Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests. A total of 696 women with vaginal discharge were recruited, 119 of whom had clinical PID. Patients with trichomoniasis had a significantly higher risk of PID than did women without trichomoniasis (P=.03). PID was not associated with any of the other pathogens. When the patients were stratified according to HIV-1 status, the risk of PID in HIV-1-infected patients with T. vaginalis increased significantly (P=.002); no association was found in patients without HIV-1. T. vaginalis infection of the lower genital tract is associated with a clinical diagnosis of PID in HIV-1-infected women.
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PMID:Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. 1179 80

Since the advent of the antimicrobial era, single-dose therapy has been a valuable tool in the management of genital infection. Most of the common sexually transmitted infections (STIs) such as gonorrhoea, syphilis, trichomoniasis and chancroid can be treated in this way, as can genital infections which are not sexually transmitted such as bacterial vaginosis and genital tract candidiasis. Until recently, treatment for Chlamydia trachomatis infection required a multi-dose regimen, but single-dose azithromycin has now been shown to be an effective and acceptable alternative to this. Unfortunately, eradicative therapy has proven to be elusive for the viral STIs such as genital herpes simplex infection, human papilloma virus infection and human immunodeficiency virus (HIV) infection. The main advantage of single-dose therapy lies in its convenience and in its ability to ensure virtually 100% compliance. This addresses the problems of reduced clinical efficacy and the difficulties in assessing the response to therapy which complicates poor treatment compliance. However, some single-dose regimens for STIs do have drawbacks, particularly in certain situations. This may be with respect to efficacy, for example in syphilis with single-dose benzathine penicillin therapy, particularly for pregnant women and individuals infected with HI. Alternatively, it may involve toxicity, for example with single-dose metronidazole therapy for trichomoniasis or bacterial vaginosis where a higher rate of gastrointestinal adverse effects may be expected than if a lower multi-dose regimen is used. In addition, single-dose therapy, for example with nevirapine, given to the mother in labour and to the baby after delivery significantly reduces the risk of mother to child HIV transmission, but resistance mutations are frequently detected in the viral genome after the brief exposure to the drug, which could jeopardise its future use. Single-dose therapy clearly has both advantages and disadvantages. We have reviewed a range of these in a variety of situations, focussing on their applications, effectiveness, compliance and toxicity, highlighting how single-dose therapy may be a double-edged sword.
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PMID:Treatment of sexually transmitted infections with single-dose therapy: a double-edged sword. 1192 35

Trichomoniasis has been implicated in the acquisition and transmission of human immunodeficiency virus (HIV) infection. The prevalence, incidence, and persistence or recurrence of trichomoniasis were assessed among HIV-positive women and among HIV-negative women at high risk for HIV infection. A total of 871 HIV-seropositive women and 439 HIV-seronegative women enrolled in the HIV Epidemiology Study (HERS) were seen biannually. The prevalence of trichomoniasis was 9.4%-29.5% among HIV-seropositive women and 8.2%-23.4% among HIV-seronegative women. Prevalence decreased over time, did not vary according to HIV status or CD4 cell count, and was higher among women who reported crack use (P=.02) or cigarette use (P=.02), women who had bacterial vaginosis (P=.02), and those who were black (compared with white women, P<.001). There were no differences, according to HIV status or CD4 cell count, in the adjusted incidence, unadjusted incidence, or persistence or recurrence of trichomoniasis. HIV infection does not make a woman more likely to have prevalent, incident, or persistent or recurrent trichomoniasis.
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PMID:Prevalence, incidence, and persistence or recurrence of trichomoniasis among human immunodeficiency virus (HIV)-positive women and among HIV-negative women at high risk for HIV infection. 1198 38

