The association of genital ulcer disease and HIV infection at a dermatology-STD clinic in Uganda

At Mulago Hospital in Kampala; Uganda; 270 consecutive patients at the dermatology and sexually transmitted disease (STD) clinic were enrolled in a study to evaluate the association of clinical STD syndromes and human immunodeficiency virus (HIV) infection. Female patients became sexually active earlier than male patients and were younger at marriage. Persons with a history of an STD during the preceding 5 years were more likely to be HIV infected (43pc) than those without such a history (26pc; OR 2.08; 95pc C.I. 1.17; 3.73). Examination at the time of the visit demonstrated an association between genital ulcers and HIV infection in male and female patients (OR 2.21; 95pc C.I. 1.08; 4.53; and OR 8.54; 95pc C.I. 1.45; 87.55; respectively) but no association between HIV and urethritis or vaginal discharge. The etiologic fraction for HIV infection of genital ulcers was 0.218. Men with a history of contact with prostitutes were more likely to be HIV infected than those without contact (50pc versus 28pc; p less than 0.05); but once controlled for STDs; this relationship was no longer significant. This study confirms other studies from East Africa that have shown a relationship between genital ulcers and HIV infection. This finding; in the presence of no association between other STD syndromes and HIV infection; suggests that genital ulcers may be truly associated with HIV infection rather than a marker of high-risk activities

Rapid Assessment of Sexually Transmitted Diseases Development of A Survey Methodology

A multicentre study was conducted in Senegal and Uganda to assess potential STD indicators to develop a standardised survey methodology would be useful to define the magnitude of the STD problem in the district level; to monitor trends in STD prevalence at time intervals; and to indicate the potential for HIV spread. Twelve potential indicators which included current symptoms; physical finding and simple laboratory tests were studied among three different populations: women attending atenatal clinic; were identified with sensitivity over 70. These are physical finding of vaginal discharge; urine leucocyte esterase test; and the RPR teardrop card test. Among these only one; the RPR teardrop card test; had a high specificity (96as opposed to specifity less than 50for physicval finding of vaginal discharge and the urine leucocyte esterase test). Based on the results of this study; these three indicators will be further studied to evaluate their usefulness in a field survey methodology among women attending antenatal clinics

Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda

Background: patient-based partner referral (PBPR); which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs); has limited effictiveness. Goal: The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala; Uganda. Study design: A total of 383 patients (187 women; 196 men) with STDs were randomised to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chosquare statistic by intention to treat for partners whose follow-up status was unknown. Results: The two groups has similar background characteristics. Of the 237 partners elicited; 176(74) were reported treated in the PDPM group. In the PBPR group; in which 234 partners were elicited; 79(34) were referred to the treatment clinic.This difference was statistically significant (risk ratio (RR); 2.44; 95CI; 1.95-3.07; P0.001). Furthermore; PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women; 86 of 103 partners in the PDPM group ; compared with only three of 45 partners (7) who were referred in the PBPR group (RR; 1.43; 95 CI; 1.40-2.65; p0.01). Conclusion : Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners