Expression of pili by Haemophilus ducreyi.
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A cross-sectional study was conducted among women attending a sexually transmitted diseases clinic in Nairobi, kenya, to determine the prevalence of and associated risk factors for human immunodeficiency virus (HIV) type 1 infection. HIV-1 antibody was detected in 13.8% of 600 women. This virus was found most frequently in prostitutes (odds ratio [OR], 7.2), in women reporting a history of genital ulcers (OR, 2.3), and in those with a current diagnosis of genital ulcers (OR, 5.1). Lifetime duration of oral contraceptive use was significantly greater in HIV-1-positive women. Multivariate analysis revealed an association between genital ulcers and HIV-1 infection (OR, 3.8). The strongest association for HIV-1 infection, however, occurred with genital ulcers in combination with the use of oral contraceptives (OR, 25.7).
Electron microscopy was used to examine Haemophilus ducreyi adherence to and entry into eukaryotic cells of genital origin. A clinical H. ducreyi isolate (90-244) adhered in snake-like whorls to the surfaces of cervical carcinoma cells (HeLa 229), endometrial adenocarcinoma cells (HEC-1-B), and human neonatal foreskin fibroblast (HFF) cells. A prototype strain of H. ducreyi (CIP542) adhered in randomly organized clumps on the surfaces of HFF. Strain 90-244 entered HFF and HEC-1-B cells but did not enter HeLa cells. The H. ducreyi in the HFF cells at 2 h were partly surrounded by a membrane consistent with that of a phagocytic vacuole. At 2 h, strain CIP542 was found in interstitial spaces between the HFF cells and also in the cytoplasm of the cells. After 7 and 24 h, both strains of H. ducreyi were found in the large interstitial spaces between the HFF cells, in the cytoplasm, and extracellularly. This model of in vitro H. ducreyi infection of eukaryotic cells will allow for more specific study of factors that determine the virulence of H. ducreyi.
Human subjects were experimentally infected with Haemophilus ducreyi for up to 2 weeks. Bacterial suspensions were delivered into the epidermis and dermis through puncture wounds made by an allergy-testing device. Subjects developed papular lesions that evolved into pustules resembling natural disease. Some papular lesions resolved spontaneously, indicating that host responses may clear infection. Bacteria were shed intermittently from lesions, suggesting that H. ducreyi may be transmissible before ulceration. Host responses to infection consisted primarily of cutaneous infiltrate of polymorphonuclear leukocytes, Langerhans cells, macrophages, and CD4 T cells of alpha beta lineage. Expression of HLA-DR by keratinocytes was associated with the presence of interferon-gamma mRNA in the skin. There was little evidence for humoral or peripheral blood mononuclear cell responses to bacterial antigens. The cutaneous infiltrate of CD4 cells and macrophages provides a mechanism that facilitates transmission of human immunodeficiency virus by H. ducreyi.
We have compared the in-vitro activity of 12 quinolone antibiotics against 50 recent isolates of Haemophilus ducreyi from The Gambia. While these isolates were relatively resistant to the parent compounds, the newly synthesized quinolones exerted significant activity against H. ducreyi. Ciprofloxacin and ofloxacin were the most active compounds (MIC90 0.03 mg/l).
The in-vitro activity of cefpirome was compared with other antibiotics against organisms causing sexually transmitted diseases (STD). The excellent activity of cefpirome against Neisseria gonorrhoeae (MIC90 1.0 mg/L), Haemophilus ducreyi (MIC90 0.5 mg/L), and Gardnerella vaginalis (MIC90 1.0 mg/L) suggests that this agent might be useful in the empirical treatment of a variety of venereal diseases.
Recent advances in diagnostic tests for sexually transmitted diseases include the development of a synthetic Venereal Disease Research Laboratory reagent that will improve the sensitivity and stability of nontreponemal serologic tests for syphilis. A second generation user friendly and high throughput nucleic acid amplification test for Chlamydia trachomatis and Neisseria gonorrhoeae has also been developed.
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OBJECTIVE: To determine the prevalence of HIV-1 infection and to identify the most important risk factors for infection. DESIGN: A cross-sectional population survey carried out in 1990 and 1991 in Mwanza Region, Tanzania. METHODS: Adults aged 15-54 years were selected from the region (population, 2 million) by stratified random cluster sampling: 2434 from 20 rural villages, 1157 from 20 roadside settlements and 1554 from 20 urban wards. Risk factor information was obtained from interviews. All sera were tested for HIV-1 antibodies using enzyme-linked immunosorbent assay (ELISA); sera non-negative on ELISA were also tested by Western blot. RESULTS: The response rate was 81%. HIV-1 infection was 1.5 times more common in women than in men; 2.5% of the adult population in rural villages, 7.3% in roadside settlements and 11.8% in town were infected. HIV-1 infection occurred mostly in women aged 15-34 years and men aged 25-44 years. It was associated with being separated or widowed, multiple sex partners, presence of syphilis antibodies, history of genital discharge or genital ulcer, travel to Mwanza town, and receiving injections during the previous 12 months, but not with male circumcision. CONCLUSION: This study confirms that HIV-1 infection in this region in East Africa is more common in women than in men. The results are consistent with the spread of HIV-1 infection along the main roads. There is no evidence that lack of circumcision is a risk factor in this population.
