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PubMed1977

How suitable are available pharmaceuticals for the treatment of sexually transmitted diseases? (2) Conditions presenting as sores or tumours.

The pharmaceutical industry is not supplying the penicillin preparations that are required for the treatment of syphilis. For those in whom penicillin hypersensitivity is suspected there is a need for a safe injectable alternative that is effective if given once daily or, preferably, at two- or three-day intervals. Existing treatments for chancroid, lymphogranuloma venereum, and granuloma inguinale are described, but even collectively there are few cases and treatments for other sexually transmitted diseases merit priority. Treatments for scabies and pediculosis pubis, although not perfect, are reasonable. There is a need for better local treatment for condylomata acuminata and systemic immunological methods, including those that increase cell-mediated immunity, deserve attention. The same is true for molluscum contagiosum. There is an urgent need for an effective, safe treatment of herpes genitalis that is able to eradicate the virus from the host. If it is proved that the herpes virus is responsible for carcinoma of the cervix this could then be the most serious sexually transmitted disease as in many countries such carcinomas are responsible for approximate seven times more deaths in women than is syphilis in men and women together. The limitations of prophylactic methods in preventing all possibility of infection with one or more of the sexually transmitted diseases are discussed.

Condylomata Acuminata↗
PubMed1990

The prevalence of symptomatic sexually transmitted diseases and human immunodeficiency virus infection in outpatients in Lilongwe, Malawi.

In June 1989 a pilot study on the prevalence of STDs was performed at Kamuzu Central Hospital, Lilogwe, Malawi. Among unselected out-patients an STD prevalence of 4.4% was found. The patients were predominantly males (82.7%), the age was predominantly 20-35 yr. The distribution of the diagnoses was dominated by a relatively large proportion of "ulcer-diseases" (syphilis, chancroid and lymphogranuloma venereum) making up 67% of the patients. Almost two thirds of the patients were HIV-positive (62.4%). No significant difference was found in HIV-infection prevalence when patients with ulcer diseases were compared with patients with discharges. Among the patients with gonorrhoea a prevalence of penicillinase-producing Neisseria gonorrhoeae of 53% was found. It is concluded that a plan for the management of STDs is urgently needed as it is of paramount importance to combat STDs in order to prevent the spread of HIV-infection.

Adolescent↗
PubMed1993

HIV and other sexually transmitted diseases at a rural hospital in Zimbabwe.

OBJECTIVE: To define the epidemiological characteristics of STD patients attending an outpatient clinic in rural Zimbabwe, to examine the aetiologic agents causing infection and to determine their relationship with HIV infection. SUBJECTS: 319 men and 146 women, making a sample of about 7% all patients attending an STD clinic during the 3 month study period. Microbiological data were collected from 104 men and 72 women selected randomly from these. Pregnant women were excluded and patients who had received antibiotics within the previous 14 days were excluded from the microbiology sub-sample. SETTING: An outpatient STD clinic at a District Hospital on a major truck route about 300 km north of the capital, Harare. METHODS: All new patients attending the clinic during a 3 month period were enrolled for clinical and epidemiological investigations using a standard procedure. Specimens for microbiological investigation were taken from every second patient seen on the first three days of each week. RESULTS: The typical patient was male (m:f ratio 2.2) aged 20-29 years (68% patients), not married (56% men) and in paid employment (66% men vs. 27% for the district). In men the most common presenting feature was genital ulceration, while in women, discharges were more common. Genital warts were noted frequently in both sexes. In the sub-sample examined microbiologically, H ducreyi was isolated from 46% ulcers clinically diagnosed as chancroid, and motile spirochaetes were detected in 25% painless ulcers. Neither of these were detected in ulcers in women, but HSV antigen was found as frequently in ulcers from men (19%) as from women (17%). In patients with genital discharges, gonococcal infection occurred in 64% men and 17% women, while T vaginalis was isolated from 39% women and only 8% men. Over 60% gonococcal isolates were PPNG, and 18% showed in vitro resistance to tetracycline. Yeasts, mainly C albicans were isolated from 42% women with a discharge and 25% women with ulcers. In men the presence of yeasts was associated with superficial ulceration and itchiness of the glans. Positive HIV-1 serology was found in 64% patients. There was no statistical association with current genital ulcers, though there was an association with previous STD episodes and particularly with serological evidence of syphilis. Apart from yeasts, there was no association between positive HIV-1 serology and the presence of pathogens in the genital tract. CONCLUSIONS: The high prevalence of HIV-1 antibodies in STD patients in Karoi suggests integration of STD and AIDS control programmes to be a necessity. Since paid employment was a common feature of both STD clinic attendance and HIV-1 seropositivity, these programmes may be effectively directed through the work place.

