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Barbosa-Cesnik, C T; Gerbase, A; Heymann, D
doi: 10.1136/sti.73.5.336pmid: 9534740
OBJECTIVES: To describe the role and current status of vaccine research against sexually transmitted diseases (STDs). METHODS: The available literature was reviewed with particular emphasis on bacterial STDs. RESULTS: Strategic approaches to possible implementation of STD vaccine programmes were analysed. The status of vaccines against bacterial STDs (syphilis, chancroid, gonorrhoea, and chlamydia) is described in detail. CONCLUSIONS: The development of safe and effective STD vaccines offers a potent tool for the control of STDs, including direct and indirect prevention of HIV infection. Future priorities should be in the development of vaccines against gonorrhoea, chlamydia, and syphilis. When such vaccines become available, caution should be exercised to ensure that they do not interfere with the effectiveness of other prevention programmes.
doi: 10.1136/sti.73.5.343pmid: 9534741
Human immunodeficiency virus (HIV) can cause both primary and secondary brain diseases. Numerous neuropathological studies have shown that up to 90% of patients with acquired immune deficiency syndrome (AIDS) have lesions in the nervous system. In this review, we discuss the entry of HIV into the brain, the general features of HIV associated neuropathology, the role of different brain cells in HIV mediated neuronal damage, and the putative molecular mechanisms involved. We conclude by correlating which factors might be important in the development of HIV associated dementia.
Petruckevitch, A; Nicoll, A; Johnson, A M; Bennett, D
doi: 10.1136/sti.73.5.348pmid: 9534742
OBJECTIVE: To estimate the number of prevalent HIV infections in England and Wales at the end of 1991 and 1993. METHOD: A direct method was used whereby population estimates derived from the National Survey of Sexual Attitudes and Lifestyle (NATSAL) and prevalence data from the Unlinked Anonymous HIV Prevalence Monitoring Programme (UAPMP) were combined to produce estimates of the number of adults infected and alive in the population. RESULTS: In the population of England and Wales the numbers of prevalent infections for defined transmission categories, at the end of 1993, were as follows: 12,600 through sex between men, 2500 through injecting drug use, and 6900 through heterosexual intercourse. The overall estimate was 22,800 HIV seropositive individuals. CONCLUSIONS: The direct method attempts to provide an estimate of the number of HIV infections using population based survey data. These estimates are consistent with other approaches using independent methods. Such methods are essential for inferring recent HIV incidence, projecting future AIDS cases, and for healthcare planning.
doi: 10.1136/sti.73.5.355pmid: 9534743
OBJECTIVE: To describe the establishment and outcomes of a regional programme of continuing long term surveillance of antibiotic susceptibility of Neisseria gonorrhoeae over the period 1992-4. METHODS: Laboratories in 17 countries in the WHO Western Pacific Region participated in a continuing programme of surveillance of the susceptibility of gonococci to an agreed group of antibiotics over 3 years. Established techniques were used and these included quality control and proficiency testing systems. RESULTS: About 20,000 gonococci were examined over a 3 year period. Resistance to the penicillins through beta lactamase production or chromosomal mechanisms was widespread, with further changes evident over the 3 years. Spectinomycin resistance was infrequently encountered but high level tetracycline resistance was present in most participating centres, with some having high proportions of tetracycline resistant organisms. Quinolone resistance increased and became widespread throughout the region in the 3 years, ultimately involving all but one centre. Both the number and minimum inhibitory concentrations of quinolone resistant isolates increased markedly. CONCLUSIONS: Patterns of gonococcal resistance to antibiotics continue to evolve, at times rapidly, and have the potential for wide and rapid dissemination. Regional surveillance programmes can be developed by using and expanding existing resources. Data thus derived were applied to the development of appropriate treatment regimens in the region, and emphasised further the need for a global expansion of the programme of integrated surveillance of gonococcal resistance.
Dowe, G; King, S D; Brathwaite, A R; Wynter, Z; Chout, R
doi: 10.1136/sti.73.5.362pmid: 9534744
OBJECTIVES: To determine the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmunofluorescence (MIF) test. RESULTS: The DFA detected C trachomatis in 16% (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24% (31/129) and 25% (33/129) respectively. The overall prevalence of current chlamydial infection detected by the isolation techniques used was 25% (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95%, 61/64) was found in CSSW compared with blood donors (53%, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9%) and Candida albicans (7%) were found in comparatively low frequencies, while Trichomonas vaginalis (0%) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequelae of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.
doi: 10.1136/sti.73.5.365pmid: 9534745
OBJECTIVE: To describe the epidemiology of genital warts in England and Wales over the period 1971 to 1994. METHOD: Retrospective study of available statistics. RESULTS: The rate of attendance for genital warts increased by 390% and 594% for men and women respectively between 1971 and 1994. Most of this increase occurred between 1980 and 1986. From 1986 to 1991 virtually no change occurred, but since 1992 the rate of attendance has risen by 15%. The ratio of male to female cases has declined steadily from 1.85 in 1971 to 1.34 in 1994. Rates of attendance for first attack in men were highest in the 20 to 24 year age group whereas for women it peaked in those aged 16 to 24 years. Regional data indicate that the rate of attendance has increased consistently over England and Wales during this period. CONCLUSIONS: Rates of genital warts have risen substantially over the past 25 years. If these are a reflection of changes in sexual behaviour then the rise since 1992 is of considerable concern particularly for the incidence of cervical cancer in the coming decades.
Evans, B A; Bond, R A; MacRae, K D
doi: 10.1136/sti.73.5.368pmid: 9534746
OBJECTIVE: To examine the effect of patient defined non-regular sexual relationships and other risk behaviours on the incidence of sexually transmitted infections in heterosexual men and the role of condom use in the prevention of their spread. DESIGN: A prospective cross sectional study of sexual behaviour reported by a standardised self administered questionnaire in new patients who presented for screening and diagnosis. SETTING: A genitourinary medicine clinic in west London. SUBJECTS: 957 consecutive newly attending heterosexual men who completed a sexual behaviour questionnaire in 1993/94. MAIN OUTCOME MEASURES: Variables relating to sociodemographic status, sexual behaviour, condom use, sexually transmitted infections and testing for HIV infection, stratified by the reporting of non-regular partners. RESULTS: We found that the 65% of men who reported non-regular sexual partners were more likely to be white collar class (d = 7.5%, 95% CI = 1.3, 13.7) and to have had sexual intercourse with non-United Kingdom born women (d = 7.8%, 95% CI = 3.5, 12.2). They also reported coitarche before 16 years of age (d = 13.4%, 95% CI = 8.0, 18.8) and many more sexual partners both in the last year (d = 13.1%, 95% CI = 10.2, 16.0) and in their lifetime (d = 27.9%, 95% CI = 21.6, 34.2). They were significantly more likely to practise anal intercourse (d = 8.7%, 95% CI = 3.3, 14.1), to smoke (d = 16.3%, 95% CI = 9.8, 22.6), to drink alcohol (d = 4.9%, 95% CI = 1.2, 8.6), and to have chlamydial infection (d = 5.7%, 95% CI = 2.2, 9.2), of which 30% was subclinical. Increasing condom use with regular partners correlated with decreasing incidence of urethral infection (gonorrhoeal and/or chlamydial infection) (p < 0.03) and candidal balanitis (p < 0.03) and a greater likelihood of no infection being detected (p = 0.0002). Use of condoms with non-regular partners was much more frequent than with regular partners (d = 21.4%, 95% CI = 16.7, 26.1). However, we found evidence of oral transmission of urethral gonorrhoea and chlamydial infection among men who reported always using condoms. HIV infection was found in only two men (0.2%), both of whom reported intercourse with non-United Kingdom born women. CONCLUSIONS: Heterosexual men who reported non-regular sexual relationships compensated for their increased risk lifestyle by using condoms more frequently and showed only an increased incidence of chlamydial infection. More consistent condom use with regular partners was significantly associated with the absence of sexually transmitted infection. These findings suggest that transmission between regular partners has been underestimated.
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