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

The control of sexually transmitted diseases (STDs) is vital to combat AIDS in developing countries. The 1993 World Development Report showed the cost effectiveness of STD control per healthy life-year saved. A meeting of the Network of AIDS Researchers in East and Southern Africa was held on this issue in Mwanza, Tanzania, attended by 20 experts from 5 countries in the region. The World Health Organization recommends that STDs should be managed without laboratory tests, at the primary health care level in developing countries, using drugs of proven local efficacy. In Africa, this policy has been implemented only in Zimbabwe, but without a striking fall in STDs, since in 1991 STDs were responsible for over 20% of visits by adults at primary health care clinics in Harare. A contact-tracing study in Harare indicated that only 20 contacts were found after 3 months' work by 6 staff members. Asymptomatic STDs in women have hampered STD control, but a community study from Mwanza has also shown that 6% of men were infected with gonorrhea or chlamydia and 90% had no symptoms. A WHO risk-assessment protocol is being evaluated in Mwanza among women with vaginal discharge. A controlled trial of mass treatment for gonorrhoea, chlamydia infection, chancroid, and syphilis is to start in Uganda early in 1994 in a community where the incidence of HIV has remained static at 2% per annum in the general adult population (over 6% in young women) despite intensive education campaigns. Even when symptoms are present, most patients seek unofficial treatment in Africa. Increasing antimicrobial resistance among sexually transmitted pathogens in Africa makes STD treatment more expensive. The introduction of user charges in Nairobi led to a sudden fall in attendances at the main STD clinic and in other countries in the region. The treatment of the STDs prevents future infections, thus STD treatment should be free with the help of international donors.
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PMID:STD research in Africa. 790 91

Even though the population of developing countries is heterogeneous, it is young, and the incidence and prevalence of sexually transmitted diseases (STDs) are likely to increase among persons aged 20-40. STD epidemiologic data tend to be unreliable in most developing countries. Zimbabwe, a country with a good information system, has about 1 million reported STD cases each year (40% urethritis, about 25% genital ulcers, and 20% vaginal discharge and/or pelvic inflammatory disease). Gonococcal infections among pregnant women vary from 2% to 20% in Africa and are 10-20 times higher here than in comparable populations in the West. Chlamydial infection rates in developing countries tend to be similar to and lower than rates in the West. Syphilis prevalence rates range from 1% to 20% in some developing countries. STD complications and their sequelae pose an important public health problem for developing countries. They mostly affect women and newborns. STD complications and their sequelae include spontaneous abortion, fetal death, low birth weight, congenital syphilis, blindness, infertility, and social and personal damage. It appears that STDs facilitate HIV transmission. HIV-related immune deficiency increases one's susceptibility to genital ulcers. Increasing resistance to antibiotics complicates treatment of gonorrhea and chancroid. HIV infected persons respond poorly to classic treatment of chancroid. Two major STD interventions are prevention through behavior modification and promotion of barriers and limiting the duration of infection through optimal case management and case finding activities. The emergence of HIV has placed primary prevention as an absolute priority. Social marketing of condoms has been successful in several developing countries. Provision of accessible and affordable care can change health seeking behavior of persons with STDs such that they seek care from medical services. The primary health care systems of several developing countries use simple diagnostic algorithms to identify STD cases.
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PMID:Epidemiology and control of sexually transmitted diseases in developing countries. 804 15

Sexually transmitted diseases (STD) cause significant morbidity in the industrialized nations and, even more so in third world countries. Genital ulcerative STD such as herpes genitalis, syphilis, and chancroid have been identified as important risk factors for the spread of human immunodeficiency virus infection. Efficient and safe therapeutic regimen are therefore essential to cure the individual and to prevent spread of STD in the community. In this review, the current treatment guidelines for the bacterial STD gonorrhoea, chlamydial infections, syphilis, and chancroid are summarized and recent therapeutic developments are discussed.
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PMID:Treatment of bacterial sexually transmitted diseases. 808 May 4

