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Researchers enrolled 600 prostitutes from an AIDS control and prevention program in a study to determine the prevalence of Chlamydia trachomatis in prostitutes and other sexually transmitted diseases (STDs). The prostitutes worked in the port city of Santos, Brazil where many people use intravenous (IV) drugs. Only 45 prostitutes met the study criterion of 5-100 sexual partners/day. Health practitioners took sera from each woman to test for HIV-1, HIV-2, hepatitis B surface antigen (HBsAg) and antibody (HBsAb), Treponema species (syphilis), and C. trachomatis. All the women tested positive for C. trachomatis. This high percentage may have been due to previous contact with the microbe and not necessarily due to an active infection. 42% had been exposed to Treponema. 20% were HBsAb seropositive and 9% HBsAg seropositive. 9% tested positive for HIV-1 and 2% for HIV-2. In another study in Campinas, Brazil, HIV-1 and seropositivity was 21.5% for prostitutes and transvestites. In addition, in a study in metropolitan Sao Paulo, HIV infection prevalence varied from 18-73% among 935 women and 22% among prostitutes. 58% of the prostitutes in Santos had had sexual intercourse with bisexuals or IV drug users. 44% had previously experienced an STD. 42% used IV drugs. 42% practiced both oral and vaginal sex. 36% practiced oral, vaginal, and anal sex. Only 22% limited themselves to oral sex. Since C. trachomatis can cause infertility, chronic pelvic pain, and spontaneous abortion and since every prostitute in the study had been exposed to it, health workers should institute regular STD screening for prostitutes.
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PMID:Seropositivity to Chlamydia trachomatis in prostitutes: relationship to other sexually transmitted diseases (STDs). 210 Oct 95

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

Genital infections in impoverished countries take a heavy toll both in the etiology of childlessness and in pregnancy-related morbidity, both for the carrier (mother) and the passenger (fetus/newborn). Tubal damage is by far the most common single etiology in cases of childlessness. Among the three factors principally contributing to childlessness, infertility, pregnancy wastage and child loss, tubal infertility is the predominant one. Prevalence figures of N. gonorrhoeae among women in reproductive ages range between 5 and 15% in several countries. Similar figures prevail among pregnant/puerperal women. Preliminary figures indicate that prevalence of Chlamydia trachomatis is similar. Genitally acquired infections during pregnancy contribute to pregnancy wastage in the second and third trimesters of pregnancy. There is virtually no data to support that HBV, HSV and HPV significantly contribute to transmitted intra-uterine disease leading to pregnancy wastage. In the third category of childlessness, child loss, HSV and HIV play a well-known role. Maternal and neonatal morbidity is adversely affected by genital infections acquired during pregnancy. While hepatitis in some places is an important contributor to maternal mortality and morbidity, other viral diseases like HSV and HPV do not appear important in pregnancy-related maternal morbidity. Gonorrhea and chlamydia infection give few maternal problems during pregnancy but may be more important as a cause of puerperal endometritis-myometritis, which constitutes one of the leading causes of maternal death in many developing countries. The fetal/neonatal infant morbidity is affected by gonorrhea and chlamydia infection, while HSV is less frequent but extremely serious when it appears.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Genital infections and reproductive health: infertility and morbidity of mother and child in developing countries. 226 2

The prevalence of HIV-infection was studied in a district hospital in Botswana, in southern Africa. Sera from 466 patients were analysed. The sexually transmitted diseases (STD) group consisted of 175 women and 178 men, who consulted the STD-clinic for complaints which could be attributed to STD or infertility and the antenatal clinic (ANC) group consisted of 113 pregnant women, who attended routine ANC. Sera were analysed with HIV-ELISA, and 3% were positive. All sera were negative in Western blot and were considered false-positive in HIV-ELISA. In the STD group, 42% of the women and 39% of the men, were seropositive for syphilis, while 41% were positive in the ANC group. The figures for clinically demonstrated genital lesions were 33%, 60% and 13%, respectively. It is concluded that HIV-infection is a new disease in Botswana, and that the prevalence is still low in the rural population examined in the present survey.
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PMID:[HIV infection, syphilis and genital diseases in Maun, Botswana]. 234 2

The objective of the study was to monitor the HIV prevalence in the years 1988-1991 among pregnant women in the Amsterdam region, visitors to an abortion clinic and 3 outpatient infertility clinics. All women attending these clinics were asked to participate in the study on a voluntary basis and were tested with informed consent. The women were questioned about risk-bearing behaviour of themselves and their sexual partner(s). In the period 1988-1991, of the 23,827 eligible pregnant women, 22,165 women participated (93.0%). Twenty-seven women were found to be positive for HIV antibodies (0.12%, 95% CI: 0.08%-0.17%), of whom twenty belonged to a known HIV risk group or had a partner who belonged to one of these groups and 7 women had no known HIV risk. Seventeen of the 27 women had a foreign nationality. The annual HIV prevalence among pregnant women was: 1988: 0.28%; 1989: 0.10%; 1990: 0.10%; 1991: 0.11%. In the years 1990 and 1991, of the 1,128 eligible women visiting the abortion clinic 953 (84.5%) were tested. Eleven women were HIV-seropositive (1.15%, 95% CI: 0.6%-2.0%), of whom 9 were from an AIDS endemic region, 1 woman had a partner from this region and 1 woman had no known HIV risk. Four African women had HIV-2 antibodies. At the 3 outpatient infertility clinics 1 woman was found to be HIV-positive (0.13%; 95% CI: 0.02-0.9). She had no other risk than a partner from an AIDS endemic area. In the Amsterdam region there was a steady and low HIV prevalence (0.1%) among pregnant women through the years 1988-1991. The prevalence in the abortion clinic was ten times higher. The program was able to detect possible high risk groups within the population. Migration and travelling can play an important role in the spread of HIV in the general heterosexual population.
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PMID:The HIV prevalence among pregnant women in the Amsterdam region (1988-1991). 785 45

