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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aspects of sexually transmitted diseases (STDS) peculiar to the developing countries in South America and sub-Saharan Africa are discussed. The most common STD infections are N. Gonorrhoeae, Chlamydia trachomatis, T. pallidum and T. vaginalis. Vertical transmission, particularly of syphilis among prostitutes, and of Chlamydia and gonorrhea after ophthalmia neonatorum, are common. Chlamydia is also a common respiratory tract infection in African neonates. Late complications of STDs, infertility and ectopic pregnancy, and particularly pelvic inflammatory disease, are responsible for a high proportion of hospitalizations. Antibiotic resistant gonorrhea strains are common, a result of poorly managed antibiotic treatment. Genital ulcer diseases (GUD), which predispose to HIV infections, are more common in Africa than in developed countries, not only herpes but chancroid, donovanosis and lymphogranuloma venereum. Chancroid, caused by Haemophilus ducreyi, causes 36-49% of ulcers in 2 reports. The L1-L3 strains of Chlamydia trachomatis cause lymphogranuloma venereum, the agent responsible for ulcers in 3.6-6.1% of 2 clinic populations. HIV infections have an equal sex ratio in Africa, with a younger age incidence in women and a high vertical transmission rate, while in Latin America, bisexual men, and increasingly, heterosexual transmission by intravenous drug users is reported. There is also an HIV-2 virus, whose virulence is in question, common in West Africa.
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PMID:The epidemiology of sexually transmitted diseases in Africa and Latin America. 220 6

In a prospective, systematic investigation, 2215 new patients with sexually transmitted diseases (STD) were screened for human immuno deficiency virus (HIV) infection during April 1986 to December 1988. Among them 9 were positive for HIV antibody giving a rate of 4/1000. In addition, 5 patients had been referred to our clinic with a diagnosis of HIV infection and STD. Among these 14, there was one married couple. Of the remaining 5 married individuals, 4 were men; the wives of 3 of them were infected but asymptomatic, and were not included in this report. The rate of conjugal infection was 71 per cent. Most (57%) patients belonged to poor socio-economic background; 78 per cent of patients were young, in the age group 15-25 yr. The presenting STD were syphilis, venereal warts, gonorrhoea, chancroid, genital herpes, non-gonococcal urethritis and candidiasis. It appeared that the course of associated STD had not been altered in these HIV infected individuals.
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PMID:HIV seropositivity among patients with sexually transmitted diseases in Vellore. 222 49

The three major diseases characterized by genital ulcers--genital herpes, syphilis, and chancroid--are common, with genital herpes being most common in industrialized countries and chancroid being most common in developing countries. One fourth to one half of patients with genital ulcers have no diagnosed cause for their illness despite diagnostic efforts. The bulk of these cases is probably constituted by one of the three diseases for which diagnostic tests are falsely negative. There is accumulating evidence that genital ulcers facilitate the transmission of human immunodeficiency virus (HIV), and they may also be markers of high-risk behavior for acquisition of HIV. Appropriate therapy of patients with genital ulcers (as well as their sexual partners) depends on accurate diagnosis. Patients with genital ulcers, particularly those with syphilis or chancroid, should be encouraged to undergo testing for HIV infection.
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PMID:Approach to the patient with genital ulcer disease. 224 53

Epidemiologic studies in Nairobi and elsewhere in Africa, have shown that men infected with HIV-1 more commonly have a history of genital ulcer disease compared to uninfected men. In one study, HIV infected men were three times as likely to have a recent history of genital ulcers. In a prospective study of seronegative men, those presenting with chancroid had a five-fold risk of seroconversion during follow-up compared to men presenting with urethritis. Uncircumcised men had an increased risk of seroconversion which was independent of their risk of genital ulcer disease. Over 95% of attributable risk in men with STD was either genital ulceration or the presence of a foreskin. Genital ulcers are a major risk factor for HIV infection among prostitutes. The increased risk is about 10-fold among prostitutes with ulcers compared to a cohort who did not. We hypothesize from these studies that genital ulcers are the major portals of entry for HIV infection and also increased shedding of virus infected cells into the vaginal secretions. HIV seropositive prostitutes are more susceptible to chancroid with a two-fold increase in the prevalence of genital ulcers as compared to HIV negative women. The use of condoms by their clients prevents both genital ulcer disease and HIV acquisition among prostitutes. Chancroid is more difficult to treat in HIV infected men with one-third of patients failing single dose treatment regimens as compared to less than five percent of men without HIV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Human immunodeficiency virus, genital ulcers and the male foreskin: synergism in HIV-1 transmission. 226 93

