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This paper discusses the gender dynamics of sexually transmitted diseases (STDs) and HIV/AIDS based on the relationship between gender violence, reproductive health, sexuality, STD and HIV/AIDS. This approach highlights AIDS as an increasingly female concern, a consequence of the social makeup of female and male sexuality, and the result of inequalities that characterizes many heterosexual relationships. Gender violence is considered as the most intimate enemy among most women with an extremely high indirect cost to development. Not only that, it also causes more death and disability among women aged 14-44 years, having greater risk from their husbands, fathers, and neighbors or colleagues. Moreover, the link between gender violence and HIV/AIDS and STD can be observed through the rising incidence of these infections among women particularly during unprotected vaginal intercourse. Also, these women often bear the pain and discomfort associated with STD because of social constraints. The study calls for further research into behavior change interventions that address gender dynamics to prevent the fatal intimacy of women's vulnerability to STD and HIV, the intimate enemy of gender violence and the fatal encounter with AIDS. Lastly, the paper includes information about the work of the Pacific Women's Resource Bureau and its pioneering initiative on the Pacific multi-site study on violence against women.
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PMID:New Caledonia: fatal intimacy: gender dynamics of STD and HIV / AIDS. 1229 69

Management of sexually transmitted diseases for developing countries is reviewed with special attention to appropriate technology, with sections on diagnosis, treatment, prevention, and program issues. Brief descriptions of gonorrhea, chlamydia, syphilis and chancroid are provided. Some diagnostic techniques can be adapted effectively to remote locations, i.e., microscopy, dark field microscopy, and some serological tests. The VDRL test for syphilis, agglutination tests and ELISA (enzyme-linked immunoassay) screens for AIDS, chlamydia or gonorrhea can be done without electric power. Some serological tests may be adapted by collecting and transporting blood on filter paper. No culture techniques can be controlled well without reliable electric power and fairly expensive equipment. The most practical type of diagnosis for remote areas is the WHO syndromic approach. This is a standardized decision tree which incorporates therapeutic tests using antibiotics. The advantages are immediate initiation of treatment, and no need for laboratory backup, although lab tests would help consolidate diagnoses, if available. The most problematic aspect of treatment of STDs is drug resistance of the causative organisms. Since the STDs cause similar symptoms, and diagnosis may be uncertain or a client may have more than one infection, it is best to treat the disease causing the most frequent, severe and costly complications 1st. Thus, syphilis is treated 1st because of its adverse complications; chancroid is treated 2nd because of its pain. Contact tracing by patients, health education, use of condoms, diaphragms with spermicide, and silver nitrate or erythromycin for newborns' eyes are examples of feasible prevention measures.
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PMID:Sexually transmitted diseases. 1231 9

The intrauterine contraceptive device (IUD) is effective and reversible and has a high continuation rate. It can also be used within 7 days postcoitus. Developed separately by Richter, Grafenberg, and Ota between 1909 and 1934, the IUD gained popularity in the 1960s and 1970s with the introduction of the Margulies Spiral, the Lippes Loop, the Birnberg Bow, and the Dalkon Shield. The last proved dangerous, and the IUD became unpopular. The 4 IUDs which are available in Canada include the TCu-380S (GYNE T Slimline), the TCu-200, the NOVA-T, and the Progestasert. All are T shaped and medicated (copper or progesterone). The 1st and 3rd can be left in situ for 10 years; the 2nd, for 4 years; and the 4th, for 1 year. The NOVA-T has a copper wire with a silver core and is inserted with a unique pull-push technique. The Progestasert, which contains 38 mg of progesterone, releases 65 mcg of the hormone daily. The best candidate for IUD use is parous, but not pregnant, is in a stable monogamous relationship, and has a healthy reproductive tract and no history of ectopic pregnancy, sexually transmitted disease, pelvic inflammatory disease, undiagnosed genital bleeding, endometrial or cervical neoplasia, abnormal endometrial anatomy, compromised immune system, allergy to copper, or Wilson's Disease. The only infection related to the IUD is that associated with insertion. Such an infection is polymicrobial and involves the endogenous, cervicovaginal flora (primarily anaerobes). It is usually asymptomatic and contained by the immune system. 200 mg of Doxycycline can be given orally as a prophylactic 1 hour prior to insertion. A nonprescription, nonsteroidal, anti-inflammatory drug, also taken 1 hour before the procedure, will prevent pain and a vasovagal reaction. Paracervical anesthesia should be used. If the depth of the uterus is less than 6 cm or greater than 10 cm, another form of contraception should be used. Although little research is being done in Canada on new IUDs, the Levonorgestrel IUD from Europe and the CuFix-360 (Flexigard) offer promise. The former, which is T shaped, contains polydimethylsiloxane and levonorgestrel (52 mg, total; releases 20 mcg daily) and can be used for 7 years. The latter IUD is shapeless and consists of 6 copper sleeves strung on surgical nylon thread knotted at 1 end. The knot is inserted, using a needle, into the fundal myometrium. The truth and falsehood of several myths about IUDs are noted with supporting citations.
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PMID:The intrauterine device today. 1231 29

