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

An integrated STD (sexually transmitted disease) and HIV control program is vital to tackling the major public health problem of STDs and HIV/AIDS. The World Health Organization estimates that there are 333 million new STD infections and 15-20 million new HIV infections each year. The two basic principles common to all STD control programs worldwide include prevention of STDs, their complications, and sequelae and the interruption and reduction of their transmission. These principles also apply to bringing about the reduction of the incidence of HIV infection. Primary prevention strategies, which should be accessible to all sexually active adults and youth, include health education and information, education, and communication (IEC). Secondary prevention strategies include promotion of health care seeking behavior, case management of people with an STD, and early detection and treatment of asymptomatic infections through case finding and screening. In developing countries especially, the most realistic and cost effective way to treat STD patients is the syndromic approach. This approach uses algorithms based on common signs and symptoms (e.g., genital ulcer, urethral and vaginal discharge). It can be used either with or in the absence of laboratory support. The two most common causes for genital discharge are syphilis and chancroid, so, given no laboratory support, the health provider would provide treatment for both STDs. The algorithm for urethral discharge is similarly clear cut. That for vaginal discharge is not so discriminating, since this symptom is very common and non-specific with multiple non-sexually acquired etiologies possible. Since most chlamydial and gonococcal infections in women are asymptomatic, active case finding, screening, and partner notification are very important in women-focused STD control programs.
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PMID:Sexually transmitted diseases control in developing countries. 869 72

Important unpublished literature and literature published since 1980 on sexually transmitted diseases (STDs) in South Africa were reviewed to provide a picture of what is known about the epidemiology of STDs in the country. STD infection is a serious public health problem in South Africa, with significant morbidity from both ulcerative and nonulcerative infections, particularly in women. The body of data on STDs was found to be largely sound, but incomplete. Ulcerative infections, caused mainly by syphilis and chancroid, are present in 5-15% of asymptomatic clinic attenders, while prevalence rates of gonorrhea average 8%, with up to 13% of gonococcal isolates resistant to penicillin antibiotics. Chlamydia and vaginal infections are detected in 16% and 20-49%, respectively, of antenatal and family planning clinic attenders. HIV seroprevalence has reached 7.6% among antenatal clinic attenders.
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PMID:Sexually transmitted diseases in South Africa. 915 64

Azithromycin is an azalide antibiotic with important properties which allow it to be used as a single-dose treatment for genital Chlamydia trachomatic infections. A single 1 g dose is as effective as a standard seven-day course of doxycycline. Ofloxacin 400 mg bid for seven days is also effective against Chlamydia trachomatis. Both azithromycin 2 g and ofloxacin are also effective against uncomplicated gonorrhoea. Neisseria gonorrhoeae continues to be sensitive to third generation cephalosporins, e.g. ceftriaxone 125 mg. Oral single dose cephalosporins offer ease of administration and safety, e.g. cefixime (400 mg), cefuroxime axetil (1 g) and cefpodoxime proxetil (200 mg). The fluoroquinolones, e.g. ciprofloxacin (500 mg) and ofloxacin (400 mg), are being increasingly used as first-line medications, however, caution is recommended as the development of resistance is anticipated and already being detected in many areas. Syphilis continues to be sensitive to penicillin. This should be administered parenterally. Coexistent human immunodeficiency virus infection may make standard therapy inadequate, and closer follow-up is recommended. Therapy with non-penicillin antibiotics is still inadequately studied. Chancroid is treated with ceftriaxone, ciprofloxacin, azithromycin, or erythromycin. In some areas, resistance to tetracyclines and TMP-SMX has made these drugs ineffective as first-line treatments. Bacterial vaginosis is effectively treated with a single dose of metronidazole 1 g or 500 mg bid over seven days. Similar regimens are also effective against trichomoniasis. Vulvovaginal candidiasis can be treated with topical imidazole preparations or oral antifungal medications.
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PMID:Antimicrobial therapy of non-viral sexually transmitted diseases--an update. 884 92

A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care center in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, the authors simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and etiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simply syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection. (author's)
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PMID:Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda. 890 69

