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PubMed1994

Kaposi's sarcoma in HIV infected women in Germany: more evidence for sexual transmission. A report of 10 cases and review of the literature.

OBJECTIVE: To assess the natural history of Kaposi's sarcoma (KS) in HIV-positive women living in Germany. METHODS: All physicians reporting the diagnosis of KS in a female patient were contacted and asked for detailed information. DESIGN: Descriptive study of clinical, epidemiological and immunological data of ten women with biopsy-proven KS living in Germany were evaluated. The results are compared with those of other previously published studies of women with KS from Italy, France and the USA. SETTING: Five centres in Germany. RESULTS: Of 765 German women with AIDS, only 10 (1.3%) were reported to suffer from Kaposi's sarcoma (KS) compared with 1771 of 8128 men (21.8%). Mean age in these women was 39.7 years. KS was the first AIDS defining event in nine women and the reason for HIV-testing in three. The mean CD4 count was 215/microliters. Two patients were of African origin, had only recently come to Germany and were most likely to have acquired their HIV-infection in Africa. Three patients were i.v.-drug users (IVDU). Two of these (and most likely all three) had worked as prostitutes. Of five women who had contracted HIV via heterosexual contacts, one worked as a prostitute and the other four were married to or were living together with a bisexual HIV-positive man. All four male partners have also developed KS. The course of the disease seems to be particularly aggressive in female patients with eight of 10 women presenting with or progressing to widely disseminated disease with extensive involvement of internal organs. In this cohort survival was longer in females who acquired their HIV infection heterosexually compared to IVDU and was strongly correlated with higher CD4-counts at diagnosis. CONCLUSIONS: KS seems to run a particularly aggressive course in women. Our data are consistent with a sexually transmittable aetiological agent of KS. Prostitution, an issue yet to be addressed by other authors reporting series of women with KS, was reported in four of our patients. Further studies are needed to clarify the significance of this finding.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Sex workers and the control of sexually transmitted disease.

OBJECTIVES: To describe and assess measures to control sexually transmitted diseases (STDs) among sex workers and their partners. METHODS: A review of medical, historical and social literature, focusing on selected cases. RESULTS: Measures to control disease in sex workers today are often prompted by concerns about HIV transmission. However, the literature shows that prostitution varies from one place and time to another, together with the risk of sexually transmitted disease. A broad social definition of prostitution rather than a narrow reference to levels of sexual activity is important for effective disease control, as an understanding of the relation between social disadvantage and sexual activity enables the provision of occupational services that sex workers actually want and use. Social prejudice and legal sanctions cause some sex workers and their partners to avoid even the most appropriate and accessible specialist services. Therefore targeted programmes can only complement, and not replace, general measures to control STDs, which are developed for other social groups or the local population as a whole. CONCLUSIONS: Sex workers and sex work differ from one place to another and so a single model for STD control is inappropriate. None the less, occupational health risks suggest a general need for specialist services. Where these do not compound the disadvantages that sex workers already suffer, medical services are likely to offer significant benefits in prevention, early diagnosis, and treatment of STDs. As the stigma of prostitution leads many people to remain invisible to services, a general health infrastructure and anti-discriminatory measures will be equally important to effective disease control.

Delivery of Health Care↗
PubMed1994

Rapid diagnosis of Chlamydia trachomatis with a nucleic acid probe in male and female patients.

To evaluate a commercially available DNA hybridization test, the Gen-Probe Pace 2 assay (GP) was compared with the Chlamydiazyme (CZ) for the detection of Chlamydia trachomatis in urethral and endocervical specimens. Samples were collected from 300 persons, including 199 registered and 43 nonregistered female prostitutes, examined for screening purposes, as well as 22 male and 36 female symptomatic sexually transmitted disease (STD) patients. The overall prevalence of C. trachomatis was 7.3% in all persons examined with an infection rate of 20.9% in the nonregistered prostitutes, 2.5% in the registered prostitutes and 13.8% in the STD patients. The overall concordance of both diagnostic methods was 98.7% in all samples examined, 100% in male and 98.6% in female samples. Specimens with discordant results were further analyzed by a direct immunofluorescence test (MicroTrak) and by the probe competition assay (PCA). All samples only positive in the GP assay could be confirmed by the PCA while one result which was positive in the CZ could not be confirmed by any other test. The GP assay was superior to the CZ, when compared with true-positive and -negative results. The data demonstrate that the GP assay can be recommended as an alternative diagnostic technique to the CZ for Chlamydia diagnosis.

