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1.
Int J STD AIDS ; 21(6): 435-40, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20606226

ABSTRACT

Research on hygiene has been relatively limited in the current era of rigorous observational studies and clinical trials. We set out to investigate the perception and practices of genital hygiene among fishermen working on the beaches along Lake Victoria, targeted for a topical male microbicide hygiene intervention. We conducted 12 focus group discussions involving fishermen (n = 130), recording the discussions in Dholuo (the local language) and transcribing them verbatim before translating into English. Transcripts were double-coded and analysed using constant comparative analysis. Despite easy access to lake water and recognition of a link that may exist between poor genital hygiene and the risk of penile infection and poor sexual relationships, few fishermen regularly washed their genitalia due to fear/embarrassment from cleaning their genitalia in public, traditional Luo beliefs such as that washing with soap would reduce the fish catch, lack of time because of their busy schedules, laziness and lack of responsibility, and excessive consumption of alcohol and illicit drugs. Hygiene practices of the fishermen were poor and could contribute to genital infections including sexually transmitted infections. Given the fishermen's poor genital hygiene practices, they may benefit from hygiene intervention, including that provided by penile microbicides, which can be applied in the privacy of their bedrooms.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , Hygiene , Sexually Transmitted Diseases/prevention & control , Adolescent , Adult , HIV Infections/prevention & control , Humans , Kenya , Male , Middle Aged , Sexual Behavior , Socioeconomic Factors
2.
Sex Transm Infect ; 84(2): 140-2, 2008 Apr.
Article in English | MEDLINE | ID: mdl-18096647

ABSTRACT

OBJECTIVES: To determine the prevalence and correlates of herpes simplex virus type 2 (HSV-2) seropositivity among fishermen along the shores of Lake Victoria in Kisumu district, Kenya. METHODS: Sera from a random sample of 250 fishermen from 18 beaches were collected after a detailed sociodemographic interview. HSV-2 infection was tested by Kalon HSV-2 ELISA. RESULTS: The HSV-2 seroprevalence was 63.9%. In multivariate analysis, fishermen were more likely to be infected with HSV-2 if they were HIV positive (prevalence ratio (PR) 1.27; 95% CI 1.06 to 1.52) compared with those testing HIV negative, were aged 18-20 (PR 0.49; 95% CI 0.24 to 0.99) and older than 40 (PR 1.66; 95% CI 1.30 to 2.14) years compared with those aged 21-25 years, perceived their last two sexual partners to have a sexually transmitted infection (STI; PR 1.27; 95% CI 1.06 to 1.52) compared with those who did not and were more likely to be circumcised (PR 1.49; 95% CI 1.19 to 1.86). CONCLUSIONS: HSV-2 seroprevalence is high among this population and is associated with HIV serostatus, age, perception about partner's STI status and circumcision.


Subject(s)
Fisheries/statistics & numerical data , Herpes Genitalis/epidemiology , Herpesvirus 2, Human/immunology , Unsafe Sex/statistics & numerical data , Adolescent , Adult , Aged , Enzyme-Linked Immunosorbent Assay , Herpes Genitalis/virology , Humans , Kenya/epidemiology , Middle Aged , Seroepidemiologic Studies , Sexual Partners
3.
Sex Transm Infect ; 84(1): 62-6, 2008 Feb.
Article in English | MEDLINE | ID: mdl-17991686

ABSTRACT

OBJECTIVES: The epidemiology of human papillomavirus (HPV) infection in men in Kenya is largely uncharacterized. We set out to determine the prevalence and determinants of HPV infection among sexually active fishermen along Lake Victoria in the Kisumu district of Kenya. METHODS: Genital swabs were obtained from 250 consenting fishermen from 18 beaches and a detailed sociodemographic questionnaire was administered. HPV positivity was determined by polymerase chain reaction amplification and detected by dot blot hybridisation with generic HPV and beta-globin probes. HPV positive samples were genotyped using the Roche Linear array assay. RESULTS: Overall, 144 (57.6%) fishermen had detectable HPV DNA, 106 (42.4%) were infected with oncogenic HPV types, with HPV-16 being the most frequent type (12.4%). Among HPV positive men, 105 (72.9%) were infected with more than one HPV type and 20 (13.9%) were infected with more than six different types. HIV seropositive men (PR 1.49, 95% CI 1.19 to 1.86) and those divorced or separated (PR 1.62, 95% CI 1.13 to 2.33) were more likely to be infected with HPV. HIV infection (PR 1.22, 95% CI 1.01 to 1.47) was the only factor independently associated with infection with multiple types of HPV. CONCLUSION: The prevalence of oncogenic HPV infection is high among this population and is associated with HIV serostatus and marital status. This community could benefit from enhanced sexually transmitted infection and HIV prevention interventions.


