Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.7.10.2 (focal adhesion kinase)
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Gonorrhea has been declining since its 1975 peak. Risk factors include age 15 to 19 years, multiple or casual sexual contacts, sexual activity related to drug use, and low socioeconomic status. Infection is usually mild but may be asymptomatic. While no physical signs are specific to the gonococcus, pelvic inflammatory disease is a common complication and cause of infertility and should be treated if it is suspected. Diagnosis of gonorrhea is typically by culture. Newer, more accurate tests are available but are more expensive. For treatment, the CDC recommends only highly effective regimens. Patients need to refer recent sexual partners for treatment and abstain from sexual intercourse until completion of therapy and resolution of symptoms. The incidence of syphilis appears to be declining in the United States, but it should be considered if an ulcer is found in the genital region. If untreated, the disease progresses through primary, secondary, latent, and tertiary phases, and systemic symptoms can mimic other conditions. Positive standard screening tests should be confirmed by fluorescent treponemal antibody absorption testing. Darkfield microscopy is appropriate for diagnosis of an ulcer. The treatment of choice for all phases of syphilis is a single dose of intramuscular benzathine penicillin. Other components of therapy include partner notification and patient follow-up. The spread of HIV is closely linked to STD transmission. Therefore, testing for HIV is strongly encouraged when another STD has been diagnosed.
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PMID:Sexually transmitted diseases in women. Gonorrhea and syphilis. 1068 16

Chlamydia trachomatis is one the most important sexually transmitted diseases; it can cause serious sequelae despite the absence of symptoms in some people. It's estimated that about 25% of women who have acute salpingitis become infertile, and chlamydial infection is the commonest cause. The introduction of screening programs for its detection are still a topic of discussion. The literature shows that the total cost of examination and treatment of complications known to be associated with genital chlamydial infection (PID, chronic pelvic pain, tubal factor infertility) is generally higher than the total cost of a large-scale Chlamydia screening program. The selection of a diagnostic test for detection of chlamydial genital infection depends on availability, local expertise, and prevalence of Chlamydia trachomatis in the test population. Cell culture is too expensive in nonendemic regions, so the use of non-culture techniques is very attractive. PCR (polymerase chain reaction) and LCR (ligase chain reaction) are actually the two most commonly used alternatives to conventional methods for detecting STD agents. In fact, PCR and LCR have proved useful for detection of Chlamydia trachomatis in cervical and urethral samples both in symptomatic and asymptomatic women. Recently, testing of first-void urine (FVU) specimens with these techniques has shown that the amplification tests are as sensitive as tests with endocervical swab cultures.
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PMID:Update on Chlamydia trachomatis. 1081 17

The aim of this study was to estimate the level of knowledge about sexuality, attitudes and sexual behaviour of female adolescents. The study included 194 female students, 117 from Medical High School (MHS) and 77 from General High School (GHS) in Zagreb. Data was collected using an anonymous self-administered questionnaire. In addition to items on personal data (age, parental education etc.), the participants were asked to define terms about sexuality (e.g. menstruation, puberty) the definitions of which are found in biology textbooks for the fifth and eighth grade of primary school. The aim of the third part of the survey was to collect information about attitudes and behaviour of female adolescents. The results showed a low level of knowledge in students of both schools. General High School students showed a higher level of knowledge than their Medical High School peers. One fifth of General High School students and 1/3 of Medical High School students were unable to define the term "menstruation". The majority of adolescents talk about sexuality with their friends, 92.1% of General High School and 81.2% of Medical High School students. Almost 50% of students of both schools would like to talk about sexuality with their school doctor. 6.9% of Medical High School students had at least one sexual intercourse while none of the General High School students had been sexually active at the time of the survey. As the majority of students were not sexually active and results showed a rather low level of knowledge, this seems to be the ideal period for the implementation of educational programs aimed at increasing the level of knowledge, and thus preventing unwanted consequences (STD, pregnancy, abortion, infertility).
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PMID:Attitudes, behaviour and knowledge on sexuality among female adolescents in Zagreb, Croatia. 1089 32

