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[Infectious diseases and sexual transmitted diseases in two different cohort of extra communitarian people in Palermo (Sicily, Italy) from 2000 to 2004].

UNLABELLED: The Authors have studied the prevalence of Infectious and Sexually Transmitted Diseases (STD) in a cohort of 109 Nigerian prostitutes and 37 extra communitarian drug addicts, with the aim to quantify the circulation of infectious and diffusive diseases in these groups of people. RESULTS: HIV infection was diagnosed in 2 prostitutes (1.8%) and in 4 drug addicts (10.8%). In the female population it has not been evidence of STD, neither tuberculosis neither active infection from hepatitis virus B and C. In the drug addicts, in a single case it has been evidence active infection from HBV. The search of antibodies anti-HCV has turned out positive in 20 of 37 subject heads (54%). Neither case of tuberculosis nor of syphilis infection was diagnosed in the all population. The analysis of the collected data supplies elements for some considerations: HIV infection in young Nigerian prostitutes with short history is bounded (1.8%) and it correlates with the absence of sexually transmitted diseases (thanks to the use of condom). More in a generalized manner, they are young healthy women probably "selected" at the origin by people interested to protect them from diseases that would compromise their rendering. As far as the population of the drug addicts, the prevalence of HIV infection is meaningfully higher regarding that one of the Italian drug addicts observed in our Division and that their style of life hinders the access to the necessary therapeutic approaches.

Adolescent↗

[Syphilis in sixteenth-century in Bologna. Health care and social assistance (Part one)].

Syphilis arrived in Bologna in the summer of 1495, after Fornovo's battle on the Taro where Charles VIII's army, following the invasion of Naples, fought against the anti-French league who faced up to the invaders as they withdrew. It was the battle-weary Bolognesi, prisoners, deserters and probably some prostitutes following the French and mercenary army who introduced the infection into the city. At the beginning of the syphilis epidemic, the disease was very aggressive with particularly visible symptoms and many resulting deaths. Subsequently, contemporaries mention an abatement of this aggressivity in time spans that varied, but in no cases exceeded 60 years. In 1507 Bologna lost its political autonomy, becoming dependent on Rome. This was symptomatic of the upheavals throughout Italy in the sixteenth century. In this situation of economic and institutional crisis the Bolognesi were able to react with decision to the epidemic, re-converting the municipal hospital dedicated to S. Maria dei Guarini during the sixteenth century. This hospital, specializing in treating syphilis, was called "Ospedale di San Giobbe". It was closed in 1798, after the entry of the French army into Bologna. In 1560 the Bolognesi, realising that the most important causes of the spread of syphilis were social degradation, prostitution and poverty, founded another institution for the poor and for the prevention of prostitution. This institution was developed by the Opera dei Mendicanti and provided hospitality during the 1590 famine, in a city of 55,000 inhabitants, for as many as 1400 poor and sick. We also present the cure (guaiac and mercury) that they used at the time against syphilis. In such a difficult historical period beset with political and economic problems, the Bolognesi established two important institutions and showed that social solidarity is a value for the whole population.

Catholicism↗

[Risky practices associated with HIV infection of seamen who travel in sub-Saharan West Africa].

We report the results of the epidemiological and serological studies concerning HIV-1 and HIV-2 infections carried out in a group of 203 seamen who visited the sub-Saharan area (west coast of Africa). The following risky practices were detected: history of drugs abuse 8 (3.9%), transfusion 3 (1.5%), use of parenteral medicines in Africa 80 (39.4%), surgery in Africa 41 (20%), tattoos 18 (8.9%). Sexual behavior: stable couple 180 (88.7%), number of sexual couples 4.2 +/- 6, contacts with prostitutes 108 (53%), contacts with prostitutes in Africa 83 (40.9%), others heterosexual contacts 58 (28.6%), homosexual 1 (0.5%), history of VD 34 (16.7%), 94% of the seamen never (or occasionally) used the preservative with theirs couples and 73% of them didn't use it with others contacts. Four seamen were HIV-1 (+): contacts with prostitutes in Africa 2, use of parenteral medicines in Africa 1 and drugs abuse 1. We observed a high prevalence of risky practices associated with HIV-1 infection between seamen population. It is interesting to remark the importance of heterosexual transmission and the use of parenteral medicines.

Acquired Immunodeficiency Syndrome↗

[Syphilis in sixteenth-century in Bologna. Health care and social assistance (part two)].

