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Query: UMLS:C0001175 (AIDS)
 120,706 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A study of 4718 women 15-49 years old in southwestern Uganda's Rakai district suggests that the loss of lactobacilli and the presence of bacterial vaginosis may increase susceptibility to HIV-1. These women were part of an ongoing community-based trial of sexually transmitted disease (STD) control as a strategy for AIDS prevention. The rate of HIV-1 infection among these women was 19.5%. Moderate bacterial vaginosis was detected in 44.5% of women, while 6.4% had severe bacterial vaginosis. STD rates were 10.2% for active or recent syphilis, 22.4% for trichomonas, 2.4% for gonorrhea, and 3.6% for chlamydia. The HIV rate was lowest (14.2%) among women with normal bacterial flora and highest (26.7%) among those with severe bacterial vaginosis. The HIV-abnormal flora association was higher in younger women, for whom HIV acquisition is likely to be recent, than in older women. In multiple logistic regression analyses adjusted for age, number of sexual partners, trichomonas, and syphilis, the odds ratio (OR) for HIV-1 infection associated with any abnormal vaginal flora was 1.52 (95% confidence interval [CI], 1.22-1.90) and with all bacterial vaginosis was 1.56 (95% CI, 1.24-1.97). These adjusted ORs were 1.50 (95% CI, 1.18-1.89) for moderate and 2.08 (95% CI, 1.48-2.94) for severe bacterial vaginosis. A cross-sectional study cannot ascertain whether the abnormalities in vaginal flora occurred before or after HIV seroconversion. However, the significantly increased proportion of HIV-infected women with depleted or absent vaginal lactobacilli is consistent with in vitro studies showing that hydrogen peroxidase-producing lactobacilli in vaginal flora inhibit HIV-1 viral replication. If the ongoing prospective study suggests a causal association with HIV, treatment of abnormal flora or bacterial vaginosis with inexpensive, effective drugs such as metronidazole may be indicated.
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PMID:HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. 965 90

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of childbearing age. In some women it shows a relapsing and remitting course with apparently spontaneous onset and resolution. There are intermediate patterns of vaginal flora in which lactobacilli and other species co-exist. We asked women with recurrent BV to prepare vaginal smears daily, and to record symptoms, time of menstruation, sexual activity and use of douches or medication. We Gram-stained the smears and assigned a Nugent score for BV, and noted the presence of candida, pus cells, sperm and blood. Eighteen women collected daily vaginal smears for up to 10 months. Forty months of slides were collected in total. Bacterial vaginosis arose spontaneously on 23 occasions. We saw candida arise 11 times. Bacterial vaginosis appeared after candida on 9 of these 11 episodes. We saw BV regress spontaneously 13 times. Nine of these resolutions occurred within 48 h of unprotected sexual intercourse: BV only arose on one occasion within 48 h of unprotected intercourse. The intermediate pattern was seen for up to 10 days, and occurred as BV began or resolved in some women, and sometimes resolved without developing into BV. Bacterial vaginosis arose most often in the first 7 days of a menstrual cycle, and resolved spontaneously most often in mid-cycle. In women with recurrent BV, BV arises most often around the time of menstruation and resolves spontaneously in mid-cycle. Recurrences often follow an episode of candidiasis, and BV often regresses after unprotected sexual intercourse.
Int J STD AIDS 1997 Oct
PMID:Sex, thrush and bacterial vaginosis. 931 Feb 18

An ongoing (1994-98) randomized, community-based trial in Uganda's Rakai District is assessing the assumption that intensive sexually transmitted disease (STD) control efforts result in marked declines in HIV/AIDS prevalence. Described, in this article, are the project design and findings of the first-round baseline survey. 56 communities were grouped into 10 clusters designed to encompass social/sexual networks and clusters within blocks were randomly assigned to the intervention or control arm. All consenting permanent residents of the district are visited in their homes at 10-month intervals where they are administered extensive questionnaires, provide urine and vaginal swab samples, and are offered mass treatment regardless of symptoms or laboratory testing (single oral dose STD treatment in the intervention arm and anthelmintics and iron folate in the control arm). Both groups receive identical health education, condom promotion, and serologic counseling services. In the first round of home visits, 5834 intervention and 5784 control arm subjects were enrolled, representing about 90% of eligible adults. The groups were comparable in terms of sociodemographic and behavioral characteristics and baseline rates of HIV and STDs. 16.9% of subjects were HIV-positive, 10.0% had syphilis, 23.8% of women had trichomonas, and 50.9% had bacterial vaginosis. Detailed STD assessment is expected not only to document the relationship between STD control and HIV, but also to identify which STDs confer the greatest population attributable risk for HIV transmission, facilitating targeted control efforts in the future.
AIDS 1998 Jul 09
PMID:A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda. 967 71

