Socio-demographic characteristics and sex practices related to herpes simplex virus type 2 infection in Mexican and Central American female sex workers.

This study aimed to evaluate the relationship between HSV-2 infection and several socio-demographic and sexual practices of Mexican and Central American female sex workers (FSWs) in the Soconusco region in the State of Chiapas, Mexico. A cross-sectional study was carried out based on a sample frame of bars where FSWs were active in the Soconusco region. FSWs consented to investigations and answered a questionnaire and provided a blood sample for specific HSV-2 antibody analysis. One hundred and sixteen bars were studied and 484 women were interviewed. The overall frequency of HSV-2 infected women was 85.7%. Variables that reflected exposure to HSV-2 were significantly associated with the frequency of the infection. Additionally, variables such as education and country of origin were significantly associated with HSV-2 infection. These results suggest that this infection is highly endemic in the Soconusco, posing a health risk for the study population.

High prevalence of antibodies to herpes simplex virus type 2 among middle-aged women in Mexico City, Mexico: a population-based study.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted diseases worldwide. In Mexico there is a lack of population-based HSV-2 surveys. GOALS: To determine population-based HSV-2 seroprevalence and risk factors among women in Mexico City. STUDY DESIGN: A random sample of 730 women was identified among the residents of Mexico City. Women ages 25 to 85 years were selected from 3,694 households. Western blot serology testing was conducted on serum samples to determine HSV-2 type-specific serostatus. A structured questionnaire was administered, and multivariate analyses were performed to identify risk factors for HSV-2 seropositivity, which were stratified into two age categories: younger than 50 years of age and 50 years of age or older. RESULTS: The HSV-2 seroprevalence among female participants was 29.8%, with a significant trend of increasing HSV-2 prevalence for each higher level of age (P < 0.001). Female participants had a median age of 46 years and were predominantly monogamous (82.6%). The overall population-based seroprevalence estimated in Mexico City among women was 35.8%. The independent risk factors for HSV-2 seropositivity included a history of two or more sexual partners (odds ratio [OR], 2.2; 95% CI, 1.4-3.4), two or more sexual partners before first pregnancy (OR, 2.3; 95% CI, 1.4-3.7), cohabitation with partner (OR, 2.5; 95% CI, 1.3-4.7), and current vaginal douching (OR, 1.7; 95% CI, 1.2-2.6). CONCLUSIONS: Population-based HSV-2 seroprevalence is endemically high among middle-age women in Mexico City, and clearly is correlated with higher-risk sexual behavior. This elevated HSV-2 seroprevalence may reflect unrecognized HSV-2 transmission throughout life.

Human papillomavirus: a highly prevalent sexually transmitted disease agent among female sex workers from Mexico City.

BACKGROUND: Cervical cancer, a human papillomavirus (HPV)-caused neoplasia, is highly prevalent in Mexico. GOAL: To determine the prevalence of HPV infection in female sex workers (FSW) from Mexico City and to assess the association between HPV infection and the characteristics of these women. STUDY DESIGN: A questionnaire was applied to 495 FSW. Cervical cell specimens were obtained for DNA amplification and hybridization to detect 27 HPV types. A risk factor analysis was performed. RESULTS: The overall prevalence of HPV infection was 48.9%. The prevalence of high-risk HPV types was 43%, whereas that of low-risk types was 24.6%. A total of 18.8% of study participants was infected with both high-risk and low-risk HPV types, and 28.5% were infected with two or more HPV types. Younger age and failure to use a condom were independently associated HPV risks (odds ratio, 7.3 and 2.3; 95% CI, 3.5-15.0 and 1.2-4.4, respectively). CONCLUSIONS: Infection with high-risk and multiple HPV types is high among Mexican FSW. This study corroborated a higher infection rate in younger women. A higher risk of HPV infection is also observed in women who have been involved with sex work for less than 1 year. However, condom use showed a protective effect against HPV infection.

Analysis of herpes simplex virus 1 and 2 infection in women with high risk sexual behaviour in Mexico.

BACKGROUND: This paper describes the seroprevalence and risk factors of Herpes simplex virus (HSV) infection in a group of female prostitutes from Mexico City. METHODS: Women who consented to participate in the study voluntarily attended a sexually transmitted disease (STD) clinic during 1992. A standardized questionnaire was administered and a blood sample was obtained from each participant. Type-specific Western blot serology was performed to determine the serostatus of HSV-1 and HSV-2 for participants. Bivariate and multivariate analyses were applied to identify variables associated with an increased risk for HSV infection. RESULTS: Prevalences of infection among the 997 prostitutes studied were 93.9% for HSV-1 and 60.8% for HSV-2. Only 1.8% of the women were seronegative for both viruses. The only variable associated with HSV-1 seropositivity was crowding index. The following variables were associated with an increased risk for infection with HSV-2: age, level of education, working site, born outside Mexico City and increasing time as a prostitute. CONCLUSIONS: This is the first assessment of HSV infection in Mexico and may be useful for the development and application of control and preventive measures among the prostitute population at risk of acquiring and transmitting human immunodeficiency virus (HIV) and other STD.

