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

To identify risk factors for HIV infection among women not known to be members of high-risk groups in Dar-es-Salaam, Tanzania, and assess associations between contraceptive use and HIV infection, we conducted a cross-sectional case-control study at three representative family planning clinics. Between February 1991 and June 1992, we enrolled 2,285 women; women were interviewed using a structured questionnaire, and specimens were collected for laboratory diagnosis of HIV and other sexually transmitted diseases (STDs). The overall HIV prevalence was 11.5% (95% CI: 10.2-12.8). Other prevalent STDs included gonorrhea (4.2%), trichomoniasis (14.3%), candidiasis (11.5%), and syphilis (2.5%). HIV seroprevalence was significantly lower among younger women and women in nonpolygamous marriages. HIV risk increased with both women's education and male partner's education. Number of sex partners in the last 5 years was positively associated with HIV risk; however, among HIV-seropositive women, the median number of sexual partners was only two. For married women with only a single partner, their risk increased significantly if their husbands had other partners. The risk of HIV infection was higher among subjects with STDs, although only significantly so for gonorrhea (OR 1.95, 95% CI: 1.10-3.45). After controlling for known and potential risk factors, the risk of HIV infection was significantly increased among women who had ever used an intrauterine device (IUD) (OR 2.50, 95% CI: 1.35-4.64). Use of other contraceptives, including oral contraceptives, was not significantly associated with HIV infection. Our findings confirm that HIV and STDs are a major public health problem among women in Dar-es-Salaam.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Risk factors for HIV infection among women in Dar-es-Salaam, Tanzania. 810 70

Drug users may be considered to be at high risk for having sexually transmitted diseases (STD). The government of Malaysia has therefore established facilities in which they incarcerate and attempt to rehabilitate such individuals. 5472 drug users had been imprisoned in the country's fourteen facilities by the end of 1991. Since 97.8% of drug users in Malaysia are male, only on facility exists for female users. The authors determined and report the prevalence of STDs among 130 new female resident drug users at the facility. The women were admitted over the period May 1989-July 1991, and 104 were IV-drug users. They were aged 18-44 years, with 87.7% in the 20-40-year range. Further, 77.7% were sex workers and 13.1% were salaried workers in other fields. 50.8% had syphilis, 52.2% hepatitis B, 23.8% moniliasis, 19.2% trichomoniasis, and 8.5% gonorrhea vaginitis. 6 were HIV-seropositive, of whom 5 admitted to needle sharing and prostitution. More than half of the women were infected with 2 or more STDs. STDs were not found in 14.6% of subjects, however, even though 10 acknowledged being sex workers. Given the high prevalence of STDs in this population and the ease of HIV transmission with ulcerative STDs, the authors recommend that incarcerated female drug users be routinely screened and treated for STDs as part of their rehabilitation program.
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PMID:Prevalence of sexually transmitted diseases among female drug abusers in Malaysia. 835 Jul 86

A total of 1380 patients with syphilis were diagnosed and treated from January 1983 to December 1991 at the Department of Dermatology and Venereology at Leipzig University in West Saxon, Federal Republic of Germany where the population is 1.4 million. The incidence of syphilis increased gradually from 1983 to 1989 and then decreased again. The number of recent cases of syphilis was almost twice as high as latent syphilis cases (63:37%). The vast majority of cases suffered from early syphilis. In almost half the source of infection was casual contacts (44%); in one-third it was a stable partners (30%); about 6% were homosexuals and about 4% were prostitutes. Among the primary syphilis cases multiple chancres were seen in 16%. In 31% of cases, the ulcus durum was extragenital. Among the secondary syphilis cases macular and maculopapular exanthema were the commonest features (51%), followed by palmoplantar syphilis (5%), condylomata lata (5%), angina specifica (3%) and papular exanthema (3%). However, in 30% of the cases multiple skin features were observed. Secondary syphilis with persistent chancres were seen in 12%. Five percent of the patients were suffering from the second to the fifth reinfection in their life, and again 5% of the syphilis cases were detected during pregnancy. Only two patients had an HIV infection, 10% suffered from gonorrhea and 10% from trichomoniasis, 12% from chlamydial infection, 4% from genital warts and 8% from herpes simplex genitalis at the same time. The therapy of choice was penicillin. In 0.3% an allergy to penicillin was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Analysis of 1983-1991 Leipzig University Dermatology Clinic observed cases of syphilis]. 843 4