Gynecologic conditions associated with HIV infection were examined in 481 regular female sex partners of HIV-positive male blood donors enrolled in a study of heterosexual HIV transmission conducted at Chiang Mai University Hospital and Lampang Provincial Hospital in Thailand in 1992-96. Of these women, 224 (46.6%) were HIV-infected. HIV-positive and HIV-negative women were similar in terms of age, education, and age at first intercourse; however, a history of sexually transmitted disease was more common among the HIV-infected women (31.7%) than their uninfected counterparts (18.7%). HIV-infected women also were significantly more likely to have abnormal gynecologic conditions, including abnormal vaginal discharge at physical examination (odds ratio (OR), 2.6; 95% confidence interval (CI), 1.6-4.2) and cervical dysplasia (OR, 5.3; 95% CI, 2.0-15.2). Among HIV-positive women, the prevalence of abnormal vaginal discharge and bacterial vaginosis increased significantly with decreasing CD4 count. Syphilis, gonorrhea, chlamydia, and trichomoniasis rates were generally low and did not differ by HIV status. These findings suggest a need for further research on variations in gynecologic conditions associated with HIV infection in different countries.
Int J STD AIDS 1998 Nov
PMID:Gynaecological conditions associated with HIV infection in women who are partners of HIV-positive Thai blood donors. 986 81

The Russian Federation has had a well developed state system for the surveillance and control of sexually transmitted diseases (STDs) since World War II. The system is centered around clinical dermatovenereology (DV) services controlled by the Ministry of Health, and in the regions by the Divisions of Health Care. DV Service provides free diagnosis, treatment, and partner notification conducted by DV dispensaries. STDs are monitored through mandatory universal notification by physicians of newly identified cases. The following STDs must be reported: syphilis, gonorrhea, trichomoniasis, urogenital chlamydiosis, human papillomavirus infection, genital herpes, mycoplasmosis, candidiasis, and bacterial vaginosis. The rate of syphilis increased to 265 cases per 100,000 population in 1997, a 63-fold increase since 1993. The level of gonorrhea declined from 1984 to 1990, then increased from 1991 to the reported 1993 rate of 230.9/100,000; incidence declined from 1994. These data, however, do not reflect the actual situation because of under-reporting due to self-treatment and treatment by private practitioners. More than 26,000 cases of adolescent syphilis were reported in 1997.
Int J STD AIDS 1998
PMID:STD surveillance in the Russian Federation. 987 10

Our objective is to compare the efficacy of using Papanicolaou (PAP)-stained cervical cytology smears with a standardized method of interpreting Gram-stained vaginal smears for the diagnosis of bacterial vaginosis (BV) in pregnancy. High vaginal smears were Gram-stained and examined by a single observer to characterize 3 grades of vaginal flora and diagnose BV. Cervical smears were PAP-stained and examined for characteristic patterns of vaginal flora including evidence of BV by either a number of cytotechnicians or a single cytopathologist. The results of the 2 methods were compared. Seven hundred and forty-seven women attending an antenatal clinic in a district general hospital who consented to have a smear of vaginal secretions and cervical cytology in early pregnancy. The main outcome measure is the diagnosis of BV by different methods in a pregnant population. Compared with the Gram-stain method for the diagnosis of BV, there was good agreement between PAP-stain interpretation by a single observer but the agreement was not as good with PAP-stain interpretation by multiple cytotechnicians. When the grades were consolidated to normal (grade I) and abnormal flora (grades II and III), compared to Gram-stained smears, PAP cytology undertaken by several cytotechnicians had a sensitivity of 80.7% and a specificity of 90.7%. The sensitivity and specificity increased to 87% and 97%, respectively, when the PAP-stained smears were read by a single cytopathologist. Using kappa scores, only those readings made by a single cytopathologist were reliable. The setting in a cytopathology laboratory comprises multiple cytotechnicians, so that PAP-stain analysis of vaginal smears for the diagnosis of BV is likely to provide results which are less reliable than those obtained by Gram staining. The latter should be the first choice and every effort should be made to set up this service.
Int J STD AIDS 1999 Feb
PMID:A comparison of the use of Papanicolaou-stained cervical cytological smears with Gram-stained vaginal smears for the diagnosis of bacterial vaginosis in early pregnancy. 1021 13