In June 1989, a pilot study investigating the prevalence of sexually transmitted diseases (STDs) was conducted at Kamuzu Central Hospital, Lilongwe, Malawi. Among unselected outpatients, an STD prevalence of 4.4% was found. The patients were predominantly 20-35 years of age. The distribution of diagnoses was dominated by a relatively large proportion of ulcer diseases (syphilis, chancroid, and lymphogranuloma venereum), seen among 67% of the patients. Almost 2.3 of the patients were HIV-positive (62.4%). No significant difference was found in HIV infection prevalence when patients with ulcer diseases were compared to patients with discharges. Among the patients with gonorrhea, a prevalence of penicillinase-producing Neisseria gonorrhoea of 53% was found. It is concluded that a plan for the management of STDs is urgently needed as it is of paramount importance in combatting STDS in order to prevent the spread of HIV infection.
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PMID:The prevalence of symptomatic sexually transmitted diseases and human immunodeficiency virus infection in outpatients in Lilongwe, Malawi. 239 Nov 10

There is increasing evidence that genital ulceration, including syphilis, chancroid, and herpes simplex type 2, increases susceptibility to HIV infection. It may be that the HIV penetrates more easily through ulcerated membranes or that the lymphocytes associated with the inflammatory response present target cells for HIV infection. There is also evidence that HIV-infected women with genital ulcers are themselves more infective due to shedding of the virus in the genital tract. Nonulcerative sexually-transmitted diseases have also been associated as cofactors of HIV infection. Programs for the control of sexually transmitted diseases should be strengthened and should focus on eliminating chancroid, which is easily treated with antibiotics. Patients with genital ulcer disease should receive counseling, so that they will know that untreated genital ulcers increase the risk of HIV infection.
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PMID:Genital ulcers, other sexually transmitted diseases, and the sexual transmission of HIV. 249 85

In Kenya, researchers enrolled 53, men aged 18-60 years with chancroid who enrolled at the Nairobi City Council Special Treatment Clinic in a clinical trial to test the efficacy of fleroxacin in clinical Haemophilus ducreyi infections. They randomly allocated the men the group receiving 200 mg of oral fleroxacin or the group receiving 400 mg of oral fleroxacin. 88% of the men receiving 200 mg oral fleroxacin (group 1) experienced either improvement in their clinical status or healing compared to 78% of the men receiving 400 mg oral fleroxacin. 2 of 7 (29%) patients who experienced delayed healing tested positive for HIV-1. 2 of 22 patients (9%) who healed right away were HIV-1 positive. The size of the genital ulcer had the most significant effect on healing time. The mean widest ulcer diameter was 9.5 mm in men who healed quickly while it was 18.5 mm in men who experienced a delay in healing (p .005). Microbiological cure occurred in 92% of men from group 1 and in 83% of those in group 2. The difference in microbiological failure rates of HIV-1 seropositive men and HIV-1 seronegative men approached significance (27% vs. 5%; p = .07). These results showed that a 200 or 400 mg single dose of oral fleroxacin is an efficacious treatment for men with microbiologically confirmed chancroid who are not HIV-1 infected. On the other hand, a single dose of neither 200 or 400 mg of oral fleroxacin adequately treats chancroid in HIV-1 infected men. Further study of chancroid treatment in HIV infected patients is needed, especially since chancroid may facilitate HIV transmission.
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PMID:Evaluation of fleroxacin (RO 23-6240) as single-oral-dose therapy of culture-proven chancroid in Nairobi, Kenya. 250 65

