Seroprevalence of HIV, hepatitis B virus, and syphilis in women at their first visit to public antenatal clinics in Vitória, Brazil.

BACKGROUND: In some countries, HIV infection in pregnancy has become a common complication of pregnancy. GOAL: To determine the seroprevalence of HIV, hepatitis B virus, and syphilis among pregnant women, and to assess risk factors for these infections. STUDY DESIGN: A cross-sectional study was performed. METHODS: Pregnant women attending antenatal clinics of Vitória Municipality from March to December 1999 were included in this study after giving written informed consent. The women were systematically interviewed. During the interview, their demographics and patterns of risk behavior were explored. A blood sample was collected for testing HIV, hepatitis B virus, and syphilis. RESULTS: The participants in this study were 1608 pregnant women. The prevalence of HIV infection was 0.8% (95% CI, 0.4-1.2), hepatitis B virus carriers 1.1% (95% CI, 0.8-1.3), and syphilis 3% (95% CI, 2.6-3.5). The potential risk behaviors were found to be a history of STDs (6.5%), condoms never used (52.8%), prostitution (0.5%), noninjection drug use (6.3%), blood transfusion (1.5%), and intravenous drug abuse (0.7%). CONCLUSION: These results show the necessity of implementing programs aimed at preventing transmission of these infections in women and their children.

Passive sentinel surveillance system for sexually transmitted diseases in primary healthcare sites in Ethiopia, 1991-3.

BACKGROUND: In 1989 the ministry of health of Ethiopia launched an STD control programme to strengthen the STD case management capabilities at public health centres and hospitals. The programme included the introduction of a syndrome based system for notification of STD cases. We here report the data originated by the syndromic case reporting system under programme conditions. METHODS: 35 (17%) of the total 225 hospitals and public health centres of Ethiopia were included in the programme. Information relevant to the years 1991 to 1993 was analysed at mid 1994. RESULTS: 32 clinical sites (91% of the total) provided at least one monthly report. The proportion of monthly reports received was 65% of those due, ranging from 51% in 1991 to 73% in 1992 and 42% in 1993. A total of 77,294 consultations for STD related symptoms were recorded, including 70,200 new cases, 6588 repeated consultations, and 506 partners of STD patients. Among first attendant patients 38,459 (52.7%) were males with a male to female ratio of 1:1. Urethral discharge and vaginal discharge were the leading cause of consultation among males (58%) and females (64%) respectively. The frequency of genital ulcer diseases was 26% among males and 15% among females. Inguinal adenopathy in the absence of genital ulcers was also frequent, accounting for 10% of consulting males and 5% of females. Based on Gram stain, gonorrhoea was identified in 64% of the cases of urethral discharge, while trichomoniasis and candidiasis were identified by wet mount in 28% and 16% of the cases of vaginal discharge respectively. CONCLUSIONS: STDs are a common cause of consultation at public health centre sites in Ethiopia. A syndromic case reporting system proved to be efficient and produced valuable information to initiate assessment of the problem and to set up bases for monitoring trends of STD morbidity.

Global prevalence and incidence estimates of selected curable STDs.

OBJECTIVES: To update the WHO global and regional estimates of the prevalence and incidence of syphilis, gonorrhoea, chlamydia, and trichomoniasis. METHODS: Prevalence estimates for syphilis, gonorrhoea, chlamydia, and trichomoniasis were generated for each of the nine UN regions for males and females between the ages of 15 and 49 in 1995 based on an extensive review of the published and unpublished medical literature since 1985. Incidence estimates were based on the prevalence figures and adjusted to take into account the estimated average duration of infection for each disease in a particular region. The latter was assumed to depend upon a number of factors including the duration of infection in the absence of treatment, the proportion of individuals who develop symptoms, the proportion of individuals treated, and the appropriateness of treatment. RESULTS: In 1995 there were over 333 million cases of the four major curable STDs in adults between the ages of 15 and 49--12 million cases of syphilis, 62 million cases of gonorrhoea, 89 million cases of chlamydia, and 170 million cases of trichomoniasis. Geographically, the vast majority of these cases were in the developing world reflecting the global population distribution. CONCLUSIONS: STDs are among the most common causes of illness in the world. Estimates of the global prevalence and incidence of these infections are limited by quantity and quality of data available from the different regions of the world. Improving global STD estimates will require more well designed epidemiological studies on the prevalence and duration of infection.

Sexually transmitted diseases in Africa: time for action.

PIP: Sexually transmitted diseases (STDs) are major public health problems which often lead to serious complications and sequelae, including infertility. Infection with STDs also facilitates the transmission of HIV, making the early diagnosis and care of STDs integrated into other services one of the most cost-effective strategies to prevent the spread of HIV. The direct and indirect costs of STDs worldwide are considerable. Sub-Saharan Africa ranks first in STD yearly incidence compared to other world regions. The World Health Organization has estimated that every year in Africa there are 3.5 million cases of syphilis, 15 million cases of chlamydial disease, 16 million cases of gonorrhea, and 30 million cases of trichomoniasis. STDs are a high public health priority especially because of their widespread prevalence and treatability. Herpes simplex virus infection and human papillomavirus infection are growing problems in sub-Saharan Africa. While STDs are caused by more than 20 microorganisms, they present themselves mainly in 4 syndromes and may therefore be treated syndromically. Africa must implement effective and comprehensive integrated activities against the STD epidemic. Elements of such a strategy will include disease prevention, screening and case finding, and the early diagnosis and treatment of cases.^ieng

STD vaccines--an overview.