Adolescent↗
PubMed1993

Osteomyelitis presenting as genital sore: a case report.

A female attending the skin outpatient department presented with a genital sore which was treated as chancroid. On further investigation it proved to be the opening of a sinus secondary to chronic osteomyelitis of the pubic symphysis.

Adult↗
PubMed1998

Oral sex and transmission of non-viral STIs.

OBJECTIVES: To review the literature on the role of oral sex in the transmission of non-viral sexually transmitted infections (STIs). METHOD: A Medline search was performed using the keywords oro-genital sex, and those specific to each infection. Further references were then taken from each article read. CONCLUSIONS: Oral sex is a common sexual practice between both heterosexual and homosexual couples. Oro-genital sex is implicated as a route of transmission for gonorrhoea, syphilis, Chlamydia trachomatis, chancroid, and Neisseria meningitidis. Other respiratory organisms such as streptococci, Haemophilus influenzae, and Mycoplasma pneumoniae could also be transmitted by this route. Fellatio confers risk for acquisition of infection by the oral partner. Cunnilingus appears to predispose to recurrent vaginal candidiasis although the mechanism for this is unclear, while a link between oro-genital sex and bacterial vaginosis is currently being studied. Oro-anal sex is implicated in the transmission of various enteric infections. In view of the increased practice of oral sex this has become a more important potential route of transmission for oral, respiratory, and genital pathogens.

Chlamydia Infections↗
PubMed2002

Coexistence of urethritis with genital ulcer disease in South Africa: influence on provision of syndromic management.

OBJECTIVE: To assess whether syndromic management of genital ulcer disease was sound, if based on the premise that men with genital ulcers rarely have a concomitant urethral infection. METHODS: Specimens were taken in 1998 from 186 mine workers in Carletonville, South Africa, who were seen consecutively with genital ulcers. The specimens comprised a swab from the ulcer, a urethral swab for a Gram stained smear, and 10-15 ml of a first catch urine sample. The latter was tested by ligase chain reaction assays for Neisseria gonorrhoeae and Chlamydia trachomatis specific DNA sequences and by a polymerase chain reaction (PCR) assay for Mycoplasma genitalium. Ulcer inducing micro-organisms were detected either by a multiplex PCR assay, or in the case of lymphogranuloma venereum (LGV) serologically, and human immunodeficiency virus (HIV) infection was detected by an enzyme linked immunosorbent assay (ELISA) test. RESULTS: Most (54%) of the ulcers were chancroidal, 18% were herpetic (HSV type 2), 6.5% primary syphilitic, and 3.2% due to LGV. More than one micro-organism was detected in 9.1% of the ulcers and less than 10% were undiagnosed. Microscopic examination of the urethral smears showed that 99 (53%) of the men had urethritis, of whom 45 (45%) were infected with N gonorrhoeae. Of the 54 men (55%) who had non-gonococcal urethritis (NGU), 11 (19.6%) harboured C trachomatis or M genitalium. Almost two thirds (64.5%) of the men had HIV infection, but this did not seem to have influenced the aetiology of the ulcers. Nor was a particular ulcer associated with one type of urethritis more than the other. Neither C trachomatis nor M genitalium was associated significantly with non-gonococcal urethritis (NGU) in either HIV positive or HIV negative men. CONCLUSION: The combination of antibiotics used for the management of genital ulcer disease in men in this South African mining population needs to be widened to encompass frequently occurring concomitant gonococcal urethritis and NGU infections. This means treatment with long acting penicillin, combined with ciprofloxacin and azithromycin or erythromycin. A similar situation may exist in other geographical locations with a need to provide appropriate antimicrobial combinations depending on the patterns of infection detected.

