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Query: UMLS:C0019693 (HIV)
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A sexually transmitted disease (STD) prevalence survey of 1873 female sex workers recruited from six types of sex establishments in Surabaya, Indonesia, in 1992-93 failed to reveal any cases of HIV. The prevalence rates of the other STDs included in the study (chlamydia, gonorrhea, syphilis, and trichomoniasis), by setting, were as follows: brothels (n = 696), 48%; streets (n = 192), 42%; massage parlors (n = 344), 16%; barber shops (n = 150), 25%; call-girl houses (n = 73), 17%; and nightclubs (n = 418), 10%. Sex workers based in brothels and on the streets had the lowest socioeconomic status, while nightclub and call-girl house workers had the highest status. Brothel workers had the highest rates of gonorrhea (24%) and trichomoniasis (8%), while street and barber-shop based workers had the highest prevalences of syphilis (30%) and chlamydia (18%). Condom use in the week preceding the survey ranged from 14% among brothel workers to 67% among call girls. STD rates decreased with increases in age and education and with any condom use. The high rates of STDs documented in this survey, especially among sex workers in brothels, indicate the need for programs aimed at preventing an HIV epidemic. For example, the medical monitoring available from a private physician to workers in most massage parlors, barber shops, call-girl houses, and nightclubs should be made available to brothel-based prostitutes. Also urged are free distribution of condoms to sex establishments, sanctions against establishments where condoms are not used consistently, and a media campaign to encourage men to use condoms with sex workers.
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PMID:Patterns of sexually transmitted diseases in female sex workers in Surabaya, Indonesia. 929 47

Prevalence rates of HIV-1 and other sexually transmitted diseases (STDs) among pregnant and postpartum women were investigated in sequential, cross-sectional studies (1990, 1993, and 1994-95) conducted at Queen Elizabeth Central Hospital in Blantyre, Malawi. Annual anonymous, unlinked testing revealed a linear increase in HIV-1 prevalence among antenatal patients from 2.0% in 1985 to 32.8% in 1996. Analysis of demographic attributes of women enrolled in the 1990 and 1993 surveys of consecutive, first-visit antenatal women (n = 6603 and 2161, respectively) and the 1994-95 study of all women giving birth at the hospital during a 6-month period (n = 6964) indicated that HIV-infected women were most likely to be young, with fewer pregnancies, and be more educated. The highest age-specific HIV prevalence shifted from 20-24 years in 1990 to 30-34 years in 1996, indicating an aging cohort of women who became infected at a younger age. Reported lifetime use of condoms increased from 5.6% in 1990 to 17.5% in 1993, then declined to 4.9% in 1995; condom use was consistently higher among HIV-positive than HIV-negative women. The prevalence of all STDs (syphilis, trichomoniasis, gonorrhea, and genital warts and ulcers) declined significantly during 1990-96, with the most consistent decreases recorded among HIV-positive women. In a follow-up study of 1173 HIV-seronegative, postpartum women evaluated for 2302 person-years (average duration, 30.9 months), 97 seroconverted (4.21/100 person-years). The seroconversion rate declined steadily from 21.26/100 person-years in 1990 to 1.11/100 person-years in 1994-95. These findings are consistent with those from other sub-Saharan African countries, indicating a rapid increase in HIV prevalence followed by stabilization within about 10 years of the onset of the epidemic. The large decline in STD prevalence in the antenatal population suggests that Malawi's national AIDS prevention program is having an impact, either through improved STD diagnosis and treatment or reduced risk behaviors.
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PMID:Trends of HIV-1 and sexually transmitted diseases among pregnant and postpartum women in urban Malawi. 946 69

Little information is available regarding human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Burkina Faso, West Africa. A cross-sectional study was conducted in Ouagadougou and Bobo-Dioulasso, the 2 largest cities of the country, to determine the prevalence of HIV infection and other sexually transmitted diseases (STDs) among FSWs, and to investigate the factors which were associated with HIV infection in this population. From October to November 1994, 426 FSWs were recruited. The method of anonymous and unlinked HIV screening recommended by the World Health Organization (WHO) was used. The overall HIV seroprevalence was 58.2% (95% confidence interval: 53.4-62.9) and 52.6% of FSWs had at least one STD agent. The most common STDs were trichomoniasis (23%), syphilis (15%) and gonorrhoea (13%). In a logistic regression analysis, risk factors for HIV infection were high gravidity (> or = 2 pregnancies), low perception of personal risk of HIV infection, syphilis and the presence of genital warts. These results suggest that FSWs in Burkina Faso need better information about HIV transmission and prevention and then need better access to STD detection and management services.
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PMID:Prevalence and risk of HIV infection among female sex workers in Burkina Faso. 953 Aug 99

