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Since patients with sexually transmitted disease (STD) form the most apparent risk group for HIV infection in general practice, differences in sexual behaviour in patients with and without STD were studied. Patients fulfilling at least one of four clinical criteria for suspicion of STD were offered four microbiological tests and a serological HIV test and were asked to complete a questionnaire concerning possible HIV exposure. Control patients were selected from a sample of ordinary consulting patients in general practice, without clinical suspicion of STD. The answers to the questionnaires given by six male and 52 female patients with a positive microbiological test for STD were compared with answers given by control patients matched for sex, age, education and geographical region. Females with STD had multiple male partners more often than controls. STD patients were more uncertain whether they had had sex with a HIV-positive person, and they reported more previous gonorrhea than the control patients. The proportion of patients who reported practicing oral sex was the same in both groups, while data for anal sex were insufficient. There were no significant differences in the use of condoms with a new partner, although there was a higher proportion of never-users of condoms among the STD patients. Identifying STD patients on clinical grounds is difficult in general practice. Clinical criteria have limited sensitivity because of asymptomatic infections, and the specificity is low. Patients with microbiologically confirmed STD should receive HIV-related attention, but attention to STD patients alone is not enough. Many people without STD have sexual behaviour which may exposure them to the HIV virus. The only means to a selective approach is increased attention to an appropriate sexual medical history.
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PMID:Patients with sexually transmitted disease: a well-defined HIV risk group in general practice? 204 71

Bacterial pathogens account for a significant portion of the current STD epidemic in the United States. Gonorrhea, syphilis, and chancroid are especially rife in the nation's poverty pockets. Chlamydial infection, the most common bacterial STD, is prevalent at all socioeconomic levels. A recurrent theme in these diseases is coexisting infection, sometimes involving HIV.
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PMID:Recent developments in STDs: I. Bacterial diseases. 207 82

A study was conducted to determine the effect of preventive educational efforts among 621 female prostitutes in Mae Sot, Tak Province, in 1989. The intensive health education program at a personal level and free condom distribution to the prostitutes began in March and June 1989, respectively. The proportion of prostitutes' sexual partners using condoms increased from 13.5% in January 1989 to 50.4% by December 1989. The reported increase in condom use was supported by the decline in the incidence rate of gonorrhea among the prostitutes during the same period. Anal intercourse was not commonly practised in these women and decreased from 9.7% in January to 1.8% in December 1989. None of the prostitutes interviewed throughout the year reported using intravenous drugs, nor reported having a steady sexual partner who was an intravenous drug user. None out of 248 prostitutes tested in January 1989 were HIV-1 seropositive. After that throughout the year, 15 of 373 (4.0%) additional prostitutes in this area were found to be seropositive on their first test. Ten out of 405 (2.5%) initially-seronegative prostitutes who were subsequently tested at 3-month intervals became seropositive. The effect of health education and condom promotion among our study prostitutes was modest. Similar studies are needed to evaluate the programs in other settings of Thailand, particularly in areas with high prevalence of HIV-1 infection.
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PMID:Effect of health education and condom promotion on behavioral change among low socioeconomic prostitutes in Mae Sot, Tak, Thailand. 207 87

This overview provides a discussion of the special concerns of sexually transmitted diseases (STDs) for women, particularly because of its asymptomatic character; screening; primary prevention; e.g., abstinence, selection of sexual partners restriction of sexual activities, use of barriers (condoms, vaginal spermicides, diaphragm in conjunction with spermicides), and vaccines; and the role of the gynecologist in StD prevention. Gonorrhea and chlamydial infection are usually asymptomatic STD infections in women; long term sequelae are pelvic inflammatory disease (PID), infertility, and pregnancy complications. There is an increased risk of cervical cancer. Infection is lifelong for herpes simplex virus (HSV) and HIV and malingering for chronic hepatitis B (HPB). Genital human papillomavirus (HPV) and HSV infections cannot be identified serologically. The fetus can be fatally or severely affected by STDs. Abstinence is the only effective prevention for STDs. Likelihood of infection may be reduced by limiting partners, but how partners are chosen and knowledge of infection is a more important determinant. Partners need to be asked about current symptoms, history of STDs, multiple partners, and history of known STD partners, as well as past history of homosexual activity, intravenous drug use, hemophilia, and previous exposure to high-risk persons for STDs. Visible genital warts or lesions, wartlike growths, ulcers, or rash need explanations. Avoidance of oral anal and digital anal activity reduces transmission of hepatitis A, giardiasis, amebiasis, and shigellosis. Any mechanical barrier that remains intact should reduce the risk of STD; barriers specifically covering the cervix are excellent. Condom use is effective when used as follows: 1) at the onset of sexual activity, 2) without petroleum jelly or baby oil on latex, 3) with care of fingernails which may tear holes, 4) with complete withdrawal of the penis before complete detumescence, and 5) with a withdrawal hold at the base of the penis. Spermicides, such as nonoxynol 9, are effective against STDs. Diaphragm use with spermicide may be effective because of the spermicide. There is a reduced risk of transmission of HSV or HPV to a partner. Vaccines are only available for hepatitis B. Obstetrics and gynecology residency training in STDs in unavailable in 4 out of 5 medical schools, and gynecologists are ethically obligated to accurately inform about STD diagnosis, treatment, and diagnosis.
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PMID:Avoiding sexually transmitted diseases. 209 42