Chlamydia Infections↗
PubMed2001

HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners.

OBJECTIVE: This study assessed HIV risk behaviors and their association with psychiatric disorders among women prisoners. METHODS: HIV risk behaviors practiced in the five years before incarceration were ascertained with the Risk Behavior Assessment interview for 177 inmates at the Maryland Correctional Institution for Women. The Structured Clinical Interview for the DSM-IV was used to determine the occurrence of posttraumatic stress disorder (PTSD), major depression, and dysthymic disorder among the women. Regression models were used to determine the association between HIV risk behavior and psychiatric disorders. RESULTS: HIV risk behaviors in the five years before incarceration included never or rarely having used condoms (56 percent of the women), injection drug use (42 percent), sexual intercourse with a partner who used injection drugs (42 percent), prostitution (30 percent), needle sharing (30 percent), receptive anal sex (19 percent), and having more than 100 sex partners (7 percent). After the analysis adjusted for age, education, race, HIV status, and addictive disorders, a lifetime occurrence of PTSD was associated with the practice of anal sex (odds ratio=1.7; 95 percent confidence interval=1.26 to 2.16; p<.02) and prostitution (OR=1.56; 95% CI=1.17 to 1.95; p<.03). CONCLUSIONS: HIV risk behaviors before incarceration were highly prevalent among the women in this study. Rates of PTSD, depression, and dysthymic disorder were also high. PTSD was associated with prostitution and receptive anal sex, and the disorder may contribute to high rates of risky sexual behavior. Targeted HIV risk reduction efforts among women prisoners should include evaluation for PTSD; conversely, women prisoners with a diagnosis of PTSD should be evaluated for prior HIV sexual risk behaviors.

Adult↗
PubMed1979

Selective mass treatment in a venereal disease control program.

To control syphilis among prostitutes and seasonal farm workers in Fresno County, California, we developed a program of selective mass treatment of prostitutes. From August 1976 to July 1977, 512 women entered the program. Overall, 4.6 per cent of women treated prophylactically for syphilis were actually infected. Compared to cases in the previous year, infectious syphilis cases among prostitutes and seasonal farm workers decreased 51.3 per cent and 26.8 per cent, respectively.

Adult↗
PubMed2000

Masturbation and its relationship to sexual activities of young males in Korean military service.

This study examined the masturbatory experiences and other sexual activities of young Korean males in military service. The actual status of masturbation and its relationship to sexual activity questionnaire. A total of 1,212 young males among military personnel in Korea were interviewed with sexuality questionnaires on masturbation, sexual intercourse and personal characteristics. We divided these subjects into four groups according to the age of initiation of masturbation and analyzed the relationship between masturbation and other sexual activities. The mean age of subjects was 22.03 +/- 1.22 (19-27) years. The percentage of men who reported ever having masturbated was 98.1% (1189/1212) and the average age of initiation of masturbation was 14.26 +/- 1.66 years. So we divided 1,212 males into four groups on the basis of the average age below and above one standard deviation. Overall, 67.7% (821/1212) had experienced sexual intercourse, and significantly, the earlier the initiation age of masturbation, the higher the coitus rate in each group (p < 0.05). About 21.5% of the men who were not virgins had experienced their first sexual intercourse with prostitutes. The mean age of first coitus, the incidence of sexually transmitted disease (STD) and the frequency of masturbation were closely linked to the initiation age of masturbation, respectively (p < 0.05). A masturbatory guilt feeling was seen in about 10.9% (132/1212) and there was no significant difference according to the types of religious worship (p = 0.227). On the basis of this study, sexual activities generally increased accordingly as the beginning of masturbation was earlier. Coital incidence in this study was 67.7% for young males in Korean military service, and 21.5% of them had their first sexual intercourse with prostitutes. Prostitution still plays an important role in the sexual lives of males in Korea. The incidence of STD was over 10% and homosexual manifestation was seen in 1.07% of subjects. Thus a proper and sound sex education at school during childhood is needed in Korea. A large scale survey of sexual behavior in various populations is essential for the improvement of correct sexual concepts.