Mucosal immune system activation may represent a critical determinant of adverse consequences associated with bacterial vaginosis (BV), such as sexual human immunodeficiency virus transmission, upper genital tract infections, postsurgical infections, and adverse pregnancy outcomes. Concentrations of sialidase, prolidase, and anti-Gardnerella vaginalis hemolysin (Gvh) immunoglobulin A (IgA) were higher in vaginal fluids of 75 fertile women with BV, compared with concentrations in vaginal fluids of 85 healthy control subjects. Interleukin (IL)-8 levels were positively associated with anti-Gvh IgA response and inversely correlated with high levels of prolidase and sialidase in women with BV. IL-8 concentration was strongly associated with leukocyte count in both healthy and BV-positive women. The absence of leukocytes in most women with BV likely is due to lack of IL-8 induction. Parallel impairment of innate and adaptive mucosal immune factors, likely through microbial hydrolytic effects, may allow for the ascent of microorganisms to the upper genital tract and may facilitate viral infections.
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PMID:Correlation of local interleukin-8 with immunoglobulin A against Gardnerella vaginalis hemolysin and with prolidase and sialidase levels in women with bacterial vaginosis. 1202 67

This is the first report demonstrating the in vitro inhibitory activity of two novel microbicides (cellulose sulfate and polystyrene sulfonate) against bacterial vaginosis (BV)-associated bacteria. Vaginal application of these microbicides not only may reduce the risk of acquisition of human immunodeficiency virus and other sexually transmitted infection-causing organisms but may also decrease the incidence of BV.
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PMID:Two novel vaginal microbicides (polystyrene sulfonate and cellulose sulfate) inhibit Gardnerella vaginalis and anaerobes commonly associated with bacterial vaginosis. 1212 59

To evaluate correlates of anti-human immunodeficiency virus (HIV) type 1 (HIV-1) immunoglobulin (Ig) in the genital tract, anti-HIV-gp120 IgA and IgG titers in cervicovaginal lavage specimens obtained from 104 HIV-1-infected women were measured by enzyme-linked immunosorbent assay. Overall, 24% and 94% of women had detectable anti-gp120 IgA and IgG, respectively. CD4 cell count correlated negatively with total IgA concentration (r=-0.301; P=.0027) and positively with specific IgA activity (anti-gp120 IgA titer/total IgA concentration, r=0.306; P=.0023). Women with bacterial vaginosis had 5-fold lower anti-gp120 IgG titer (P=.0042), 5-fold lower total IgG concentration (P< or =.0001), and 4-fold higher specific IgG activity (P=.0474) compared with women who did not have bacterial vaginosis. Enhanced understanding of correlates of mucosal immunity to HIV-1 may assist in the design of vaccine strategies or in the prevention of vertical transmission of HIV-1.
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PMID:Human immunodeficiency virus (HIV)-specific antibody in cervicovaginal lavage specimens obtained from women infected with HIV type 1. 1217 38

These guidelines for the treatment of patients who have sexually transmitted diseases (STDs) were developed by the Centers for Disease Control and Prevention (CDC) after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on September 26-28, 2000. The information in this report updates the 1998 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 1998;47 [No. RR-1]). Included in these updated guidelines are new alternative regimens for scabies, bacterial vaginosis, early syphilis, and granuloma inguinale; an expanded section on the diagnosis of genital herpes (including type-specific serologic tests); new recommendations for treatment of recurrent genital herpes among persons infected with human immunodeficiency virus (HIV); a revised approach to the management of victims of sexual assault; expanded regimens for the treatment of urethral meatal warts; and inclusion of hepatitis C as a sexually transmitted infection. In addition, these guidelines emphasize education and counseling for persons infected with human papillomavirus, clarify the diagnostic evaluation of congenital syphilis, and present information regarding the emergence of quinolone-resistant Neisseria gonorrhoeae and implications for treatment. Recommendations also are provided for vaccine-preventable STDs, including hepatitis A and hepatitis B.
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PMID:Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. 1218 49