The effect of non-heterosexual factors on the vaginal flora has been studied. Ninety-one lesbians attending a specialist genitourinary medicine service for lesbians were studied. Bacterial vaginosis (BV) was diagnosed in 51.6% of them. While most of the women had previously had a male sexual partner, the presence of BV was not associated with a male sexual partner in the previous 12 months. A detailed analysis of lesbian sexual practices in the group did not relate BV to any sexual practice which would have the propensity to pass vaginal secretions from one to the other.
Int J STD AIDS 1999 May
PMID:Bacterial vaginosis in lesbians: evidence for lack of sexual transmission. 1036 19

The diagnosis and treatment of vaginal and sexually transmitted infections constitute an important part of the activity of the gynaecologist and of the general practitioner. In this review article, we will describe various clinical entities, including bacterial vaginosis, vulvovaginal Candidiasis, trichomoniasis, gonorrhea, syphilis, genital herpes, Chlamydial infection, and pelvic inflammatory disease. The acquired immunodeficiency syndrome will not be described here.
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PMID:[Vaginal infections and sexually transmitted diseases]. 1038 73

Evidence linking bacterial vaginosis (BV) to chorioamnionitis and spontaneous preterm birth is mounting. Successful treatment of BV could reduce the rate of late miscarriage and preterm birth. Mucinase and sialidase activity have been implicated in the pathogenesis of BV. This study extends the work of previous studies to investigate sialidase, other known mucin degrading enzymes and overall mucin degrading activity in samples of vaginal fluid from women with and without BV. Samples from 31 women were diagnosed for BV, and tested for enzyme activity using established assays. Activity was recorded in all samples. Significant increases in activity were detected in BV samples for sialidase using a mucin (BSM P<0.005) and serum type glycoprotein (AGP P<0.005) substrates, beta-galactosidase (P<0.001), and beta-N-acetylhexosaminidase (P<0.01). No significant increases in BV patients were detected in O-glycanase, proteinase, arylesterase, sulphatase or whole mucinase activities. These results support the hypothesis that certain BV-associated enzymes may detrimentally affect the mucosal barrier, permitting bacteria access to the uterus.
Int J STD AIDS 1999 Jul
PMID:Mucinase and sialidase activity of the vaginal microflora: implications for the pathogenesis of preterm labour. 1045 78

This study reports on the prevalence of sexually transmitted infections (STIs) among pregnant women in Bangui, Central African Republic. A total of 481 pregnant women visiting the antenatal services of the 3 major governmental health centers were included in the study. All these women were interviewed and underwent gynecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhea, syphilis and bacterial vaginosis. The results revealed that 34% of the women were diagnosed with at least one STI. Gonorrhea accounted for 3.1%, chlamydiasis for 6.2%, trichomoniasis for 9.9%, syphilis for 6.7%, and HIV-1 for 12.2%. In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. The majority of the women diagnosed with an STI reported specific clinical symptoms during the week before they entered into the study, but only a minority of them actively sought treatment, and only half of those consulted the formal health sector. Self-reported and health worker-recognized symptoms, signs and laboratory results manifested only low sensitivities, specificities, and positive predictive values in STI diagnosis. These results confirmed the high susceptibility of young African women to STIs. Therefore, specific control interventions should be carried out which incorporate affordable and user-friendly services.
Int J STD AIDS 1999 Sep
PMID:Sexually transmitted infections in young pregnant women in Bangui, Central African Republic. 1049 29


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