Subject(s)
Fisheries/statistics & numerical data , Papillomavirus Infections/epidemiology , Adult , Aged , Cross-Sectional Studies , HIV Infections/complications , HIV Infections/epidemiology , Humans , Kenya/epidemiology , Male , Middle Aged , Papillomavirus Infections/complications , Prevalence , Sexual Behavior
4.
Sex Transm Infect ; 83(2): 142-6, 2007 Apr.
Article in English | MEDLINE | ID: mdl-16916881

ABSTRACT

OBJECTIVE: To determine prevalences and predictors of sexually transmitted and reproductive tract infections among men and women seeking care at pharmacies. METHODS: Men and women with urethral discharge or dysuria and vaginal discharge were enrolled at 12 central and 52 smaller pharmacies in Lima, Peru. All participants answered a questionnaire. Men provided urine for polymerase chain reaction (PCR) testing for Neisseria gonorrhoeae and Chlamydia trachomatis, and for leucocyte esterase testing. Women provided self-obtained vaginal swabs for PCR testing for N gonorrhoeae and C trachomatis, Trichomonas vaginalis culture and bacterial vaginosis and Candida. RESULTS: Among 106 symptomatic men, N gonorrhoeae and C trachomatis were detected in 34% and were associated with urethral discharge compared with dysuria only (odds ratio (OR) 4.3, p = 0.003), positive urine leucocyte esterase testing (OR 7.4, p = 0.009), less education (OR 5.5, p = 0.03), and with symptoms for <5 days (OR 2.5, p = 0.03). Among 121 symptomatic women, 39% had bacterial vaginosis or T vaginalis, and 7.7% had candidiasis. N gonorrhoeae and C trachomatis were detected in 12.4% of the women. Overall, 48.8% had one or more of these infections. No factors were associated with vaginal infection, and only symptoms of vaginal discharge for <5 days were associated with N gonorrhoeae and C trachomatis (OR 4.0, p = 0.02). The main reason reported for seeking advice at pharmacies by both men and women was trust in pharmacy workers. CONCLUSIONS: Among men and women presenting to pharmacies with urethral and vaginal symptoms, rates of urethral and vaginal infections were comparable to those found in other clinical settings. Pharmacies can contribute to the care and prevention of sexually transmitted infection in developing countries.


Subject(s)
Genital Diseases, Female/epidemiology , Sexually Transmitted Diseases/epidemiology , Adolescent , Adult , Dysuria/epidemiology , Female , Humans , Male , Middle Aged , Peru/epidemiology , Pharmacies/statistics & numerical data , Prevalence , Vaginal Discharge
5.
Sex Transm Infect ; 82 Suppl 5: v1-6, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17151023

ABSTRACT

In the developing world, laboratory services for sexually transmitted infections (STIs) are either not available, or where limited services are available, patients may not be able to pay for or physically access those services. Despite the existence of national policy for antenatal screening to prevent congenital syphilis and substantial evidence that antenatal screening is cost-effective, implementation of syphilis screening programmes remains unacceptably low because of lack of screening tools that can be used in primary health care settings. The World Health Organization Sexually Transmitted Diseases Diagnostics Initiative (SDI) has developed the ASSURED criteria as a benchmark to decide if tests address disease control needs: Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free and Deliverable to end-users. Rapid syphilis tests that can be used with whole blood approach the ASSURED criteria and can now be deployed in areas where no previous screening has been possible. Although rapid tests for chlamydia and gonorrhoea lack sensitivity, more tests are in development. The way forward for STI diagnostics requires a continuing quest for ASSURED tests, the development of a road map for test introduction, sustainable programmes for quality assurance, and the creation of a robust infrastructure linked to HIV prevention that ensures sustainability of STI control efforts that includes viral STIs.


