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PubMed2005

Vaginitis and sexually transmitted infections in a hospital based study.

OBJECTIVE: To determine the frequency of Sexually transmitted infections (STIs) in immigrant population versus the local population, comparing the symptomatic patients against the asymptomatic women as controls. METHODS: A cross-sectional comparative study was conducted in Gynaecology Clinic of Unit 1, Bolan Medical Complex Hospital, Quetta. The study duration was six months from 1st April, 2004 to 31st October, 2004, examining 500 women. World Health Organization (WHO) recommended questionnaire was answered and High Vaginal Swab (HVS) was taken from posterior fornix of patient's vagina. Gram staining was done by the Pathology Department of the same hospital and description was based on Nugent's score and modified Spiegel's criteria. Blood was analyzed for human immunodeficiency virus (HIV) and hepatitis-B surface antigen (HBsAg) by immunochromatography. Analysis of results was done by Chi square test, screening test validity and incidence testing. RESULTS: Women with vaginal discharge had higher incidence of STI (84%) than without it (38%). Refugees and women with grand multiparity made the high risk groups of targeted testing (P < 0.001). The commonest notifiable infections, in this study were vaginitis (33.48%), bacterial vaginosis (30.7%), candidiasis (10%), trichomoniasis (7.2%), gonorrhea (1.35%) and 1 case each of lymphogranuloma venereum and chancroid, and 3 carrier states of HbsAg were detected. No case of syphilis or HIV/AIDS, or genital herpes was found. CONCLUSION: This study will serve as a marker for the tip of an iceberg of STI in Balochistan, needing targeted testing in high risk groups.

Adolescent↗
PubMed2006

Profile of men suffering from sexually transmitted infections in Pakistan.

BACKGROUND: To evolve effective prevention and efficient treatment strategies for sexually transmitted infections (STIs) in a country, comprehensive understanding of the prevalent STI and their modes of transmission is needed. The aim of this present study was to generate such data for Pakistan. METHODS: The study was conducted between June 1999 and September 1999 in four provincial capitals. In each city, data was collected from one or more teaching hospitals and a number of general practitioners. During this period, 465 men suffering from STIs were interviewed. RESULTS: The mean age of study population was 31.9 +/- 8.6 years, 60% were married, 58.3% urbanites, 81.7% living with their families and 83.3% smokers. Only 10.5% were drug addicts. Out of 465 cases, 27.5% cases had gonorrhea, 31.6% syphilis, 17.2% chancroid, 18.3% herpes, 5.2% chlamydial infections while only one case (0.2%) was HIV positive. Most men (55%) acquired the infection heterosexually, 11.6% through homosexuality, 18.4% through bisexual relations and 2 men (0.5%) reported bestiality. Among 78.1% of those contracting the infection heterosexually, the source of infection was a sex worker. None acquired infection through his wife. The knowledge about STIs was very poor. Wrong notions were prevalent. CONCLUSIONS: The pattern of STIs is different from developed countries. Those acquiring STIs in Pakistan were older, married and living with their families whereas in developed countries most men acquiring STIs are younger, unmarried and living alone.

Journal Article↗
PubMed2006

Changing trends in sexually transmitted infections at a Regional STD Centre in north India.

BACKGROUND & OBJECTIVES: Sexually transmitted infections (STIs) a major public health problem in India show various trends in different parts of the country. However, there are limited data on the changing profile of laboratory proven STIs in the same clinic over the years. The present study was thus aimed to determine the changing trends of the profile of STIs and HIV seropositivity in STD clinic attendees over a 15 yr period, and also to detect change, if any, in the antimicrobial resistance pattern of Neisseria gonorrhoeae. METHODS: The STIs were diagnosed clinically and confirmed by standard laboratory techniques. Socio-demographic data were collected through pre-designed proformae. The STI profile and HIV seropositivity were compared between 1990-1993 (A), 1994-1997 (B), 1998-2001 (C) and 2002-2004 (D). Antimicrobial resistance pattern of N. gonorrhoeae was determined by standard techniques and compared between the last three periods. RESULTS: Of the 78,617 STD attendees, 12,709 (16.2%) had STIs. During period A, genital discharges and during B, C and D, genital ulcerative diseases were predominant. Syphilis was the commonest STI. There was significant rise in the cases of syphilis, herpes progenitalis and genital warts and reduction in that of chancroid, lymphogranulomavenereum (LGV), donovanosis, candidiasis, trichomoniasis and bacterial vaginosis cases. The number of cases with primary syphilis diminished significantly (P<0.001), with a concomitant rise in secondary and early latent syphilis. A rising trend was observed in the HIV seropositivity during the different periods. The association of HIV seropositivity was consistently more in patients presenting with genital ulcers specially syphilis, and rose significantly from A (0.6%) to C (8.8%), but became stationary during D. A drastic change in the antimicrobial resistance of N. gonorrhoeae from B to C and C to D and the emergence of less sensitive isolates to ceftriaxone during the later part of the study were observed. INTERPRETATION & CONCLUSION: Our study showed a definite changing trend in the profile of STIs in the clinic attendees of a major STD centre during a 15 yr period. However, the significant rise in the cases of viral STIs and syphilis contrasted with reduction in the rest.

