Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:2.7.10.2 (focal adhesion kinase)
 44,029 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Epidemiologic trends of STD are strikingly different in various parts of the world. In Northern and Western Europe there has been a spectacular decline in the incidence of STD, particularly gonorrhea and syphilis. It is probably due to a combination of an early initiation of sex education at school, behavior change, condom promotion, and the wide availability of STD treatment. The situation in North America is far more complex, with geographic areas and large population groups having low levels of STD and others continuing to experience an epidemic of STD, particularly inner-city minority populations in the United States. In developing countries both the prevalence and incidence of STD are still very high and STDs are a major public health problem making up the second cause of healthy life lost in women of 15 and 45 years of age after maternal morbidity and mortality. "Business as usual" is clearly not acceptable any longer. A better understanding of the determinants of STD epidemiology is essential for a more effective approach to STD control as well as recognizing the limitations of each single intervention, be it medical or behavioral. The major challenges are to mobilize political commitment and funds, and to transfer small scale interventions into large scale public health programs, and to apply the right mix of approaches, including medical, behavioral, societal interventions.
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PMID:Sexually transmitted diseases in the 1990s. Global epidemiology and challenges for control. 804 21

Incidence numbers of Neisseria gonorrhoeae, Treponema pallidum and Chlamydia trachomatis differ substantially in different countries at different times. In European countries, the incidence of gonorrhea and of primary and secondary syphilis currently is extremely low. In North American countries gonorrhea incidence declined at a very slow annual rate and syphilis incidence increased. Chlamydial infections show a profile that seems to be delayed by two decades from infections with Neisseria gonorrhoeae. Our efforts in the future should be directed to prevent the resurgence of gonorrhea and syphilis and to achieve the same success with chlamydial infections. Poor populations in developed and developing countries, which have similar demographic, social and economic characteristics, represent one important target group for control programs. Education of young and poor people represent the challenge of the future for sexually transmitted diseases control strategies. Combined strategies also will have an effect on incurable viral STD.
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PMID:Epidemiology of sexually transmitted diseases. What does it tell us? 804 24

Treatment regimens for sexually transmitted infections continue to evolve. The natural history of syphilis in HIV-infected patients is leading to more aggressive policies in terms of both investigation and treatment. In particular, treatment protocols for late syphilis, especially neurosyphilis, are under scrutiny. Epidemiological change typified by the spread of penicillinase-producing Neisseria gonorrhoeae (PPNG) has led to a search for new agents to treat gonorrhoea, with a more extensive use of cephalosporin and quinolone antibiotics emerging. The problem of compliance with the antibiotic courses presently required for chlamydial infection may be close to being solved with the development of newer macrolide agents. Single dose azithromycin, although expensive, seems to be as effective as longer courses with other agents. Furthermore, its efficacy in gonococcal infection is also encouraging. Increased understanding of the pathogenesis and natural history of pelvic inflammatory disease (PID) and bacterial vaginosis (BV) has led to rationalization of treatment policies for these conditions.
Int J STD AIDS
PMID:Antibiotic chemotherapy of bacterial sexually transmitted diseases in adults: a review. 806 Oct 86

Qualitative research was conducted with traditional healers in Manica Province, Mozambique to develop an empirical, culturally-appropriate strategy for communication between government and traditional healers related to the prevention of STDs including AIDS. Most Manica healers regard AIDS as a new disease for which they lack medicines. However, when questioned on other sexually transmitted diseases, as defined by healers themselves, relatively complex disease taxonomies based on fine distinctions between symptoms emerged. Manica healers recognize two broad categories of STDs: siki and nyoka-related. The former seems to correspond with the more serious common STDs of Western biomedicine--syphilis, gonorrhea, chlamydia and chancroid--and is believed to be caused by a common invisible, microscopic agent, khoma. Nyoka-related illnesses are understood in terms of traditional ideas of pollution, and denote less serious, self-limiting genito-urinary conditions. Healers express great faith in the efficacy of traditional medicines. Based on the ethnomedical research findings, a culturally-sensitive and -specific AIDS/STD health education strategy for Manica indigenous healers was developed and began operating in a week-long workshop held in Chimoio, Mozambique in November 1991.
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PMID:Sexually-transmitted diseases, AIDS and traditional healers in Mozambique. 811 22

