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Query: UMLS:C0019693 (HIV)
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In northern Thailand, baseline interviews with and blood testing for syphilis and HIV-1 antibodies of military conscripts were conducted during May-November 1993. Researchers also examined conscripts discharged in April 1993. They interviewed and tested a total of 2047 men. 134 men (6.5%) had had at least one male sex partner. (These men are referred to as MSM.) Only 4 (2.9%) had had sex with only men. The remaining 130 (97.1%) had also had female sex partners. The 134 MSM men were more likely than heterosexual men to be married (odds ratio [OR] = 2.67) and to have a girlfriend with whom they had sex (OR = 1.6). They were also more likely than heterosexual men to have ever had any sexually transmitted disease (STD) (OR = 2.71), gonorrhea (2.05), syphilis (OR = 3.17), nongonococcal urethritis (OR = 4.54), penile discharge with pus (OR = 2.47), watery penile discharge (OR = 6.24), and dysuria (OR = 2.43). The overall HIV prevalence was 12.1% (247 men). MSM men were only somewhat more likely to be HIV infected (PR = 1.51). MSM men with more than one male lifetime partner were significantly more likely to be infected with HIV than those with only one male partner (OR = 2.89). Same-sex behavior was more common among discharged men who had returned to civilian life than those were still in the military (9.3% vs. 6.5%). Discharged bi/homosexual men was the only group of Royal Thai Army current or former conscripts in which sex with men was independently associated with HIV infection (27.3% vs. 12.4% for HIV-infected heterosexual former conscripts; OR = 2.54). Among all subjects, HIV infection was associated with ever visited a female commercial sex worker (OR = 4.16) and ever had any STD (OR = 5.47), gonorrhea (OR = 3.08), syphilis (OR = 3.81), genital herpes (OR = 3.54), genital warts (OR = 3.56), and genital ulcer disease (OR = 5.59). These findings show that MSM in Northern Thailand are at high risk of STDs and HIV. HIV/STD prevention efforts should target all young Thai men and try to change high risk sexual practices.
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PMID:Same-sex behavior, sexually transmitted diseases and HIV risks among young northern Thai men. 771 88

The spondyloarthropathies occur with variable frequency in the tropics. Ankylosing spondylitis, in particular, is thought to be rare in tropical Africa, reflecting a low frequency of the HLA B27 gene. However, in the Melanesian populations of Papua New Guinea where there is a relatively high frequency of HLA B27, ankylosing spondylosis is infrequent. These diverse observations may be related to variations in B27 sub-types. Reactive arthritis is a common and important form of acute arthritis in the tropics and in Papua New Guinea at least has a strong association with HLA B27. In Africa an increasing prevalence of reactive arthritis may be related to the spread of HIV infection. Extra-articular features such as balanitis and enthositis are helpful pointers to the diagnosis. Disseminated gonococcal infection and tuberculosis must always be considered and treatment offered if doubt exists. The mainstay of treatment of reactive arthritis is, as always, an anti-inflammatory drug, supplemented by hydrocortisone injections; docycline is available for chlamydia-triggered arthritis and chloroquine or dapsone for more chronic, unresponsive cases.
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PMID:The spondyloarthropathies. 772 92

Early intervention for persons infected with human immunodeficiency virus (HIV) involves characterization of the stage of HIV disease, institution of therapy to prevent associated infections and postpone deterioration of immune function, and assistance in preventing transmission of the virus. This review examines the available data on the efficacy of current recommendations regarding the evaluation and management of persons with early HIV infection. Existing evidence supports the efficacy of physical examination, monitoring of the CD4+ cell count, tuberculin testing (with chemotherapy for persons who test positive), anergy testing, Papanicolaou testing and screening for gonorrhea and chlamydial infection (for high-risk women), screening for syphilis, antiretroviral therapy (for symptomatic patients), and guidance in reducing the transmission of HIV. Recommended measures for which evidence of clinical efficacy is less certain include immunization against infections due to influenza virus, Streptococcus pneumoniae, Haemophilus influenzae, and hepatitis B virus as well as antiretroviral therapy for asymptomatic persons. Quantitative measurement of viral titers appears promising for the monitoring of HIV disease and antiretroviral therapy; the correlations of these titers with clinical end points need to be confirmed.
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PMID:Early intervention for persons infected with human immunodeficiency virus. 779 7