Adult↗
PubMed1991

Low prevalence of human immunodeficiency virus-1 (HIV-1), HIV-2, and human T cell lymphotropic virus-1 infection in Somalia.

A seroepidemiologic survey was conducted to determine the prevalence of human immunodeficiency virus type 1 (HIV-1), HIV-2, human T cell lymphotropic virus type I (HTLV-I), and Treponema pallidum infection among southern Somalis. Sera were collected from 1,269 study subjects in the urban area of the capital city, Mogadishu, and in the rural towns of Merka, Qoryoley, and Kismayo. The subjects included 57 prostitutes, 79 sexually transmitted disease (STD) patients, and 1,133 others, including outpatient and hospitalized patients with leprosy, tuberculosis, other infectious diseases, individuals from rehabilitation camps and secondary schools, and Ethiopian immigrants. Results indicated that none of the sera were positive for HIV-1 and HIV-2 by Western blot, but one was positive for HTLV-I. The prostitutes had a significantly higher prevalence of treponemal antibody (50.8%; P less than 0.0001) than either the STD patients (12.6%) or the other subjects (5.2%). Epidemiologic data indicated that 94% of the males and females were circumcised and only 2.6% of the males used condoms. Overall, the results of this study suggested a very low prevalence of HIV-1, HIV-2, and HTLV-I infections, especially among prostitutes and STD patients, who were considered at greatest risk of contracting these retroviral infections.

Adolescent↗
PubMed1998

[Research on risk factors of 5 types of viral hepatities among population with high risk behaviors].

Epidemiological and serological survey on five types of viral hepatities (hepatitis A-hepatitis E) was conducted from October 1994 to December 1996 among 119 labourers returned from abroad, including 55 female prostitutes, 86 medical workers, 88 STD patients and 88 paid blood donors. HAV infection rates for all of the 5 groups were above 83%. HBV infection rate showed significantly different (chi 2 = 3.86, P < 0.05) between medical workers (53.49%) and the control group (30.43%). A significant difference (chi 2 = 5.36, P < 0.05) between HBV infection among prostitutes (52.73%) and control group (26.67%) was also noticed. In all the five groups, none was found to be anti-HDV positive. The HEV infection rates for the medical workers, prostitutes, blood donors, returned labourers and STD patients were 1.16%, 3.64%, 2.27%, 5.88% and 6.82%, whereas the anti-HCV positive rates were 1.16%, 3.64%, 0.00%, 0.00% and 1.14%, among them respectively.

Adult↗
PubMed1999

[Increase of early syphilis in a red light district in Rotterdam (1995-1997) and preventive treatment].

The number of cases of syphilis in Rotterdam has increased dramatically since 1995. The prevalence of early syphilis in 1997 was highest among street prostitutes (16%). Some prostitutes could not be reached for further evaluation and treatment, probably due to their addiction to hard drugs. Prophylactic treatment for syphilis was given to most street prostitutes in a cruising zone during a screening programme for sexually transmitted diseases (STD) in January 1997. Since then, STD checkups were performed regularly in the cruising zone. The prevalence of early syphilis in the cruising zone dropped to 1.3% in 1998. The total number of reported cases of syphilis in Rotterdam also decreased sharply in 1998.

Adult↗
PubMed2000

Frequency of herpes simplex virus in Syria based on type-specific serological assay.

