Sexually Transmitted Infections

Gibb, D M; Duggan, C; Lwin, R

doi: 10.1136/sti.67.5.363pmid: 1743706

The impact of HIV and AIDS on the family is described, with particular focus on the situation where the child is the first member of the family to be diagnosed. The results of the social stigma, the effect on relationships together with the global, economic and cultural aspects of the disease make it unique. These issues are discussed and an integrated approach to confidentiality, the provision of services for families and involvement of the community is described.

de Jong, M D; Hulsebosch, H J; Lange, J M

doi: 10.1136/sti.67.5.367pmid: 1743707

Walckiers, D; Piot, P; Stroobant, A; Van der Veken, J; Declercq, E

doi: 10.1136/sti.67.5.374pmid: 1743708

OBJECTIVE--To examine trends in some sexually transmitted diseases in Belgium and to discuss them in the light of the European background. DESIGN--Analysis of the time trends of C trachomatis and N gonorrhoeae infections diagnosed by a network of microbiological laboratories, and of male urethritis diagnosed by a network of general practitioners. SETTING--Belgium. SUBJECTS--Reports of C trachomatis and N gonorrhoeae infections by a network of microbiological laboratories, and of male urethritis by a network of general practitioners, to the Institute of Hygiene and Epidemiology. RESULTS--Whereas an increase in the number of C trachomatis infections, more pronounced among women, was observed up to 1986, a small decrease has been observed afterwards in males. The mean number of chlamydial infections per laboratory and per year was 4.2 in 1983, 15.7 in 1986 and 13.9 in 1989. A decrease in the number of N gonorrhoeae infections, more pronounced among men, has been observed. The mean number of cases of gonorrhoea per laboratory and per year was 10.9 in 1983 and only 2.2 in 1989. The same declining trend has been observed in another surveillance programme of male urethritis, based on a network of general practitioners. The number of cases of male urethritis per 100 patient encounters went down from 0.06 in 1982-3 to 0.04 in 1988-9. CONCLUSION--The declining trend in Western Europe in incidence of gonococcal infections and of urethritis in men is also occurring in Belgium, but genital chlamydial infections remain an important public health problem.

Hooykaas, C; van der Velde, F W; van der Linden, M M; van Doornum, G J; Coutinho, R A

doi: 10.1136/sti.67.5.378pmid: 1743709

OBJECTIVES--To study risk factors for sexually transmitted diseases (STDs) and sexual behaviour. Especially to assess whether there is a higher risk of being infected with STDs among ethnic minorities, and if so for what reasons. SETTING--STD-clinic of the Municipal Health Service of Amsterdam, the Netherlands. SUBJECTS--Cross-sectional study of heterosexuals (255 men and 343 women) with multiple sexual partners, who participated between October 1987 and January 1990. RESULTS--Besides STD-related complaints, ethnicity was an important independent predictor of one or more diagnosed genital STDs. STD-prevalence was higher among men born in Turkey (47%, OR = 3.4) and men born in Surinam (36%, OR = 2.1), compared with Dutch men (21%). While Turkish men had mainly riskful sexual behaviour with prostitutes, Surinam men had more often riskful sexual contact with private partners. Among women, STD prevalence was higher among West-European (38%, OR = 2.3) and Latin-American women (30%, OR = 1.6), compared with Dutch women (21%). Latin American women had more often riskful sexual contact with clients; sexual behaviour of West-European women was riskful with both clients and private partners. CONCLUSIONS--Prevention activities should be directed at specific sexual and ethnic groups, sources of information should be carefully selected, and some groups should be addressed differently with regard to language but to content as well.

