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In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to "sensitive" services like abortion, family planning, HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers' right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White's analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients' right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal "bypass" legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.
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PMID:Crisis of conscience: reconciling religious health care providers' beliefs and patients' rights. 1055 39

This article aims to understand the perception of lay people in Uganda towards sexually transmitted infections (STIs). Focus group discussions and semi-structured interviews were conducted in the communities and statistical analysis through the Chi-square test was used to treat the data. Results showed that causes and modes of transmission of STIs were known to the people. An STI was perceived as a natural disease from an agent called "akakoko or akawuka," although female infertility, one of the common STI complications, was perceived as a supernatural ailment. People infected with HIV/AIDS were accepted by the society, but a person with another STI was stigmatized, in the sense that, they are infecting themselves when they already knew of AIDS. For STI prevention, avoiding and preventing sexual promiscuity was the most common method, but the people demonstrated a strong negative attitude towards the use of condom. Common among the respondents is the use of traditional healers for treating STIs and self-treatment of the disease.
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PMID:Lay people's perceptions of sexually transmitted infections in Uganda. 1056 56

Gonorrhea has been declining since its 1975 peak. Risk factors include age 15 to 19 years, multiple or casual sexual contacts, sexual activity related to drug use, and low socioeconomic status. Infection is usually mild but may be asymptomatic. While no physical signs are specific to the gonococcus, pelvic inflammatory disease is a common complication and cause of infertility and should be treated if it is suspected. Diagnosis of gonorrhea is typically by culture. Newer, more accurate tests are available but are more expensive. For treatment, the CDC recommends only highly effective regimens. Patients need to refer recent sexual partners for treatment and abstain from sexual intercourse until completion of therapy and resolution of symptoms. The incidence of syphilis appears to be declining in the United States, but it should be considered if an ulcer is found in the genital region. If untreated, the disease progresses through primary, secondary, latent, and tertiary phases, and systemic symptoms can mimic other conditions. Positive standard screening tests should be confirmed by fluorescent treponemal antibody absorption testing. Darkfield microscopy is appropriate for diagnosis of an ulcer. The treatment of choice for all phases of syphilis is a single dose of intramuscular benzathine penicillin. Other components of therapy include partner notification and patient follow-up. The spread of HIV is closely linked to STD transmission. Therefore, testing for HIV is strongly encouraged when another STD has been diagnosed.
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PMID:Sexually transmitted diseases in women. Gonorrhea and syphilis. 1068 16

Prevention and treatment of sexually transmitted infections (STIs) in the sexually active population are the main steps to prevent perinatal infection. However, the spread of STIs continues at an astronomical pace despite various attempts at controlling the epidemic. An important reason for this lack of STI control is that a large percentage of infected people go untreated because they have asymptomatic or unrecognized infections. The microbial differential diagnosis of STIs implicated in adverse pregnancy outcome is broad and includes viral, bacterial and protozoal infections. Infertility, ectopic pregnancy, pelvic inflammatory disease, chorioamnionitis, premature rupture of membranes, preterm birth and puerperal sepsis are some of complications seen in women as a result of infection with sexually transmitted pathogens. In addition, STIs may facilitate the acquisition and transmission of HIV. In the fetus or neonate, complications include abnormalities of the major organ systems. Infections in the form of pneumonia or conjunctivitis may also occur. Due to the lack of simple, inexpensive and sensitive point-of-care tests, screening for STIs in pregnancy is not performed routinely.
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PMID:Sexually transmitted infections, adverse pregnancy outcome and neonatal infection. 1095 50

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.
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PMID:The intrauterine device and its dynamics. 1099 94

Concern about upper-genital-tract infection related to intrauterine devices (IUDs) limits their wider use. In this systematic review I summarise the evidence concerning IUD-associated infection and infertility. Choice of an inappropriate comparison group, overdiagnosis of salpingitis in IUD users, and inability to control for the confounding effects of sexual behaviour have exaggerated the apparent risk. Women with symptomless gonorrhoea or chlamydial infection having an IUD inserted have a higher risk of salpingitis than do uninfected women having an IUD inserted; however, the risk appears similar to that of infected women not having an IUD inserted. A cohort study of HIV-positive women using a copper IUD suggests that there is no significant increase in the risk of complications or viral shedding. Similarly, fair evidence indicates no important effect of IUD use on tubal infertility. Contemporary IUDs rival tubal sterilisation in efficacy and are much safer than previously thought.
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PMID:Intrauterine device and upper-genital-tract infection. 1104 14