OBJECTIVE: This study aimed to determine the seroprevalence of herpes simplex virus types 1 and 2 antibodies in Syrian populations. Serum samples collected between 1995-1998 from a total of 1293 healthy persons, neonates, pregnant women, labial herpes patients, kidney transplantation patients, atherosclerosis patients, cervical cancer patients, patients with suspected herpetic keratitis, viral encephalitis patients, patients with sexually transmitted diseases, AIDS patients, female prostitutes and bar girls. METHODS: Serum samples were studied by enzyme immunosorbent assay using herpes simplex virus type-specific antigen, glycoprotein (gG). RESULTS: In the healthy group, herpes simplex virus type 1 infections correlated mostly with age and was prevalent among subjects >30 years (approximately 95% of persons in our country have herpes simplex virus type 1 antibodies by 30 years of age), while they varied moderately among other groups. Herpes simplex virus type 2 prevalence varied greatly among the groups defined by sexual activity and was associated with risk behavior for prostitution. Herpes simplex virus type 2 seroprevalence was highest among prostitutes (34%) and bar girls (20%); lowest in healthy persons (0.15%); and intermediate in sexually transmitted disease patients (9.5%), cervical cancer patients (8%) and AIDS patients (4%). CONCLUSION: It can be concluded that infection of herpes simplex virus type 2 is very rare in persons in our country.

Adolescent↗
PubMed1975

Serological evidence for syphilis in different population groups in Rwanda.

The prevalence of serological syphilis, based on qualitative VDRL slide test was studied in different population groups in Rwanda. A positive VDRL was found in 0.7% of female students of a social school, in 2.2% of male and female premarital consultants, in 3.2% of prenatal consultants, in 6.5% of soldiers, and in 27.9% of prostitutes. As the first groups were not exposed to venereal disease, VDRL reactivity due to biological false positive reaction or to yaws antecedents is estimated at 0.5 to 2%. Accordingly, VDRL reactivity due to syphilis is estimated at 1 to 2% in prenatal consultants, 5 to 6% in soldiers and 25 to 26% in prostitutes. It is concluded that syphilis is not yet an important public health problem except in certain promiscuous population groups in towns, as soldiers, migrant workers and prostitutes.

Adolescent↗
PubMed2000

[National sentinel surveillance of HIV infection in China from 1995 to 1998].

OBJECTIVE: To monitor the trend of HIV infection in China in order to provide accurate information for AIDS prevention policymakers and planners. METHODS: Since 1995, cross - sectional sentinel surveys have repeatedly been conducted in China. The target populations in these surveys were STD clinic attenders, prostitutes, drug users, long distance truck drivers, pregnant women, and blood donors. RESULTS: In 1995, survey results found no HIV infection among drug users in 8 sentinel surveillance sites. In 1998 however, HIV infection had been found in 17 of 19 sentinel surveillance sites. HIV infection prevalence rates among drug users in Urumqi had increased from 0% in 1995 to 28.8% in 1998 and in Guangxi and Guangdong, from 1% in 1997 to 12.8% and 10.4% respectively. The highest HIV prevalence rate was 82.2% among drug users in Yining city. The HIV prevalence rate remains low in other risk groups but has increased among prostitutes, whose rate of insistent condom use remains low, and among STD clinic attenders. Needle and syringe sharing among drug users have also increased in many sites. CONCLUSION: HIV infection is spreading rapidly among drug users. There are many risks involved in the spread of HIV among prostitutes and their clients, and thus more efficient interventions are urgently needed.

Adult↗
PubMed2002

[Detection of HIV antibodies in clients of the AIDS Center of the District Health Service in Karvina 1993-2000].