Each year 250 million new cases of sexually transmitted diseases (STDs) have the potential to cause pelvic inflammatory disease, infertility, blindness, and death. Sometimes the onset of these STDs is symptomless, but the following conditions indicate the presence of an STD: genital discharge, sores, wounds, or blisters; swollen glands in the groin; cauliflower-like growths on the genitals; skin rash; lower abdominal pain in females; painful swelling in the testicles; alopecia; discharge from the eyes; and pain during intercourse. The 5 most common STDs which can be cured with antibiotics are chancroid, chlamydial infection, gonorrhea, syphilis, and trichomoniasis. By the end of 1994 in Uganda, 390 primary health units will be available for STD treatment, and most health workers will be trained in STD patient management. Since patients will receive the minimum amount of treatment needed to cure the STD, they will be well advised to use the drugs provided. Notification of all recent sex partners is also essential, and sex partners should be evaluated even if they are asymptomatic. Patients are advised to engage in safe sex behavior, including remaining faithful to a monogamous relationship and using condoms, and to seek medical advice if they develop STD symptoms or are exposed to STD. The AIDS virus is also transmitted through sexual intercourse as well as through blood transfusions, from mother to child, and through the use of contaminated needles. HIV infection progresses from a stage where it cannot be detected to an asymptomatic stage to a symptomatic stage. Chronic diarrhea, fever, and weight loss are the major symptoms. There is no treatment for HIV infection, but zidovudine (AZT) can delay progress of the disease. The most important treatment available is counseling and understanding. The Uganda AIDS Commission works to control the disease through education, treatment of STDs, provision of safe blood for transfusion, monitoring, counseling patients, and promoting research. The primary objective in the care of AIDS patients is to improve the quality of their life as much as possible.
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PMID:Telling signs and symptoms. 1231 60

A couple's awareness of fertility affects use of any contraceptive method. Staff members who educate clients about fertility awareness need to discuss how family planning methods affect ovulation and menstruation. The methods that have no effect on ovulation or menstruation include natural family planning methods, male contraceptive methods, and barrier methods. Hormonal contraceptive methods and the IUD affect menstruation. Hormonal methods also interfere with ovulation. Combined oral contraceptives (OCs) suppress ovulation and can reduce the number of days of menstrual bleeding and minimize menstrual cramps and premenstrual syndrome symptoms. They can effect changes in bleeding patterns. Progestin-only contraceptives may also effect menstrual changes and ease menstrual cramps. Counseling on possible effects of progestin-only contraceptives is needed to minimize their discontinuation. Women can use emergency contraception (some OCs) within 48 or 72 hours of unprotected intercourse (e.g., rape), depending on OC type, and again 12 hours later to prevent unwanted pregnancy. An advisory committee of the US Food and Drug Administration has recently recommended the use of some OCs for emergency use. IUDs thwart sperm movement and viability. IUD users tend to have increased menstrual bleeding and pain. IUDs with synthetic progestin reduce these effects. Female sterilization methods do not affect ovulation but may induce changes in bleeding patterns or cause painful periods. Providers should inform clients which genital symptoms are normal and which are not. For example, purulent vaginal discharge may be a sign of a sexually transmitted disease (STD). Untreated STDs may lead to pelvic inflammatory disease. Changes in cervical secretions call for clients to seek medical advice.
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PMID:Fertility awareness affects method use. 1232 Apr 48

Sexually transmitted diseases (STDs) have shown a considerable resurgence in recent years both in number of cases and in spread of new infectious agents. The spread of STDs is favored by numerous factors including the liberalization of sexual behavior made possible by reliable contraception. Information on STDs has not been widely diffused. Changes in the status of women and the development of means of communication and transportation have encouraged less rigid control of sexual behavior. STDs themselves have often escaped diagnosis or not been cured despite treatment, increasing the risk of spread. Numerous organisms cause STDs, from external parasites to life-threatening viruses. 60% of upper genital tract infections that can lead to sterility, tubal alterations, ectopic pregnancy and pain result from STDs. Chlamydia infections are insidious and chronic, and cause greater damage with each recurrence. The risk of STDs should be considered in contraceptive choice along with other indications and contraindications. Combined oral contraceptives provide protection against acute upper genital tract infections. The protective role has been explained by scanty and highly viscous cervical mucus forming a barrier against germs and by reductions of menstrual flow, myometrial activity, and inflammation. It is actually uncertain whether combined oral contraceptives protect against latent chlamydia infections, since higher rates of cervicitis caused by chlamydia have been found in pill users. In situations carrying risk of STDs, pill users should be protected by a supplementary barrier method. IUDs have been implicated in numerous studies in acute pelvic infections. Possible explanations are the local trauma and inflammations due to the physical presence of the IUD, more abundant bleeding, absence of a cervical barrier to motile sperm that could be a vector for germs, and possible ascent of the infectious agent on the string. Other risk factors are involved. Epidemiologic studies indicate that the spermicides benzalkonium chloride and nonoxynol 9 have a protective effect against gonococcus, trichomonas, and chlamydia as well as cervical cancer. The protection is not absolute and is associated with the use of barrier methods. Condoms provide an excellent barrier against gonorrhea, chlamydia, cytomegalovirus, herpes, hepatitis B, and HIV infection. Use of spermicides may increase protection even more.
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PMID:[Sexually transmitted diseases (STD) and contraception]. 1234 83