Philpot, C R; Harcourt, C L; Edwards, J M

doi: 10.1136/sti.67.5.384pmid: 1743710

OBJECTIVE--To determine risk factors for the transmission of human immunodeficiency virus (HIV), including injecting drug use (IDU), sexual behaviour and other sexually transmissible diseases (STDs), in female prostitutes who attended the Sydney Sexual Health (previously STD) Centre. DESIGN--We surveyed by questionnaire 231 (47%) of 491 female prostitutes who visited the Centre over a 19 month period from 1986 to 1988. All were tested for HIV antibody. MAIN OUTCOME--All the women were seronegative for HIV but a number of major risk factors for infection were identified. RESULTS--Seventeen of 26 (65%) current injecting drug users had shared needles in the previous 6 months. Nineteen per cent of those surveyed had bisexual non-paying partners and 21% had partners who injected drugs. Sixty nine per cent always used condoms for vaginal intercourse with paying clients, but they were rarely used with non-paying partners. Condom use was also rare for anal intercourse with clients and/or partners by those (18%) who practised it. Seventeen per cent used condoms alone for contraception and 48% relied on oral contraceptives. We found a reduction in gonorrhoea, herpes and trichomoniasis when compared with a 1985 study conducted at the same Centre. However, there was an increase in reported abnormal cervical cytology. CONCLUSION--In spite of behaviour change by some, there are still many women working as prostitutes in Sydney who remain seriously at risk of HIV infection. We recommend more widespread use of barrier methods of contraception, intensified efforts to prevent the sharing of intravenous needles, closer monitoring of the health of prostitutes, and scientific study of their paying and non-paying sexual partners.

Poh, C L; Ocampo, J C; Sng, E H; Bygdeman, S M

doi: 10.1136/sti.67.5.389pmid: 1743711

OBJECTIVE--To characterise Neisseria gonorrhoeae isolates from Singapore. DESIGN--Characterisation of Neisseria gonorrhoeae isolates by auxotyping, serological analysis and plasmid profile analysis. SPECIMENS--Sixty randomly collected isolates from 41 symptomatic, untreated males and 19 female prostitutes were studied. RESULTS--Auxotyping of 25 PPNG and 35 non-PPNG strains showed that the Pro-auxotype was prevalent among both PPNG (56%) and non-PPNG (42.5%) strains. Prototrophic strains comprised 28% of PPNG and 32.5% of non-PPNG strains respectively. Serovar analysis showed that with the exception of seven serogroup WI strains, the majority belonged to serogroup WII/III. Serovar Aedih was predominant among both serogroup WI PPNG (80%) and non-PPNG (100%) strains. Serogroup WII/III PPNG strains were represented by nine serovars with the predominant serovars being Bacjk (28%) and Bcgjk (16%). Eleven serovars were identified in the WII/III non-PPNG strains and the major serovars were Bajk (20%), Bacjk (17%), Back (11.4%) and Beghjk (11.4%). Analysis of the 25 PPNG strains showed that 16 of them carried the 4.4 MDa (Asian type) resistance plasmid and nine strains harboured the 4.4 MDa plasmid in conjunction with the 24.5 MDa transfer plasmid. The cryptic plasmid of 2.6 MDa was present in 27 of the 35 non-PPNG strains. Five of the non-PPNG strains harbouring the cryptic plasmid also contained the 24.5 MDa transfer plasmid. The plasmid combination of 2.6 + 7.8 + 24.5 MDa was detected in three non-PPNG strains. CONCLUSION--The combination of epidemiological methods used in this study indicated the heterogeneity of N gonorrhoeae strains in Singapore. A total of 16 different combinations of auxotype, plasmid profile and serovar were seen in the 25 PPNG strains compared with 24 such combinations in the 35 non-PPNG strains. Such sensitive differentiation would otherwise not be possible using either auxotype-serovar (A/S) or auxotype-plasmid analysis.

doi: 10.1136/sti.67.5.394pmid: 1743712

OBJECTIVES--to compare the response to treatment and recurrence rate of condylomata accuminata using subcutaneous injection of interferon alfa 2a 1.5 million units three times weekly for four weeks, or podophyllin resin 25% applied to lesions twice weekly for up to six weeks. DESIGN--Randomised open study. SETTING--Multicentre European study in genitourinary medicine, dermatovenereology, and gynaecology departments. PATIENTS--87 males and 67 females with condylomata acuminata for less than six months and no history of previous treatment. MAIN OUTCOME MEASURES--Complete clearance of lesions and evidence of recurrence at three months and nine months after treatment commenced. RESULTS--A complete response was achieved at three months in 15 of 64 (23%) in the interferon treated group, and 31 of 69 (45%) in the podophyllin treated group (p = 0.003). At nine months 10 of 13 patients in the interferon group and 22 of 30 patients in the podophyllin group remained completely clear of lesions.