Subject(s)
Point-of-Care Systems/trends , Sexually Transmitted Diseases/diagnosis , Chlamydia Infections/diagnosis , Female , Forecasting , Gonorrhea/diagnosis , Humans , Internet , Point-of-Care Systems/standards , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Prenatal Diagnosis/standards , Prenatal Diagnosis/trends , Quality Control , Syphilis/diagnosis , Vaginal Discharge/etiology
6.
Sex Transm Infect ; 82 Suppl 5: v44-6, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17116641

ABSTRACT

OBJECTIVES: The World Health Organization Sexually Transmitted Diseases Diagnostics Initiative (SDI) website publication review seeks to provide health care providers in all geographic and economic settings with timely, critical, and concise information concerning new developments in laboratory and field diagnosis of sexually transmitted infections (STI). METHODS: Since 2003, the website (www.who.int/std_diagnostics/literature_reviews) has disseminated information in the form of annotated abstracts and commentaries on articles covering studies of STI laboratory-based and rapid assays that are commercially available or under development. Articles identified through searches of PubMed, specific journals, and by referrals from Editorial Board members are selected for inclusion if they meet pre-specified criteria. The objectives, methods, results, and conclusions for each article are summarised and board members are invited to prepare commentaries addressing study design and applicability of findings to end users. RESULTS: Currently, 91 STI diagnostics experts from 17 countries on six continents serve on the Editorial Board. Twelve quarterly issues have been posted that include summaries of 214 original and 17 review articles published from January 2002 through March 2005, with expert commentaries on 153 articles. Interest in the site has increased every year. In 2005, over 36 700 unique visitors from more than 100 countries viewed over 75,000 pages of information. CONCLUSIONS: The SDI Publication Review series has the potential to contribute to SDI's goal of improving care for patients with STI by increasing knowledge and awareness of STI diagnostics. Given the proliferation of internet-based STI testing services, this website may be broadened to meet the needs of a wider range of users.


Subject(s)
Internet/statistics & numerical data , Publishing , Sexually Transmitted Diseases/diagnosis , Global Health , Guidelines as Topic , Humans , Review Literature as Topic , World Health Organization
7.
Sex Transm Infect ; 82 Suppl 5: v22-5, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17116642

ABSTRACT

OBJECTIVES: This study sought to evaluate the utility of the Determine Syphilis TP test performed in Peruvian commercial sex venues for the detection of active syphilis; and determine the feasibility of integrating rapid syphilis testing for female sex workers (FSW) into existing health outreach services. METHODS: We tested 3586 female sex workers for syphilis by Determine in the field using whole blood fingerstick, and by rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) in a central laboratory in Lima using sera. RESULTS: 97.4% of the FSW offered rapid syphilis testing participated; and among those who tested positive, 87% visited the local health centre for treatment. More than twice as many specimens were RPR reactive using serum in Lima (5.7%) than tested positive by whole blood Determine in the field (2.8%), and although most were confirmed by TPHA, only a small proportion (0.7%) were RPR reactive at >or=1:8 dilutions, and likely indicating active syphilis. Sensitivity, specificity and positive predictive value of the Determine Syphilis TP test in whole blood when compared to serum RPR reactivity at any dilution confirmed by TPHA as the gold standard were 39.3%, 99.2% and 71.4%, respectively. Sensitivity improved to 64.0% when using serum RPR >or=1:8 confirmed by TPHA. Invalid tests were rare (0.3%). CONCLUSIONS: Rapid syphilis testing in sex work venues proved feasible, but Determine using whole blood obtained by fingerstick was substantially less sensitive than reported in previous laboratory-based studies using serum. Although easy to perform in outreach venues, the utility of this rapid syphilis test was relatively low in settings where a large proportion of the targeted population has been previously tested and treated.