OBJECTIVES: To describe the role and current status of vaccine research against sexually transmitted diseases (STDs). METHODS: The available literature was reviewed with particular emphasis on bacterial STDs. RESULTS: Strategic approaches to possible implementation of STD vaccine programmes were analysed. The status of vaccines against bacterial STDs (syphilis, chancroid, gonorrhoea, and chlamydia) is described in detail. CONCLUSIONS: The development of safe and effective STD vaccines offers a potent tool for the control of STDs, including direct and indirect prevention of HIV infection. Future priorities should be in the development of vaccines against gonorrhoea, chlamydia, and syphilis. When such vaccines become available, caution should be exercised to ensure that they do not interfere with the effectiveness of other prevention programmes.

Cutaneous lupus erythematosus: direct immunofluorescence and epidermal basal membrane study.

Biopsy specimens of cutaneous discoid lesions of 71 patients with cutaneous lupus erythematosus (CLE) were studied. The material was examined by direct immunofluorescence (DIF) to establish positivity and morphologic patterns of immunoglobulins and complement deposits in the basement membrane zone (BMZ). A correlation between DIF results and thickening of the epidermis basement membrane (BM) stained by periodic acid-Schiff (PAS), obtained from 31 matched biopsy specimens, also is presented. Direct immunofluorescence had positive results in 66.20% of the 71 examinations and 70.97% of the matched examinations, whereas PAS showed BM thickening in 100% of the specimens. This observation stresses the importance of such histopathologic findings in the diagnosis of discoid lesions in CLE. There was no correlation between DIF patterns and PAS-stained BMZ thickening. These findings merit additional study. In conclusion, an accordance between PAS-stained BM thickening and immunoglobulin deposits has occurred in 70.97% of cases. This phenomenon does not depend on the presence of immunocomplexes, for it occurs even in cases in which immunocomplex deposits were not detected.

Use of the life table to eliminate from the active record Hansen's disease patients out of control and of unknown whereabouts: a six-year experience using this method in the state of Rio Grande do Sul.

Three criteria for the withdrawal of Hansen's disease patients of unknown whereabouts from the active record are presented, based on patients' age, number of years they have been out of control, and probability of their being alive, calculated according to a regional mortality table. In the first criterion, patients who have been lost and who according to their life table have a lower than 50% mathematical probability of being alive were given "statistical discharge." In the second and third criteria, Mitsuda-negative patients who had been lost for more than 20 years and Mitsuda-positive patients who had been lost for more than ten years and who had not been included in the first criterion were given "statistical discharge." During the six years in which the method was used in the state of Rio Grande do Sul, Brazil, 506 patients of unknown whereabouts were withdrawn from the active record, four of whom were found to be alive with the disease in progress. The results that have been achieved suggest an accuracy rate of about 100% for the first criterion of "statistical discharge" and about 98% for the other two criteria.

[Clinical picture in scabies: comparison of the clinical description found in the literature with 179 patients examined]. / Quadro clínico da escabiose: comparação da descrição clínica encontrada na literatura com 179 pacientes examinados.

After analysing the recrudescence of scabies and its incidence in the State of Rio Grande do Sul, Brazil, clinical manifestations of this parasitic infestation found in 179 patients examined are commented. The patients, 83 men and 96 women, were between 16 and 65 years old, interned in a psychiatric hospital. The clinical diagnosis was given by experienced dermatologists. Twenty-five text-books have been reviewed so as to compare them to the series of patients examined. The main conclusions were the following: Burrons were found in only 3.4% of the cases examined, although this kind of scabies lesion is the most valued and mentioned in specialized literature. It is considered to be the pathognomonic lesion of scabies and its finding defines the diagnosis. However, the data found show that its low frequency limits greatly the utilization of its finding in this parasitic form diagnostic practice. Although not expected in a precarious hygienic condition environment, the percentage of patients with secondary infection and eczema was relatively low. There was no apparent explanation for this fact. Confirming our clinical idea, previous to this study, papule-crusted kind lesion was the form most frequently present. It corresponds to the burron disrupted by scratching.(ABSTRACT TRUNCATED AT 250 WORDS)

Controle da hanseniase num sistema integrado de atencao de saude. / Control of hanseniasis within an integrated health care system

Os autores apresentam a politica atual adotada no Estado do Rio Grande do Sul,Brasil, no controle da hanseniase e sua relacao com o sistema de saude existente, e mostram os resultados de seis anos de trabalho apos a implantacao do sistema de registro de doentes atraves de arquivo nominal de computador. E descrita a distribuicao dos casos novos por forma clinica, sexo, grupo etario e coeficientes de incidencia no periodo 1975-1980. Indicam-se as altas concedidas no periodo a variacao dos coeficientes de prevalencia e os indices de controle de doentes e contatos. Juntamente com essa descricao, analisam-se os criterios de classificacao, em especial da forma I, os criterios de concessao de alta o efeito da "alta estatistica" sobre o numero de doentes registrados, e a politica de internamento de doentes em hospitais-colonia