Trichomonas vaginalis, a parasitic protozoan, is the etiologic agent of trichomoniasis, a sexually transmitted disease (STD) of worldwide importance. Trichomoniasis is the most common nonviral STD, and it is associated with many perinatal complications, male and female genitourinary tract infections, and an increased incidence of HIV transmission. Diagnosis is difficult, since the symptoms of trichomoniasis mimic those of other STDs and detection methods lack precision. Although current treatment protocols involving nitroimidazoles are curative, metronidazole resistance is on the rise, outlining the need for research into alternative antibiotics. Vaccine development has been limited by a lack of understanding of the role of the host immune response to T. vaginalis infection. The lack of a good animal model has made it difficult to conduct standardized studies in drug and vaccine development and pathogenesis. Current work on pathogenesis has focused on the host-parasite relationship, in particular the initial events required to establish infection. These studies have illustrated that the pathogenesis of T. vaginalis is indeed very complex and involves adhesion, hemolysis, and soluble factors such as cysteine proteinases and cell-detaching factor. T. vaginalis interaction with the members of the resident vaginal flora, an advanced immune evasion strategy, and certain stress responses enable the organism to survive in its changing environment. Clearly, further research and collaboration will help elucidate these pathogenic mechanisms, and with better knowledge will come improved disease control.
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PMID:Clinical and microbiological aspects of Trichomonas vaginalis. 956 65

Persons with human immunodeficiency virus (HIV) infection who subsequently develop an acute sexually transmitted disease have an increased probability of transmitting HIV. Therefore, characterizing such persons can help direct prevention efforts to a group who are likely to be continuing sources of HIV transmission. We assessed the incidence and factors associated with trichomoniasis in a cohort of HIV-infected women receiving care at a public clinic in Los Angeles County, California from 1992 through 1995. Demographic, clinical, and behavioral data were available from medical records and from patient interviews. Trichomonas infection was the most frequently identified sexually transmitted disease and was found in 37 (17.4%) of 212 women representing a crude incidence rate of 14.1 per 100 person-years experience. The crude rate of trichomoniasis was highest in black women (69.0 per 100 person-years), women with a history of trading sex for drugs or money (51.0 per 100 person-years), those using crack or cocaine (35.5 per 100 person-years), women with four or more sex partners (43.0 per 100 person years), and those born in the United States (23.3 per 100 person-years). Among women with severe immunosuppression (CD4+ count < 200), 18.4% (18 of 98) were diagnosed with trichomoniasis. After multivariate analysis using a Cox proportional hazards approach, black race (adjusted rate ratio [RR] = 5.6, 95% confidence interval [CI] = 2.3, 13.3) continued to be strongly associated with Trichomonas infection. Trading sex for money or drugs (adjusted RR = 25.2, 95% CI = 4.3, 148.6) and single marital status (adjusted RR = 3.7, 95% CI = 1.1, 13.0) were independent risk factors for trichomoniasis in nonblack women but not among black women. Data from this study indicate that Trichomonas may be a frequently acquired infection in HIV-positive women. Our findings suggest that HIV-infected women who are black, and nonblack women who trade sex for money or drugs or are unmarried, are at increased risk of trichomoniasis and therefore may be more likely to transmit HIV infection. Local HIV prevention strategies should target such women for intervention efforts.
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PMID:Risk factors for trichomoniasis among women with human immunodeficiency virus (HIV) infection at a public clinic in Los Angeles County, California: implications for HIV prevention. 957 98

Situated between Russia and China, two countries with growing rates of HIV prevalence, Mongolia is a country with a population of 2.3 million people. Although there is only 1 known case of HIV infection in Mongolia, HIV is spreading rapidly in Asia. The prevalence of sexually transmitted diseases (STDs) was assessed among 137 men and 123 women of mean ages 26 and 28 years, respectively, attending the public health STD clinic in Ulaanbaatar, the capital and largest city of Mongolia. Overall, study subjects were aged 15-62 years and mainly from urban areas. Only 1 man and 1 woman admitted to having sex with a same-sex partner. 7% of men and 10% of women consistently used condoms, and 45% of men and 33% of women reported ever having had STDs. 31.1%, 8.1%, and 8.6% of men and 10.3%, 9.9%, and 6.0% of women were infected with gonorrhea, chlamydia, and syphilis, respectively. 19.7% of men had nongonococcal urethritis and 67% of women had trichomoniasis. 42% of gonococcal isolates were plasmid-mediated resistant to penicillin, while chromosomal resistance to penicillin, tetracycline, and ciprofloxacin was observed. Even though no patient was infected with HIV, improved control efforts are urgently needed to prevent the spread of HIV in Mongolia given the existence and communication of STDs in the country.
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PMID:Sexually transmitted diseases in Ulaanbaatar, Mongolia. 967 Dec 51