Adult↗
PubMed1992

Update on bacterial sexually transmitted disease.

Sexually transmitted diseases (STDs) are the most frequently reported bacterial infections. In 1990, slightly more than 700,000 cases of gonococcal disease were reported to the Centers for Disease Control, and the estimated incidence of chlamydial infections is 3 million to 4 million annually. Bacterial genital ulcer diseases such as syphilis and chancroid are increasing in epidemic proportions. The author reviews bacterial STDs in two categories: exudative mucosal infections and genital ulcer diseases.

Female↗
PubMed1991

[Epidemiology of sexually transmissible diseases in developing countries in the era of AIDS].

Recent developments in the epidemiology of sexual transmitted diseases (STD) in developing countries are reviewed. STD are very frequent in the tropics, particularly in large urban areas. They put a heavy burden on public health because they affect the economically most important age groups and because their sequellae may be fatal. Pelvic inflammatory disease and its consequences, and morbidity during pregnancy and the neonatal period are among the most important causes of mother and child morbidity. STD favour sexual transmission of HIV and may therefore explain the explosive AIDS epidemics in many developing countries. Antimicrobial resistance has made treatment of gonorrhoea and chancroid more difficult and more expensive. STD and HIV infection may be responsible for up to 17% of productive years lost to disease in certain regions. Strategies to control STD should be developed and linked with the AIDS programs. Both should be integrated in the primary health care system.

Developing Countries↗
PubMed1990

The epidemiology of sexually transmitted diseases in Southeast Asia and the western Pacific.

Sexually transmitted diseases (STDs) and their complications are common in Southeast Asia (SEA) and the Western Pacific region. Gonorrhea, chancroid, nongonococcal urethritis, and syphilis are still the major STDs. However, the clinical incidence of genital herpes and genital warts show a definite increase. The gonococcal infections in SEA show high levels of antimicrobial resistance. There is a high level of chromosomal-mediated and plasmid-mediated penicillinase resistance. The sex industry, strongly fueled by local consumption, travel, and tourism, continues to play an important focal role in maintaining the high level of transmission of STDs in SEA and the Western Pacific region.

Asia, Southeastern↗
PubMed1990

The epidemiology of sexually transmitted diseases in Africa and Latin America.

We review some aspects of the epidemiology of sexually transmitted diseases (STDs) in the developing countries of Africa and Latin America. Apart from their elevated prevalence, they are responsible for important morbidity in mother and child. Stillbirth, premature delivery, conjunctivitis, and respiratory tract morbidity of the neonate are frequently caused by STDs. Sequelae in adult women include pelvic inflammatory disease, ectopic pregnancy, and infertility. The emergence of antimicrobial resistance has complicated the picture in recent times. Genital ulcer disease is very common in developing countries, the most important being chancroid. Both continents are experiencing major epidemics of the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection with different epidemiological characteristics than in the industrialized world. A link might exist between the high prevalence of STDs and the rapid heterosexual spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Diagnosis and management of acute genital ulcers in sexually active patients.

Sexually transmitted genital ulcer diseases include herpes simplex, chancroid, granuloma inguinale, lymphogranuloma venereum, and syphilis. Each of these infections has a characteristic clinical picture, but an accurate diagnosis usually requires the support of laboratory tests. The diagnosis will determine the appropriate therapy as well as sexual partner management.

