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PubMed1996

Herpes simplex virus type 2 in Brazil: seroepidemiologic survey.

BACKGROUND: The incidence of genital herpes is increasing worldwide. Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcerations among the sexually transmitted diseases (STDS). In order to investigate the sexual transmission of genital herpes infection in Brazil, the prevalence of specific antibodies to HSV-2, in populations of high and low risk for STDS was evaluated. METHODS: The population at low risk for STDS was composed of 155 voluntary blood donors at the University Hospitals between February and August, 1994. The population at high risk for STDS was composed of 85 HIV-seropositive persons, consisting of homosexual and promiscuous heterosexual men. A group of 20 highly active prostitutes was also studied between May and July, 1994. All blood samples were screened using an enzyme-linked immunosorbent assay (ELISA) that detects type-specific antibodies to HSV-2 glycoprotein G. Before donating blood, all persons in the study group were given a questionnaire concerning risk factors for acquisition of STDS and suitable to show the socioepidemiologic characteristics of the subjects. RESULTS: The prevalence of ELISA showing HSV-2 infections among HIV-seroposite persons, was 73% (P < 0.01). In the whole group at high risk for STDS, the prevalence was 72% (P < 0.05). Infection with HSV-2, as determined by seroprevalence, was significantly and independently associated with years of sexual activity, history of previous STDS, number of sexual partners in the previous month, number of pregnancies, and previous induced abortions, as well as the percentage of sexual acts involving receptive anal intercourse. CONCLUSIONS: The current strategy for diagnosing genital HSV-2 infection misses many cases. Newly developed type-specific serologic methods can identify cases of unrecognized or subclinical infection. With the high seroprevalence rates detected, routine screening for HSV-2-specific antibodies should be considered in populations at high risk for STDS.

Adolescent↗
PubMed1996

Sexual health and use of condoms among local and international sex workers in Sydney.

OBJECTIVES: To compare indicators of sexual health and predictors of condom use for commercial sex among local and international female sex workers first attending an STD clinic. SETTING: A public STD clinic in Sydney, Australia. SUBJECTS: All sex workers first attending between June 1991 and May 1993. METHODS: Cross-sectional analysis of demographic, behavioural and morbidity data from proforma medical records. RESULTS: 91 local sex workers and 123 international sex workers (predominantly from Thailand, Malaysia and China) first presented during the study period. There were significantly higher prevalences of chlamydia (0 v. 15%, p = 0.0002), gonorrhoea (0 v. 14%, p = 0.0006), syphilis (0 v. 10%, p = 0.006) and clinical genital herpes (0 v. 5%, p = 0.04) among international sex workers. The only case of HIV infection was in an international sex worker. Inconsistent condom use for commercial sex was significantly more common among international sex workers (RR = 4.5; 95% CI 3.1-6.5). On multivariate analysis, inconsistent condom use in international sex workers was associated with a recent history of prostitution outside Australia (p = 0.04), while inconsistent condom usage among local sex workers was associated with increasing age (p = 0.003). CONCLUSIONS: These data illustrate the efficacy of condoms and the success of targeted education programmes in local sex workers in Sydney. By contrast, international sex workers continued to be at high risk of STDs. The international sex industry in Sydney requires enhanced culture-specific interventions. Immigration laws as they affect sex workers should also be reviewed.

Adult↗
PubMed1993

Antibody to Rmp (outer membrane protein 3) increases susceptibility to gonococcal infection.

The severe adverse effects of gonococcal infection on human fertility suggests that Neisseria gonorrhoeae would exert powerful selection for the development of a protective immune response in humans. N. gonorrhoeae is an obligate human pathogen and must persist in humans to survive. Since it is an ecologically successful organism, it must have evolved strategies to evade any human immune response it elicits. In a longitudinal study among 243 women working as prostitutes and experiencing frequent gonococcal infection, younger women, women with HIV infection, and women with antibody to the gonococcal outer membrane protein 3 (Rmp) were at increased risk of infection (adjusted odds ratio 3.4, CI95% 1.1-10.4, P < 0.05). Rmp is highly conserved in N. gonorrhoeae and the blocking of mucosal defences may be one of its functions. As similar proteins occur in many gram negative mucosal pathogens, the enhancing effect of such proteins may be a general strategy whereby bacteria evade human immune responses.

Adult↗
PubMedDate not supplied

Syphilis and HIV infection among prisoners in Maputo, Mozambique.