Syphilis arrived in Bologna in the summer of 1495, after Fornovo's battle on the Taro where Charles VIII's army, following the invasion of Naples, fought against the anti-French league who faced up to the invaders as they withdrew. It was the battle-weary Bolognesi, prisoners, deserters and probably some prostitutes following the French and mercenary army who introduced the infection into the city. At the beginning of the syphilis epidemic, the disease was very aggressive with particularly visible symptoms and many resulting deaths. Subsequently, contemporaries mention an abatement of this aggressivity in time spans that varied, but in no cases exceeded 60 years. In 1507 Bologna lost its political autonomy, becoming dependent on Rome. This was symptomatic of the upheavals throughout Italy in the sixteenth century. In this situation of economic and institutional crisis the Bolognesi were able to react with decision to the epidemic, re-converting the municipal hospital dedicated to S. Maria dei Guarini during the sixteenth century. This hospital, specializing in treating syphilis, was called "Ospedale di San Giobbe". It was closed in 1798, after the entry of the French army into Bologna. In 1560 the Bolognesi, realising that the most important causes of the spread of syphilis were social degradation, prostitution and poverty, founded another institution for the poor and for the prevention of prostitution. This institution was developed by the Opera dei Mendicanti and provided hospitality during the 1590 famine, in a city of 55,000 inhabitants, for as many as 1400 poor and sick. We also present the cure (guaiac and mercury) that they used at the time against syphilis. In such a difficult historical period beset with political and economic problems, the Bolognesi established two important institutions and showed that social solidarity is a value for the whole population.

Combined Modality Therapy↗

Male sexual behavior as risk factor in cervical cancer.

Risk factors of male sexual behavior for squamous cell carcinoma of the uterine cervix were studied in Thai women at Chulalongkorn Hospital, Bangkok, Thailand, using an unmatched case-control design. A total of 93 case husbands and 169 control husbands were recruited in the study. Case husbands are prone to have more sexual partners than the control and have an age of first sexual intercourse earlier than the controls. More husbands of cases than of controls had history of prostitute visits in their life with the odds ratio of 9.42. Prostitute visit is a main risk factor, irrespective of whether the husband had a history of sexually transmitted diseases or not. Condom use in sexual intercourse with prostitutes seemed to have a protective effect for their wives in decreasing risk of cervical cancer. This study supports the infectious and venerally transmitted character of cervical cancer and indicates that the other measure of preventing and controlling cervical cancer in women is to educate and prevent men from having high risk sexual behavior.

Adult↗

[Genital Chlamydia infections. A seroepidemiologic study in Algiers].

The prevalence of anti-Chlamydia antibodies was studied among 329 patients divided into 5 groups, 34 (36%) of the women with a low genital infection have antibodies at a titre greater than 16 versus 12 (17%) of the patients attending the women's clinic for routine pelvic examination. 44 (100%) of 44 prostitutes had antibodies greater than 16 meanwhile only 2 (7%) of 30 women attending an obstetric clinic had antibodies greater than 16. Titres suggesting active chlamydial infection were found in prostitutes (95%), women with low genital infection (17%) and patients attending a cancer screening clinic (11%). In other hand, using immunofluorescence test with monoclonal anti Chlamydia trachomatis antibodies, 20 (45.5%) of the prostitutes were found antigen positive.

Adult↗

Localized outbreak of penicillinase-producing Neisseria gonorrhoeae. Paradigm for introduction and spread of gonorrhea in a community.

In King County, Washington, penicillinase-producing Neisseria gonorrhoeae infections increased from 0.8% of reported cases of gonorrhea in 1986 to 6.8% of cases in the third quarter of 1987, then stabilized at 2.7% to 3.6% of cases. Of 268 penicillinase-producing N gonorrhoeae isolates tested, 159 (59%) belonged to a single clone, as evidenced by auxotyping, protein-I serotyping, plasmid analysis, and antimicrobial susceptibility testing. As this strain spread, the predominance of cases shifted from whites to blacks and from men to equal numbers of men and women. The proportion of cases associated with illicit drug use rose steadily from 19% in the first quarter of 1987 to 82% in the fourth quarter. Sixty percent of cases occurred in prostitutes or recent sexual contacts of prostitutes. These results suggest that core gonorrhea transmitters in King County are predominantly black illicit drug users, prostitutes, and their sexual partners. These are priority target populations for behavioral intervention and other measures to control the spread of all sexually transmitted diseases, including human immunodeficiency virus infection.

Black or African American↗

[AIDS Hotline Flanders: results in 1988].