In incidence and epidemiology of sexually transmitted disease (STD)s in Southeast Asia and the Western Pacific, with gonorrhea, chancroid, nongonococcal urethritis, syphilis, genital herpes and genital warts at the forefront, are reviewed. The bacterial STDs gonorrhea, chancroid and syphilis are the major problems. Gonorrhea is the most prevalent STD in the region, with a high incidence of chromosomally-mediated resistant and penicillinase-producing strains comprising 35-53% of isolates. Clinical treatment failures due to spectinomycin-resistant gonococci are reported as increasing. Uncontrolled antibiotic sales are blamed for these resistant strains. Syphilis has declined in the 1950s, but has re-emerged. Chancroid is declining, while herpes is making up a greater share of ulcer disease. nongonococcal genital infection and chlamydia are thought to be the 2nd most common infection, however most centers do not have the facilities to isolate chlamydia. Genital warts are becoming a common cause for attendance at STD clinics and are a concern for cervical cancer. Prostitutes are most often cited as the source of male STD infection. The anonymity and large number of contacts of the sex industry, and high mobility of the indigenous population and of tourists are considered central in STD transmission. The high incidence of STDs in this area is a harbinger of future trends of HIV/AIDS in Asia.
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PMID:The epidemiology of sexually transmitted diseases in Southeast Asia and the western Pacific. 211 64

During a 10-year period from 1976 to 1985, N. gonorrhoeae demonstrated remarkable genetic resiliency in developing clinically important antimicrobial resistance through a variety of chromosomal mutations and by acquiring either entire plasmids or resistance determinants on plasmids from other species. Gonococcal resistance is widespread, and few communities will be spared all types. None of the newer diagnostic technologies has provided any performance or cost advantages over traditional Gram-stained smears and cultures. The two most important components of a control program are (1) the National Gonococcal Isolate Surveillance project and (2) treatment with ceftriaxone, 125 or 250 mg intramuscularly, which is active against all known types of resistance and will cure all forms of uncomplicated gonorrhea, including the more difficult-to-treat infections of the pharynx and anorectum. Fear of AIDS has had a powerful motivating effect on sexual behavior, and in the United States has been associated with an overall reduction in incidence of gonorrhea in homosexual men of over 95%. After peaking in 1985, incidence of gonorrhea in white heterosexual men and women has declined as well. A diagnosis of gonorrhea in 1990 implies recent high-risk behavior for acquiring HIV infection. The gonorrhea epidemic in the United States is rapidly contracting down around poor urban minorities; although this is not good, at least it tells us where to target our resources.
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PMID:Gonorrhea. 212 79