Haemophilus ducreyi is a fastidious pathogen that can be routinely cultured with the appropriate media and incubation environment. Prostituted women appear to be the usual reservoir. In Africa, chancroid is emerging as the major risk factor for acquisition of HIV-1 following heterosexual intercourse. Despite the emergence of resistance to a number of antimicrobial agents, H. ducreyi remains susceptible to ceftriaxone, erythromycin, and ciprofloxacin. Control and eradication of outbreaks of chancroid have been successful on several occasions in Western societies; strategies to control epidemic genital ulcer disease are required in developing countries. Granuloma inguinale is caused by a small, gram-negative rod, which has never been well-characterized. The presence of Donovan bodies is a specific and sensitive diagnostic characteristic. Very little is known about the epidemiology of the disease. Specific treatment programs using trimethoprim-sulfamethoxazole or erythromycin seem to be quite effective. Control strategies have not been adequately investigated.
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PMID:Chancroid and granuloma inguinale. 267 22

The epidemiologic and social aspects of AIDS are different in developed and developing countries. In Africa, where there are several tens of thousands of cases, the ratio of female to male cases is 1:1. The highest incidence in men is at age 37.4 and in women 30 years. In Haiti the female to male ratio is 1:1.8. In Rwanda and Zambia the incidence is higher among educated people. In most of Africa AIDS is predominantly urban. Also, in Africa the time between diagnosis and death is shorter. Seroprevalence rates in Africa and the Caribbean are between .5 and 18% for the population at large. In Zaire seroprevalence peaks between ages 16-20 and at under 1 year. Both in the US and in Africa the epidemic appears to have begun around 1980. In West Africa a related virus, HIV-2, has been identified. Progression rates from seropositivity to AIDS or AIDS-related complex in Africa are similar to those in the US. However, in Africa, and recently in Haiti, transmission has been heterosexual. In Africa female prostitutes have the highest incidence of HIV seropositivity, and there is much female to male transmission via this route. Genital ulcers, especially chancroid, increase the risk of AIDS, and condom use may protect women from infection. The 2nd most important route of AIDS transmission in Africa and Haiti is blood transfusion. Blood transfusion are common in treatment of children with anemia from malaria and with sickle cell anemia, and many children have been infected via this route in Africa. Medical injections, scarification and circumcision also account for HIV transmission. Perinatal transmission from seropositive mothers is also common in Africa. Among patrilineal African societies premarital or extramarital sex is rare among girls, but young men and husbands of nursing mothers often visit prostitutes. In the cities there are varying degrees of promiscuity. In couples where the husband is seropositive, he usually has a history of sex with prostitutes, but in couples where the wife is seropositive, she usually has a history of blood transfusion.
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PMID:Epidemiological and sociological aspects of HIV-infection in developing countries. 305 51

Among 115 heterosexual men who presented with genital ulcers to a sexually transmitted disease clinic in Nairobi, Kenya, the prevalence of serum antibody to HIV was 16.5%. A past history of genital ulcers was reported by 12 (63%) of 19 men with antibody to HIV versus 30 (31%) of 96 without antibody (P = 0.008). HIV infection was also positively associated with lack of circumcision, but was not associated with the etiology of the current genital ulcer. Logistic regression analysis (adjusted for age, number of recent sex partners, recent prostitute contact, circumcision, tribal ethnic identity, past history of urethritis, and current diagnoses) confirmed only the association between prior history of genital ulcer disease and HIV infection; (P = 0.04, odds ratio 2.35, 95% confidence limits, 1.01-5.47). The incidence of genital ulcers, particularly chancroid, is much higher in parts of Africa than in Europe or North America. This may contribute to the increased risk of heterosexual transmission of HIV in Africa. Aggressive control of chancroid and syphilis may offer one very feasible approach to reducing transmission of HIV in this region.
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PMID:Genital ulceration as a risk factor for human immunodeficiency virus infection. 312 96


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