Adult↗
PubMed2003

Unusual presentation of early lymphogranuloma venereum in an HIV-1 infected patient: effective treatment with 1 g azithromycin.

The incidence of lymphogranuloma venereum (LGV) is low in the western world. Early LGV is characterised by bubonic disease following a painless papule or small ulcer. We report a white bisexual male who presented with a painful perianal ulcer, inguinal lymphadenitis, and concomitant infection with human immunodeficiency virus 1 (HIV-1). Chlamydia trachomatis serovar L2 was identified as the cause after polymerase chain reaction and genotyping the major outer membrane protein by restricted fragment length polymorphism. Treatment with a single dose of 1 g azithromycin was effective. This case illustrates that early LGV may mimic other genital ulcer diseases, such as genital herpes or chancroid, especially in HIV infected patients. In the western world, LGV must still be included in the differential diagnosis of bubonic disease with or without sexually acquired ulcers.

AIDS-Related Opportunistic Infections↗
PubMed1996

The place of quinolones in everyday clinical practice.

The new fluoroquinolones have many attributes and relatively few drawbacks. As a result, they have been rapidly adopted for the treatment of serious bacterial infections. The currently available fluoroquinolones are particularly effective for the treatment of urinary tract infections, bacterial diarrhea, enteric fever, gonorrhea, chancroid, skin and soft tissue infections, acute and chronic gram-negative osteomyelitis, gram-negative pneumonias, serious infections due to a variety of gram-negative bacilli, and in the eradication of the meningococcal carrier state. As we learn more about the properties of these compounds, the number and variety of infections for which they are useful continues to expand.

Anti-Infective Agents↗
PubMed1995

Combinations of sulphonamides with diaminopyrimidines: how, when and why?

Co-trimoxazole is still widely used for indications where trimethoprim alone is equally effective. The pharmacological rationale of the combination of trimethoprim and sulphamethoxazole involves synergistic action of the two drugs. This is true only from a laboratory point of view; several considerations have led to the conclusion that the synergism between the two components is of only in vivo marginal importance in determining the clinical efficacy of co-trimoxazole. This is due to a greater tissue affinity of trimethoprim compared to that of sulphamethoxazole and, therefore, to the different tissue concentration ratios obtained in vitro and in vivo. Another claim sustaining the combination is the prevention of developing resistance to trimethoprim; however, there is no substantial clinical evidence to support this claim. It does seem likely that trimethoprim has protected against the emergence of that sulphonamide resistance. This slight benefit is outweighed by the disadvantages of the combination, mainly consisting of the occurrence of adverse events due to the sulphonamide moiety. Consequently, the incidence and severity of the adverse events seen with co-trimoxazole should be reduced by using trimethoprim alone. There are only a few cases where co-trimoxazole is better than trimethoprim: toxoplasmosis, brucellosis, nocardiosis, chancroid and pneumonia due to Pneumocystis carinii. For the other and many common infections, scientific rationale, economic and clinical reasons dictate that trimethoprim is superior to co-trimoxazole.

Dihydropteroate Synthase↗
PubMed2001

The legal framework covering the practice of genitourinary medicine in the UK: the Venereal Diseases Regulations.

The legal framework governing the practice of genitourinary medicine is traced from 1916 to the present. The first legislation, the Public Health (Venereal Diseases) Regulations of 1916 was comprehensive, and accompanied by guidance on setting up outpatient clinics and their supporting laboratories with practical advice on taking samples to support clinical diagnosis. Confidentiality was emphasized. The regulations led to the development of a nationwide network of clinics providing free care, open at times convenient to the public, and situated in general hospitals in large centres of population. Most of the principles still apply. Subsequent legislation centred on maintaining the confidentiality of all information obtained in relation to persons examined or treated for venereal disease, but allows transfer of details between healthcare providers to facilitate care and contact tracing. While the initial regulations stated that the venereal diseases were syphilis, gonorrhoea and chancroid, the legislation now covers all sexually transmitted diseases.