Findings are reported from a study conducted to assess the prevalence of sexually transmitted infections, including HIV, among female prostitutes working at truckstops in the KwaZulu-Natal midlands of South Africa. The 145 participating prostitutes were recruited from 5 truckstops along the major national road between Durban and Johannesburg from August 1996 to March 1997. Their mean age was 25 years and they had been prostitutes for an average of 3 years. A gynecologic examination was performed upon each woman, including a speculum examination, and investigations were also conducted to identify gonorrhea, syphilis, chlamydia, candidiasis, trichomoniasis, bacterial vaginosis, and HIV infection. The examinations found that 50.3% of the women were HIV seropositive, 41.3% were infected with Trichomonas vaginalis, 40.6% had Candida albicans, 14.3% had Neisseria gonorrheae, 16.4% had Chlamydia trachomatis, 71% had bacterial vaginosis, and 42.1% had active syphilis. These findings point to the need for HIV/STD prevention interventions among both the prostitutes and their clients.
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PMID:Sexually transmitted infections among sex workers in KwaZulu-Natal, South Africa. 971 13

Gynecologic conditions associated with HIV infection were examined in 481 regular female sex partners of HIV-positive male blood donors enrolled in a study of heterosexual HIV transmission conducted at Chiang Mai University Hospital and Lampang Provincial Hospital in Thailand in 1992-96. Of these women, 224 (46.6%) were HIV-infected. HIV-positive and HIV-negative women were similar in terms of age, education, and age at first intercourse; however, a history of sexually transmitted disease was more common among the HIV-infected women (31.7%) than their uninfected counterparts (18.7%). HIV-infected women also were significantly more likely to have abnormal gynecologic conditions, including abnormal vaginal discharge at physical examination (odds ratio (OR), 2.6; 95% confidence interval (CI), 1.6-4.2) and cervical dysplasia (OR, 5.3; 95% CI, 2.0-15.2). Among HIV-positive women, the prevalence of abnormal vaginal discharge and bacterial vaginosis increased significantly with decreasing CD4 count. Syphilis, gonorrhea, chlamydia, and trichomoniasis rates were generally low and did not differ by HIV status. These findings suggest a need for further research on variations in gynecologic conditions associated with HIV infection in different countries.
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PMID:Gynaecological conditions associated with HIV infection in women who are partners of HIV-positive Thai blood donors. 986 81

The pandemic impact of HIV has changed the clinical spectrum of STDs all over the world. The incidence and frequency of STDs in the different global geographic areas demonstrate the diagnostic and treatment capabilities of various local and national health systems and is simultaneously informing about the sexual behaviours of the population. The purpose of this study was to determine the frequency of curable STDs (herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis) in a hospital-based STD clinic in Madrid, Spain during a 4-year period. Patients were referred mainly from the emergency department, gynecological wards, and family planning (61%) as well as from the HIV-hospital unit (31 beds) and outpatient department (39%). The total number of patients seen was 952 (243 men, 709 women) with an annual average of 238 patients per year. Of these, 139 (14.6%) were HIV-patients and 813 (85.4%) non-HIV patients. In non-HIV patients, STDs were identified in 493 cases (54.2%). In HIV-patients, STDs were diagnosed in 108 cases (77.7%; p < or = 0.001). Two or more STDs were more prevalent in HIV than non-HIV patients. The frequency of STDs in both HIV and non-HIV patients were vulvovaginal candidiasis, 47.8%:57.2%; syphilis, 11.7%:1.4% (p < or = 0.05); gonorrhea, 5.3%:3.9%; Gardnerella vaginosis, 6.3%:4.8%; genital chlamydia, 6.3%:9.06%; trichomoniasis, 17%:6.5% (p < or = 0.05); and genital herpes, 20.2%:5.3% (p < or = 0.05).
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PMID:Differences in curable STDs between HIV and non-HIV populations in Spain. 1037 65

Sexually transmitted diseases (STDs) represent a major public health problem in the world and the advent and increase of human immunodeficiency virus infection during the last decade has highlighted the importance of infections spread by the sexual route. The World Health Organization estimates that the global incidence in 1995 of new cases of selected curable STDs, which are gonorrhea, chlamydial infection, syphilis and trichomoniasis, was 333 million. Control programs for STDs must prevent the acquisition of STDs, their complications and sequelae and interrupt and reduce transmission.
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PMID:Sexually transmitted diseases (STDs) in the world. 1043 62


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