The Stichting Aids Gezonheidszorg informs the general public about the disease via the Aids hotline. The aims are twofold: 1. We want to inform and support people; if necessary, we also refer to more adequate organisations for assistance; 2. We want to know who calls us and what are the needs so that we can help in organizing prevention campaigns. In 1988 we answered 1.987 authentic calls, about the same as in 1987. To allow more people to call, the opening hours of the hot-line will be increased from September 1989 onwards. 70% of the callers are men, 28% women. We notice two important subgroups: people who visit prostitutes and male homosexuals. Most callers are between 26 and 40 years old. Also more young people under 25 called last year. Prostitutes and I.V. drug users however rarely called. A lot of people call because they think to have run some risk. Therefore most questions deal with sexual transmission and blood tests. The number of people who had their blood tested is rather small. Most of them are homosexuals or visitors of prostitutes. This last group is most acquainted with the use of a condom, more than homosexuals and heterosexuals. Still a rather big percentage of people from all groups never use a condom. Therefore efficient campaigns are highly necessary.

Acquired Immunodeficiency Syndrome↗

Seroepidemiological studies of HTLV-III antibody prevalence among selected groups of heterosexual Africans.

T-lymphocyte subsets and human T-cell lymphotropic virus type III antibody prevalence were studied in African patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC), and in female prostitutes. African blood donors and healthy Zairian and Rwandese persons matched for age, sex, and annual income served as controls. Seropositivity was noted in 46 (87%) of 53 patients with AIDS, 29 (88%) of 33 patients with ARC, 67 (80%) of 84 prostitutes, and five (12.5%) of 40 and eight (15.5%) of 51 healthy controls and blood donors, respectively. Patients with AIDS and ARC had a significantly lower OKT4/OKT8 ratio than healthy African controls. These studies suggest that human T-cell lymphotropic virus type III infection has already spread extensively into the general African population and that female prostitutes could be an important human reservoir of AIDS virus in the heterosexual population.

Acquired Immunodeficiency Syndrome↗

Risk factors for the spread of AIDS in rural Africa: evidence from a comparative seroepidemiological survey of AIDS, hepatitis B and syphilis in southwestern Uganda.

Before commencing rational control programmes for AIDS in Africa it is desirable to determine the relative importance of heterosexual and various non-sexual modes of transmission. We investigated this by comparing the seroepidemiologies of AIDS, hepatitis B and syphilis at two rural hospitals in southwest Uganda. During August 1986, 3% of 357 outpatients, reflecting the age and sex composition of the general population, were anti-HIV positive. Anti-HIV seropositivity, both in the outpatients and among 36 suspected prostitutes and 14 suspected AIDS cases, was confined to individuals aged 20 or over. For men, seropositivity was associated with sexual contact with prostitutes (a risk factor for 61% of young men in the study). In the prostitute group, 25% were anti-HIV positive and 46% were positive on the Treponema pallidum haemagglutination (TPHA) test for syphilis. The risk factors for HIV, but not hepatitis B, were the same as for having a history of sexually transmitted disease (STD). However, there was, surprisingly, an association between a history of STD and seropositivity for hepatitis B virus but not for HIV infection. The geographical and age distributions of seropositivity for HIV and hepatitis B virus were also quite different. Finally, blood transfusions, scarification and exposure to mosquitoes (as assessed by a history of malaria) were not evident risk factors for either HIV or hepatitis B virus. AIDS in rural Africa seems to differ in its epidemiology from hepatitis B and appears to be spread predominantly by pre-existing patterns of heterosexual activity responsible for high rates of other sexually transmitted diseases.

AIDS Serodiagnosis↗

Seroepidemiology of human immunodeficiency viruses in Africa.

The first generation of serological tests for anti-HIV-1 gave so many false positives with African sera that it was wrongly postulated that the virus was endemic in Africa. As there is no simian or other virus sufficiently closely related to HIV-1 as to suggest a recent common ancestor, the evolution of HIV-1 is obscure and there is no current evidence to support the hypothesis of an African origin. However, the similarity of HIV-2 to SIV and its geographical distribution do suggest an evolution of this virus in west Africa. The earliest anti-HIV-1 positive serum was from a subject in Kinshasa in 1959. Seroprevalence rose in pregnant women in Kinshasa from 0.25% in 1970, to 3.0% in 1980 and 5.7% in 1986. When two sexually promiscuous groups are compared, seropositivity rose sharply in female prostitutes in Nairobi from 4% in 1981, to 59% in 1984 and 64% in 1986, a curve which is approximately parallel to, but three years later than that of homosexual males in San Francisco. In central and east Africa, HIV-1 is now epidemic from Congo to Kenya and from Uganda to Zimbabwe. In west Africa, both HIV-2 and HIV-1 are epidemic: seroprevalence of HIV-2 is highest in southern Senegal, Guinea-Bissau and Côte d'Ivoire: HIV-1 has the highest frequency in Côte d'Ivoire and Ghana. HIV-2 has not been reported, and HIV-1 is pre-epidemic in Africa north of the Sahara, Nigeria, Angola, Mozambique and southern Africa, being found at significant frequency only in female prostitutes, patients with STD, or, in Morocco and South Africa only, in male homosexuals. Seroprevalence is greatest in female prostitutes and patients with STD: infection is more frequent in urban than in rural populations, except in Uganda. The peak frequency is at 30-34 yr in males and 20-24 yr in females. Other groups at risk are infants born to infected mothers, and those requiring blood transfusions, especially pre-school children, patients with sickle-cell disease and pregnant women. The doubling time for seropositivity is about one year in the sexually active age range in some populations. Even at existing seroprevalence, decimation or worse of the most productive age groups is inevitable during the next few years in certain countries.(ABSTRACT TRUNCATED AT 400 WORDS)

