Epidemiologic risk factors for incident sexually transmitted diseases in young Thai men.

BACKGROUND AND OBJECTIVES: Prospective studies of incidental sexually transmitted diseases in developing countries rarely have been reported. As the human immunodeficiency virus epidemic widens, knowledge of the epidemiology of sexually transmitted diseases as co-factors for human immunodeficiency virus infection is viewed as vitally important. GOAL: To determine epidemiologic risk factors for incidental sexually transmitted diseases in young men in northern Thailand. STUDY DESIGN: A cohort of 2,417 men selected by lottery for military conscription was followed an average of 22 months, with epidemiologic risk factors and sexually transmitted disease histories assessed semiannually. Sexually transmitted diseases were determined by physician or symptom histories obtained by interview. RESULTS: Sexually transmitted disease incidence was 17.04 per 100 person-years. Gonorrhea and chancroid were commonly reported, whereas incident syphilis was rare. Sexually transmitted disease incidence declined significantly in the 2-year period. Most sexually transmitted diseases were acquired through commercial sex patronage. However, among men who did not report visiting a brothel, there was a significant increase in sexually transmitted diseases among men reporting sex with a girlfriend. Other risk factors included inconsistent condom use, drug use, and low educational level. Frequent alcohol use was associated with incident sexually transmitted diseases in bivariate analysis, but drinking at the time of last brothel visit was not associated with increased sexually transmitted diseases. CONCLUSIONS: Sexually transmitted disease control in Thailand is based on an integrated sexually transmitted disease clinic system. Many commercial sex workers are examined and treated routinely, but too infrequently to reduce sexually transmitted disease transmission between them and their male clients. Condom-use levels in commercial sex settings still may be too low to reduce sexually transmitted disease transmission. More consistent and effective sexually transmitted disease treatment of commercial sex workers and their clients and education of men on the effective and consistent use of condoms is required to reduce the risks of sexually transmitted disease transmission in this population.

Adult↗