There is only a small probability that HIV-1 will be transmitted via any single sexual contact. The risk of transmission, however, during such an act may be greatly increased by the presence of ulcerative genital sexually transmitted disease (STD). Little evidence is published on whether infection with non-ulcerative STD facilitates the transmission of HIV-1. The authors therefore investigated whether treatable STD enhanced the sexual transmission of HIV-1 in a cohort of female prostitutes in Kinshasa, Zaire. 431 initially HIV-1-seronegative women were followed prospectively in this nested case-control study for a mean duration of two years in monthly STD check-ups and three-monthly HIV-1 serology. The 68 women who seroconverted were compared against the 126 women who remained HIV-1-seronegative for the incidence of STD and sexual exposure during the presumed period of HIV-1 acquisition. There was a 9.8% annual incidence of HIV-1 in this cohort of subjects. Seroconverters were of mean age 24.6 years compared to 26.8 years for the HIV-seronegative women. During the period of HIV-1 acquisition, cases had a much higher incidence of gonorrhea, chlamydial infection, and trichomoniasis, and engaged in unprotected sex with clients and partners more frequently than controls. After controlling for sexual exposure by multivariate analysis, adjusted odds ratio for seroconversion were 4.8 for gonorrhea, 3.6 for chlamydial infection, and 1.9 for trichomoniasis. Genital ulcers were more frequent in cases than controls, but much less common than other STD. These findings therefore suggest that non-ulcerative STDs were risk factors for the sexual transmission of HIV-1 in these women. Such STD may be a considerable population-attributable risk in the transmission of HIV-1 worldwide given the high prevalence of non-ulcerative STDs in some populations.
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PMID:Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. 851 63

Malawi is one of the countries that has been most affected by the HIV epidemic with an estimated national HIV seroprevalence rate of 10% in the age group over 15 years and 32% among pregnant women who attended prenatal clinics in Blantyre in 1993. Queen Elizabeth Central Hospital (QECH) is the district hospital in Blantyre, Malawi, and the tertiary referral hospital for Malawi's southern region. About 11,000 patients were admitted there in 1993. The aim of this cross-sectional study was to determine the prevalence of sexually transmitted diseases (STDs) in inpatients under general medical care in view of the limited examination facilities in the wards. All patients who were in the general medical wards on June 23, 1994, were enrolled for the study. After obtaining informed consent, external genital lesions were identified visually noting the presence of ulcers, warts, and urethral discharge in men. The patients' case notes were reviewed to identify those with known current STDs. A total of 123 patients were examined: 62 males (age range 20-90 years) and 61 females (age range 16-65 years). There were 6 (9.7%) males vs. 8 (13.1%) females with discrete ulcers; no males vs. 2 (3.3%) females had nondiscrete ulcers; 3 (4.8%) males and 6 (9.8%) females had genital warts; 6 (9.7%) males had urethral discharge; and 13 (21%) males vs. 14 (23%) females had one or more lesions. One man had Kaposi's sarcoma of the glans penis. The survey showed that STDS are common in general medical patients in Blantyre with an overall prevalence of 22%. This percentage is an underestimate given the fact that the limited facilities precluded the diagnosis of trichomoniasis, gonorrhea, and chlamydia in women. Of the 123 patients, 14 (11.4%) who had discrete genital ulcers received treatment with erythromycin and penicillin to cover the main possible causes (chancroid, syphilis, and lymphogranuloma venereum). In view of the known link between STDs and the risk of HIV transmission, treatment of STDs may be more effective in preventing sexual transmission of HIV.
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PMID:Prevalence of genital infections in medical inpatients in Blantyre, Malawi. 852 42

To determine the frequency of reported condom use and validate the reliability of self-reporting among urban women in Malawi, 6561 women in 1989 and 2460 women in 1993 answered survey questions about condom use and sexual activity, had a physical examination, and were screened for HIV. A subset of women from the 1989 screening were administered a questionnaire and tested for syphilis, gonorrhea, and Trichomonas vaginalis infections every six months. The study populations consisted of consecutive women presenting for their first antenatal visit to Queen Elizabeth Hospital in Blantyre, Malawi. Intermittent condom use increased from 6% to 15% between the two cross-sectional studies, with no difference according to HIV infection; consistent condom use was reported by less than 1%. In the prospective study, women reported higher condom use at any visit than either group assessed cross-sectionally. Consistent condom use peaked at 62% in the first six months, but declined to as low as 8% during the second year of follow-up. Condom use at each visit, either intermittent or consistent, was higher among HIV-seropositive than HIV-seronegative women. Overall, the incidence of syphilis, gonorrhea, and trichomoniasis did not decline in women reporting consistent condom use. This incidence of new sexually transmitted diseases suggests that the studied population either overreports condom use or underreports sexual activity, or both.
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PMID:Reported condom use is not associated with incidence of sexually transmitted diseases in Malawi. 883 10