AIDS Serodiagnosis↗

[Detection of Chlamydia trachomatis antigen with an enzyme immunoassay].

Urogenital swabs (571) were investigated with a solid-phase enzyme immunoassay for the detection of Chlamydia trachomatis antigen (Chlamydiazyme, Abbott). The results were compared with the conventional cell culture method (McCoy cell culture). Urogenital C. trachomatis infections were diagnosed with the cell culture in 14 of 122 male STD patients (12%), in 12 of 79 female STD patients (15%), in 23 of 89 prostitutes (26%), and in 3 of 115 asymptomatic males (3%). In comparison with cell culture, the sensitivity of Chlamydiazyme for urethral specimens from male STD patients was 86%. In female STD patients, for urethral specimens a sensitivity of 83% was found and for cervical specimens a sensitivity of 80%. The corresponding values for specimens from prostitutes were 60% and 100%, respectively. The specificity of Chlamydiazyme for urethral specimens of male STD patients reached 95%. With respect to urethral and cervical specimens of female STD patients, the specificity was 88% and 82%, respectively, and in prostitutes 92% each. The low specificity in female patients cannot be ascribed only to Chlamydiazyme since, after subcultivation and detection of inclusions by the use of fluorescein-labeled monoclonal antibodies, some of the false-positive Chlamydiazyme results turned out culture positive. This means that the specificity of Chlamydiazyme is actually higher. Because it can be performed rapidly and simply and reaches detection rates approaching those of the cell culture method, the enzyme immunoassay is an improvement in the diagnosis of C. trachomatis infections.

Adult↗

[Genital Chlamydia infections in female patients at risk of having sexually transmitted diseases].

Investigations for Chlamydia infections of the genital tract were performed in 270 Viennese registered, as well as in 51 non-registered prostitutes. The results were compared with findings obtained in 56 female patients attending an out-patient STD clinic and 48 pregnant women seeking antenatal care in a department of obstetrics. Diagnosis of Chlamydia infection was the organisms on cultured McCoy cells after treatment with cycloheximide. The highest infection rate (31%) was found in non-licensed prostitutes. In registered prostitutes, 20.4% of the cervical smears proved to be positive for Chlamydia. The control groups showed lower infection rates of 9% and 4%, respectively. These results indicate that women who frequently change their sexual partners are considerably more at risk of contracting Chlamydia infections. Hence, this group of persons should be more regularly investigated and--if necessary--given appropriate treatment in order to prevent further spread of the disease.

Austria↗

Syphilis and gonorrhea; epidemiology update.

The epidemiologic patterns of venereal diseases (VD) in Greece were studied using data from the National Statistical Service, the University Hospital for VD and the special clinic for VD of the Ministry of Health, where prostitutes and homosexuals are examined. The main findings are as follows. Between 1962 and 1976 the frequency of both syphilis and gonorrhea declined among men as well as among women but the decline was more evident among women and among the older age groups (20+). Among men, the highest incidence is the age group 20-29 years, whereas among women the peak incidence is a little earlier. The rates for both syphilis and gonorrhea are higher in men than in women, higher in the greater Athens area than in the rest of Greece, and higher in single persons than in married one. There was a marked seasonal variation of VD with peak incidence at late summer. The decline of VD was also evident among prostitutes and male homosexuals with the exception of syphilis among uncontrolled prostitutes (increase) and male homosexuals (slight decrease).

Adolescent↗

[Hepatitis B in persons at high risk for sexually transmitted diseases. Screening and vaccination campaign--acceptance and results].