Acute Disease↗
PubMed1990

HIV seropositivity among patients with sexually transmitted diseases in Vellore.

In a prospective, systematic investigation, 2215 new patients with sexually transmitted diseases (STD) were screened for human immuno deficiency virus (HIV) infection during April 1986 to December 1988. Among them 9 were positive for HIV antibody giving a rate of 4/1000. In addition, 5 patients had been referred to our clinic with a diagnosis of HIV infection and STD. Among these 14, there was one married couple. Of the remaining 5 married individuals, 4 were men; the wives of 3 of them were infected but asymptomatic, and were not included in this report. The rate of conjugal infection was 71 per cent. Most (57%) patients belonged to poor socio-economic background; 78 per cent of patients were young, in the age group 15-25 yr. The presenting STD were syphilis, venereal warts, gonorrhoea, chancroid, genital herpes, non-gonococcal urethritis and candidiasis. It appeared that the course of associated STD had not been altered in these HIV infected individuals.

Adolescent↗
PubMed1990

Sexually transmitted diseases in leprosy patients in north and northeastern India. A futile search for human immunodeficiency virus antibody.

Three-hundred-eighty-four leprosy patients were clinically examined for sexually transmitted diseases (STD) in north and northeastern India, revealing a high incidence (5.2%) of STD among them. Eighteen males, one female, and one eunuch were found to have chancroid ulcer, gonococcal urethritis, lymphogranuloma inguinale, and primary chancre. Of these patients, only 100, selected randomly, could be screened serologically for STD due to Treponema pallidum, herpes simplex (type 1 and 2), Entamoeba histolytica, hepatitis-associated virus, cytomegalovirus, Chlamydia trachomatis and human immunodeficiency virus (HIV); 100 control sera were included for comparison. In addition, sera from another 133 normal subjects and another 176 lepromatous patients were also screened for HIV antibody. Thus, a total of 233 normal sera and 276 leprosy sera were tested for HIV antibody. Although our leprosy patients have shown significantly high incidences of clinical STD and also high seropositivity against T. pallidum, herpes-simplex viruses types 1 and 2, hepatitis-associated virus, and cytomegalovirus, the search for antibody against HIV was negative. Our clinical and serological data suggest promiscuity in our patient population. The absence of HIV antibody in this high-risk population, however, seems to be an enigma.

Adult↗
PubMed1990

Epidemiology of sexually transmitted diseases: the global picture.

Sexually transmitted diseases (STD) are now the commonest group of notifiable infectious diseases in most countries, particularly in the age group of 15 to 50 years and in infants. Their control is important considering the high incidence of acute infections, complications and sequelae, their socioeconomic impact, and their role in increasing transmission of the human immunodeficiency virus (HIV). The worldwide incidence of major bacterial and viral STD is estimated at over 125 million cases yearly. STD are hyperendemic in many developing countries. In industrialized countries, the bacterial STD (syphilis, gonorrhoea, chancroid) declined from the peak during the Second World War till up to the late fifties, then increased during the sixties and early seventies, and they have been decreasing again from the late seventies till the present. In the industrialized world, diseases due to Chlamydia trachomatis, genital herpes virus, human papillomaviruses and human immunodeficiency virus are now more important than the classical bacterial ones; both groups remain major health problems in most developing countries. Infection rates are similar in both women and men, but women and infants bear the major burden of complications and serious sequelae. Infertility and ectopic pregnancies are often a consequence of pelvic inflammatory disease, and are preventable. Sexually transmitted diseases in pregnant women can result in prematurity, stillbirth and neonatal infections. In many areas 1-5% of newborns are at risk of gonococcal ophthalmia neonatorum, a blinding disease; congenital syphilis causes up to 25% of perinatal mortality. Genital and anal cancers (especially cervical cancer) are associated with viral sexually transmitted diseases (genital human papillomavirus and herpes virus infections). Urethral stricture and infertility are frequent sequelae in men.

Adolescent↗
PubMed1990

Diagnosis and management of sexually transmitted genital lesions.