The authors present the trends of some characteristics recorded in a group of subjects examined for HIV antibodies in the AIDS centre of the District Hygiene Station in Karviná in 1993 to 2000. These characteristics reflect the development of activities of the centre. During the period a total of 3733 HIV tests were made, incl. three positive ones. In two instances men with homosexual relations in the case-history were involved, in one case a male heterosexual. The declining trend of the ratio of anonymous examinations is apparent from 58.8% in 1993 to 7.7% in 2000. Parenteral drug users, prostitutes (in particular women) and homosexuals account on a long-term basis for ca 30% of all examinations. Recently this ratio is even higher. Repeated examinations (check-ups) of the same client account for 16.1% of all implemented HIV tests. At least once 384 parenteral drug users were examined, in prostitutes similarly as in men with homosexual relationships the number of subjects examined at least once is ca 200. Repeated tests were made in ca one quarter of all parenteral drug users, ca one third of the prostitutes and ca one fifth of homosexuals. In none of the repeated tests seroconversion to HIV positivity was recorded. To achieve close contact and monitoring of the HIV statute of groups with a risk behaviour despite their existence at the brink of law and despite their natural tendency to hide is real. Without collaborating organizations, without gaining their confidence and in particular without the confidence of the clients this would not be possible.

Adolescent↗
PubMed2001

Another decade of social scientific work on sex work: a review of research 1990-2000.

The international, psychological and sociological research literature on prostitution from 1990 through 2000 is reviewed. The stage is set by scanning topics and perspectives in earlier writings. Then the research is discussed under the following headings: (a) HIV related research (HIV prevalence studies, factors in condom use, and prevention program evaluation); (b) workers' background and motivational issues (early victimization and connected factors, economic motives and connected factors); (c) work related issues (working routines, risks and stresses, and managing risk, work and identity); (d) research on clients, and (e) issues related to social and legal status. The literature is still much more about sex than it is about work. In addition, although an increasing number of authors have criticized the dominance of a deviance perspective over work perspectives on prostitution, the literature still reveals many features of stigmatization. For instance, the wrongs associated with sex work are all too often attributed to the nature of sex work itself instead of to the stigma attached to it or to specific negative circumstances. Likewise, the association between prostitution and negative features (in particular HIV and early victimization) is overwhelming, despite evidence that, for large groups of sex workers, these issues are of limited relevance. Generally, writers fail to adequately differentiate among types of sex workers. In particular, in relation to issues of health and well-being, differentiation among sex workers on the basis of specific features of their working situation (e.g., contexts, routines, relations, conditions) has hardly been studied and is recommended for the future.

Condoms↗
PubMed2003

Sexually-transmitted infections in adolescents and young adults in a large city of Northern Italy: a nine-year prospective survey.

To determine demographic, epidemiological, clinical features and risk factors of sexually-transmitted diseases (STD) in adolescents and young adults referring to a STD centre in Northern Italy, patients diagnosed with a STD and aged 13-20 years, were prospectively evaluated from the year 1991. Teenagers showed an appreciable and increasing risk of a broad spectrum of STD, and represented 3.6-13.3% of patients yearly diagnosed with a STD in a nine-year period. More than 10% of patients were under the age of 18, and did not report condom use in the six months preceding diagnosis in 96.7% of cases. A significant increase in the female gender was found since 1993 (but our series was massively influenced by the recent immigration of female sex workers, who declared frequent condom use), while male homosexuals and drug addicts represented a minority. When excluding subjects engaged in prostitution, over 50% of patients declared only 0-1 sexual partners during the last six months, but a significant increase in sexual promiscuity was observed over time (1997-1999 versus 1991-1996) (p<.02). Over two thirds of our teenagers never used a condom prior to the diagnosis of STD, and the apparently increased temporal trend to condom utilization proved related only to the recent immigration of sex workers; lack of condom use proved significantly related to the male gender, and a lower education. Non-gonococcal STD and human Papillomavirus infection accounted for over 60% of overall diseases, while the frequency of molluscum contagiosum, gonorrhea, HSV genital ulcer, and Chlamydia disease ranged from 6.1 to 7.4%, and that of syphilis, phthiriasis, trichomoniasis, and HIV infection varied from 1.3 to 4.7%. Non-gonococcal STD and syphilis were increasingly diagnosed over time, especially in immigrant prostitutes (and despite their frequent condom use). According to our surveillance study of teenagers, a number of demographic, epidemiological, and clinical features of STD showed significant variations over time: recent immigration, spread of prostitution, increased sexual promiscuity, and infrequent condom use, are relevant and/or persisting risk factors. A permanent monitoring of STD in young adults and adolescents is strongly warranted, to allow a timely diagnosis and an appropriate treatment, and to plan preventive strategies specifically addressed to this target population, with special attention to immigrants and sex workers.

