Low prevalences of HIV infection and sexually transmitted disease among female commercial sex workers in Mexico City.

OBJECTIVES: This study tried to determine human immunodeficiency virus (HIV)/sexually transmitted disease (STD) prevalences among female commercial sex workers in Mexico City. METHODS: A sampling frame was constructed that included bars, massage parlors, and street corners. RESULTS: Prevalences for Treponema pallidum, herpes simplex virus type 2, HIV, Neisseria gonorrhoeae, and Chlamydia trachomatis were 6.4%, 65%, 0.6%, 3.7%, and 11.1%, respectively. A significant association was found between higher STD frequencies and working at street sites. CONCLUSIONS: Most STD frequencies were lower in comparison with rates found for female sex workers in other countries. However, preventive programs against STD/ HIV are needed in this population.

[Seroprevalence of various viruses and sociodemographic characteristics of women seeking HIV screening]. / Seroprevalencias a diversos virus y características sociodemográficas en mujeres que buscan detectarse VIH.

OBJECTIVES: To study the seroprevalence of syphilis, herpes simplex-2, hepatitis B and HIV, and main sociodemographic characteristics and sexual behavior in women seeking testing for human immunodeficiency virus (HIV) in Mexico City. METHODOLOGY: A self-applied questionnaire was used in 454 women; and a blood sample was taken for the detection of markers for syphilis, herpes simplex virus-2 (HSV-2)), antibodies against core and surface antigens for hepatitis B virus (HBV), and ELISA and Western blot for HIV. RESULTS: Seroprevalences for antibodies against T. pallidum, HSV-2, HBV and HIV were 4.6%, 29.3%, 3.5% and 4.0%, respectively. Forty-six percent of the women were 20 to 29 years old; 70% reported complete junior high school or higher education level; 75% were sexually active; 56% reported at least one stable male sexual partner, 17% reported at least one occasional male sexual partner in the last three months, and 60% had had at least one sexual relation in the last three months; of these, only 18% (n = 82) reported the use of a condom as a preventive measure. Almost 30% of the HIV positive women had a history of blood transfusion, while less than 10% of the HIV negative women had received a transfusion. In addition, 10.6% said that one of their sexual partners was infected with HIV or had AIDS. CONCLUSIONS: Risks of HIV/STD transmission for this group of self-selected women were linked to blood transfusion, low education and, most important, the risk from male sexual partners who were HIV seropositive. It is expected that these results will contribute to the improvement and development of strategies for the control and prevention of STD among this population group, as well as the general population in Mexico.

[Characteristics related to STD/HIV in men working in Mexico City bars where female prostitution takes place]. / Características relacionadas con ETS/VIH de hombres que trabajan en bares de la Ciudad de México donde se ejerce la prostitución femenina.

OBJECTIVE: This research work intended to describe the characteristics and the seroprevalence of some sexually transmitted diseases (STD), in men working in bars where female commercial sex takes place. MATERIAL AND METHODS: The study included an evaluation of 171 males during 1993, who were employed in bars and who were potentially at risk of contact with female commercial sex workers (FCSW). A structured survey was conducted in order to collect information about social, demographic and sexual behavior characteristics. Blood samples were also obtained to test for antibodies against Treponema pallidum (RPR/FTA-ABS), human immunodeficiency virus (VIH) (ELISA, Western blot), Herpes simplex virus type-2 (HSV-2) (Western blot) and the core antigen of hepatitis B virus (HBV) (ELISA). RESULTS: Test results showed low infection rates of HIV, T: pallidum and HBV: 0%, 2.4% and 1.8%, respectively. However, their HSV-2 infection proportion (32.4%) was considered intermediate in comparison to the prevalence of FCSW from bars (55.5%), to that found in heterosexual men (14.6%), and to proportions found in women general population (29.3% and 17.9%). CONCLUSIONS: The men's age and a history of sexual intercourse with FCSW were strong predictors of HSV-2 infection. These findings evidence a relationship between men working in bars and FCSW in terms of STD transmission and show the need for preventive care directed to this group.

[Contraceptives, HIV, and other sexually transmitted diseases]. / Anticonceptivos, VIH y otras enfermedades de transmisión sexual.