A variety of genital lesions can be caused by sexually transmitted diseases. These lesions present in sexually active clients of all ages and socioeconomic groups with varying degrees of pain, lymphadenopathy and constitutional symptoms. If lesions are misdiagnosed or improperly treated, sexually transmitted diseases spread and clients may suffer complications. Differential diagnosis of genital lesions caused by sexually transmitted diseases includes herpes genitalis, syphilis, lymphogranuloma venereum, chancroid, condyloma acuminatum, granuloma inguinale, and molluscum contagiosum. Health care providers must be skilled at differential diagnosis, institution of appropriate treatment, and sexual counseling of clients and their partners.

Counseling↗
PubMed1988

[The campaign against sexually transmissible diseases and endemic treponematoses].

From the moment WHO was established in 1948, the control of venereal diseases was felt to deserve highest priority, together with activities to control malaria and tuberculosis. International action was needed in view of the high morbidity and mortality from venereal diseases, their serious human and social consequences, and the prevalence of congenital syphilis and other sexually transmitted diseases (gonorrhoea, chancroid, venereal lymphogranulomatosis, granuloma inguinale). WHO immediately set up a global programme for the control of STDs and, with the participation of other agencies, especially UNICEF, furnished countries with assistance in the form of personnel, equipment and funds for the operation of programmes to assess the extent and impact of STDs and to plan and implement practical measure of control. The 1950s witnessed a steady and considerable decline in syphilis and gonorrhoea and many health authorities relaxed their control activities and efforts to maintain public awareness of the problem. In contrast to the prevailing optimism, WHO repeatedly stressed the possibility of a renewed upsurge of STDs. In the 1960s and 1970s, there was a sharp rise in STDs, both in the "classic" diseases (the five venereal diseases mentioned above) and also in the "second generation" STDs (chlamydial infection, genital herpes, human papillomavirus and other infections). Through its programme for the control of STDs, WHO put forward suitably designed control strategies, essentially based on information and education for health, screening for STDs, diagnosis and treatment of cases, contact tracing, and the training of health personnel. By the end of the 1970s, the bacterial, but not the viral STDs, had been contained in the industrialized countries. In many of the developing countries, STDs remained a priority public health problem, above all on account of the seriousness of their sequelae. In 1981, a new sexually transmitted disease-the acquired immunodeficiency syndrome (AIDS)-was identified. As of 1982, the WHO Programme on STDs organized meetings to define the extent of the problem, compare experience, promote and coordinate research and propose strategies for prevention. In 1987, WHO established a Global Programme on AIDS. It is clear that the control of STDs is now more than ever a priority. We have strategies for the prevention and control of STDs and the WHO Programme will continue to collaborate closely with countries in strengthening their national control programmes.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1989

International travel and sexually transmitted diseases.

Sexually transmitted diseases (STDs) are a group of communicable diseases transferred mainly by sexual contact. Population movements are undoubtedly a major contributing factor in the spread of STDs. Owing to the ease of modern travel, larger numbers of people are moving around than ever before in peacetime. Travellers may both import and export infection, and the importance of their role in the transmission of STDs is demonstrated by the rapid worldwide spread of penicillinase-producing strains of N. gonorrhoeae (PPNG) and AIDS. While in most industrialized countries the incidence of the classic STDs (syphilis, gonorrhoea, chancroid) has decreased during the last decade, they remain hyperendemic in many developing countries due to poorly developed STD services. In many industrialized countries, the incidence of genital C. trachomatis infection now exceeds that of gonococcal infection. Chlamydial infections were previously thought to be infrequent in developing countries, but recent research has made it clear that this infection is at least as frequent as gonorrhoea. Incidence of genital herpes and genital human papilloma-virus infections (HPV) has increased dramatically during the last 20 years. Now that international travel takes place increasingly by air, it is more likely than previously for a traveller to return home within the incubation period of many STDs. Moreover, people behave differently when they travel. Tourists travel to seek adventure and new experiences, including sex. In countries where a good notification system exists, up to 30% of new cases of syphilis were found to be acquired abroad. Since PPNG appeared in 1976, these strains have spread to almost all areas of the world. During the first five years of the epidemic, most cases in Europe and the United States of America were imported. Measures for preventing STDs are the same whether the individual is travelling or not. Abstinence or sexual intercourse between two mutually-faithful uninfected partners exclusively are the only totally effective prevention strategies. The risk of infection can also be significantly reduced by adopting safe sexual practices such as the use of condoms. Prophylactic use of an antibiotic is not recommended, however.