Infections of the urogenital tract in women represent a major burden on the quality of life of women and on the health care system of Canada and other countries. Complications arising from bacterial vaginosis (BV) include increased risk of sexually transmitted diseases including human immunodeficiency virus and elevated risk of preterm birth (PTB). Pharmaceutical interventions, such as antibiotics, have been suboptimally effective and have failed to reduce the incidence of PTB. The absence of lactobacilli in the vagina, a specific feature of BV, raises the question as to whether restoration of lactobacilli, by probiotic therapy, can restore the normal flora and improve the chances of having a healthy term pregnancy. The rationale for probiotic use in pregnant women is quite strong. Certain lactobacilli strains can safely colonize the vagina after oral and vaginal administration, displace and kill pathogens including Gardnerella vaginalis and Escherichia coli, and modulate the immune response to interfere with the inflammatory cascade that leads to PTB. Additional attributes of probiotics include their potential to degrade lipids and enhance cytokine levels, which promote embryo development. In a society that focuses on disease rather than health and drug therapy rather than natural preventive measures, it will take some effort to get remedies such as probiotics into mainstream care. Perhaps the escalating health care budgets and emergence of "superbugs" will provide the incentives to put in place clinical trials designed to evaluate how best to use the commensal organisms that, after all, make up more of our body than human cells, and without which none of us would survive.
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PMID:The potential for probiotics to prevent bacterial vaginosis and preterm labor. 1458 79

Restoration of the balance of different ecological niches has been proposed as a way to control the income of pathogenic microorganisms. The genus Lactobacillus has been used in different human and animal tracts as probiotic microorganisms with this objective in mind. The characteristics of the strains proposed as probiotics have been published or patented under the process of elaboration of different types of products. One of the mechanisms suggested to control the vaginal ecosystem is the production of antagonistic substances (lactic acid, bacteriocins, or H2O2). The H2O2-producing microorganisms present in the vagina of healthy women have been suggested as some of the bacteria responsible for maintenance of ecological balance, mainly in pregnant women. The absence of these microorganisms is related to a higher risk of: bacterial vaginosis, recurrent urinary tract infections by Escherichia coli, and acquisition of human immunodeficiency virus type 1 (HIV-1). Bauer has proposed that H2O2-producing lactobacilli also might exert control over vaginal cancer through specific interactions of reactive oxygen species, such as superoxide anion, hydroxyl radicals, and hypochlorous acid. The conversion of H2O2 into more toxic compounds during the oxidative process is potentiated by peroxidase and halures. This enzyme and some halures, such as chloride and bromide, are present in vaginal washes in sufficient amounts to allow an optimal environment for successful inhibition of pathogens. In vitro tests provide an approach for determining the ability of lactobacilli to produce H2O2. The H2O2 amounts produced in such systems are probably not a direct reflection of what happens in the vaginal tract of women or animals, which is not yet know. However, there is a registered patent with an H2O2-generating L. crispatus strain, also supporting the use of H2O2-producing lactobacilli to restore the vaginal ecosystem.
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PMID:Production of antimicrobial substances by lactic acid bacteria I: determination of hydrogen peroxide. 1515 44

The seroincidence of herpes simplex virus type 2 (HSV-2) infection was determined among 1766 patients attending sexually transmitted disease (STD) clinics and enrolled in a randomized, controlled trial of human immunodeficiency virus (HIV)/STD risk-reduction counseling (RRC). Arm 1 received enhanced RRC (4 sessions); arm 2, brief RRC (2 sessions); and arm 3, the control arm, brief informational messages. The overall incidence rate was 11.7 cases/100 person-years (py). Independent predictors of incidence of HSV-2 infection included female sex; black race; residence in Newark, New Jersey; <50% condom use with an occasional partner; and, in females, incident trichomoniasis and bacterial vaginosis. Only 10.8% of new HSV-2 infections were diagnosed clinically. Incidence rates were 12.9 cases/100 py in the control arm, 11.8 cases/100 py in arm 2, and 10.3 cases/100 py in arm 1 (hazard ratio, 0.8 [95% confidence interval, 0.6-1.1], vs. controls). The possible benefit of RRC in preventing acquisition of HSV-2 infection offers encouragement that interventions more specifically tailored to genital herpes may be useful and should be an important focus of future studies.
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PMID:Incidence of herpes simplex virus type 2 infection in 5 sexually transmitted disease (STD) clinics and the effect of HIV/STD risk-reduction counseling. 1531 54


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