Subject(s)
Point-of-Care Systems , Sex Work , Syphilis Serodiagnosis/methods , Syphilis/diagnosis , Feasibility Studies , Female , Hemagglutination Inhibition Tests/methods , Hemagglutination Inhibition Tests/standards , Humans , Peru , Point-of-Care Systems/standards , Sensitivity and Specificity , Syphilis Serodiagnosis/standards , Treponema pallidum/isolation & purification
8.
Int J Tuberc Lung Dis ; 10(5): 516-22, 2006 May.
Article in English | MEDLINE | ID: mdl-16704033

ABSTRACT

SETTING: Risk factors for mortality in hospitalized patients with community-acquired pneumonia (CAP) are well known. There are limited data on prognostic indicators among out-patients. OBJECTIVE: To compare the clinical presentation, outcome and prognostic factors for clinical improvement in human immunodeficiency virus (HIV) infected and non-HIV-infected out-patients with CAP. METHODOLOGY: Adults in Nairobi with CAP were treated with erythromycin as first-line therapy. Clinical symptoms were evaluated using a validated CAP-related symptom score (CSS). Clinical improvement was defined as reduction of baseline CSS by > or = 50%. RESULTS: Of 531 adults enrolled with CAP, 422 (79.5%) completed follow-up. Participants had a mean age (+/- SD) of 33.7 +/- 11.4 years, 274 (51.6%) were male and 193 (37%) were HIV-seropositive with a higher baseline CSS (27 vs. 25, P < 0.006). Overall, 196 of 422 (46%) had clinical improvement by 28 days. Factors independently associated with a longer time to clinical improvement included not being married (adjusted hazard ratio [aHR] 0.66, 95% CI 0.48-0.92) and higher baseline CSS (aHR 1.05, 95% CI 1.03-1.06). CONCLUSIONS: HIV-infected and non-infected patients with CAP responded similarly to out-patient treatment, but HIV-infected patients were more likely to present with severe symptoms. Baseline CSS and marital status were predictive of time to clinical improvement.


Subject(s)
Community-Acquired Infections/complications , HIV Infections/complications , Pneumonia/complications , Adult , Anti-Bacterial Agents/therapeutic use , Chi-Square Distribution , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Erythromycin/therapeutic use , Female , HIV Infections/epidemiology , Humans , Kenya/epidemiology , Male , Pneumonia/drug therapy , Pneumonia/epidemiology , Prognosis , Proportional Hazards Models , Risk Factors , Surveys and Questionnaires , Treatment Outcome
9.
J Neurovirol ; 11(1): 70-3, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15804962

ABSTRACT

People with human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) develop spasticity. The authors examined 34 patients with HAM/TSP in Perú using a device that measures tone in the gastroc-soleus-Achilles tendon unit and provides a quantitative spasticity assessment (QSA). Tone in the 34 patients was more than double that of women with asymptomatic HTLV-I infection. The device may help to track progression in HTLV-I infection.


Subject(s)
HTLV-I Infections/complications , Muscle Spasticity/physiopathology , Muscle Spasticity/virology , Paraparesis, Tropical Spastic/physiopathology , Paraparesis, Tropical Spastic/virology , Adult , Female , Human T-lymphotropic virus 1 , Humans , Male , Middle Aged
10.
Sex Transm Infect ; 80(6): 471-6, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15572617

ABSTRACT

OBJECTIVES: Attitudes and practices concerning genital hygiene may influence topical microbicide use by men. This study examines knowledge and behaviours related to hygiene, genital hygiene, circumcision and hygiene, and to genital hygiene before and after sex among men in Nairobi, Kenya. METHODS: We conducted 463 interviews of men recruited by respondent driven sampling techniques and 10 focus group discussions with a subsample of 100 volunteers from this group. Men were asked individual quantitative survey and qualitative group discussion questions about general hygiene behaviours, genital hygiene, and the temporal relation of genital hygiene behaviours to sexual encounters. RESULTS: Bathing once daily was associated with education, income, and inside tap water. Genital washing aside from regular bathing and washing before sex ever were negatively associated with bathroom crowding. Genital hygiene before the most recent sexual encounter was uncommon and negatively associated with HIV risk perception, bathroom crowding, and ethnicity. Men believed genital hygiene before sex would arouse suspicions of infidelity or cool sexual ardour. Genital hygiene after sex was associated with education, religion, and having inside tap water. Genital hygiene after the most recent sexual encounter was associated with age, income, and with men having at least one child. CONCLUSIONS: Genital hygiene behaviours were associated with resource access factors and group discussions suggest that they are modulated by interactions in sexual partnerships. Topical microbicides may improve hygiene before and after sex.


