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PubMed1985

[Digestive localizations of sexually transmitted diseases in male homosexuals].

The common practice of sexual relations with many different and anonymous partners and the great variety of responsible micro-organisms account for the high incidence, growing complexity and uneasy prevention of sexually transmitted diseases of the digestive tract in male homosexuals. Syphilis, gonorrhoea, papillomas, chancroid, donovanosis, herpes virus or Chlamydia infections are known to be transmitted by anal coitus; amebiasis, giardiasis and shigellosis by oro-anal contact (faecal contamination). Still under discussion, however, are the predominant mode of transmission of Campylobacter jejuni, the true frequency in homosexuals of intestinal anguilluliasis, oxyuriasis and salmonellosis and the anorectal pathogenicity of Neisseria meningitidis, intestinal spirochetes, Mycoplasma homini, Ureaplasma urealyticum and Campylobacter-like organisms. Diagnosis is difficult since these infections are polymicrobial as a rule and often clinically asymptomatic or atypical and may be further modified by features of the acquired immunodeficiency syndrome, traumatic lesions or anorectal tumours. Microbiological examination is an essential prerequisite to rational treatment.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Genital ulcers in French Guyana. Apropos of 231 cases screened in 2 years].

In fight against Sexually Transmitted Diseases (STD), 231 cases of genital ulcers were observed, in 1985 and 1986, in Cayenne (French Guiana) according to a clinical and laboratory study protocol described by the authors. The diagnosis shown, in 146 cases, one STD agent, with a high frequency of chancroid, herpes genitalis and primary syphilis. In addition, 18 cases of mixed genital infections are described: emphasis is laid on the great diversity of these associated diseases. 67 genital ulcers had not been caused by a STD agent, however in each case a complete laboratory investigation was done, and each patient received a treatment according to the diagnosis.

Adolescent↗
PubMed1978

Ulcerative vaginitis due to Torulopsis glabrata: a case report.

A patient with ulcerative vaginitis is presented. The differential diagnosis included malignant ulcer, chancroid, and granuloma venereum. Torulopsis glabrata vaginitis, which was subsequently proven, responded successfully to clotrimazole suppositories. Predisposing and related factors and isolation and identification procedures are discussed.

Candida↗
PubMedDate not supplied

Amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination.

The chemistry, microbiology, pharmacokinetics, therapeutic use, adverse effects, and dosage of amoxicillin-potassium clavulanate, a beta-lactamase-resistant antibiotic combination, are reviewed. Clavulanic acid is a "suicide" inhibitor of bacterial beta-lactamase enzymes and has been effective in preventing destruction of penicillins by these enzymes. Clavulanic acid alone has weak antibacterial activity against most organisms. After oral administration, clavulanic acid is rapidly absorbed; amoxicillin appears to increase its absorption. Absorption of amoxicillin-clavulanic acid is not affected by food. Amoxicillin-clavulanic acid is effective in treating both acute uncomplicated and complicated urinary-tract infections and exacerbations of chronic bronchitis caused by amoxicillin-resistant organisms in adults. It appears to be comparable in efficacy to cefaclor for treating uncomplicated urinary-tract infections in adults and children, acute bronchitis and bronchopneumonia, and acute sinusitis, otitis media, and skin and soft-tissue infections in children. Other infections for which the combination has been effective include cellulitis and intra-abdominal and pelvic sepsis caused by mixed aerobic/anaerobic organisms. Amoxicillin-clavulanic acid has also successfully cured urethritis in men caused by penicillinase-producing Neisseria gonorrhoeae and is superior to amoxicillin alone for beta-lactamase-positive Haemophilus ducreyi infections (chancroid). Diarrhea or loose stools is the most common side effect seen with amoxicillin-clavulanic acid; nausea, vomiting, and skin rash may also occur. Nausea, vomiting, and diarrhea may be lessened by taking the combination with food.(ABSTRACT TRUNCATED AT 250 WORDS)

Amoxicillin↗
PubMed1984

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

The causes of genital ulcers vary with the age of the patient. Although sexually related genital ulcers can be seen at any age, they are most common between the ages of 15 and 30. The differential diagnosis includes syphilis, chancroid, genital herpes, lymphogranuloma venereum, granuloma inguinale, fixed drug reactions, and traumatic ulcers.

Acute Disease↗
PubMed1983

Problems in the management of sexually transmitted diseases in South Africa.