For cultural reasons modern contraception has been slow to gain acceptance in Ethiopia. Knowledge about contraception and abortion is still limited in many family and community settings in which it is socially disapproved. By 1990 only 4% of Ethiopian females aged 15-49 used contraception. Little is known of sexually transmitted disease (STD) prevalence in family planning (FP) attenders in Africa in general and Ethiopia in particular, even though attenders of family planning clinics (FPCs) are appropriate target groups for epidemiological studies and control programmes. A study of 2111 women of whom 542 (25.7%) attended FPCs in Addis Ababa showed utilisation rates to be highest in women who were: Tigre (33%) or Amhara (31%), aged 20-34 years (30%), age 16 or older at first marriage/coitus (28%:38% in those first married after 25 years); who had a monthly family income of 10 Ethiopian Birr (EB) or more (33%:36% for those with income 100-500 EB), three or more children (37%), more than five lifetime husbands/sexual partners (39%); or were bargirls (73%) or prostitutes (43%). The seroprevalence rates for all STDs, higher in FPC attenders compared with other women, were syphilis (TPHA) 39%, Neisseria gonorrhoeae 66%, genital chlamydia 64%, HSV-2 41%, HBV 40% and Haemophilus ducreyi 20%. Only 4% of FPC attenders had no serological evidence of STD: 64% were seropositive for 3 or more different STD. Clinical evidence of pelvic inflammatory disease (PID) was also more common in the FPC attenders (54%), 37% having evidence of salpingitis. The FPC provides a favourable setting for screening women likely to have high seroprevalence of STD, who for lack of symptoms will not attend either an STD clinic nor a hospital for routine check up. We recommend that measures be taken to adequately screen, treat and educate FPC attenders, their partners, and as appropriate and when possible their clients, in an attempt to control STDs and ultimately HIV in the community. Social, economic and cultural factors in the occurrence of STDs, prostitution, family planning and modern contraception coverage in Ethiopia are identified and deficiencies of current programmes briefly discussed with the objective of targeting services more effectively.
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PMID:STDS in women attending family planning clinics: a case study in Addis Ababa. 901 81

Haemophilus ducreyi is the causative agent of the genital ulcer disease Chancroid. Chancroid has been shown to increase the risk of heterosexual transmission of HIV. Little is known regarding the attachment or localization of this organism to human cells in either the dermal or epidermal layer. In this study the attachment of H. ducreyi to human foreskin fibroblast (HFF) cells was further characterized. Attachment was mediated by more than one mechanism. Proteinase K treatment but not trypsinization of H. ducreyi significantly reduced attachment suggesting protein involvement. In addition, purified lipooligosaccharide (LOS) was able to inhibit attachment in a dose dependent manner. It appeared that the organism binds to fibronectin in the extracellular matrix of HFF cells, since competition studies using fibronectin showed that it was able to significantly reduce attachment in a dose dependent manner whereas collagen did not. We hypothesize that the attachment of H. ducreyi involves both a protein mediator of attachment (likely pili) as well as LOS and that one or both of these bacterial components interacts with fibronectin in the extracellular matrix to mediate attachment to HFF cells.
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PMID:Attachment of Haemophilus ducreyi to human foreskin fibroblasts involves LOS and fibronectin. 903 61

A retrospective study of 821 commercial sex workers attending a sexually transmitted disease (STD) clinic in northern Thailand's Chiang Rai Province from 1989 to 1993 revealed an explosive epidemic of human immunodeficiency virus (HIV). The overall seroprevalence among the 556 women for whom antibody tests were available was 52.3%. However, a dramatic increase in HIV-1 seroprevalence occurred from 1989 (29.3%) to 1990 (54.1%), followed by a leveling off through 1993. Among the 96 (36.2%) initial seronegatives who underwent subsequent testing, 64 seroconverted over a mean follow-up period of 5.9 months, yielding an incidence rate of 12.6/100 person-months. Incidence increased from 12.0/100 person-months in 1989 and 1990 to 17.0/100 person-months for 1991, and then declined to 9.3/100 person-months in 1992-93. The cumulative risk of seroconversion was 57% at 6 months after initial testing and 77% after 12 months. Diagnosis of chancroid during follow up was the only factor significantly associated with seroconversion. Although the retrospective nature of this study limits analysis of predictors of HIV infection in this population, the findings suggest a need for improved STD management.
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PMID:HIV-1 infection among female commercial sex workers in rural Thailand. 911 80