OBJECTIVE: To establish a cohort of high-risk individuals suitable for HIV-prevention trials, and to measure changes in sexual behaviour and sexually transmitted disease (STD) incidence after a behavioural intervention. DESIGN: Prospective cohort study in trucking company depots in Mombasa, Kenya. PARTICIPANTS: A total of 556 male HIV-seronegative employees of trucking companies. INTERVENTIONS: HIV serological testing, individual counselling, condom promotion, STD diagnosis and management. MAIN OUTCOME MEASURES: Sexual risk behaviour and symptomatic STD incidence. RESULTS: Using time-trend modelling, significant declines in self-reported high-risk sexual behaviour were demonstrated during a 1-year follow-up. The percentage of men reporting any extramarital sex during the 3-month period prior to a follow-up visit decreased from 49% durig the first quarter of follow-up to 36% during the last quarter (P < 0.001). The decline in reported female sex worker contact was from 12% to 6% (P = 0.001). Approximately 30% of men reported consistent condom use during extramarital sex and this percentage remained unchanged during the study period. The incidence of STD declined from 34 per 100 person years (PY) during the first quarter to 10 per 100 PY during the last quarter (P = 0.001). Significant reductions in gonorrhoea (15 to five cases per 100 PY, P = 0.04), non-gonococcal urethritis (10 to two cases per 100 PY, P = 0.05), and genital ulcer disease (nine to two cases per 100 PY, P = 0.02) were observed. CONCLUSIONS: Among truck company workers who participated in a cohort study in Mombasa, Kenya, there was a significant decrease in sex with high-risk partners, but no change in condom use. The change in heterosexual risk behaviour was accompanied by a significant decrease in incidence of gonorrhoea, non-gonococcal urethritis, and genital ulcer disease.
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Despite advances with antibiotic therapies and increased public attention to acquired immunodeficiency syndrome, sexually transmitted diseases remain a major public health problem of epidemic proportions in the United States. The emergence of new pathogens and clinical syndromes has increased the complexity of the situation. Incurable conditions and asymptomatic disease states during an era of constrained public resources and deficient public awareness further heighten and compound the devastating consequences of sexually transmitted disease. The provision of comprehensive disease prevention, education and clinical services is an important and complicated dimension. Sexually transmitted diseases are responsible for considerable morbidity and substantial mortality, particularly among young women. This article provides an overview of the epidemic in financial and human terms, with a discussion of eight major pathogens from an epidemiological, clinical and educational-counseling perspective.
Material from 100 consecutive men who presented with penile ulcerations was tested for a variety of microorganisms. Fifty-one patients had microorganisms identified that were considered primary pathogens. The laboratory data were compared with the clinical diagnoses and the diagnostic accuracy and index of suspicion calculated. The diagnostic accuracy for lesions due to Treponema pallidum was 77.8%, Herpesvirus hominis 62.9% and Haemophilis ducreyi 33.3%, whereas the indexes of suspicion were 88.2%, 67.7% and 300% respecitively. These data show that the clinical diagnosis of genital ulcers is oftern inaccurate and that definitive diagnosis requires laboratory tests.
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Haemophilus influenzae was isolated from the urethra of three of 85 men attending a sexually transmitted diseases clinic. These isolates of H. influenzae were nonencapsulated; one was biotype III, and two were biotype IV. Haemophilus parainfluenzae was isolated from the urethra or coronal sulcus of five men; three isolates were biotype II, and two were biotype III. Neither H. influenzae nor H. parainfluenzae was isolated from the genital secretions of 84 women. Haemophilus ducreyi and Haemophilus equigenitalis (contagious equine metritis bacterium) were not isolated from any of the 169 patients.
In October 1982, penile ulcers were identified in 248 (19%) of 1282 men at Bangrak Hospital, Bangkok, Thailand. The etiology of the ulcers was determined for 120 (48%) of these patients. Haemophilus ducreyi was isolated from 45 (38%), herpes simplex virus from 14 (12%), and Neisseria gonorrhoeae from two (2%) of 120 patients. Syphilis was detected in one patient. Two patients had both H. ducreyi and herpes simplex virus isolated from the same ulcer. Thirty-five per cent of patients had a single ulcer, 56% had two to four ulcers, and 9% had more than four. Ulcers were located on the prepuce or coronal sulcus (69%), frenulum (18%), shaft (9%), and glans (4%). Inguinal adenopathy was present in only 11% of patients. H. ducreyi infection was diagnosed by gram stain in 28 (62%) of 45 patients from whom H. ducreyi was isolated and in only one of 75 patients from whom H. ducreyi was not isolated. Of the 45 isolates of H. ducreyi, 42 (93%) were isolated with use of media containing horse blood and 34 (76%) with use of media containing rabbit blood.