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

The increase in female-dependent contraceptive methods (e.g., the pill) usurped often older and less use-effective barrier methods, perhaps explaining the increase in sexually transmitted diseases (STDs) and their consequences. Barrier methods tend to afford STD protection for both partners. Most male condoms are made of latex. Polyurethane male condoms are stronger, more durable in storage, and allow more sensation than latex condoms. Condom use has increased with the emergence of AIDS. Consistent condom usage can provide 100% protection from HIV. Acceptability of the polyurethane female condom has not been assured. It appears that its contraceptive efficacy matches that of the diaphragm, cervical cap, or spermicidal sponge. Diaphragms used with a spermicide provide a moderate protective effect against some common STDs (e.g., trichomoniasis). There are no data on the STD/HIV preventive efficacy of cervical caps. There have been tentative links between the cervical cap and progression of cervical dysplasia and cervical lacerations, which could theoretically facilitate entry of HIV. The detergent effect of nonoxynol-9 and other surfactants disrupts cell membranes, including those of HIV and other STDs. Yet, nonoxynol-9 causes a dose-related epithelial disruption and inflammation. Other possible spermicide/microbicides include gramicidin and cholic acid (present in uterine secretions toward the end of the luteal phase). Postcoital chemical prophylaxis is perhaps another option. Since HIV transmission is more efficient from the insertive to the receptive partner and HIV concentrates in semen, withdrawal may provide some protection for the unprotected receptive partner. Douching, be it anal or vaginal, increases the risk of STDs and HIV. Vasectomy protects against pregnancy but there is no evidence that it protects against STD/HIV. Use of a combination of barriers has increased as a result of the AIDS epidemic. There is a need to develop a more diverse range of better barrier methods and to better promote existing methods. The means to stop the spread of HIV exist. There is no scientific basis to support moral arguments against barrier methods.
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PMID:Barriers to conception and disease. 884 97

Genitourinary infections have a major impact upon public health, especially in Africa. This paper describes findings from a study conducted to describe the etiology of such infections in Bobo-Dioulasso, to establish the sensitivity of Neisseria gonorrhoeae to antibiotics, and to provide epidemiologic and biologic evidence to optimize the treatment of genitourinary infections. The findings are based upon clinical and biologic diagnoses among 223 women with genitourinary infections. Study found the following etiologies: trichomoniasis in 27.8%, chlamydia in 26.9%, bacterial vaginosis in 19.7%, candidiasis in 16.6%, and Neisseria gonorrhoeae infection in 10.9%. HIV antibodies were present in 42% of patients. The authors recommend spectinomycin or ceftriaxone for the treatment of gonorrhea in Bobo-Dioulasso. Moreover, that the prevalence of Chlamydia trachomatis is higher than that of Neisseria gonorrhoeae should be taken into account when managing STDs in this setting.
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PMID:Etiologic study of genitourinary infections in women of childbearing age in Bobo-Dioulasso, Burkina Faso, 1992. 891 43

Vaginal sponges offer women control over protection against both pregnancy and sexually transmitted diseases (STDs), including HIV. Spermicide-impregnated sponges combine the actions of a physical barrier that blocks the cervix with a material that absorbs the ejaculate and a spermicide. Commercially available spermicides contain 1-5% of nonoxynol-9, shown to inhibit organisms responsible for gonorrhea, chlamydia, candidiasis, genital herpes, syphilis, trichomoniasis, and HIV. On the other hand, nonoxynol-9 is associated with a significantly higher risk of vaginal colonization with bacterial agents, ulcerative genital diseases, and vulvitis. A lower dose of nonoxynol-9 appears to avert vaginal irritation without compromising contraceptive efficacy. Use of chlorhexidene, a spermicide less irritating to mucosal cells than nonoxynol-9 but active against HIV in vivo and in vitro, is under investigation. Also promising are initial findings regarding the Protectaid contraceptive sponge with F-5 gel. Epidemiologic studies and clinical trials should provide quantitative estimates of the level of protection offered by barrier methods and identify the method that combines the highest protection, ease of use, and user acceptability.
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PMID:Anti-STD vaginal contraceptive sponges. 923 1


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