Subject(s)
Health Knowledge, Attitudes, Practice , Hygiene , Sexual Behavior , Adult , Circumcision, Male , Educational Status , Genitalia, Male , Humans , Income , Kenya , Male , Regression Analysis , Risk-Taking , Sexual Partners , Water Supply
11.
Clin Infect Dis ; 39(7): 1079-82, 2004 Oct 01.
Article in English | MEDLINE | ID: mdl-15472866

ABSTRACT

To determine whether human T cell lymphotropic virus type 1 (HTLV-1) infection is associated with delayed neurological development, we examined 48 Peruvian children with exposure to HTLV-1 who were identified at the Instituto Materno-Perinatal. Compared with 38 HTLV-1-seronegative children, the 10 seropositive children did not have higher rates of neurodevelopmental delay. Long-term follow-up is planned.


Subject(s)
Developmental Disabilities/epidemiology , Developmental Disabilities/etiology , HTLV-II Infections/complications , HTLV-II Infections/epidemiology , Antibodies, Viral/blood , Child , Child, Preschool , Female , HTLV-II Infections/blood , Humans , Infant , Male , Peru/epidemiology
12.
Sex Transm Infect ; 79(5): 403-7, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14573837

ABSTRACT

OBJECTIVES: To describe trends in STD visits to physicians in private practice in Peru over a 15 year period and in the patterns of treatments used for STD. METHODS: IMS Health conducts for pharmaceutical marketing purposes surveys of a random cluster sample of 1.63% of practising physicians in Peru, stratified by region and specialty. Physicians record details of diagnoses and treatments for all patients seen during a 7 day period every 6 months. Data collected on selected STD syndromes were retrospectively reviewed over a 15 year period. RESULTS: The number of first visits for pelvic inflammatory disease (PID) and trichomoniasis, and total visits for genital herpes increased from 1983-5 to 1996-7; while first visits for gonorrhoea and total visits for syphilis have changed little in recent years. Treatment for gonorrhoea usually involved the use of spectinomycin or an aminoglycoside only. Treatments offered for PID were remarkably inadequate and for trichomoniasis often involved products not known to be effective for trichomoniasis or other causes of vaginal discharge. CONCLUSIONS: This form of active surveillance provides information potentially useful to guide policies for prevention and management of STDs and HIV infections in developing countries.


Subject(s)
Patient Acceptance of Health Care/statistics & numerical data , Private Practice/statistics & numerical data , Sexually Transmitted Diseases/epidemiology , Cluster Analysis , Female , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Humans , Male , Pelvic Inflammatory Disease/drug therapy , Pelvic Inflammatory Disease/epidemiology , Peru/epidemiology , Sexually Transmitted Diseases/drug therapy , Trichomonas Infections/drug therapy , Trichomonas Infections/epidemiology
13.
Sex Transm Infect ; 79(3): 197-201, 2003 Jun.
Article in English | MEDLINE | ID: mdl-12794201

ABSTRACT

BACKGROUND: Key strategies advocated for lowering personal risk of sexual exposure to STD/HIV include having fewer partners and avoiding risky partners. However, few studies have systematically examined how well people can actually discern their sex partners' risk behaviours. METHODS: We conducted face to face interviews with 151 heterosexual patients with gonorrhoea or chlamydial infection and 189 of their sex partners. Interviews examined the patients' perceptions of their sex partners' sociodemographic characteristics and risk behaviours. Patients' perceptions of partners were then sociometrically compared for agreement with partner self reports, using the kappa statistic for discrete variables and concordance correlation for continuous variables. RESULTS: Agreement was highest for perceived partner age, race/ethnicity, and duration of sexual partnership; and lowest for knowledge of partner's work in commercial sex, number of other sex partners, and for perceived quality of communication within the partnership. Index patients commonly underestimated or overestimated partners' risk characteristics. Reported condom use was infrequent and inconsistent within partnerships. CONCLUSION: Among people with gonorrhoea or chlamydial infection, patients' perceptions of partners' risk behaviours often disagreed with the partners' self reports. Formative research should guide development and evaluation of interventions to enhance sexual health communication within partnerships and within social networks, as a potential harm reduction strategy to foster healthier partnerships.