A comparative study was carried out in the andrology clinic, Parirenyatwa Hospital, Harare, Zimbabwe, to investigate the sperm characteristics and accessory sex gland functions in HIV-infected individuals. Sixty-two patients with infertility problems who attended the clinic were requested to donate semen and blood after consent was obtained. HIV antibodies in paired semen and blood samples, sperm morphology, sperm count, sperm motility, seminal leucocytes, seminal fructose, seminal neutral alpha-glucosidase, and citric acid were analyzed. Nine out of 31 blood samples tested positive, while 21 out of 62 semen samples were positive for HIV. Leucocytospermia was associated with HIV-seropositive men (p < .01). The accessory sex gland function, as evaluated by biochemical markers, was not affected in HIV-seropositive men. HIV causes impairment of sperm motility by activating seminal leucocytes, which in turn induce oxidative stress on the sperm. Leucocytospermia is almost always present in HIV-seropositive men.
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PMID:Sperm characteristics and accessory sex gland functions in HIV-infected men. 1129 70

Over one million women experience an episode of pelvic inflammatory disease (PID) each year. It is the most common serious complication of STDs; long-term sequelae include ectopic pregnancy, chronic pelvic pain, and tubal infertility. One in five cases of PID occurs among younger women < 19 years of age. Although only about half of female adolescents are sexually active, they have the highest age-specific rates of PID among sexually experienced women. The risk of developing PID for a 15-year-old sexually active girl is estimated to be 10 times that of a 24-year-old woman. The higher relative risk of PID for younger women has been attributed to their greater biologic vulnerability and their behavioral and cognitive risk factors. In addition, HIV-infected women with PID may be at increased risk for more severe pelvic disease, a growing concern as rates of HIV infection among adolescent girls continue to rise. This article reviews the epidemiology, risk factors, pathogenesis, clinical assessment, and management of PID in adolescent females, including age-specific information when available.
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PMID:Pelvic inflammatory disease in adolescents. 1136 5

Pelvic inflammatory disease (PID) begins with an infection in women. The woman is usually young and sexually active when it first appears. The infection travels to the fallopian tubes and uterus, and inflammation occurs as the body attempts to combat the germs and heal damaged tissues. Treatment consists of rest, antibiotics and abstention from sexual relations. Up to one third of the women with PID will have recurrences. Chronic cases can cause infertility, ectopic pregnancies, or constant pain. Little is known about the relationship between PID and HIV. A woman with HIV may suffer repeated attacks of PID as the immune system is weakened. To prevent recurring episodes, rest, intravenous antibiotics and even surgery to remove abscesses may be required. Vaginal candidiasis and yeast infections, which may occur prior to menstruation, are also discussed. Reduce sugar intake, and add yogurt with acidophilus to prevent symptoms.
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PMID:[AIDS and women's health--a column to answer your questions]. 1136 10

Seven research centers have been established by the National Institute of Allergy and Infectious Diseases (NIAID) to support collaborative multi-disciplinary studies of serious infections. The Sexually Transmitted Diseases Cooperative Research Centers (STD-CRCs) will focus on the objectives of the NIAID STD program, which include prevention of four serious consequences of STDs: infertility, adverse outcomes of pregnancy, cancer of the cervix and other anogenital sites, and HIV infection. Investigators will work together to bridge biomedical, clinical, behavioral, and epidemiological research, promote productive collaborations, and facilitate the development of intervention-oriented research. Studies will focus on: preventing reproductive tract infections, evaluating the microbial etiology of non-gonococcal ureteritis, determining new approaches to primary and secondary STD prevention, answering biomedical and behavioral questions associated with chlamydia and gonococcus, and creating prevention strategies.
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PMID:NIAID funds STD research centers. National Institute of Allergy and Infectious Diseases. 1136 49


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