An anonymized sero-survey of the prevalence of HIV antibody was performed at an inner city Genitourinary medicine clinic in Birmingham. In 1991 8686 patients undergoing routine serological syphilis tests were anonymously tested for HIV antibodies once during the year. Demographic information was recorded for each sample but they were otherwise unlinked. There were 31 samples which tested positive for anti-HIV 1 from this group compared with 13 diagnosed by concomitant voluntary named testing. Sero-prevalence rates of 0.17% for women and heterosexual men and 4.37% for homosexual/bisexual men were found. No drug users tested positive. The survey provided evidence of occult disease outside the recognized risk behaviour patterns of homosexual men and injecting drug users outside London.
Int J STD AIDS
PMID:Anonymized sero-survey of HIV in a genitourinary medicine clinic population. 847 62

Syphilis has become less common in Europe in the last decade, but has once again become a major problem in the USA, and remains so in many developing countries. Several treponemal genes have now been cloned and expressed in Escherichia coli, allowing study of treponemal proteins. The importance of cell mediated immunity in syphilis has been demonstrated in animal models. A diagnosis of syphilis is usually confirmed by dark-field microscopy or serological tests. Seroconversion may be delayed in HIV infected individuals. A positive reaginic test in cerebrospinal fluid (CSF) has a high specificity but low sensitivity in the diagnosis of neurosyphilis. Indeed, virulent treponemes can be identified in CSF samples which have negative reaginic tests, normal cell counts and protein levels. In the CSF, the FTA-Abs test has a high sensitivity but low specificity for neurosyphilis. Penicillin remains the treatment of choice for all stages of syphilis, although it penetrates the blood brain barrier poorly. Treatment with intramuscular benzathine penicillin 2.4 million units stat, or 600,000 units procaine penicillin daily does not produce treponemicidal levels within the CSF. However, the incidence of neurosyphilis is low in immunocompetent patients treated with such regimens during early syphilis. Acceptable alternatives in penicillin-allergic patients include ceftriaxone and doxycycline. Erythromycin is not recommended as it has produced unacceptably high rates of treatment failure. Recently, a strain of macrolide-resistant Treponema pallidum was isolated from a patient with secondary syphilis. For the treatment of neurosyphilis, treponemicidal levels of penicillin can be achieved in the CSF using 2.4 million units procaine penicillin daily with concurrent probenecid 500 mg 4 times a day, or an intravenous infusion of benzyl penicillin 12-24 million units daily. Early syphilis can be treated adequately over 10 days, but 21 to 28 days is appropriate for late syphilis. In HIV-infected patients syphilis may present atypically with initially negative serological tests. Treatment of early syphilis in HIV-positive patients has been associated with the early development of neurosyphilis. It is advisable to treat all patients co-infected with HIV with an antibiotic regimen that achieves adequate levels within the CSF.
Int J STD AIDS
PMID:A review and update on adult syphilis, with particular reference to its treatment. 847 69

A retrospective study of 767 HIV positive patients from a large urban public hospital, 238 of whom were co-infected with syphilis, was performed to determine the prevalence of neurosyphilis. A prevalence of 3% of neurosyphilis in the co-infected cohort was demonstrated. The 7 cases of neurosyphilis ascertained were of the early stage variety, with cranial nerve involvement the predominant focal deficit. Of the 5 cases presenting after initial diagnosis and treatment of syphilis, 4 were felt to be inadequately treated. An overall prevalence of 1% (7/767) was determined for the entire HIV(+) cohort. The majority of the cases of syphilis (90%) were characterized as latent syphilis. Based on these findings, the authors recommend routine CSF examination in all patients who are HIV positive and who present with latent syphilis. Treatment regimens should be maximized in an effort to reduce the prevalence of neurosyphilis in such a co-infected cohort.
Int J STD AIDS
PMID:Determining the prevalence of neurosyphilis in a cohort co-infected with HIV. 847 73