A cross-sectional study was carried out among 1284 male and 54 female prisoners to assess the prevalence of and risk factors for sexually transmitted diseases (STD) in 4 correctional institutions of Maputo, Mozambique. Among the men, 32% reported a history of prostitute contact and 41% reported a history of STD. Only 9% reported having ever used condoms. Seventy (5.5%) men reported having had sexual intercourse while in prison, in all but one instance this involved sex with another man. There was no reported intravenous drug use. One hundred and four (7.8%) inmates had positive serological tests for syphilis and 8 (0.6%) had antibodies to HIV. Among men, syphilis was associated with a history of genital ulcer [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.4, 6.4] and uncircumcised status (OR = 1.5, 95% CI = 1.0, 2.5). This study demonstrates that syphilis is common among inmates in Maputo and that risk behaviours for STD transmission exist within Maputo prisons. There is a need for STD screening and treatment programmes within prisons in Mozambique and the introduction of educational interventions, including condom promotion.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Epidemic spread of plasmid-mediated tetracycline resistant Neisseria gonorrhoeae in Zaire.

A cohort of 650 prostitutes from Kinshasa, Zaire, was followed at monthly intervals for sexually transmitted diseases as part of an HIV intervention project. Neisseria gonorrhoeae isolates, obtained during a period of 30 months, were auxotyped, serotyped and tested for antimicrobial susceptibility. Among 1085 gonococcal isolates tested, 725 (67%) produced beta-lactamase (PPNG) and 323 (30%) showed plasmid-mediated resistance to tetracyline (TRNG). Over time, the prevalence of PPNG varied between 60 and 73%, while the level of TRNG increased from 11 to 45%.

Democratic Republic of the Congo↗
PubMed1997

Patterns of sexually transmitted diseases in female sex workers in Surabaya, Indonesia.

Sex workers and their clients as core groups of high frequency transmitters play a dominant role in the transmission of HIV and other sexually transmitted diseases (STDs). In Surabaya, Indonesia, little is known about the prevalence of STDs in various sex establishments. We conducted an STD prevalence survey of 1873 female sex workers in Surabaya, Indonesia. We did not find any sex workers with HIV infection. Prevalence rates of other STDs (chlamydia, gonorrhoea, serological test for syphilis positive, and/or trichomoniasis) in female sex workers were 48% in brothels (n = 696), 42% on the streets (n = 192), 16% in massage parlours (n = 344), 25% in barber shops (n = 150), 17% at call-girl houses (n = 73), and 10% in nightclubs (n = 418). Sex workers from the brothels had the highest prevalence rates of gonorrhoea (24%) and trichomoniasis (8%), while sex workers from the streets and the barber shop had the highest rates of serological test for syphilis (STS) positive (30%) and chlamydia (18%). STD rates decreased with an increase in age (except for STS positive), an increase in education, a decrease in the number of sex partners, and condom use in the previous week. Condom use in the previous week was universally low among sex workers, especially among sex workers from the brothels (14%). Sex workers from the brothels had STD rates about 4 times higher than sex workers from the nightclubs (adjusted odds ratio of 4.4). Although the HIV seroprevalence rate is currently low, widespread prostitution and high rates of STDs in sex workers warrant programmes to avert a potential explosion of HIV transmission. Because sex workers from the brothels in Surabaya have high rates of STDs and low use of condoms but good cooperation with local authorities, STD preventive measures should focus on this group.

Adolescent↗
PubMed1999

A prospective study of pharyngeal gonorrhoea and inconsistent condom use for oral sex among female brothel-based sex workers in Singapore.

Oral sex among female sex workers in Singapore has risen sharply from 27.1% in 1992 to 81.7% in 1997. A prospective cohort study was carried out on 724 female brothel-based sex workers who practised oral sex, to determine the risk of contracting pharyngeal gonorrhoea through inconsistent condom use. The prevalence of consistent condom use for oral sex was 70.4% compared to 96.8% for vaginal sex. One hundred and twenty-nine (17.8%) were lost to follow up because they quit prostitution. The other 595 sex workers were followed up for a maximum period of 6 months. Thirty-eight (5.2%) sex workers contracted pharyngeal gonorrhoea compared to 2.5% who contracted cervical gonorrhoea. Sex workers with inconsistent condom use for oral sex were 17.1 times (95% CI: 8.0-36.5) more likely than consistent condom users to develop pharyngeal gonorrhoea, after controlling for ethnic group, class and number of clients. STD control programmes for sex workers should place stress on consistent condom use for oral sex.

Adult↗
PubMedDate not supplied

Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference?

