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

Our objective was to assess whether antibiotic prophylaxis should be offered to women post sexual assault by considering acceptability of prophylaxis, follow up attendance rates and the prevalence of sexually transmitted infections (STIs) in these women. Retrospective case notes review of female survivors of rape or sexual assault attending the Rose Clinic, Ambrose King Centre, Royal London Hospital between 1 January 1997 and 31 May 1999 was carried out. The following selection criteria were applied: age greater than 16 years; attending within two weeks of assault; having experienced vaginal and/or anal penetration. All women were screened for STI using standard investigation methods detailed below. Antibiotic prophylaxis was offered within two weeks of the assault, the antibiotic regimens used as recommended. The women were invited to attend for results at two weeks and offered a further screen at three months post assault. Bacterial vaginosis was present in 32% of the women screened, Chlamydia trachomatis was identified in 8%, none tested positive for Neisseria gonorrhoeae. Of the 25 women who were offered antibiotic prophylaxis, 88% accepted. Follow up attendances were 57% at two weeks and 30% at three months. Antibiotic prophylaxis was acceptable to women. Among recent rape victims, follow-up rates are low confirmed by our study. These factors support the use of antibiotic prophylaxis post sexual assault. There was an apparently high prevalence of STIs amongst women in this study. More research is required with respect to this aspect of the work and to consider the cost-benefit analysis of antibiotic prophylaxis.
Int J STD AIDS 2003 Feb
PMID:Should we offer antibiotic prophylaxis post sexual assault? 1266 87

The objectives were, first, to determine the sensitivity and specificity of the Osmetech Microbial Analyser (OMA) for the diagnosis of bacterial vaginosis (BV) and, secondly, to determine the factors that interfere with the performance of the test. Women presenting to a genitourinary medicine clinic underwent routine screening for genital infections. Additional swabs were tested on the OMA, and by Nugent scoring. The optimum method for sampling was determined on the first 372 samples. BV was diagnosed in 182 (27%) of the remaining 665 subjects by Amsel criteria, and 188 (29%) of 642 women with evaluable Gram-stains. The sensitivity and specificity of the OMA were 81.45% and 76.1% compared to Amsel criteria and 82.9% and 77.3% compared to Gramstain. Further refinements to improve the sensitivity and specificity of the OMA are required to provide an accurate near patient testing method.
Int J STD AIDS 2003 Feb
PMID:Evaluation of a novel diagnostic test for bacterial vaginosis: 'the electronic nose'. 1266 90

The objective of the study was to measure the lactate dehydrogenase (LD) activity in vaginal lavage fluid of women with vaginitis/vaginosis and in healthy pre- and post-menopausal controls. Also to analyse the LD isoenzyme patterns in such samples and compare the influence on the LD activity by different storage and sampling methods. Twenty of the women studied, who had no signs of inflammation as evidenced from vaginal wet smears, were pre-menopausal and 8 post-menopausal. Fifty-eight non-pregnant patients with vaginitis/vaginosis or non-inflammatory gynaecological conditions were analysed for LD isoenzyme patterns. The LD activity was correlated to vaginal pH. Furthermore, the LD activity was determined in another 100 women screened for Chlamydia trachomatis. Finally, the influence on the LD activity when sampling was made by a cytological brush vs vaginal lavage and analysed after different storage periods, as studied. The LD activity was elevated, i.e. >2 micro kat/L, in all but two of the women with leucorrhoea. Only women with bacterial vaginosis (BV) without leucorrhoea, had an increased LD activity. An increased vaginal pH correlated to the LD concentration. The LD activity was elevated in cases with vulvovaginal candidiasis, trichomoniasis, chlamydial cervicitis and senile colpitis. Storage of samples for up to six hours had no influence on the test outcome. Brush and lavage fluid samples did not differ with regard to the rate of positive LD tests. In healthy women, the LD activity is low and predominated by slow-migrating isoenzymes, i.e. LD 4 and 5. The LD activity is generally increased in cases of vaginitis and in women with BV and chlamydial cervicitis. In trichomoniasis, particularly high concentrations of LD 5, are found.
Int J STD AIDS 2003 Apr
PMID:Lactate dehydrogenase and its isoenzymes in vaginal fluid in vaginitis/vaginosis cases and in healthy controls. 1271 98