HIV transmission risks were specified during infertility treatment. An investigation was performed by gynecologists who work in IVF. Most of gynecologist refuse to treat infertility in these cases.
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PMID:[Evaluation of risks of HIV transmission during medically assisted reproduction]. 803 81

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

Family planning and its association with women's health and the health of families, communities, and societies will be a central theme of the International Conference on Population and Development in Cairo, Egypt, in September 1994. The conference will provide an opportunity to determine new directions for the development of family planning programs. Making family planning programs woman-friendly is to insure that they: are based on the principle of voluntary informed choice; are available to all; offer confidentiality in counseling and services; provide a broad choice of traditional and modern methods; make the user's safety a prime concern; encourage male involvement; are supportive of women with unwanted pregnancies; and provide protection from, as well as management of, sexually transmitted diseases. The need to encourage male involvement and sharing in responsibilities is essential. Although the bulk of contraceptive methods are for use by women, many require the active cooperation of men. With the spread of sexually transmitted diseases and HIV/AIDS, barrier methods and cooperation between sex partners will gain importance. The responsibilities of men as partners, fathers, and family members should be emphasized in all family planning programs. Policy makers must insure that family planning programs offer high quality counseling, the prevention of unsafe abortion, and the management of genital infections, sexually transmitted diseases, infertility and diseases of the reproductive tract.
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PMID:Family planning and health. 808 66

Acute salpingitis complicating cervical gonococcal infection is a significant cause of infertility. Relatively little data are available concerning the pathophysiologic mechanisms of this disease. A cohort of 243 prostitutes residing in Nairobi were followed between March 1985 and April 1988. Gonococcal cultures were performed at each visit, and acute salpingitis was diagnosed clinically. Serum at enrollment was tested by immunoblot for antibody to gonococcal outer membrane proteins. 8.6% (146/1689) of gonococcal infections were complicated by salpingitis. Increased risk of salpingitis was associated with younger age, shorter duration of prostitution, HIV infection, number of gonococcal infections, and episodes of nongonococcal salpingitis. Rmp antibody increased the risk of salpingitis. Antibody to Opa decreased the risk of salpingitis. By logistic regression analysis, antibody to Opa was independently associated with decreased risk of gonococcal salpingitis (adjusted odds ratio [OR], 0.35; 95% confidence interval [95%CI], 0.17-0.76); HIV infection (adjusted OR, 3.5; 95% CI, 0.96-12.8) and episodes of nongonococcal salpingitis (adjusted OR, 3.4; 95% CI, 1.8-6.4) were independently associated with an increased risk of salpingitis. Antibody to Opa appears to protect against ascending gonococcal infection, perhaps by interfering with Opa mediated adherence and endocytosis. The demonstration of natural immunity that protects against upper genital tract infection in women suggests that a vaccine to prevent gonococcal salpingitis is possible.
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PMID:Antibodies to opacity proteins (Opa) correlate with a reduced risk of gonococcal salpingitis. 816 73

Childbearing, now and in the future, brings with it many challenges due to the complexity of living in a highly technological world with diminishing natural resources. A dialogue about these challenges should be initiated and should involve everyone in the community: patients, families, policy-makers, health professionals, and business leaders. Key problems in 1989 were unintended pregnancy, pregnancy among unmarried mothers, lack of prenatal care, children in poverty, teenage births, lack of health insurance, low birth weight babies, birth defects among infants, pregnancy among alcoholic mothers, and infant mortality. Controversial issues will continue to be abortion, lesbian health care, AIDS and pregnancy, and lifestyle issues. The women's health research agenda for the future aims to improve the health of all women and to eliminate competing agendas. Working mothers are viewed as representing the prevalent lifestyle. More study should, therefore, be devoted to the impact of the work situation on the health of mothers and children and to such issues as quality day care and sharing of household responsibilities among families. Global demographic trends referenced from Kennedy's "Preparing for the 21st Century" indicate that costs of health care for the aged, teenagers, and HIV-infected infants and mothers will be high. Women are viewed as vulnerable in sexual relationships. Assisted reproductive technology has advanced women's ability to bear children, but little has been studied about who infertility affects. Poverty among women is increasing, and it is estimated that by the year 2000, three billion people will lack adequate fuel, food, or energy. Economic cooperation and integration will be needed to accommodate increases in technology, communications, and trade.
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PMID:Women and the family of the future. 820 53


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