On the subcontinent sexually transmitted diseases present considerable diagnostic and therapeutic problems. With the recognition of vast numbers of non-gonococcal and chancroid infections, penicillin therapy is no longer adequate. This article outlines an approach to the management of urethritis and genital ulcer disease, giving suitable guidelines for the treatment of these 'disease syndromes'. The management of sexually transmitted vaginal discharges is also discussed, and the relevance of the rapidly performed 'wet mount' in the diagnosis of those discharges arising from the vaginal wall is stressed.

Acute Disease↗
PubMed1980

[Therapy of sexually transmissible diseases].

Penicillin is still the drug of first choice for the treatment of Syphilis and Gonorrhoea. The therapy of infections with Treponema pallidum requires long lasting stabile blood and tissue levels, Neisseria gonorrhoeae can be eradicated by high serum concentrations of short duration. Chancroid and Donovanosis respond well to tetracylines, macrolide antibiotics and aminoglycosides while the application of sulfonamides or tetracyclines is suitable for the control of Lymphogranuloma venereum. Metronidazole or nimorazole derivatives may cure Trichomoniasis. Infections with Mycoplasmas (Urea-plasma) or Chlamydiae can be treated by tetracyclines only. Genital candidosis usually disappears after topical use of miconazole- or econazole- or clotrimazole-ointments. Herpes genitalis cannot be influenced by pharmacotherapeutical means, relapsing forms may be suppressed by vaccination. Mollusca contagiosa should be removed by the surgical spoon and genital warts can be destroyed by electrocautherization or by topical application of podophyllin solution.

Anti-Bacterial Agents↗
PubMed1995

Therapeutic algorithms for the management of sexually transmitted diseases at the peripheral level in Côte d'Ivoire: assessment of efficacy and cost.

In the acquired immunodeficiency syndrome (AIDS) era, adequate management of sexually transmitted diseases (STDs) is a primary concern in Africa. Assessed in this study is the clinical efficacy and feasibility of WHO-recommended therapeutic algorithms for genital discharges and ulcers, diagnosed without laboratory tests, for use at the primary health care level. Drugs were sold on a cost-recovery basis and included intramuscular ceftriaxone and oral ciprofloxacin for single-dose therapy of gonorrhoea and chancroid. During April 1993 in 10 peripheral health care centres in Abidjan, Côte d'Ivoire, a total of 207 patients were followed up, including 89 cases of male urethritis, 92 cases of vaginal discharges and 26 cases of genital ulcers; clinical success, assessed 7 days after the onset of therapy, was, respectively, 92%, 87%, and 100%. Less than 10% of the 207 patients were referred to the next care level, an acceptable rate from a public health point of view. Medical adherence to the algorithms was excellent for urethral discharges and genital ulcers but poor for vaginal discharges, partly because of intentional therapeutic modifications, without detriment to success. For drugs, the average cost per cure was 1546 francs CFA (US$ 5.60) (maximum, 2980 francs CFA (US$ 10.70). Effective and affordable treatments for STDs are necessary for their realistic case management in Africa.

Adolescent↗
PubMed1995

Increasing HIV-1 seroprevalence associated with genital ulcer disease, New York City, 1990-1992.

OBJECTIVE: To measure HIV seroprevalence trends associated with sexually transmitted diseases (STD) causing ulcerative lesions [genital ulcer disease (GUD)], such as syphilis, chancroid and genital herpes, in New York City between 1990 and 1992. DESIGN: Unlinked HIV-1 serosurvey using remnant serum drawn originally for routine syphilis screening. SETTING AND PATIENTS: Consecutive sample of patients presenting to New York City Department of Health STD clinics for STD examination (n = 41,678). MAIN OUTCOME MEASURE: Serologic evidence of antibody to HIV-1. RESULTS: Although overall HIV seroprevalence and GUD incidence declined between 1990 and 1992, seroprevalence in patients with GUD increased from 10 to 16%. In contrast, seroprevalence in patients with non-ulcerative STD decreased. The most dramatic changes in seroprevalence associated with GUD occurred in patients using crack cocaine and injecting drugs. CONCLUSIONS: Despite declining HIV seroprevalence and GUD incidence, the association between GUD and HIV infection has strengthened over time in New York City STD clinics. Longitudinal incidence studies are needed to elucidate the biological, behavioral and temporal associations between GUD and HIV. Timely diagnosis and treatment of acute STD and more intensive risk reduction strategies at the clinics and associated testing sites, with a particular focus on GUD patients, are indicated.