The real prevalence of pelvic inflammatory disease (PID) is unknown since many women are either asymptomatic or have atypical symptoms. It is often difficult to detect, manage, and prevent PID. Since PID has obstetric, gynecologic, and contraceptive-related causes, its prevalence is quite high. About 70% of PID hospital admissions in sub-Saharan Africa are a result of reproductive tract infections (RTIs) while this figure is 34% in Asia and 31% in developed countries. Only 10-20% of lower RTIs ascend into the upper genital tract and an even smaller percentage of women with PID develop chronic sequelae. Still, just 1 episode carries an increased risk of a tubal infertility, ectopic pregnancy, chronic pelvic pain, considerable pain during coitus, a new episode, and menstrual irregularities. Neisseria gonorrhoea and Chlamydia trachomatis are the most common causative organisms of PID. In Africa, the risk factors for PID are the same as they are for sexually transmitted diseases (STDs): multiple sex partners, young age at first intercourse, high frequency of coitus, and a high rate of acquiring new partners. The largest percentage of women with RTIs are monogamous women who are infected and constantly reinfected by their promiscuous husbands. The primary means to prevent PID are promotion of safer sexual behavior and condom usage. Secondary measures include accessible, acceptable, and effective STD services and education and counseling during case management. WHO suggests that STD treatment become part of the primary health care system. It has developed flow charts on syndromic diagnosis for urethral discharge in men and genital ulcer disease in women. Health workers should assume increased PID risk if the partner has had a history of urethral discharge and/or treatment for gonorrhea or nongonococcal urethritis. Partner notification is also needed for case management, but stigmatization in some countries poses a problem. WHO also recommends use of drugs which have a 95% STD cure rate.
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PMID:Pelvic inflammatory disease. 1234 39

Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods.
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PMID:[Information on advances in sciences and technology. Advances in contraceptive technology]. 1234 21

The representative from the International Planned Parenthood Federation (IPPF) at the 15th Asian Parliamentarians' Meeting addressed the issue of negative consequences of the failure to meet the goals set at the ICPD. Global statistics on sexual and reproductive health are as follows: millions of women and men do not have access to safe and reliable family planning methods; thousands of women continue to die in pregnancy and childbirth; many suffer pain, ill health and permanent disability as a result of pregnancy and childbirth complications; up to 20 million unsafe abortions are performed on women, of whom 70,000 die every year; many young women and girls become unfactionally pregnant and lose the chance of an education and employment; pregnancy and childbirth are major killers of young women aged 15-19 years; a significant proportion of young women contract an STD; 70% of the world's 1.3 billion people living in absolute poverty are women. These women are also at risk during pregnancy and are least able to protect themselves from violence and rape, STDs and HIV/AIDS, unsafe abortion, and sexual exploitation. In conclusion, all the above concerns need support in moving governments toward better service organization and more frankness in a field where life and death are dangerously close to one another.
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PMID:Failure to meet ICPD goals will affect global stability, health of environment, and well-being, rights and potential of people. 1234 6

Quality of life (QoL) changes among 56 adult patients living with HIV/AID (PHA) were assessed following two years of care in which most had received highly active antiretroviral therapy (HAART). The sample was stratified by initial disease stage; subjects were classified 'asymptomatic' if they had no HIV-related constitutional symptoms, 'symptomatic' if they had at least one symptom, and 'AIDS' if symptomatic with a history of opportunistic infections and/or CD4 count less than 200 cells/ micro L. For the overall group, changes in mean QoL (Medical Outcomes Study Short-Form-36 [SF-36]) ratings were non-significant, irrespective of initial disease stage or prior HAART exposure. Although overall there were health status improvements over the two-year period, clinical changes were generally unrelated to changes in QoL ratings. Patients with better immunologic/virologic outcomes showed slight improvements in mean QoL ratings, while those with poorer clinical outcomes showed slight deterioration. These within-group changes over time were statistically non-significant. The corresponding between-group differences in changes in SF-36 social and psychological dimensions were significant. Statistically significant differences among the three disease stage groups on a number of subscales at baseline (Physical Function, Body Pain, Vitality, Role Limitations due to Physical Problems) became non-significant (i.e. nullified) at follow-up. Significant increases in mean number of symptoms for the asymptomatic and symptomatic groups were not associated with two-year changes in QoL ratings. Overall, wellbeing was moderately stable over the two-year follow-up period, although somewhat affected by symptom changes and immunologic/virologic outcome. The study results contrast with pre-HAART longitudinal research, in which deterioration in all areas of QoL occurred.
Int J STD AIDS 2002 Oct
PMID:Evaluating health-related wellbeing outcomes among outpatient adults with human immunodeficiency virus infection in the HAART era. 1239 38


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