Seven research centers have been established by the National Institute of Allergy and Infectious Diseases (NIAID) to support collaborative multi-disciplinary studies of serious infections. The Sexually Transmitted Diseases Cooperative Research Centers (STD-CRCs) will focus on the objectives of the NIAID STD program, which include prevention of four serious consequences of STDs: infertility, adverse outcomes of pregnancy, cancer of the cervix and other anogenital sites, and HIV infection. Investigators will work together to bridge biomedical, clinical, behavioral, and epidemiological research, promote productive collaborations, and facilitate the development of intervention-oriented research. Studies will focus on: preventing reproductive tract infections, evaluating the microbial etiology of non-gonococcal ureteritis, determining new approaches to primary and secondary STD prevention, answering biomedical and behavioral questions associated with chlamydia and gonococcus, and creating prevention strategies.
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PMID:NIAID funds STD research centers. National Institute of Allergy and Infectious Diseases. 1136 49

Mycoplasma genitalium was first isolated from men with non-gonococcal urethritis (NGU) more than 20 years ago. Use of polymerase chain reaction technology has shown it to be a cause of acute NGU and probably chronic NGU, almost independently of Chlamydia trachomatis, but there is no substantial evidence that it causes acute or chronic prostatitis. In women, M. genitalium is not associated with bacterial vaginosis, but it is strongly associated with cervicitis and endometritis and serologically with salpingitis and tubal factor infertility. Further studies may show M. genitalium to be associated, perhaps causally, with epididymoorchitis, neonatal disease and reactive arthritis. Furthermore, its potential for enhancing HIV transmission needs to be explored. M. genitalium is susceptible to various broad-spectrum antibiotics, but M. genitalium-associated diseases are probably best treated with azithromycin.
Int J STD AIDS 2002 Mar
PMID:Mycoplasma genitalium -- an up-date. 1186 Jun 89

500,000 cases of PID (pelvic inflammatory disease) are reported annually in the US, with 34,000 to 92,000 women becoming sterile as a consequence of the disease. In addition, the contraceptive methods women use during their exposure to PID-causing agents may directly affect their relative risk of developing PID, at an annual cost of $2.7 billion in health-care expenses. Another sequelae of PID is ectopic pregnancy. The STD epidemic years from 1965 to 1975 are projected to increase the rate of ectopic pregnancies to 50,000 a year, or one for every 60 live births before leveling off. By 1990, 1 out of 32 women will have had an ectopic pregnancy. Tubal occlusion can result in involuntary infertility. The National Survey of Family Growth estimates that the prevalence of infertile women aged 15 to 44 who are married and use no contraceptive method has increased in the past 2-1/2 years from 2.7% to 6.1%. These women number 142,000 annually and resort to nonsurgical sterilization, with PID as a major reason. Gonococcal PID accounts for 34,000 to 92,000 women becoming involuntarily sterile each year. However, over 80% of PID is nongonococcal PID, which is a worst disease. Chronic PID and infertility are found "more often in women who have had nongonococcal PID than in women who have had gonococcal PID." Etiologic organisms of PID include gonorrhea; E. coli, anaerobes and Chlamydia trachomatis.
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PMID:Rates of ectopic pregnancy, sterility follow PID rise. 1227

Infertility is very common in some areas of Africa, and accounts for a significant proportion of the demand for health services in some countries. Infertility has profound social implications, as blame is often assigned to the woman and she is frequently divorced. Infertility must be distinguished from pregnancy wastage as they have different etiologies, necessitating different control strategies. Primary infertility is common in some countries, with considerable differences between countries. In Zaire, 22.1% of women aged 25-29 are childless, with rates up to 46.2% in some areas, as opposed to rates of 17% in the Congo, 26% in Mali, and 7.2% in Upper Volta. Worldwide, there is a "core" infertility rate of 5% due to chromosomal, congenital and endocrinologic factors. Rates above this are indicative of acquired infertility, of which the most common cause in women is infectious salpingitis. In the World Fertility Study, all 4 African countries studied had 2ndary infertility rates above the mean. Infectious salpingitis can also cause 1st degree infertility if acquired at a young age. Data from developing countries implicate tubal factors as the main cause of infertility. A WHO study found that bilateral tubal occlusion is 3x as frequent in Africa as in other developing areas (49% vs. 11%) as a cause of infertility. 85% of African women had an infectious etiology (vs. 36%). Pelvic inflammatory disease (PID), the main cause of tubal blockage, causes infertility in 15% of women after 1 bout. Various studies have shown that PID in Africa is caused mainly by N. gonorrhoea (38 to 46%) and C. trachomatis (21 to 23%). PID in Africa occurs commonly after childbirth and abortion, with the same pathogens. STDs may also cause male infertility by blockage of the sperm ducts or decreased sperm count. Thus, STD is responsible for a large proportion of infertility in Africa and preventing STD is a major part of reducing infertility.
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PMID:Determinants of infertility in Africa. 1228 Nov 23