The objective was to replicate a Zaire study with a cohort of 273 Cameroonian sex workers to determine whether gonorrhea increased the risk of HIV acquisition, and whether the crude association between gonorrheal infection and HIV acquisition was weakened when unprotected coitus was more carefully controlled. 303 Cameroonian female sex workers were enrolled in Yaounde between 1989 and 1990. Eligibility criteria included age 18 years or older; no pregnancy during the previous 42 days; no history of adverse reaction to a spermicidal product; negative enzyme-linked immunosorbent assay (ELISA) HIV-antibody test; and monthly follow-up visits for 1 year. Women were asked to use condoms and suppositories containing N-9 at every sexual activity and coital logs were reviewed monthly. 17 women were identified as cases and 68 as controls. Unlike in Zaire, where 8% of the cases and controls reported never using condoms, none of the women reported unprotected coitus more than 50% of the time in Cameroon. Almost 30% of both cases and controls in Cameroon had evidence of genital ulcers, compared with less than 5% of the cases and controls in Zaire. The crude OR of HIV infection among those who had gonorrhea during the exposure period was much higher in Zaire than in Cameroon (6.3 vs. 2.2). In both the Zaire and Cameroon data the crude OR were reduced (6.3 to 4.8 and 2.2 to 1.7, respectively) by controlling for risk factors of young age, number of partners per week, trichomoniasis, genital ulcers, and a dichotomous variable indicating irregular or no condom use. In the 1st alternative model, the OR for gonorrhea was 2.0 when the dichotomous measure of unprotected coitus (i.e., more than 25% of coital acts were unprotected) was used. When a more precise continuous estimate of level of unprotected coitus was used (i.e., the percentage of acts where neither condoms nor N-9 was used) the OR for gonorrhea was reduced to 1.4.
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PMID:Gonorrhea as a risk factor for HIV acquisition. 851 63

This article will review the 1993 STD Treatment Guidelines of particular importance to dermatologic clinical practice. Topics include STD/HIV prevention, management of sexual partners, STD in persons with HIV co-infection, genital ulcer disease (GUD) including syphilis, herpes simplex virus (HSV) infection, lymphogranuloma venereum (LGV) and chancroid, therapy of nongonococcal (NGU) and chlamydial urethritis and cervicitis, gonococcal (GC) infections, HPV infection, hepatitis B virus (HBV) infection, pediculosis pubis, and scabies.
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PMID:The 1993 sexually transmitted disease treatment guidelines. 784 21

Women attending the Queen Elizabeth Central Hospital in Blantyre, Malawi, between November 1989 and October 1993 were studied as part of a longitudinal cohort study of mother-to-infant HIV transmission. 694 HIV-seropositive and 687 HIV-seronegative women were enrolled at delivery. In the follow-up phase, women attended the clinic every 3 months for the first 24 months and every 6 months thereafter, where they were administered a questionnaire and underwent pelvic exam for the diagnosis of sexually transmitted diseases. HIV testing was performed by ELISA and Western Blotting. A nested case-control study was performed to identify risk factors for HIV seroconversion, and for each seroconverter, 2 seronegative women were selected. A total of 43 women seroconverted in the follow-up period. The rate of new HIV infection increased in the first 24 months postpartum. Postpartum rates were 1.42, 1.70, 2.43, and 4.33 per 100 person-semesters, respectively, in each of the first 4 semesters, which corresponded to annual seroconversion rates of 2.84 per 100 person-years in the 1st year and 6.66 in the 2nd year postpartum. Only 2.2% of the women reported sexual contact in the first 6 weeks postpartum, increasing to 57.6% in the period of 6 weeks to 6 months and to 86.5% in the period 7-12 months postpartum. Univariate analysis indicated the largest risk factor for HIV seroconversion as reported condom use (odds ratio [OR] = 5.67). Other factors included young age and low parity (OR = 2.90 and 2.77, respectively), a short interval between the birth of the study infant and a subsequent conception (OR = 4.20), and vaginal infection with Trichomonas vaginalis (OR = 3.4). Other factors with nonsignificant association with HIV seroconversion included: 1) genital ulcerations with a fourfold higher risk, 2) visible genital warts with a threefold increase, 3) hormone-containing contraceptives and cervical ectopy (OR = 1.13 and 1.07, respectively), and 4) vaginal irritants. Syphilis, cervical human papilloma virus, and cervical gonococcal infection were not associated with HIV seroconversion.
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PMID:Preparations for AIDS vaccine evaluations. Rate of new HIV infection in a cohort of women of childbearing age in Malawi. 786 10