More than 300 million new cases of gonorrhea, chlamydia, syphilis, and chancroid will develop in 1997, with 85% occurring in developing countries. While diagnostic tests for sexually transmitted diseases (STDs) are sensitive and specific, their expense has led the World Health Organization to promote syndromic management of STDs. This approach, however, can lead to overtreatment with expensive drugs and may result in development of antibiotic-resistant strains of infection. Also, gonococcal and chlamydial infections are often asymptomatic in women. Because the presence of an STD facilitates HIV transmission, STD treatment is an important strategy in HIV/AIDS prevention and control. Since 1990, the STD Diagnostics Initiative (SDI) has sought to identify sensitive, specific, simple, stable, and inexpensive means of diagnosing STDs. Since 1994, 8 research proposals have received a total of $850,000 for a 3-year period. The efficient diagnostic tests sought by the SDI would encourage greater expenditures on STD treatment. The SDI believes that collaboration with industry should remove most of the constraints to product development and market penetration that exist in developing countries. Incentives to achieve the goals of the SDI include a million dollar prize offered by the Rockefeller Foundation for development of a rapid, sensitive, specific, simple, stable, and inexpensive assay. SDI can provide research funds, controlled access to pedigreed clinical specimens, and guidelines for effective evaluations. Industry has the market and the challenge to join with SDI in this effort.
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PMID:How can industry, academia, public health authorities, and the sexually transmitted diseases diagnostics initiative work together to help control sexually transmitted diseases in developing countries? 911 49

Absent for several decades, the chancroid reappeared in Algeria in 1988. In the unique department of Dermatology and Venereology of the University Hospital of the country of Tlemcen (more than 700,000 inhabitants), we wanted to know the state of this STD seven years after the report of the first cases. The file of the consulting patients were examined. We looked for the principal characteristics of this STD: age, sex, incubation period, place infection contact, type of relation, clinical presentation, evolution without and with treatment, other associated STD (syphilis, HIV). From August 1988 (1st case) to December 1995, 144 cases of chancroid were collected = 1988: 6, 1989: 5, 1990: 7, 1991: 18, 1992: 11, 1993: 33, 1994: 48, 1995: 16. The presentation is quite stereotyped; it concerns males only, singles in must cases, having had sexual relations with prostitutes. The incubation period is short (less than 10 days), the characteristic ulceration presents, very often, some adenopathies. The treatment by cotrimoxazole is efficient. They are no concomitant syphilis or HIV infection. The chancroid is the first cause of genital ulceration in the world. Since 1991, it is the principal STD in our department. It spreads within a male population, young singles associated with prostitutes. It is well installed in Algeria, and its role, although minor, in the transmission of the HIV infection, should not be neglected.
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PMID:[Chancroid in Algeria: the status of this sexually transmitted disease in 1995]. 928 57

Chancroid, the most prevalent form of genital ulcer disease in developing countries, increases the risk of HIV transmission. Use of monoclonal antibodies against leukocyte differentiation antigens enabled analysis of the composition of the inflammatory infiltrate of genital ulcers. In this study, biopsies of six genital ulcers caused by Haemophilus ducreyi were examined immunohistochemically. In each case, staining revealed a superficial necrotic layer of polymorphonuclear leukocytes with fibrin and erythrocytes at the base of the ulcer, a middle layer of the edematous inflammatory dermis with prominent blood vessels and vascular thrombi, and a deep layer of an inflammatory infiltrate of plasma cells and lymphocytes. The lymphocytic infiltrate of chancroid ulcers consisted of both B- and T-lymphocytes and showed a cluster-like formation. B-lymphocytes were preferentially localized perivascularly in the middle layer, while T-lymphocytes tended to be located in the deep layer of the inflamed edematous tissue. These findings provide further evidence of the importance of the involvement of T-cells in the local immune clearance of H. ducreyi. Future studies should investigate lymphocyte secretions detected in genital ulcers caused by H. ducreyi to gain more information on the role of the cellular immune mechanisms in the disease.
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PMID:Immunohistochemical investigations of genital ulcers caused by Haemophilus ducreyi. 929 49


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