O'Farrell, N; Hammond, M

doi: 10.1136/sti.67.5.400pmid: 1743713

OBJECTIVE--To compare the frequencies of HLA antigens in patients with donovanosis and in controls. DESIGN--HLA Class I, Class II and DQ antigens were detected in patients with genital ulceration caused by donovanosis and in a control group. SETTING--City Health STD Clinic, King Edward VIII Hospital, Durban, South Africa. Participants--Sixty (47 men, 13 women) patients with donovanosis. RESULTS--HLA B57 was detected in nine of 60 (15%) with donovanosis and 75 of 1478 (5.1%) controls (RR = 3.3 chi 2 = 11.0, p = 0.001, p corrected = 0.026). CONCLUSIONS--A possible link between donovanosis and HLA B57 could be explained by coexisting alleles or immune response genes in linkage disequilibrium altering disease susceptibility.

Engelkens, H J; Vuzevski, V D; ten Kate, F J; van der Heul, P; van der Sluis, J J; Stolz, E

doi: 10.1136/sti.67.5.403pmid: 1743714

OBJECTIVE--To study ultrastructural aspects of infection with Treponema pertenue (Pariaman strain), originating from West Sumatra, Indonesia. MATERIALS AND METHODS--Biopsy material originating from skin lesions in ten young children suffering from early infectious yaws in Indonesia, and rabbit testicular tissue inoculated with T pertenue. Human skin as well as rabbit testicular tissue was examined by means of conventional electron microscopy. RESULTS--In human skin, treponemes were found in interepidermal spaces in 5 out of 10 specimens. In two of five positive specimens, treponemes were also seen in the dermis. In one out of five specimens from rabbit testicular tissue a profusion of treponemes was found lying in the interstitial myxomatous tissue. Microorganisms showed no adhesion to fibroblasts. CONCLUSION--This ultrastructural study of T pertenue demonstrated the scarcity and focal distribution of treponemes in tissue and did not reveal any morphological differences from the Gauthier strain of T pertenue. No differences from the ultrastructure of T pallidum were observed either.

Ross, J; Moyes, A; Young, H; McMillan, A

doi: 10.1136/sti.67.5.408pmid: 1743715

AIM--The Captia Syph G enzyme immuno assay (EAI) offers the potential for the rapid automated detection of syphilis antibodies. This study was designed to assess the role of other sexually transmitted diseases (STDs) in producing false positive reactions in the Captia Syph G EIA. The role of rheumatoid factor (RF) as a potential source of false positives was also analysed. METHODS--Patients who attended a genitourinary medicine (GUM) department and gave a false positive reaction with the EIA between 1988 and 1990 were compared with women undergoing antenatal testing and with the control clinic population (EIA negative) over the same time period. The incidence of sexually transmitted disease (STD) in the clinic population and the false positive reactors was measured in relation to gonorrhoea, chlamydia, genital warts, candidiasis, "other conditions not requiring treatment" and "other conditions requiring treatment." Male: female sex ratios were also compared. Ninety two RF positive sera were analysed with the EIA. RESULTS--The rate of false positive reactions did not differ with respect to the diagnosis within the GUM clinic population. The antenatal group of women, however, had a lower incidence of false positive reactions than the GUM clinic group. No RF positive sera were positive on Captia Syph G EIA testing. CONCLUSIONS--There is no cross reaction between Captia Syph G EIA and any specific STD or with RF positive sera. The lower incidence of false positive reactions in antenatal women is unexplained but may be related to physiological changes associated with pregnancy.