Between November 1992 and April 1993, interviews were conducted with 400 patients (169 men, 231 women) aged 14-52 years at the sexually transmitted disease (STD) clinic of the Institut d'Hygiene Sociale in Antananarivo, Madagascar, to determine the pattern of STDs and to improve treatment of the leading STDs. The 400 patients presented with 434 syndromes. 124 men had urethral discharge. 210 women had cervicovaginal discharge. 43 men and 18 women had genital ulcers. Clinicians could not establish a diagnosis in 33 patients. 171 patients had more than one infection. Chlamydia infection was the most common infection associated with another STD (gonorrhea in 22% of men and 11% of women with discharge, trichomoniasis in 2.4% of men and 13% of women, candidiasis in 1.6% of men and 9% of women, and bacterial vaginosis in 15% of women with discharge). Gonorrhea was the most common etiology for male discharge (69%) while chlamydia infection was for female discharge (52%). Women with discharge were more likely than men with discharge to have chlamydia infection (52% vs. 42%), trichomoniasis (30% vs. 9%; p 0.00001), and candidiasis (32% vs. 12%; p 0.00001). 37% of women with discharge had bacterial vaginosis. Chlamydia infection was the most common STD in this population (45%). 32% of male and 71% of female gonorrhea cases also had chlamydia infection. 70 patients had syphilis. 36 of them had secondary stage syphilis. No one had HIV-1 or HIV-2 infection. The most efficacious antibiotics for gonorrhea were ampicillin, ciprofloxacin, and spectinomycin (100% susceptibility). 31% and 26% of isolates were susceptible to tetracycline and cotrimoxazole, respectively. Public facilities in Madagascar do not have the capabilities to diagnosis chlamydia, resulting in many untreated chlamydia cases. These findings stress the need to improve combined treatment of gonorrhea and chlamydia infection and for educational efforts to increase awareness of genital ulcer disease.
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PMID:Pattern of sexually transmitted diseases in a Malagasy population. 787 44

During October 1992 to July 1993 in Abidjan, Ivory Coast, health workers conducted interviews, physical examinations, pelvic ultrasonography, and laboratory testing with 170 women with pelvic inflammatory disease (PID) at the University Hospital of Treichville and four primary care clinics. They compared clinical and microbiological characteristics and the response to PID therapy in 57 HIV seropositive women (cases) and in 113 HIV seronegative women (controls). Cases were more likely than controls to have a temperature of at least 38 degrees Celsius (odds ratio [OR] = 2.5), a genital ulcer (OR = 7.8), and a tuboovarian mass on ultrasonography (OR = 2.6) and to need surgery (OR = 6.5) and hospitalization (OR = 3.5). They also had a higher clinical severity score than did the controls (17.4 vs. 15.4; p = 0.01). Cases with a lower CD4 count (14%) were significantly more likely than cases with a higher CD4 count to have a temperature of at least 38 degrees Celsius (56% vs. 13-19%; p = 0.03) and dysuria (78% vs. 33-41%; p = 0.05). They also tended to have a genital ulcer and a tuboovarian mass, but not significantly so. Among all 170 women, the most common pathogenic organisms responsible for PID were Neisseria gonorrhoeae (29.4%) and Chlamydia trachomatis (9.4%). Neither infection was significantly related to HIV infection. Yet, the cause of PID in cases with the highest CD4 count was less likely to be N. gonorrhea than that of cases with lower CD4 counts (13% vs. 44%; p = 0.07). Among the 162 women who received oral antibiotics, 95% of the 40 cases and 93% of the controls responded to antibiotic therapy within four days. On days 4 and 14, none of these women still had a fever. These findings suggest that HIV infection affected clinical manifestations of PID but did not affect the cause of PID or response to therapy.
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PMID:The impact of human immunodeficiency virus infection on pelvic inflammatory disease: a case-control study in Abidjan, Ivory Coast. 789 86