The prevalence of HBV-markers in our patients in STD high-risk groups was markedly higher than the average in Vienna. 19% of the registered prostitutes, 44% of the illegal prostitutes, 29% of the bar hostesses and 39% of the STD patients were found to be positive in at least one HBV marker. I.v. drug abuse. African origin and irregular condom use were the most important risk factors in our patients. The hepatitis B vaccination campaign was successful to a high degree. 69% of the registered prostitutes and 85% of the regularly examined bar hostesses accepted the vaccination. Promotion programmes should focus on institutions caring for STD risk persons rather than on the persons themselves.

Adult↗

[A seroepidemiological study on sexually transmitted HBV infection].

A seroepidemiological study on HBV infection was conducted among female prostitutes in houses of detention in Guangzhou and Fuzhou in 1989, 1990 to understand the situation of sexually transmitted HBV infection in selected areas of China, and prevalence of HBV infection in sexual misbehavior populations. The incidence of HBV infection was 84.82% among the population, and 21.6% was HBsAg positive. The prevalence of HBsAg was significantly higher in prostitutes than in pregnant women. The results show that there is a relatively serious HBV infection in prostitutes in certain cities along coastal region in China.

Adolescent↗

Human immunodeficiency virus infection in long-distance truck drivers in east Africa.

BACKGROUND: A cross-sectional survey was performed to determine the seroprevalence and correlates of human immunodeficiency virus (HIV) infection among long-distance truck drivers in Kenya. METHODS: Truck drivers along the Mombasa-Nairobi highway were enrolled at a roadside research clinic. A standardized interview and serologic evaluation for HIV and syphilis were conducted. RESULTS: We enrolled 970 truck drivers and their assistants of whom 257 (27%) had HIV antibodies. In univariate analysis, HIV infection was correlated with older age, non-Kenyan nationality, Christian religion, longer duration of truck driving, travel outside of Kenya, less frequent visits to wives, and more frequent visits to prostitutes. Uncircumcised status, history of genital ulcer disease or urethritis during the previous 5 years, and a positive Treponema pallidum hemagglutination assay for syphilis were each associated with positive HIV serostatus. Univariate correlates of uncircumcised status included younger age, non-Kenyan nationality, Christian religion, travel outside of Kenya, and less frequent visits to prostitutes. There was a significant association between uncircumcised status and 5-year history of genital ulcer disease or serologic evidence of syphilis, but not with 5-year history of urethritis. In multivariate analysis, HIV infection was independently associated with uncircumcised status (adjusted odds ratio [OR], 4.9; 95% confidence interval [CI], 2.8 to 8.4), history of genital ulcer disease (adjusted OR, 2.4; 95% CI, 1.5 to 4.1), history of urethritis (adjusted OR, 1.8; 95% CI, 1.1 to 2.9), more frequent sex with prostitutes (more than once per month; adjusted OR, 1.7; 95% CI, 1.1 to 2.8), and positive T pallidum hemagglutination assay (adjusted OR, 1.2; 95% CI, 1.0 to 1.4). The attributable risk percentage for the association between HIV and uncircumcised status was 70%, and the population attributable risk was 25%. CONCLUSIONS: Truck drivers in east Africa are at high risk of HIV infection. The strongest correlates of HIV seropositivity were uncircumcised status and history of both ulcerative and nonulcerative sexually transmitted diseases.

Adolescent↗

Human immunity to Neisseria gonorrhoeae: acquired serum opsonic antibodies.

Recent studies have demonstrated that virulent (Types 1 and 2) colonial variants of Neisseria gonorrhoeae are highly resistant to phagcytosis by normal human polymorphonuclear leukocytes. To pursue this observation, sera from prostitutes were compared with sera from Catholic nuns in terms of their ability to enhance phagocytosis of Type 1 gonococci. The phagocytic system consisted of a monolayer of normal human polymorphonuclear leukocytes and an inoculum of 107 to 108 colony-forming units of N. gonorrhoeae. In a representative test, the mean percentages of phagocytosis were: 13 nuns, 10 per cent; 32 prostitutes, 30 per cent (p less than 0.01). In a separate set of experiments, 5 (45 per cent) of 11 patients with acute gonococcal salpingitis had significant increases in serum opsonic activity between the acute and one month convalescent bleeding. A pool of prostitute sera retained detectable opsonic activity at dilutions as high as 1:320. The opsonic activity was heat-stable, demonstrable without complement, and resided in both the IgG and IgA fractions of serum. These studies demonstrate the presence of acquried opsonic antibody to N. gonorrhoeae in humans: the significance of such antibodies in proction against gonococcal disease requires further exploration.

Antibodies, Bacterial↗