CONTEXT: Although a limited amount of research has retrospectively explored the childhood and adolescent heterosexual experiences of lesbians, little is known about the prevalence of heterosexual behavior and related risk factors or about pregnancy histories among lesbian and bisexual teenagers. METHODS: A secondary analysis was conducted using responses from a subsample of 3,816 students who completed the 1987 Minnesota Adolescent Health Survey. Behaviors, risk factors and pregnancy histories were compared among adolescents who identified themselves as lesbian or bisexual, as unsure of their sexual orientation and as heterosexual. RESULTS: Overall, bisexual or lesbian respondents were about as likely as heterosexual women ever to have had intercourse (33% and 29%, respectively), but they had a significantly higher prevalence of pregnancy (12%) and physical or sexual abuse (19-22%) than heterosexual or unsure adolescents. Among sexually experienced respondents, bisexual or lesbian and heterosexual women reported greater use of ineffective contraceptives (12-15% of those who used a method) than unsure adolescents (9%); bisexual or lesbian respondents were the most likely to have frequent intercourse (22%, compared with 15-17% of the other groups). In the sample overall, among those who were sexually experienced and among those who had ever been pregnant, bisexual or lesbian women were the most likely to have engaged in prostitution during the previous year. CONCLUSIONS: Providers of reproductive health care and family planning services should not assume that pregnant teenagers are heterosexual or that adolescents who say they are bisexual, lesbian or unsure of their sexual orientation are not in need of family planning counseling. Further research should explore the interactions between adolescent sexual identity development and sexual risk behaviors.

Adolescent↗
PubMedDate not supplied

Global update: Burma.

Burma faces what could become one of Asia's most devastation AIDS epidemics. Faced with a growing number of heroin addicts, and of Burmese women being sold into prostitution in Thailand and coming back infected with HIV, Burmese officials now admit that more than 5000 people have tested positive for the AIDS virus. WHO's office estimates the number of HIV-infected people in the country to be at least 100,000 and climbing.

Acquired Immunodeficiency Syndrome↗
PubMed1992

AIDS in El Salvador.

The 1st case of AIDS in El Salvador was diagnosed at Rosales Hospital in San Salvador in October 1985, in a bisexual man who had recently returned from the US. Since that time there have been 110 cases at Rosales Hospital, 81% in men. Of these patients, 54% report exclusively heterosexual histories; 42% report no travel outside El Salvador, 33% report travel to the US, 12% to Honduras, and 7% to Mexico. Risk factors include multiple sexual partners in 61%, prostitution in 7%, and injected drug use in 5%. To date, 52% are known to have died, 18% are alive, and the fate of the remainder is unknown. 5 children with symptomatic HIV infection have been seen at the Benjamin Bloom National Children's Hospital. As of September 1991, 504 persons nationwide were known to be HIV-seropositive, 63% of whom lived in San Salvador. Seropositivity among blood donors at Rosales Hospital has increased from 0% in 1988, when screening began, to 0.265 in 1991.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Immorality Amendment Act (No. 2 of 1988), 25 February 1988.

The major change made by this South African Act is the removal of gender-specific definitions of offenders and victims, so that offenses can now be committed by either sex with respect to victims of either sex. Thus, it is now an offense for a woman to have sexual intercourse or commit an act of indecency with a boy under the age of 16; it is an offense for a woman to have sexual intercourse with a male "idiot or imbecile"; it is an offense for parents to procure male children for sexual purposes; it is an offense for a male to be a prostitute; and lesbianism is an offense. The Act also 1) makes it a crime for any person to have unlawful sexual intercourse or commit an act of indecency with any other person for reward; 2) makes it a crime for a person negligently to perform for reward any act that enables a person to communicate with another person for the purpose of carnal intercourse or the commission of an act of indecency; and 3) establishes a presumption with respect to 2) as well as similar acts done with intent that, if certain facts are established, the accused will be presumed to have committed the act and contravened the law "unless the contrary is proved beyond a reasonable doubt." The latter two provisions are directed in part at escort services.

Africa↗
PubMed1992

[The reappearance of chancroid in Algeria].

After 35 observations of the chancroid observed in the department of dermato-venereology of the University Hospital of Tlemcen (West Algeria) from August 1988 to December 1991, we are led to analyze the flare of this sexual transmitted disease. The principal affected subjects are single male no older than 30 years, having had sexual intercourse with prostitutes (30/35). Less than 10 days (19/29) after the sexual contacts, the ulcer appears, and most often unique (25/35), mildly painful, accompanied frequently by adenopathies (31/35). The contamination took place mainly in Bel Abbès--city located at 90 km from Tlemcen--(12 cases), in Tlemcen (4 cases) and Morocco (5 cases). The treatment based on sulfonamides, erythromycin and tetracycline or doxycycline, has been constantly efficient. No concomitant HIV infection has been revealed. The chancroid is the first STD observed in our department in 1991, and also, the first cause for genital ulcer.

Adult↗
PubMed1992

MHA-Tp testing on HIV positive and negative women in vigilance home at Madurai.

In the study group of 94 cases of female prostitutes and their children 55 cases showed positive for HIV infection by ELISA and Western Blot tests. They showed positive also for syphilis in 37 cases by VDRL and in 43 cases by MHA-Tp tests among HIV positive and negative women. The association of HIV infection and syphilis was observed in this study due to sexual transmission of these infections. But congenital spread from infected mother to their children was not observed in this study since both mothers and their children were negative for these infections. MHA-Tp testing confirmed VDRL test results in 27 cases and also increased specificity of MHA-Tp test result over VDRL result in 16 cases and exclusion of biological false positive by VDRL in 10 cases were noticed in this study.