The large majority of women who acquire Human Immuno-Deficiency Virus (HIV) and other sexually transmitted diseases (STDs) are in their childbearing years and are current or potential users of contraceptive methods. Certain STDs augment women's risk for HIV due to damage which these diseases produce in the integrity of the epithelial lining of the vagina and the vulva. There also exists evidence that some contraceptive methods, such as the intrauterine device and certain hormonal products, may increase the risk of HIV and other STDs. Condoms and spermicides offer good levels of protection against these diseases, but are not highly effective contraceptives. The interrelations among these risks are important and create a great problem for women's reproductive health. Moreover, the high vulnerability of the female population for these diseases is also related to a variety of social factors which are referred to as gender relations (power of females in society relative to that of females). Among the gender-related inequalities which affect women are their lack of power to successfully control many aspects of sexual relations. Another problem has to do with the fact that there are no highly reliable female controlled methods for preventing infection by HIV and other STDs. Improvement in the reproductive health care of women depends on the development of new disease prevention products and structural changes in the delivery of care, as well as continued research efforts on the interrelations among contraceptive methods, HIV and other STD.

PIP: Until recently, some behaviors were viewed as entailing a high risk of HIV infection, but HIV is now considered a great risk for the female population in general. The number of HIV infected women is increasing rapidly even in areas such as Mexico and South America where women form a minority of AIDS patients. Most women infected with HIV and other sexually transmitted diseases (STDs) are sexually active and at risk of pregnancy. Some STDs, notably those producing genital ulcers, increase the risk of HIV infection. It is not yet known whether STDs not producing ulcers also increase the risk. There is controversy over the extent to which specific contraceptive methods increase or perhaps reduce the risk of HIV infection. Some unconfirmed assumptions are that the cervical ectopy produced by oral contraceptives (OCs) results in affected zones more vulnerable to trauma and thus perhaps to HIV infection, and that combined OCs by reducing menstrual bleeding also reduce risk of infection. OCs containing only progestins may increase the risk of transmission by inducing irregular bleeding, thickening the cervical mucus, and thinning the vaginal epithelium. Injectables may increase risk by increasing bleeding, thinning the vaginal epithelium, or through use of contaminated needles in application. IUDs may increase menstrual bleeding and are not advisable in any event for women at high risk of other STDS. Condoms and spermicides offer some protection against STDs, but are not highly effective contraceptives. The interrelations between risk of pregnancy and of disease are a great and largely unresolved problem in women's reproductive health. Few family planning services are able to address prevention of STDs and especially AIDS adequately. Methodological and logistical problems impede study of the interrelations between contraception and STDs, and resources are limited. Studies of commercial sex workers in different countries have offered a partial solution. Women's lack of power to negotiate successfully concerning sexual relations and their lack of access to a means of preventing STDs under their own control are factors in their vulnerability. Improved reproductive health of women will require development of new products to control disease, structural changes in health services, and continued research.

[Prevalence of antitreponemal antibodies in 3,098 female prostitutes in Mexico City]. / Prevalencia de anticuerpos antitreponémicos en 3098 mujeres dedicadas a la prostitución en la ciudad de México.

This paper describes a serological survey applied to 3098 female commercial sex workers, in order to determine the prevalence of syphilis. The women attend regularly an AIDS orientation center sponsored by CONASIDA in Mexico City. The laboratory tests included the rapid plasma reagin assay (presumptive analysis) and the fluorescent treponemal antibody-absorption technique (confirmatory test). No primary syphilis cases were detected and the prevalence of latent asymptomatic syphilis was 8.2% (255/3098). The sensitivity and specificity of the presumptive test compared to the confirmatory test were 74% and 98% respectively, and the positive predictive value was 77% and the negative predictive value 98%. All seropositive women received the standard penicillin treatment for syphilis. Considerations of importance are offered regarding interpretation and usefulness of this kind of research.

[The resistance and serotyping of 83 strains of Streptococcus pneumoniae isolated from asymptomatic carriers and ill children]. / Resistencia y serotipificación de 83 cepas de Streptococcus pneumoniae aisladas de niños portadores asintomáticos y enfermos.