The aim of this study was to assess if patient characteristics could influence the sensitivity of enzyme immunoassay (EIA) testing used for chlamydia screening. Our cohort consisted of 56 patients who were known polymerase chain reaction-positive for chlamydia, but with variable EIA results. Characteristics analysed included those already known to influence the EIA (menstruation, pregnancy, difficult examination) and those suspected from clinical observation (including presence of symptoms or signs, coexistent gonorrhoea, duration from last sexual exposure). An unexpected finding was that significantly more cases of bacterial vaginosis were found in those chlamydia EIA-negative compared to those with positive results. We postulate that an enzyme produced in bacterial vaginosis, proline aminopeptidase, may cause destruction of the chlamydial cell wall, therefore affecting the EIA adversely. Further research is needed to explore this hypothesis.
Int J STD AIDS 2003 Jul
PMID:Does bacterial vaginosis alter the sensitivity of screening tests for Chlamydia trachomatis? An analysis of patient characteristics. 1503 73

An increasing number of women with vulval problems and pain attend Olafiaklinikken, the centre for sexually transmitted infection (STI) in Oslo. The aim of the study was to investigate the prevalence of long-standing vulval problems and entry dyspareunia in a consecutive sample of STI-clinic visitors in Oslo. A self-administered questionnaire was distributed before and independent of the consultation. Response rate was 89.6% (502/560). Mean and median age were 25.9 and 24.0 years respectively, range 16-65 years. Vulval soreness, burning, dryness and fissures present for at least three months were reported by 23.1% (116/502), entry dyspareunia by 6.9% (34/494). Independent risk factors for dyspareunia were a history of >/=4 treatments for vulvovaginal candidiasis during the last year, reported by 34.6%, odds ratio (OR) 4.45, 95% confidence interval (CI) 1.81-11.0, and a history of bacterial vaginosis, reported by 42.4%, OR 2.34, 95% CI 1.11-4.92. Contraceptive methods, hygienic habits, a history of STIs, depression or sexual abuse were factors unrelated to longstanding symptoms. Investigation with regard to longstanding vulval problems and entry dyspareunia is required for a certain group of sexually transmitted disease-clinic visitors in Oslo, and referral to a special service for vulva patients would be beneficial for selected patients.
Int J STD AIDS 2003 Dec
PMID:Longstanding vulval problems and entry dyspareunia among STD-clinic visitors in Oslo-results from a cross-sectional study. 1467 85

We assessed the validity of a syndromic case management approach for reproductive tract infections (RTIs) among 371 pregnant women attending antenatal care facilities in Kingston, Jamaica, using an algorithm previously validated in high-risk Jamaican women. For our antenatal attenders, the algorithm had low sensitivities for all RTIs (66.7% for cervicitis, 35.4% for trichomoniasis, 11.1% for bacterial vaginosis (BV) and 24% for candidiasis). Specificities for BV (88.9%) and candidiasis (81.1%) were higher than for cervicitis (62.8%) and trichomoniasis (68.5%). The positive predictive values were lower than 36% for all diagnoses, especially BV (6.9%). Syndromic management of RTIs in pregnant women was problematic using a clinical algorithm that had worked well for high-risk women. Syndromic management for RTIs in Jamaican antenatal clinics is only a temporary solution until more simple and affordable diagnostic tests for RTIs are developed and/or until laboratory support and clinical care can be upgraded at antenatal clinics.
Int J STD AIDS 2004 Jun
PMID:Marginal validity of syndromic management for reproductive tract infections among pregnant women in Jamaica. 1518 80

This study evaluated Amsel's criteria, the FemExam card and pH plus amine methods for the diagnosis of bacterial vaginosis (BV) in a resource-poor setting. Two hundred Azerbaijani women participated in a study about reproductive health that included a gynaecological examination and an interviewer-administered survey. Using the WHO syndromic diagnosis algorithm, nearly all women (99%) had abnormal vaginal discharge. The prevalence of BV by Gram stain was 35%; using pH plus amine, the FemExam card and Amsel's criteria, prevalence ranged from 29% to 49%. No behavioural or demographic characteristics were associated with BV as diagnosed by Gram stain. The sensitivity ranged from 0.59 to 0.74 and specificity from 0.65 to 0.92 using the three methods. The pH plus amine test is better than syndromic management protocols, and although it is not the most sensitive or specific of the three methods it will be easiest to implement in resource-poor settings.
Int J STD AIDS 2005 Jan
PMID:Strategies for diagnosis of bacterial vaginosis in a resource-poor setting. 1570 74

This is a prospective case-controlled study of female attendees in Coventry. This study found an association of higher vaginal pH with chlamydial infection, independent of any other factors. Studies in vitro have shown that an acidic vaginal secretion inhibits chlamydial infection. Our objective was to analyse the association of vaginal pH and chlamydial infection in women attending a genitourinary medicine clinic. Chlamydial infections were diagnosed with ELISA and confirmed within direct immunofluorescence. Vaginal pH was measured by a pH indicator tape ranging from 3 to 8. Consecutive female attendees with no sexually transmitted infections (STIs) were included as controls. In all, 144 female cases, diagnosed with chlamydial infection, had a median age of 20 years. Seventeen women had associated bacterial vaginosis. Eighty-two women had no other STIs. Ninety-eight women were using the oral contraceptive pill (OCP). The 145 control women had a median age of 26 years and 52 were receiving the OCP. A significantly higher vaginal pH was seen in the cases (P = 0.0001, Wilcoxon test), even after adjusting for other risk factors associated with vaginal pH, including OCP use (odds ratio: 6.49, 95% confidence interval, 3.59-11.73, P = 0.0001). Chlamydial infection in women was associated with a higher vaginal pH level, independent of any other factors. This study has implications for the treatment of other conditions known to lead to an increase in vaginal pH, even in asymptomatic individuals.
Int J STD AIDS 2005 Apr
PMID:Higher vaginal pH is associated with Chlamydia trachomatis infection in women: a prospective case-controlled study. 1589 81

Bacterial vaginosis (BV) frequently recurs after treatment. One option in the management of recurrences is to keep the vaginal pH at 4.5 or less, in order to prevent overgrowth of bacteria, until the normal lactobacilli are re-established. We report the outcome of using maintenance acetic acid vaginal gel, after treatment of BV, in a sample of 49 women with frequent recurrences. Half of the women had no further recurrences, and in those who did there was a significant increase in time to first recurrence (4.8 months) after commencing the gel compared with the previous recurrence (2.1 months). Prior to using acidic gel, the mean recurrence rate in 49 women was 4.4 per woman/year, and this was reduced to 0.6 recurrences per woman/year. As there are few effective therapies for women with recurrent BV, we feel this offers an option that can currently be used in clinical practice.
Int J STD AIDS 2005 Nov
PMID:Recurrent bacterial vaginosis: the use of maintenance acidic vaginal gel following treatment. 1630 68

Bacterial vaginosis (BV) has been associated with HIV sexual transmission and increased levels of genital tract HIV RNA. We postulated that BV induces the appearance of substances in the genital tract that stimulate HIV expression locally. To test this, we measured HIV RNA levels in genital mucosal fluid from women with or without BV (defined by Nugent score) and compared them with the ability of those fluids to stimulate HIV expression in the chronically HIV-infected monocytic line U1. The U1 activity was significantly higher in women with BV (median = 1320 pg/ml p24) than in women with normal flora (median = 103 pg/ml p24, p = 0.0001). However, levels of the U1 activity were not significantly associated with levels in the genital tract of HIV RNA. Levels of the U1 activity were also not associated with levels of Gardnerella vaginalis or Mycoplasma hominis in genital fluids, suggesting these bacteria were not the source of the activity. Thus, while these data show a strong association of U1 stimulatory activity with BV, no influence of the U1 activity on genital tract HIV expression was observed.
AIDS Res Hum Retroviruses 2005 Nov
PMID:Relationship of U1 cell HIV-stimulatory activity to bacterial vaginosis and HIV genital tract virus load. 1638 11


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