Female Urogenital Diseases↗
PubMed2003

HIV prevalence in Zimbabwean women: 54-67% knowledge and perceived risk.

This study examined the level of knowledge of sexually transmitted infections (STI) and HIV, knowledge of symptoms and potential sequelae of STI and perceived personal risks of infection among urban women in Zimbabwe. The women consented to being interviewed, examined, tested and treated for curable diagnosed STIs. Prevalence of both STI and HIV was high 11.4% and 54.5% among women aged 15-19 years, 28.5% and 62.4% among those 20-29 years and was highest among the age group >/=30 years 39.0% and 67.0% respectively. Women aged 15-19 years least perceived their risk of infection. Of the women with the highest rates of STI/HIV infection, less than 30% were aware of their vulnerability to such infections. Knowledge of specific STIs, their symptoms and sequelae was generally low. Women who did not know about syphilis, gonorrhoea, chancroid or warts were more likely to perceive themselves at no risk of infection. Condom use was very low (16.5%). There is an urgent need to improve current education programmes to raise awareness of STIs and the dangers of their long-term sequelae along with behavioural skills building interventions that include equipping women with negotiating skills, making female condoms available at affordable prices and motivating condom use.

Adolescent↗
PubMed2004

A 16-year study of HIV seroprevalence and HIV-related diseases in a teaching tertiary care hospital in India.

A total of 183,912 persons were screened from September 1986 to May 2002 in and around Haryana, out of whom 1178 were reactive (0.64%) for anti-HIV antibodies. The overall incidence of HIV-1 in the seropositive patients was 98.5%, HIV-2 alone was 0.8% and 0.7% had a mixed infection with both HIV-1 and 2. High seropositivity (22.8%) was observed among the relatives of these HIV-positive individuals. The heterosexual route (78%) remained the predominant mode of transmission. Among the jail inmates only one individual out of 1306 (1986 to 1993) was found to be positive. Tuberculosis (46.7%) was the most common opportunistic infection in these seropositive patients. Significant titres of Venereal Disease Research Laboratory tests were observed in 8.8% seropositive patients, 7.9% were positive for hepatitis B surface antigen and only two patients were suffering from chancroid. Forty-six of these HIV-seropositive patients had already died. In order to cope with this epidemic, new models of care and cost-effective preventive measures are needed.

AIDS-Related Opportunistic Infections↗
PubMed1997

High HIV prevalence, low condom use and gender differences in sexual behaviour among patients with STD-related complaints at a Nairobi primary health care clinic.

Of 22,274 patients > or = 12 years old attending a Nairobi primary health care (PHC) clinic, 1076 (4.8%) had STD-related complaints, of whom 980 underwent assessment of risk factors for human immunodeficiency virus (HIV) infection and infrequent condom use. Gonorrhoea, chancroid, syphilis seroactivity, trichomoniasis, or objective signs of STD were found in 78%, and HIV seropositivity in 15% of men and 19% of women. Most women were married, living with a spouse; while most men were single, or married, but living separated from a spouse. Among married men, last sex was with a female sex worker (FSW) or casual partner for 60% not living with a spouse and 26% living with a spouse (P<0.005). Two or more partners during the past year were reported by 82% of men and 25% of women (P <0.001), and 55% of men and 11% of women reported the last partner was high risk. HIV seropositivity among both genders was associated with numbers of partners, and among women, with being widowed or divorced. Only 3% reported use of a condom with the last partner. Among men whose last sex was with a FSW, 74% said the reason for not using a condom was not having one. Thus, infrequent condom use, low condom availability, and gender differences in behaviour necessitate modifying development policies that separate families; and better coordination between family planning, PHC, and AIDS/STD programmes, with improved supply, social marketing and community-based distribution of condoms in high-risk settings for STD/HIV prevention.