Subject(s)
Chlamydia Infections/psychology , Gonorrhea/psychology , Heterosexuality/psychology , Safe Sex/psychology , Sexual Partners/psychology , Adolescent , Adult , Attitude to Health , Female , Humans , Male , Middle Aged , Perception , Risk Assessment , Risk Factors , Self Disclosure
15.
Sex Transm Dis ; 28(11): 658-65, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11677389

ABSTRACT

BACKGROUND: Public health partner notification (PN) services currently affect only a small minority of patients with gonorrhea or chlamydial infection and new approaches to PN are needed. OBJECTIVES: To expand PN for gonorrhea and chlamydial infection to private sector patients and to assess the feasibility of treating sex partners through commercial pharmacies. METHODS: Selected patients were offered PN assistance and were randomly offered medication to deliver to their partners. RESULTS: Providers permitted the health department to contact 3613 (91%) of 3972 potentially eligible patients, and 1693 (67%) of 2531 successfully contacted patients consented to interview. Of these, 1095 (65%) reported at least one untreated partner. Most patients (90%) wished to notify partners themselves. Patients were more likely to have partners who had not yet been treated and to request PN assistance if they had more than one sex partner in the preceding 60 days or a partner they did not anticipate having sex with in the future. These two factors characterized 49% of all patients interviewed, 70% of those with a partner that was untreated 7 or more days after index patient treatment, and 83% of those accepting PN assistance. Among 458 randomly selected patients with untreated partners at time of study interview, 346 (76%) agreed to deliver treatment to a partner. Of these, most (266) chose to obtain medication for a partner at a pharmacy, of whom 223 (84%) successfully did so. CONCLUSION: A substantial minority of private sector patients have untreated partners more than 7 days after their own treatment; some need help with PN, but most will agree to deliver medication to partners themselves.


Subject(s)
Chlamydia Infections/prevention & control , Contact Tracing/statistics & numerical data , Delivery of Health Care/statistics & numerical data , Gonorrhea/prevention & control , Interinstitutional Relations , Adolescent , Adult , Chlamydia Infections/epidemiology , Female , Gonorrhea/epidemiology , Humans , Interviews as Topic , Male , Pharmaceutical Services/statistics & numerical data , Public Health Administration/statistics & numerical data , Surveys and Questionnaires , United States , Washington/epidemiology
16.
J Clin Microbiol ; 39(8): 2924-7, 2001 Aug.
Article in English | MEDLINE | ID: mdl-11474014

ABSTRACT

Diagnostic tests presently available for Chlamydia trachomatis have widely varying performance characteristics. To assess evolving laboratory testing practices since the introduction of nucleic acid amplification tests (NAAT), we surveyed laboratories in Washington State about their testing practices in 1998 and compared our findings to a similar survey conducted in 1995. Laboratory directors of 61 (87%) of 70 laboratories performing chlamydial tests in 1998 returned a survey. Between 1995 and 1998, 36 laboratories discontinued chlamydial testing, and the total number of laboratories performing tests in the state decreased from 92 to 70, a 24% decline. Of the 36 laboratories that discontinued testing, 25 (69%) had previously used rapid tests. While no laboratory routinely used NAAT in 1995, ligase chain reaction (LCR) was used in 23% of laboratories in 1998 and accounted for 113,624 (36%) of the 318,133 tests performed that year. Among the remaining 204,509 tests performed in 1998, other tests employed included DNA probe (29%), enzyme immunoassay (20%), culture (12%), direct fluorescent antibody assays (3%), and rapid tests (<1%). The majority (65%) of tests performed in 1998 using technologies other than LCR or culture were done in laboratories that did more than 10,000 tests. Cost and loss of revenue to laboratories were the most frequently cited reasons for not adopting NAAT. We conclude that in Washington State, NAAT have been rapidly adopted in larger laboratories, but most patients are still tested with much less sensitive technologies. Financial constraints represent the major barrier to more widespread use of DNA amplification tests.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia trachomatis/isolation & purification , Laboratories/statistics & numerical data , Nucleic Acid Amplification Techniques , Bacteriological Techniques/methods , Bacteriological Techniques/statistics & numerical data , Chlamydia Infections/microbiology , Chlamydia trachomatis/genetics , Data Collection , Humans , Nucleic Acid Amplification Techniques/methods , Nucleic Acid Amplification Techniques/statistics & numerical data , Sensitivity and Specificity
17.
Am J Public Health ; 91(6): 959-64, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11392941

ABSTRACT

OBJECTIVES: Gonorrhea cases among men who have sex with men (MSM) declined in the early years of the HIV epidemic. We evaluated more recent trends in gonorrhea among MSM through the Centers for Disease Control and Prevention's Gonococcal Isolate Surveillance Project. METHODS: Isolates and case information were collected from 29 US sexually transmitted disease (STD) clinics. Gonococcal urethritis cases among MSM were compared with those among heterosexual men, and cases among MSM in 1995 to 1999 were compared with earlier MSM cases. RESULTS: Of 34,942 cases, the proportion represented by MSM increased from 4.5% in 1992 to 13.2% in 1999 (P < .001). Compared with heterosexuals, MSM were older, more often White, and more often had had gonorrhea previously, although fewer had had gonorrhea in the past year. MSM with gonorrhea in 1995 to 1999 were slightly older than those with gonorrhea in 1992 to 1994, and a higher proportion had had gonorrhea in the past year. CONCLUSIONS: MSM account for an increasing proportion of gonococcal urethritis cases in STD clinics. Given recent evidence that gonorrhea may facilitate HIV transmission, these trends demand increased attention to safe sexual behaviors and reducing STDs among MSM.


Subject(s)
Gonorrhea/epidemiology , Homosexuality, Male/statistics & numerical data , Neisseria gonorrhoeae/isolation & purification , Sentinel Surveillance , Adult , Community Health Centers/statistics & numerical data , Episode of Care , Erythromycin/analysis , Gonorrhea/complications , Gonorrhea/virology , Heterosexuality/statistics & numerical data , Hospitals, Military/statistics & numerical data , Humans , Male , Microbial Sensitivity Tests , Neisseria gonorrhoeae/drug effects , Safe Sex , Sexual Behavior , United States/epidemiology , Urethritis/etiology
18.
Clin Infect Dis ; 32(9): 1313-8, 2001 May 01.
Article in English | MEDLINE | ID: mdl-11303266

ABSTRACT

From 1994 through 1996-1997, high-level ciprofloxacin resistance (minimum inhibitory concentration [MIC], > or = 4.0 microg/mL) increased from 9% to 49% of gonococcal isolates recovered from consecutive female sex workers in Cebu and Manila, The Philippines (P < .01). During 1996-1997, 105 female sex workers with gonorrhea were prospectively randomized to receive treatment with oral ciprofloxacin, 500 mg, or cefixime, 400 mg, and followed for test of cure. Neisseria gonorrhoeae was reisolated within 28 days after treatment from 1 (3.8%) of 26 women given cefixime versus 24 (32.3%) of 72 women given ciprofloxacin (P < .01). Treatment failure (reisolation of pretreatment auxotype/serovar) occurred in 14 (46.7%) of 30 women infected with strains with MICs of ciprofloxacin > or = 4.0 microg/mL versus 1 (3.6%) of 28 infected by strains with MICs < 4.0 microg/mL (P < .01). High-level, clinically significant gonococcal resistance to ciprofloxacin has rapidly emerged in The Philippines, and spread of fluoroquinolone resistance through commercial sex poses a threat to control of gonorrhea and prevention of human immunodeficiency virus infection and the acquired immunodeficiency syndrome.