The risk of acquiring a sexually transmitted disease as a result of rape is not known, in part because it is difficult to ascertain whether infections were present before the assault or acquired during it. To investigate this question, we examined female victims of rape within 72 hours of the assault and again at least one week after the assault. Of the 204 girls and women initially examined within 72 hours of the rape, 88 (43 percent) were found to have at least one sexually transmitted disease. These diseases included infections caused by Neisseria gonorrhoeae (6 percent of those tested), cytomegalovirus (8 percent), Chlamydia trachomatis (10 percent), Trichomonas vaginalis (15 percent), herpes simplex virus (2 percent), Treponema pallidum (1 percent), and the human immunodeficiency virus type 1 (HIV-1; 1 percent) and bacterial vaginosis (34 percent). Among the 109 patients (53 percent) who returned for at least one follow-up visit (excluding those who were found to be infected at the first visit or who were treated prophylactically), the incidence of new disease was as follows: gonorrhea, 4 percent (3 of 71); chlamydial infection, 2 percent (1 of 65); trichomoniasis, 12 percent (10 of 81); and bacterial vaginosis, 19 percent (15 of 77). There were no new infections with herpes simplex virus, cytomegalovirus, Trep. pallidum, or HIV-1, but follow-up serologic testing was performed in only 26 percent of the patients. On the basis of our assumptions that most venereal infections present within 72 hours of a rape were preexisting and that new infections identified 1 to 20 weeks later were acquired during the assault, we conclude that the prevalence of preexisting sexually transmitted diseases is high in victims of rape and that they have a lower but substantial additional risk of acquiring such diseases as a result of the assault.
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PMID:Sexually transmitted diseases in victims of rape. 221 85

The diagnosis of suspected sexual abuse is nearly always based on a description of abuse provided by the child. The physician should invite a child to describe his or her sexual victimization in detail if such a "disclosure" interview has not already occurred, if the child seems ready to describe the abuse, and if a child protective services worker has not yet been notified of the suspected abuse. If an allegedly abused child has already been carefully interviewed, however, the physician should instead obtain information from the child's parents or other appropriate adults to determine how best to address the questions being raised. Nonspecific behavioral or somatic complaints unaccompanied by a specific description of sexual abuse should generate a differential diagnosis for further investigation. The goals of the physical examination of the sexually abused child are to identify abnormalities that warrant further diagnostic efforts or treatment, to obtain specimens to screen the patient for sexually transmitted infections, and to make observations and take specimens that may corroborate the patient's history of victimization. These goals should be met in the context of a standard, complete physical examination. The advisability of postcoital contraception should be discussed with every postmenarcheal victim seen within 72 hours after a rape. Because gonorrhea and chlamydial infections are the most prevalent STDs seen after sexual abuse and are often asymptomatic, universal screening for these infections is recommended. Parents of all abused children should be given an opportunity to make an informed choice about HIV screening. Because the risk of acquiring STDs is low, routine antibiotic prophylaxis is not recommended for sexually abused children. Physicians must report all cases of suspected sexual abuse to states' child protective services agencies. Failure to do so can incur legal penalties. Reporting sexual assaults of children to local law enforcement officials is strongly advised. The long-term impact of sexual abuse on children's psychological adjustment is unpredictable. In the short term, children's circumstances vary widely. Some show no evidence of psychological distress. Others have severe, pervasive difficulty. Office counseling by the empathetic and knowledgeable primary care physician, short-term crisis counseling, a more formal psychological evaluation, and longer-term psychotherapy may be recommended for individual children, depending on the nature and severity of each child's symptoms, his or her parents' preference, and the availability of services in the child's community.
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PMID:The medical evaluation of the sexually abused child. 219 18

This article focuses on the detection and management of sexual assault and sexually transmitted diseases (STDs) in adults and children. Sexual assault is a violent crime affecting both men and women and children of all ages. Sexual abuse can take many forms with rape being the most common form of sexual assault among adults. Among children, sexual assault ranges from fondling to oral and genital contact. Studies showed that the rates of gonorrhea and syphilis in adult victims range from 6% to 12% and from 0% to 3%, respectively. As to other STDs, the risk of acquiring Chlamydia trachomatis infection appears highest. Although the general prevalence of STDs among abused children remained low, studies indicated that gonococcal and chlamydial infections are frequent in this group. Moreover, post-assault infections with herpes simplex viruses, hepatitis B viruses, and HIV have been described in both adults and children. Due to the risk of STDs, prompt, sensitive, and competent care for assaulted victims is necessary which include an evaluation for STDs right after the assault and during follow-up. For adult victims, treatment should be given during the initial evaluation for any infections identified at that time. Treatment of abused children follows the same principles as treatment of adult victims but drug dosage is adjusted depending on body weight.
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PMID:Sexual assault and sexually transmitted diseases: detection and management in adults and children. 220 Oct 79

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


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