An expedited review of the Reality intravaginal pouch--the so-called "female condom"--led the Food and Drug Administration (FDA) to recommend conditional approval for the new contraceptive device on January 31. Developed by the Wisconsin Pharmacal Company, Reality consists of a lubricated polyurethane sheath that is the same length but wider than a male condom, and contains flexible rings at both ends. The closed end is inserted similarly to the diaphragm, covering the cervix. The open end remains outside the vagina in order to prevent skin contact, thereby preventing pregnancy and protecting against STD. Nonetheless, questions linger as to the efficacy of the device. In 1988, an FDA expert panel determined that female condoms were not "substantially equivalent" to male condoms. Soon after, however, the FDA issued new guidelines which streamlined the approach for bringing to market female barrier contraceptives which offer protection against STDs. The FDA's January meeting was marked by a debate between those supporting the expedited process, who viewed approval of the product as a moral imperative for protecting women, and those questioning the efficacy of the product, who said that not enough information is available. The latter group noted that one study found a 15.1% pregnancy rate among a group of women using the device. The FDA decided to grant conditional approval; pending further company data on the use-effectiveness of the device. Noting that expedited decision reflects the relatively slow pace and lack of federal support for contraceptive research, the article goes on to discuss a legislative attempt to give permanent authorization for five contraceptive and infertility research centers, a move that is not supported by the Bush administration.
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PMID:New contraceptive method, female-worn condom, approved by FDA panel. 1228 86

The formation of antibodies to human sperm may be one possible reason for demonstrated infertility in some women. Women with antisperm antibodies have also been found to possess sperm agglutinins that immobilize spermatozoa. This report discusses antisperm antibodies and autoimmunity parameters in human sperm and what, if any, relationship might exist to HIV-positive men. The predominant immunoglobulins (Ig) formed are IgA, IgG, and IgM. IgM levels are normally elevated in sera of HIV-positive patients. Three types of methods have been used to detect antisperm antibodies: 1) those that cause sperm agglutination; 2) those that cause sperm immobilization; and 3) those that detect sperm-specific antibodies. Sperm plasma membrane antigen can be recognized by antisera. This recognition could lead to the identification of sperm antibodies particular to HIV infections. This is possible, but difficult, because HIV is an intracellular agent that prevents a classic antibody reaction, which in turn could lead to a positive identification and possible HIV neutralization.
Arch STD HIV Res 1994
PMID:Immunopathogenesis and immunological parameters of human semen. 1228 75

The policy statement on infertility issued by the International Medical Advisory Panel of the International Planned Parenthood Federation (IPPF) and adopted by the Central Council of the IPPF in November, 1984, is provided. The IPPF recognizes that subinfertility and infertility is a part of family planning and provides suggestions for how Family Planning Associations (FPAs) can provide supportive assistance in this area of concern. Depending on the facilities and resources available at specific clinics, FPS can provide preventive, counseling, diagnostic, treatment, and referral services. FPAs can play a major role in prevention. Many conditions which cause infertility are preventable, and these include sexually transmitted diseases, infections stemming from abortion and childbirth, and possibly tuberculosis. IUDs increase the risk of pelvic inflammatory disease and may increase the risk of infertility; however, a direct relationship between IUDs and infertility has not been established. Injectable contraceptives may delay the return of fertility but do not lead to permanent infertility. Barrier methods protect againsr sexually transmitted diseases, and oral contraceptives may provide protection from pelvic inflammatory disease. FPAs should be familiar with the major causes of infertility in their region and adopt an advocacy role by promoting community programs to control sexually transmitted diseases which may play a role in infertility, to improve obstetric care, to increase access to reproductive health services, and to provide reproductive educational services for adolescents. FPAs can work in cooporation with other agencies concerned with infertility prevention and management. FPAs can play a direct role by educating their clients about infertility prevention. Most FPAs do have have the facilities and personnel to provide diagnostic and treatment services, but they can provide referral services. They should establish a link with centers which are fully equipped to provide diagnostic and treatment services. FPAs, with appropriately trained personnel, may offer screening services such as taking sexual histories and providing instruction in the timing of sexual intercourse. Clinics, with appropriate laboratory facilities, may offer endometrial biopsy, postcoital testing, and semen analysis.
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PMID:IPPF statement on infertility. 1231 3


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