Female↗
PubMed1994

Vaccines for classic sexually transmitted diseases.

Sexually transmitted diseases (STDs) can substantially increase the morbidity and mortality of exposed adults and children. Despite the advent of new antibiotics and focus on behavioral interventions such as condom use, attempts to limit the spread of STDs have been largely unsuccessful. Vaccines have received increasing attention as a potential strategy for STD control. This article focuses on the current status of vaccine research for five classic STDs: gonorrhea, genital herpes, syphilis, chancroid, and chlamydia.

Animals↗
PubMedDate not supplied

[Lymphogranuloma venereum (LGV). Biological diagnosis].

In his thesis inspired on Favre's works, Phylactos (in 1922) synthetized the knowledges prevailing then on the disease which was characterized in 1913 by Durand, Nicolas, and Favre. He distinguished this disease from tuberculosis, Hodgkin's disease, pestis, syphilis, and chancroid, thus establishing the basic elements of the clinical diagnosis of lymphogranuloma venereum. In 1924, Gamma described the intracellular inclusions, thus giving rise to the biological diagnosis. In 1925, Frei proved that the heated pus filtrate obtained from buboes induced a specific intradermal reaction. In 1927, Gay Prieto described the elementary corpuscles.

Female↗
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↗
PubMed1993

1993 sexually transmitted diseases treatment guidelines. Centers for Disease Control and Prevention.

These guidelines for the treatment of patients with sexually transmitted diseases (STDs) were developed by staff members of CDC after consultation with a group of invited experts who met in Atlanta on January 19-21, 1993. Included are new recommendations for single-dose oral therapy for gonococcal infections, chlamydial infections, and chancroid; new regimens for the treatment of bacterial vaginosis (BV) and outpatient management of pelvic inflammatory disease (PID); a new patient-applied medication for treatment of genital warts; and a revised approach to the management of victims of sexual assault. This report includes new sections on subclinical human papillomavirus (HPV) infections and cervical cancer screening for women who attend STD clinics or who have a history of STDs. These recommendations also include expanded sections on the management of patients with asymptomatic human immunodeficiency virus (HIV) infection; vulvovaginal candidiasis (VVC); STDs among patients coinfected with HIV; and STDs among infants, children, and pregnant women.

Adolescent↗
PubMed1993

Human immunodeficiency virus seropositivity in adolescents with syphilis.

OBJECTIVE: The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection among inner-city, minority group adolescents. METHODS: From August 1989 through June 1990, serum from all positive serologic tests for syphilis, obtained from patients attending a comprehensive adolescent health center in an acquired immunodeficiency syndrome epicenter and its two school-based clinics, were frozen without patient identifiers and were subsequently screened for HIV by enzyme-linked immunosorbent assay with confirmatory Western blot for positives. In addition, a retrospective chart review was performed for all patients with a positive serologic test for syphilis during the study period. RESULTS: Of the 59 specimens with a positive syphilis serologic test, 9 (15.3%) were HIV seropositive. Of the patients with syphilis, 57.4% were black and 42.6% were Hispanic; 16.4% were male (mean age 18.1) and 83.6% were female (mean age 17.8). Only 1 subject (female) was an injection drug user; 4 of the male subjects self-identified as having had sex with other males. Of the subjects, 27.8% had primary, 19.7% had secondary, and 52.5% had latent syphilis at the time of diagnosis. A prior or concurrent sexually transmitted disease was present in 90% of the males and 80% of the females; gonorrhea was the most prevalent sexually transmitted disease in the males (89%) and chlamydia was most prevalent in the females (35%). A history of chancroid and/or herpes was present in 16.4% of the subjects. CONCLUSIONS: It is concluded that the diagnosis of syphilis in an adolescent is a risk factor for HIV infection. All sexually active adolescents should be routinely screened for syphilis, regardless of sexual practices. Those with syphilis should be specifically counseled about their increased risk for HIV infection and the importance of consistent condom use, and they should be referred for formal HIV pretest counseling.

Adolescent↗
PubMedDate not supplied

Human immunodeficiency virus-1 infection among patients with sexually transmitted diseases in Bombay.