Female↗
PubMed1989

[Sexually-transmissible anorectal diseases].

Several anorectal diseases are described. Most are sexually transmitted (gay bowel syndrome or heterosexual transmission). The clinical aspect of nearly all of them is similar. Thus, the diagnosis usually cannot be done on clinical grounds alone: one has to request the help of the laboratory. Amebiasis, giardiasis, chancroid and donovanosis are frequent in Africa but rare in our countries, except in male homosexuals. Shigellosis, salmonellosis, pediculosis, scabies and campylobacter infections are seen in male homosexuals because of orofecal contacts. Condylomata acuminata are frequent in our country. The typical clinical aspect leads to an easy diagnosis. Electrocoagulation is the treatment of choice. Anorectal gonococcal are also frequent in our country, both homosexually and heterosexually transmitted. The clinical aspect suggests the diagnosis, but this must be confirmed by the laboratory.

Adult↗
PubMed1989

A study of morbidity pattern among prostitutes attending a municipal clinic in Pune.

The findings of the present study revealed that out of 200 prostitutes attending a clinic for various ailments, 81.50% were suffering from sexually transmitted diseases (STD) thus posing a potential risk of transmitting these diseases to their clients. Syphilis was found to be the commonest STD afflicting 36.80% of the respondents, the next common being the chancroid (31.28%); 5.52% of the respondents were found to be suffering from concomitant venereal infections. The other important communicable diseases with which some respondents were found to be afflicted, included--tinea infection (3 cases), scabies (2 cases), leprosy (2 cases), pulmonary tuberculosis (4 cases) and upper respiratory tract infection [3 cases). Thus, the prostitutes remain an undisputed potential source of infection not only of STDs but also several other communicable diseases. Therefore, their continuous surveillance, early diagnosis, appropriate treatment and subsequent follow-up should be meticulously carried out. On the other hand the public, particularly the sexually promiscuous individuals must be imparted vigorous health education to avoid exposure to this source.

Adult↗
PubMed1989

Causes and treatment of sexually acquired genital ulceration in southern Africa.

The cause of sexually acquired genital ulceration was studied in 240 consecutive migrant mineworkers attending a sexually transmitted disease clinic in Carletonville, Transvaal. Chancroid proved to be the most common cause of genital ulcer disease, with Haemophilus ducreyi being isolated from 164 patients (68%). In 60% of cases the disease was locally acquired and in the remaining 40%, the infection was acquired in Lesotho, Botswana, Natal, Transkei and Malawi. Syphilis was diagnosed in 62 patients (26%), lymphogranuloma venereum in 16 (7%), genital herpes in 8 (3%) and granuloma inguinale in 1. No cause of ulceration could be found in 31 patients (13%). Mixed infections were documented in 41 patients (17%). Diagnosis of the cause of genital ulcer disease is not possible without relatively sophisticated laboratory support; however, simplified strategies for management and treatment have been developed.

Adult↗
PubMed1987

[Clinical observations on urethritis over the last eight years in Gifu City Hospital].

Clinical observations were made on patients with urethritis, syphilis, chancroid, genital herpes and venereal warts for the last eight years at Gifu City Hospital. The patients with urethritis, genital herpes and venereal warts tended to increase yearly, and the number of the cases with urethritis increased about 2.5 times in the eight years. Slightly more patients had nongonococcal urethritis than gonococcal urethritis excluding 1981. Of the patients with gonococcal urethritis seen between 1977 and 1979, 58% were treated with benzylpenicillin intramuscularly, and 43% of the patients seen between 1980 and 1984 were treated with a concomitant therapy of spectinomycin intramuscularly and minocycline or doxycycline orally. The cure rate for each treatment was 94% and 97%, respectively. Of the patients with nongonococcal urethritis seen between 1980 and 1984, 89% were treated with minocycline or doxycycline orally, and the cure rate was 97%. On the other hand, the cure rate was 43% for the treatment between 1977 and 1979, only 10% of whom had received treatment with minocycline or doxycycline.

Adolescent↗