Adult↗
PubMed1992

AIDS in sub-Saharan Africa: implications for health education.

This paper reviews the current epidemiologic status of AIDS in sub-Saharan Africa, focusing on what is currently understood about the distinctive features of heterosexual transmission in young men, women, and children. Epidemiologic data show that AIDS is transmitted primarily through heterosexual vaginal intercourse. Heterosexual transmission is highlighted both as the principal mode of spread of AIDS in east, central, and southern Africa and as the primary focus for AIDS education and control of the epidemic. The transmission of AIDS, like that of other sexually transmissible diseases, results from sexual behaviors that are rooted in social and cultural values that are not easily changed. The primary risk factors--including multiple sex partners, prostitution, and unprotected intercourse--are examined. The perceived obstacles to control of the epidemic include unfavorable government reactions to the epidemic, poor public knowledge, prevailing sexual attitudes, and reluctance to use condoms. These and other immediate and competing risk factors like unemployment and poverty combine to complicate the task of AIDS education.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Black males who always use condoms: their attitudes, knowledge about AIDS, and sexual behavior.

One hundred six black males completed a questionnaire concerning attitudes and knowledge about the use of condoms and acquired immunodeficiency syndrome (AIDS). Of the 106 males in the study, 27 (26%) reported that they "always" used condoms, 31 (29%) did not use condoms and had low intentions of using them, and 48 (45%) reported high intentions to use condoms. Results indicated that knowledge about AIDS was exceptionally high for black males in all three groups. Black males with low intentions to use condoms reported significantly more negative attitudes about the use of condoms (eg, using condoms is disgusting) and reacted with more intense anger when their partners asked about previous sexual contacts, when a partner refused sex without a condom, or when they perceived condoms as interfering with foreplay and sexual pleasure. A significantly larger percentage of low intenders were treated for gonorrhea, syphilis, herpes, and genital warts than males in the other groups. Drug use did not differentiate the three groups, although marijuana was used more often by males in the low-intender group. Finally, a larger percentage of black males in the low-intender group reported experiences with anal intercourse and sex with a prostitute, but considered themselves at lower risk for AIDS than did their high-intender or steady-user counterparts.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Behaviour change in HIV infected subjects following health education.

A total of 85 HIV seropositive subjects among consecutive new registrants in the STD Department were given health education measures directed to avoiding high risk behaviours and also the events with a high potential for transmission of infection. The emphasis was on the use of condoms, discontinuing promiscuity, abstaining from homosexual acts and avoidance of pregnancy and advice against marriage for those contemplating it. The Health Education Programme was delivered individually to each subject over two or three sessions, each lasting for 30 to 45 min. At the time of follow up (one to 24 months) 42 per cent of subjects had become non-promiscuous. There was a good compliance on advice against marriage and pregnancy. Seven infants born during the follow up period were seronegative. The use of condom was not found to be acceptable. The prostitutes comprised the most resistant group to education. Among the factors that influenced the behaviour change favourably was the absence of earlier STD or a short duration of the current STD. Literacy, marital status, awareness of AIDS did not influence the outcome of education. The study demonstrated the feasibility of health education at individual level in the clinical setting of an STD Department. A longer follow-up may indicate the sustainability of behaviour change in the subjects.

Adult↗
PubMed1990

Serosurvey of prevalence of human immunodeficiency virus amongst high risk groups in Port Sudan, Sudan.

During October, 1987, 593 sera were collected from risk groups in Sudan's only major deepwater port, Port Sudan. The risk groups included prostitutes, lorry drivers and prisoners. A large proportion of the study participants practised high risk behaviour which included sexual promiscuity, medical treatment by injection, scarification and tattooing. Despite high risk behaviour and evidence of a high prevalence of hepatitis B infection, a virus transmitted in a manner similar to HIV, no study participants were positive for HIV infection. This data suggests that the prevalence of HIV infection amongst high risk groups in Port Sudan is very low. These findings confirm a lack of clinical cases of AIDS in hospitalized patients in Port Sudan and the small number of reported cases in other areas of northern Sudan.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Medico-social profile of male teenager STD patients attending a clinic in Pune.

A study of 250 male teenager STD cases was carried out to determine the association between certain medicosocial factors e.g. age, type of infection, educational status, source of infection, knowledge about mode of acquiring infection and prophylaxis etc. Salient findings of the study such as gonorrhoea being the commonest type of STD, curiosity being the main reason for first sexual exposure and prostitutes being the major source of infection have been highlighted in this communication.

Adolescent↗