Subject(s)
Anti-Infective Agents/therapeutic use , Cefixime/therapeutic use , Cephalosporins/therapeutic use , Ciprofloxacin/therapeutic use , Gonorrhea/drug therapy , Adolescent , Adult , Drug Resistance, Microbial , Female , Gonorrhea/epidemiology , Gonorrhea/microbiology , Humans , Neisseria gonorrhoeae/drug effects , Neisseria gonorrhoeae/isolation & purification , Philippines/epidemiology , Prospective Studies , Sex Work , Treatment Outcome
19.
J Clin Virol ; 19(1-2): 91-9, 2000 Oct.
Article in English | MEDLINE | ID: mdl-11091152

ABSTRACT

Despite the major differences in the clinical epidemiology of HIV and HPV infections, several lessons learned from the HIV epidemic may be relevant to future prevention of HPV infection. There has been a paradigm shift in conceptualizing the epidemiology of STDs; targets of prevention now include: (1) determinants of exposures of susceptibles to infectious persons; (2) the efficiency of transmission; and (3) the duration of infectiousness. Lessons learned that may be potentially relevant to HPV prevention include: (1) advances in treatment of HIV have been rapidly adopted, whereas advances in prevention have not; (2) therapeutic and preventive trials have been too brief in duration, sometimes failing to adequately address major problems with relapse that become evident later; and (3) involvement of affected individuals and populations in research and prevention efforts has been essential and useful. Specific suggestions for HPV prevention efforts are discussed.


Subject(s)
Disease Outbreaks , Female Urogenital Diseases/prevention & control , HIV Infections/epidemiology , Male Urogenital Diseases , Papillomaviridae , Papillomavirus Infections/prevention & control , Tumor Virus Infections/prevention & control , Viral Vaccines , Disease Transmission, Infectious , Female , Female Urogenital Diseases/virology , HIV Infections/prevention & control , Humans , Male , Sexually Transmitted Diseases, Viral/epidemiology , Sexually Transmitted Diseases, Viral/prevention & control
20.
AIDS ; 14(12): 1785-91, 2000 Aug 18.
Article in English | MEDLINE | ID: mdl-10985316

ABSTRACT

OBJECTIVE: Genotype determination and risk group analysis of HIV-1 infected individuals in selected regions of South America. DESIGN: Cross-sectional convenience sampling of HIV-1-positive individuals in Peru, Ecuador, Uruguay and Paraguay from March, 1994 through September, 1998. METHODS: HIV-1-positive subjects were identified through the national AIDS surveillance program in each country. A standardized questionnaire was used to obtain demographic, clinical and risk factor data on each study subject. Viral DNA was extracted from participants' peripheral blood mononuclear cells either directly or after co-cultivation. A nested PCR was used to obtain selected fragments of the envelope genes for genotyping by the heteroduplex mobility assay (HMA). A 600 bp sequence encompassing the V3 loop was sequenced from a selection of 23 of these samples for phylogenetic analysis and confirmation of HMA genotype. RESULTS: Among the 257 successfully genotyped HIV-1-positive samples, genotype B was found in 98.3% (228/232) of those obtained from subjects in Peru, Ecuador, and Paraguay. In contrast, 56% (14/25) of the samples from Uruguay were genotype F, and the remainder were genotype B. Genotype F was detected for the first time in Peru (2/224) and Paraguay (1/4), and genotype A for the first time in Peru (1/224). Phylogenetic analysis confirmed the genotype identified by HMA in the 23 samples sequenced. There was no detectable genetic clustering of HIV-1 within the different high-risk groups or geographic locations. CONCLUSIONS: These findings verify and extend the presence of several different HIV-1 genotypes in South America.


Subject(s)
Genetic Variation , HIV Infections/virology , HIV-1/genetics , Amino Acid Sequence , Base Sequence , Cross-Sectional Studies , DNA, Viral/chemistry , Female , Genotype , HIV Envelope Protein gp120/chemistry , HIV Envelope Protein gp120/genetics , HIV Infections/epidemiology , HIV-1/classification , HIV-1/immunology , Heteroduplex Analysis , Humans , Male , Molecular Sequence Data , Peptide Fragments/chemistry , Peptide Fragments/genetics , Phylogeny , Polymerase Chain Reaction , Risk Factors , Sexual Behavior , South America/epidemiology , Surveys and Questionnaires
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