Eight-three isolates of Streptococcus pneumoniae obtained from children hospitalized with several infections in Mexico City and Cuernavaca, and from healthy children attending a day-care center in Cuernavaca, from January to September 1992, were screened for antimicrobial resistance patterns by in vitro susceptibility testing against antimicrobial agents of potential use in the treatment of diseases caused by S. pneumoniae (39 infected patients and 44 from healthy children). 21.6% of strains were resistant to penicillin, 52% of the strains were multiresistant without a commun pattern. Children attending a day-care center had a higher rate of S. pneumoniae strains resistant to one or more antimicrobial than hospitalized children. Serotypes or serogroups 6, 23F, 14 and 19 were most prevalent. There are evidence that strain 23F has an intercontinental link, this strain is associated with disseminated diseases and multiresistance to antimicrobials. The results indicate that changes can occur in the susceptibility of S. pneumoniae and that selective susceptibility testing and epidemiologic studies in hospitalized patients and children in day-care centers are necessary.

[Presence of human Herpes simplex virus-2 (HSV-2) in women attending a clinic for cervico-uterine cancer control]. / Presencia del virus herpes simple-2 (HSV-2) en mujeres que asisten a una clínica de control de cáncer cervicouterino.

For this prospective study, 284 women were recruited who attended a cancer detection (Papanicolaou testing) program and appeared to be healthy. The objective was to obtain cervicovaginal samples from this group and culture them on human foreskin fibroblasts to isolate and identify Herpes simplex virus by immunofluorescence with monoclonal antibodies. A total of 12 women (4.2%) were positive for the virus; upon comparison of various sociodemographic factors in positive and negative culture patients, it was possible to establish certain associations as follows: The presence of Herpes simplex virus type 2 was related to age, start of sexual life, number of sex partners, lower education and minimum income. Other markers observed in infected women were mucopurulent cervicitis, typical and non-typical confluent ulcerations and minor disruptions of the epithelium. The knowledge of this subclinical or somewhat asymptomatic Herpes prevalence should be considered to prevent further spread among couples and also to avoid the risk of reactivation in pregnant women.

In vitro activity of several antimicrobial agents against genital mycoplasmas.

The increasing resistance of genital mycoplasmas to tetracyclines is a serious problem, since this group of antibiotics is one of the few that is effective against virtually all species of mycoplasmas. Tetracyclines are also used to treat many sexually transmitted diseases. In this study, we assessed the susceptibility of Mycoplasma hominis and Ureaplasma urealyticum to macrolides, tetracyclines, spectinomycin, and trospectomycin by the agar dilution method. For M hominis, trospectomycin was the most active agent. Spectinomycin, tetracycline, and doxycycline had comparable mycoplasmatic activity, and the macrolides were ineffective. Against U urealyticum, spectinomycin and trospectomycin were the most active drugs, and were at least twofold more active than the macrolides and tetracyclines.

[Use of molecular biology in the epidemiological characterization of Neisseria gonorrhoeae]. / Empleo de la biología molecular para la caracterización epidemiológica de Neisseria gonorrhoeae.

This paper describes current methods useful to define molecular markers from a collection of Neisseria gonorrhoeae strains. The procedures of auxotyping, serotyping and plasmid profiling led to the obtention of 10 auxotypes, 19 serotypes and five plasmid types (including beta-lactamase plasmids) among 41 gonococci studied. Twelve patterns of antimicrobial resistance were determined as well, through in vitro susceptibility testing by agar dilution. These tools in conjunction, offer the possibility to study gonorrhea in a dynamic fashion from an epidemiologic perspective. Furthermore, they have allowed us to establish a gonococcal reference laboratory in our institution.

[The prevention of urinary infection during pregnancy in patients with asymptomatic bacteriuria]. / Prevención de la infección urinaria durante la gestación en pacientes con bacteriuria asintomática.

A prospective study was carried out in which quantitative clean-voided urine cultures, were obtained at the first clinic visit from 986 consecutive pregnant women, followed to delivery to assess the maternal and pediatric finding associated with maternal asymptomatic bacteriuria. Patients to be evaluated were divided in two groups: Treatment group (TG) with 42/46 patients that were treated with nitrofurantoin 100 mg a day during 10 days, and control group (CG) with 45/46 patients that were not treated. Patients who failed were given a second course of nitrofurantoin. The patients who remained infected were given further treatment (cephalexin). Primary treatment was successful in 85%, 10% more with the second course and 5% were failure treatment. There was a highly significant difference in the incidence of symptomatic bacteriuria (pyelonephritis), premature deliver, prematurity and other perinatal events in patients with persistent infection. Eradication of asymptomatic bacteriuria reduced the risk of pre-term deliveries and lower infant birth weights for gestational age.