It appears incontestable that there is a link between genital ulcer disease and HIV infection. On the one hand the natural history and response to therapy of syphilis, HSV-2, and chancroid are all modified by the immunosuppressive effects of HIV infection. On the other hand, HIV transmission is probably facilitated by the disruption of the normal epithelial barriers of the genital organs caused by these ulcerative infections. Information is somewhat less convincing that a similar association exists between the nonulcerative STDs (trichomonas, gonorrhea, chlamydial infections) and HIV. Conceptually, the mucosal inflammation associated with these infections might serve as a focus for HIV transmission. The available data, though suggestive, do not strongly support this contention. Theoretically though, even a small risk might potentially result in significant HIV transmission given the prevalence of nonulcerative STDs. These infectious processes do not appear to be markedly altered by HIV induced immunosuppression. The ability of HPV to cause dysplastic changes in cervical and anal tissue did not require the AIDS epidemic to come to light. In HIV infection, disruptions of immunoregulatory processes, which might ordinarily control the progression of potentially malignant cell lines, have created fertile ground for an increasing incidence of premalignant and malignant cytologic changes. The mutual impact these processes have or may have on one another requires that clinicians who care for patients with either HIV infection or with STDs should be thoroughly familiar with both and not consider them somehow exclusive of one another. Efforts toward the prevention and control of STDs should be considered important in the control and prevention of HIV transmission.
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PMID:Sexually transmitted diseases in HIV-infected persons. 808 70

Several sexually transmitted diseases are endemic in the tropics. The morbidity and mortality from the human immunodeficiency viruses (HIV-1 and HIV-2) alone now rival that caused by Plasmodium falciparum malaria in several African and Asian nations. The genital ulcers of chancroid and syphilis facilitate the sexual transmission of HIV. Within the last two decades, the bacteria causing chancroid and gonorrhoea throughout the world have acquired plasmids that mediate bacterial resistance to penicillins and other antibiotics. This has significantly increased the costs of treatment. There is little prospect that the prevalence of gonorrhoea, chancroid, syphilis and HIV will decrease in the tropics in the near future without a global change in sexual behaviours and practices.
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PMID:Sexually transmitted diseases in the tropics. 813 21

In Belgium, the Department of Infection and Immunity of the Institute of Tropical Medicine in Antwerp modified an experimental enzyme immunoassay (EIA) for the detection of serum IgG to Hemophilus ducreyi to develop EIAs for detection of anti-H. ducreyi IgA and IgM antibodies. They tested the modified EIA on sera from people in Nairobi, Kenya; Kigali, Rwanda; Banjul, The Gambia; and Bangkok, Thailand, who had a sexually transmitted disease. The EIA was able to identify correctly those who did not have anti-H ducreyi IgA, IgG, and IgM antibodies in 97%, 92%, and 99% of cases, respectively. Among people with a genital ulceration for more than 8 days, it was able to identify correctly those who had IgA, IgG, and IgM antibodies in 88%, 93%, and 78% of cases, respectively. 95% of all culture-proven chancroid patients tested seropositive for at least 1 antibody type. The sensitivity of IgG and IgA EIAs was significantly enhanced in patients with culture-proven chancroid who were older than 24 years old (p .01). HIV seropositive people from Kigali who had culture-proven chancroid had higher anti-H. ducreyi IgG seropositivity rates (but not IgA and IgM seropositivity rates), than did HIV seronegative chancroid people from Kigali (p .05). The increased IgG seropositivity rate was not related to higher antibody titers, however, suggesting that HIV infection modifies the response to H. ducreyi. These results show that the 3 EIAs hold promise as a means to study the kinetics of antibodies and the epidemiology of chancroid.
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PMID:Enzyme immunoassays (EIAs) for the detection of anti-Haemophilus ducreyi serum IgA, IgG, and IgM antibodies. 814 Apr 87

In Asia, the cumulative total of HIV-infected adults will reach 1.22 million by 1995, and, by 2000, the number is estimated to reach 11-45 million. The modes of transmission vary from country to country and include injecting drug users, commercial sex workers and their clients, commercial blood donors, hemophiliacs, and homosexuals. Social, cultural, and health factors also affect transmission, such as rites of passage to adulthood, lack of female autonomy, multiple sex partners, wars and civil unrest, and availability of drugs. The HIV epidemic has economic ramifications and causes, e.g., migrant worker camps, the sex industry, and rapid urbanization luring Burmese girls to Thailand. Governments must create an environment for behavior-change through financial, political, and legislative measures. Community organizations also play a role in prevention, as in programs initiated by a squatter settlement in Bangkok, where 36% of IV drug users were found to be HIV-positive. In Maharashtra State, India, peer-based prevention programs were developed for sex workers. Successful behavior change of individuals is based on redefinition of peer norms, understanding the danger and vulnerability to infection, and building confidence to change behavior. Successful programs require placing priority on HIV issues on the political agenda, negotiation and consensus-building skills, and competent program management. For instance, in Zimbabwe a project enlisted 380,000 people in 4500 education sessions within 2 years, and distributed 2.5 million condoms. Among sex workers, condom use increased from 5% to 50%. Implementation strategies include the provision of information and interpersonal education. In Zaire, mass media and social marketing efforts boosted condom sales from less than half a million in 1987 to over 20 million in 1991. The means to change behavior requires the availability of good quality condoms, disinfectants, and syringes. Furthermore, clinical management of gonorrhea, syphilis, human papillomavirus, and chancroid is vital to lowering the risk of HIV transmission. Continuous epidemiological research and the evaluation of prevention programs improve program effectiveness.
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PMID:Confronting the HIV epidemic in Asia and the Pacific: developing successful strategies to minimize the spread of HIV infection. 828 67

The sexually transmitted diseases chancroid, lymphogranuloma venereum and granuloma inguinale should be familiar to physicians who care for patients at risk. The mucocutaneous manifestations of these three diseases must be distinguished from the lesions of other venereal diseases, such as primary syphilis and genital herpes simplex. Human immunodeficiency virus (HIV) infection should always be considered in patients with any venereal disease, since sexually transmitted diseases often occur together. Furthermore, the genital erosions that occur in patients with these three disorders may predispose them to HIV infection.
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PMID:Mucocutaneous manifestations of chancroid, lymphogranuloma venereum and granuloma inguinale. 830 62

Genital ulcer disease as a risk factor for HIV transmission has become apparent in the fight against AIDS. In poor communities in developing countries with people living under low hygienic conditions chancroid is often reported to be the most common form of genital ulcer. It is caused by Haemophilus ducreyi; a fastidious bacterium, notoriously difficult to grow in the laboratory. Apart from a few small micro-epidemics from time to time the disease, which has interesting immunological aspects, is now rare and almost forgotten in most industrialized countries. This may be part of the reason why there is no simple and inexpensive diagnostic test available yet that would be useful in the low-resource settings where chancroid is prevalent. The present review focuses on the diagnosis and pathogenesis of chancroid.
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PMID:Haemophilus ducreyi. 830 70

The management of sexually transmitted diseases (STDs) has reached a new level in the era of antibiotic resistance and human immunodeficiency virus infection. To date, no single antimicrobial is capable of eradicating the commonly encountered STD pathogens including Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum. Among the marketed fluoroquinolones, ciprofloxacin, ofloxacin, lomefloxacin, and enoxacin all provide excellent in vitro activity (MIC90 < 0.06 micrograms/ml) and excellent in vivo efficacy against N. gonorrhoeae, including multiply resistant isolates (penicillinase-producing N. gonorrhoeae and chromosomally mediated resistant N. gonorrhoeae). Ofloxacin is the only fluoroquinolone approved by the Food and Drug Administration for chlamydial infection. All of the quinolones lack reliable in vitro activity against Ureaplasma urealyticum, a cause of nongonococcal urethritis. Although limited data suggest the usefulness of ciprofloxacin and ofloxacin in the treatment of pelvic inflammatory disease, these drugs cannot currently be recommended for single-agent therapy. Haemophilus ducreyi infections, however, can be managed effectively with the fluoroquinolones. Although their role continues to evolve, this class of drugs cannot be used equally to treat all STDs, and notably, no quinolone to date inhibits T. pallidum.
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PMID:The role of fluoroquinolones in sexually transmitted diseases. 832 33


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