Adolescent↗
PubMed1992

[The prevalence of HCV antibodies in 3 groups with distinct patterns of sexual activity].

We studied the prevalence of antibodies to hepatitis C virus (anti-HCV) among 164 heterosexual partners of anti-HCV-positive subjects, 131 prostitutes and 52 homosexual men. 6.7% of heterosexual monogamous partners had anti-HCV; the seropositivity rate was associated with a long-term sexual practice and with age. Of the 131 prostitutes, 6 (4.6%) had anti-HCV; there were significant associations in patients positive for anti-HCV, with a history of parenteral drug addiction. 11.5% of homosexual men were anti-HCV positive; there were significant associations with positivity for antibodies to HIV, intravenous drug abuse and with the number of sexual partners. We concluded that the HCV may be transmitted by sexual route, but the high seroprevalence among prostitutes and homosexuals may be explained by other parenteral mechanisms.

Age Factors↗
PubMed1992

HIV infection in male patients attending a sexually transmitted disease clinic.

Three hundred and fifty-two heterosexual males, attending a sexually transmitted disease clinic at Siriraj Hospital from December 1989 to February 1991 were studied for the prevalence of HIV infection. Of these, 334 men reported prostitutes as the main source of their sexually transmitted disease. No one had received blood transfusion in the last 5 years, and there was no history of intravenous drug use, homosexuality or bisexuality. HIV antibody was found in the sera of 24 men (6.8%). HIV seropositivity was associated with serologic makers of syphilis (P < 0.05) but was not associated with present genital ulcers on physical examination or other STDs. These data indicate the high rate of female prostitutes to male transmission of HIV infection in the presence of sexually transmitted disease and confirms the relationship between syphilis and HIV infection. HIV/AIDS educational programmes and campaigns to promote condom use among prostitutes and clients are an urgent need in Thailand.

Adolescent↗
PubMed2004

[Sero-epidemiological study on the human T-cell leukaemia virus type I/II infection in the east coastal areas of Fujian province].

OBJECTIVE: To study the seroprevalence of human T-cell leukaemia virus type I/II (HTLV-I/II) infection in adult population in the east coastal areas of Fujian and to explore the possible risk factors of HTLV-I/II. METHODS: A total number of 3259 blood samples from drug users, sexually transmitted disease (STD) patients, prostitutes and blood donors for serologic assays during 1999 to 2002, were collected. All samples were screened for HTLV-I/II antibody, using enzyme linked immunosorbent assay (ELISA) kits. All of the positive samples were confirmed by western blot (WB) kits. Statistical analysis was done by Epi software, and chi(2) test by Fisher's exact test. P value < 0.05 was considered statistically significant. RESULTS: The overall seroprevalence rate of HTLV-I/II in healthy populations was 0.06% including, 0.32% in drug users, 0.58% in STD patients and prostitutes respectively. HTLV-II had not been found. The seropositive rates for HTLV-I in STD patients and prostitutes were significantly higher than the findings among healthy populations (P < 0.05). There were no different seroprevalence rates between drug users and healthy populations (P > 0.05). No significant changes in HTLV-I prevalence rates were found in the different age groups as well as in Fuzhou and Linde cities (P > 0.05). CONCLUSION: The result suggested that in the east coastal areas of Fujian province, HTLV-I was the main prevalent virus. The seroprevalence of HTLV-I was very low, with no HTLV-II. Neither age nor gender seemed to be HTLV-I risk factor in the east coastal areas of Fujian province, but the increase of exposure to sex might be one.

China↗