A set of new guidelines were formulated by an expert group meeting in Sweden organized by the pharmaceutical office during March 31-April 1, 1993. It contains various methods to avoid an undesired pregnancy and also advice about postcoital contraception. Among barrier methods, the condom is the only reversible method for men with a method failure of 2 and user failure of 10. It protects against gonorrhea, chlamydia, condyloma, herpes simplex, HIV, and hepatitis B. The diaphragm can be used with a spermicide and protects to a lesser degree against chlamydia, gonorrhea, and cervical cancer. The female condom is as effective as the condom. Among spermicides, nonoxynol-9 is not only effective against sperms but also against bacteria, viruses, and certain vaginal and cervical cells. The vaginal sponge is impregnated with nonoxynol-9 and is effective up to 24 hours. The copper IUD, with a method failure of less than 1, can cause profuse menstrual bleeding, dysmenorrhea, and endometritis-salpingitis. Hormonal methods include combination pills (2-phase and 3-phase pills) and gestagen methods (high dose with 150 mg of medroxyprogesterone acetate injection every 3 months and low-dose minipills with levonorgestrel, norethisterone, or lynestrol). Mechanisms of action concern combination pills, gestagen methods, minipills, Norplant, and Levonova. Drug cross reaction can reduce effectiveness. Side effects include bleeding and amenorrhea. Risk-benefit determination is based on health effects. Possible risks are associated with breast cancer, cervical cancer, blood pressure increase, venous thromboembolism, and heart infarction. Various phases of the reproductive age include young women, lactating women, and women in the later part of the reproductive age. Special groups include those who have experienced ectopic pregnancy, infections (candida, sexually transmitted diseases: chlamydia trachomatis, HIV infections), obesity, cardiovascular diseases, diabetes mellitus, tumors of the reproductive organs, liver diseases, migraine, epilepsy, surgery, and handicapped women. Postcoital contraception is used only in need, and methods for postcoital contraception include hormonal method and the copper IUD.
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PMID:[Contraception. Recommendations from a group of experts]. 790 65

In November 1993, WHO and the UK Department of Health cosponsored a meeting at which the participants addressed the need for women-controlled methods of preventing HIV infection. They called for animal studies to develop vaginal microbicides active against HIV which, in an ideal situation, the women could use without their sexual partners' knowledge. Ideally, any new product would also prevent transmission of other sexually transmitted diseases (STDs). They did caution, however, that the use of such microbicides should not replace, but complement other methods to prevent sexual transmission of HIV. They recommended also that appropriate clinical trials testing the safety and efficacy of the product should also take place. Participants called for WHO to develop the prototype protocols for phase I-III trials of vaginal microbicides. Some spermicides (nonionic detergents or surfactants) provide protection against some STDs (gonorrhea and chlamydial infections) and, in vitro, destroy HIV. Yet, they tend to irritate vaginal mucosa, facilitating HIV transmission. The likelihood of vaginal irritation increases with frequency of use and with doses. Women may not have symptoms indicating that they have spermicide-induced mucosal lesions. A study in Nairobi suggests that use of a sponge impregnated with high dose nonoxynol-9 increased the probability of HIV seroconversion. Lower doses of nonoxynol-9 had a protective effect against HIV seroconversion in studies in Cameroon and Zambia. In all these studies, however, there were sizable methodological limitations. The risk/benefit ratio for individuals using low to moderate doses of spermicides is not clear. Another consideration in that prevention of STDs, significant risk factors for HIV transmission, would reduce the spread of HIV.
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PMID:Boost for vaginal microbicides against HIV. 790 43


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