Adolescent↗
PubMed1998

High occurrence of HBV among STD clinic attenders in Bombay, India.

The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.

Adolescent↗
PubMed1987

Role of cephalosporins in gonorrhoea and other sexually transmitted diseases.

Cephalosporins have a role in the treatment of gonorrhoea, and especially infections caused by strains that are penicillin-resistant, either because they produce plasmid-mediated beta-lactamase or they have chromosomally mediated diminished permeability or modified penicillin-binding proteins. Although none of the oral or Group I agents are useful, most of the Group II, III and IV agents are, and especially cefuroxime, cefotaxime, ceftriaxone and cefoxitin. In addition to uncomplicated urethral, cervical or rectal infections, appropriate regimens are also effective for the treatment of pharyngeal infections, disseminated infections and gonococcal ophthalmia. The cephalosporins have no clear role in the treatment of syphilis, granuloma inguinale, Mycoplasma or chlamydial infections or bacterial vaginosis, but ceftriaxone may be effective in chancroid, and cefoxitin in combination with an antichlamydial agent (such as a tetracycline) might be used for the treatment of pelvic inflammatory disease.

Cephalosporins↗
PubMed1990

Amoxicillin/clavulanic acid. An update of its antibacterial activity, pharmacokinetic properties and therapeutic use.

Clavulanic acid enhances the antibacterial spectrum of amoxicillin by rendering most beta-lactamase-producing isolates susceptible to the drug. In clinical trials amoxicillin/clavulanic acid is clinically and bacteriologically superior to amoxicillin alone and at least as effective as numerous other comparative agents, such as orally administered cephalosporins, cotrimoxazole, doxycycline and bacampicillin, in the treatment of adults and children with the most common forms of infection encountered in general practice, i.e. urinary tract infections, upper and lower respiratory tract infections, otorhinolaryngological infections, and skin and soft tissue infections. It may also provide effective treatment for uncomplicated gonorrhoea, chancroid and gynaecological infections as well as acting as a prophylactic agent against surgical infection. Thus, in general practice environments where beta-lactamase production has restricted the effectiveness of amoxicillin, the combination of clavulanic acid with amoxicillin has clearly extended the usefulness of a tried and proven first-line antibacterial agent.

Amoxicillin↗
PubMed1993

Quinolones in sexually transmitted diseases.

The role of quinolones in the treatment of sexually transmitted diseases is assessed. Little is known of their activity against Treponema pallidum. These compounds are all highly active against Neisseria gonorrhoeae, and have produced good in vivo results with a single dose. Only the more recent compounds show useful antichlamydial activity in vitro. Clinical trials with ofloxacin demonstrate the efficacy of a single daily dose for 7 days for chlamydial genital infection in men and women. Results for treatment of bacterial vaginosis have so far been disappointing. Ciprofloxacin and fleroxacin are effective for chancroid. The potential for treating pelvic inflammatory disease with new quinolones is discussed.

Anti-Infective Agents↗
PubMed1995

Quinolones in sexually transmitted diseases. Global experience.

The role of quinolones in sexually transmitted diseases is still being defined. In vitro and in vivo efficacy of established agents against gonorrhoea after a single oral dose is well established, although problems with emerging resistance have been identified. However, among these agents only ofloxacin is reliably active against Chlamydia trachomatis infection, and only as a course of treatment. Preliminary trials with sparfloxacin are encouraging. Other new agents show potentially useful in vitro activity, but clinical studies are awaited. To date, clinical activity of quinolones in bacterial vaginosis has been disappointing. The efficacy of newer agents with anaerobic activity will be of interest. Chancroid can be cured with ciprofloxacin or ofloxacin; resistance has been reported, but is not yet clinically significant. Ofloxacin appears to be effective therapy for pelvic inflammatory disease, without the need for additional anaerobe cover. The possibility of improved clinical efficacy justifies further in vitro and in vivo studies.

4-Quinolones↗