BACKGROUND: Patients with sexually transmitted diseases form a particularly vulnerable group for infection with the human immunodeficiency virus (HIV-1), and serological surveillance is a sensitive tool for assessing the prevalence of this disease. METHODS: We carried out a serological survey for the detection of antibody to HIV-1 among persons belonging to various high-risk groups in Bombay from 1987 to 1989. Among these were 599 patients with various sexually transmitted diseases. RESULTS: Thirty-nine patients (5.2%) were found to be HIV-1 antibody seropositive by the ELISA and Western blot tests. An increase in HIV-1 antibody seropositivity among both the male and female patients with sexually transmitted diseases was detected from 1987 to 1989 and seropositivity was maximally associated with condylomata acuminata, genital herpes and chancroid. CONCLUSION: HIV-1 is established in this sentinel population and needs to be controlled vigorously.

AIDS Serodiagnosis↗
PubMed1993

[Prevention of sexually transmitted diseases or control of prostitutes and patients with venereal diseases? An exemplary, epicritical study in Bremen].

Data derived from laboratory and activity statistics of the Venereal Disease" department of the Public Health Office in Bremen were analysed between 1961 and 1991. The traditional concept to fight venereal diseases" aimed at controlling persons "at risk" for syphilis, gonorrhoea, chancroid or lymphogranuloma. This "high-risk" approach of STD prevention stressed the compulsory, at least twice monthly screening of female prostitutes and neglected other population groups like clients of prostitutes and young people, who might have an elevated risk in acquiring STD. The spread of STD like chlamydia, HPV, herpes and even HIV in considerable parts of the general population underlines the need for developing a more effective STD prevention, based on scientific diagnosis and treatment. Intervention programmes in STD control must be performed in full partnership with the targeted population; this can require great effort and time. But STD control certainly cannot be achieved under the threat of punishment or proscription.

Adolescent↗
PubMedDate not supplied

Sexually transmitted disease services in Madras: could their role in AIDS prevention be strengthened?

A baseline evaluation of the quality of STD case management was conducted in five areas of Madras city in 1992, using HIV prevention indicators recommended by the World Health Organization. Eighty-four interviews and 108 observations of private and public clinic practitioners were conducted. Sixty-one percent of interviewed doctors reported making only specific "clinical" diagnoses and 17% reported making only the WHO recommended syndrome-based diagnoses while 22% reported making both types of diagnosis. The adequacy of treatment was compared against various standards, including the Indian National Guidelines for STD management. Almost half of the health care providers (HCP) reported using a treatment effective against the two main pathogens that may cause male urethritis, while 20% reported using a treatment that was not effective against either. For male ulcers only 12% of HCPs reported using treatment effective against both syphilis and chancroid. Seventy-nine percent of the HCP reported that they advised their patients to use condoms, but in 30% only of observed consultations, condoms were promoted for STD or HIV/AIDS prevention. As information concerning the relative prevalence of pathogens in different areas is unlikely to be available, there is an urgent need for the syndromic approach to STD treatment be adopted by health care providers.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Sexually transmitted diseases in Australia: a decade of change. Epidemiology and surveillance.

Survival data in the last decade for sexually transmitted diseases (STDs) other than human immunodeficiency virus (HIV) are uneven across the states/territories. The incidence of gonorrhoea decreased by more than 80%, but at different times in different patient groups, different states, and different anatomical sites. There was a resurgence of rectal gonorrhoea in homosexual men in 1989-1991. Resistance to penicillin steadily increased, and partial resistance to quinolones has emerged. There was a marked decline in syphilis in most states. Lymphogranuloma venereum is rare, and chancroid seen mostly in returning travellers from Southeast Asia; however, hundreds of cases of donovanosis are seen annually among rural Aborigines. The prevalence of genital infections with Chlamydia trachomatis remained stable at 2.5%-14% in STD clinics, and 5% in family planning clinics. The numbers of cases of clinical genital herpes and warts are mostly unavailable. However, specific serology for herpes simplex virus type 2 (HSV-2) indicates that 14% of antenatal clinic patients, and 40%-60% of STD patients have been exposed. Pap smears have detected the presence of human papilloma virus (HPV) in 14%-40% of various clinic populations. Exposure to hepatitis B in the non-Aboriginal population decreased markedly. Hepatitis C infection occurred in a high percentage of injecting drug users; the evidence for sexual transmission is not strong. An epidemic of hepatitis A infection occurred in male homosexuals in 1989-1991. Changes in the Australian sex industry resulted in marked improvements in the sexual health of local (but not international) sex workers. The high levels of STDs in Aboriginal communities continues to cause concern.

Australia↗