Data derived from laboratory and activity statistics of the Venereal Disease" department of the Public Health Office in Bremen were analysed between 1961 and 1991. The traditional concept to fight venereal diseases" aimed at controlling persons "at risk" for syphilis, gonorrhoea, chancroid or lymphogranuloma. This "high-risk" approach of STD prevention stressed the compulsory, at least twice monthly screening of female prostitutes and neglected other population groups like clients of prostitutes and young people, who might have an elevated risk in acquiring STD. The spread of STD like chlamydia, HPV, herpes and even HIV in considerable parts of the general population underlines the need for developing a more effective STD prevention, based on scientific diagnosis and treatment. Intervention programmes in STD control must be performed in full partnership with the targeted population; this can require great effort and time. But STD control certainly cannot be achieved under the threat of punishment or proscription.
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PMID:[Prevention of sexually transmitted diseases or control of prostitutes and patients with venereal diseases? An exemplary, epicritical study in Bremen]. 850 94

In 1988, in South Africa, staff at the City Health STD Clinic at King Edward VIII Hospital in Durban took tissue smears from 130 men and 41 women to study the epidemiological and clinical features of donovanosis as it relates to a possible risk of HIV-1 transmission. Laboratory personnel used the RapiDiff staining method and histological examinations to detect Donovan bodies in 169 and 2 of the patients, respectively. 96% of patients were 16-39 years old. 55.6% came from rural areas. Lesions were mainly limited to the genital area (96.2% for men and 78% for women). Women were more likely to also have lesions in the inguinal area (17.1% vs. 1.5%). Most donovanosis lesions were ulcero-granulomatous (96.2% for men and 90.2% for women). 3 of the 6 pregnant female patients had hypertrophic lesions. The only case of anal donovanosis was a woman. Even though the patients had ulcers, many continued to have sexual intercourse. 55.4% of the men and 46.3% of the women had ulcers for more than 28 days before coming to the clinic. 40 patients with donovanosis (23%) also had syphilis. Donovanosis was diagnosed in just 1 of 21 regular sexual partners examined. 2 tablets of co-trimoxazole 2 times daily for, mostly, 14 days cured 41 (24%) patients who returned to the clinic for follow-up. Pregnant women took 500 mg of erythromycin 2 times a day. A few cases had to take 100 mg minocycline twice a day. 4 men tested positive for HIV-1 antibodies while none of the women did. 3 of the HIV-1 positive men who returned to the clinic were completely cured of donovanosis. None of these men had HIV-related symptoms. They were treated with co-trimoxazole. These findings suggest that rural health facilities are not adequately serving patients with donovanosis. Since genital ulcer disease, such as donovanosis, facilitates transmission of HIV-1, strategies to curb the spread of HIV should consider specific measures aimed at eradicating donovanosis in areas where it is prevalent.
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PMID:Clinico-epidemiological study of donovanosis in Durban, South Africa. 850 89

The efficacy of oral azithromycin (500 mg daily for 10 days or 500 mg on alternate days for 11 days) in 100 patients with seropositive syphilis was studied. Clinical manifestations regressed more rapidly in azithromycin-treated patients compared with patients who received erythromycin or penicillin, and there was also a more rapid reduction in serum antibody levels. In 90.3% of patients, the complete resolution of classic serological tests was observed within 4 months of completion of the azithromycin treatment. The immobilization (TPI) test and absorbed fluorescent treponema antibody tests became negative 12 months after treatment in 40% of patients. After 4 years of follow-up, no symptoms of neurosyphilis or syphilitic changes of visceral organs were observed.
Int J STD AIDS 1996
PMID:Treatment of syphilis with azithromycin. 865 20


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