Risk factors for herpes simplex virus type 2 infection among female commercial sex workers in Mexico City.

A scarce number of studies have been carried out to determine the epidemiology of herpes simplex virus type 2 (HSV-2) infection in female sex workers (FSWs). The objective of this study was to examine the correlates of infection for HSV-2 with socioeconomic and demographic characteristics, sexual behaviour and history of sexually transmitted diseases (STDs) among FSWs in Mexico City. A sample frame of commercial sex work sites was constructed during the fall of 1992. Sites identified were streets, bars and massage parlours. During 1993 we surveyed 757 FSWs aged 18-76 years, from a random sample of sites. Participating women provided a blood sample and answered a standardized questionnaire. HSV-2 antibodies were identified based on a Western blot assay, using type-specific recombinant glycoprotein gG2. In a multivariate analysis, the presence of HSV-2 antibodies was correlated (P < 0.005) with increasing age and time working as prostitutes, low education, street working site and positive serology for syphilis. The results showed that the working site and the education level are contextual variables related to the risk of HSV-2 infection, where poorly educated and street FSWs had the highest probability of infection. Characteristics that represent periods of exposure to the virus as age and time working in prostitution were predictors of the HSV-2 infection.

PIP: The authors investigated the relationship between herpes simplex virus type 2 (HSV-2) infection and socioeconomic and demographic characteristics, sexual behavior, and history of STDs among female prostitutes in Mexico City. During 1993, 757 female prostitutes aged 18-76 years, of mean age 28.5 years, from a random selection of prostitution sites provided blood samples and answered a standardized questionnaire. The presence of HSV-2 antibodies was identified through Western blot assay, using type-specific recombinant glycoprotein gG2. Overall seroprevalences for the study population were 65.1%, 0.6%, 3%, and 6.4% for HSV-2, HIV, hepatitis B virus, and syphilis, respectively. There was no significant correlation between HIV and HSV-2 serological results, although all 5 HIV-seropositive women were HSV-2 seropositive. In a multivariate analysis, the presence of HSV-2 antibodies was correlated with relatively higher age and longer time working as prostitutes, low education, prostitution at a street site, and positive serology for syphilis.

Low prevalence of hepatitis B markers among Mexican female sex workers.

OBJECTIVES: To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serological markers in female sex workers (FSW) in Mexico City. METHODS: The study population consisted of 1498 FSW who attended a detection centre for human immunodeficiency virus (HIV) in Mexico City, between January and October 1992. Study participants responded to a standardised questionnaire and provided a blood sample for serology of syphilis, HIV, and HBV. RESULTS: A total of 0.2% (95% CI 0.1-0.3) of the population were hepatitis B surface antigen (HBsAg) carriers. The general prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 6.3% (95% CI 5.5-7.1). This marker of previous exposition to HBV, was independently associated by logistic regression multivariate analysis with age, working in the street, and history of blood transfusion (BT) before 1987 (OR 4.8, 95% CI 2.1-11.3). Syphilis prevalence was 7.6% (95% CI 6.2-8.9) and HIV prevalence was 0.1% (95% CI 0-0.3). CONCLUSIONS: The prevalence of HBV infection in this group of Mexican FSW is lower than previously reported in other countries. In addition, the frequency of HBsAg carriers is similar to that in the general Mexican population. The absence of two major risk factors for HBV transmission in this group of FSW--that is, injecting drug use and anal intercourse, could help to explain this finding. However, the positive association between anti-HBc and history of blood transfusion demonstrated here, highlights the need to reinforce strict control of blood supplies in Mexico.

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.

Hepatitis B markers in men seeking human immunodeficiency virus antibody testing in Mexico City.

OBJECTIVES: To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serologic markers in 1,377 men with high-risk sexual behavior attending a center for human immunodeficiency virus (HIV) detection in Mexico City. METHODS: The study population consisted of all men who were tested for HIV from March to September, 1992. Study participants responded to a standardized questionnaire and provided a blood sample for serology. RESULTS: A total of 1.9% of the population were hepatitis B surface antigen (HBsAg) carriers, and there was a significant difference in HBsAg prevalence between HIV-negative (0.8%) and HIV-positive individuals (7.9%). Sexual preference was associated with HBsAg prevalence; only 0.3% of men who had female sexual partners exclusively were HBsAg carriers, compared with 4.8% of men who had male sexual partners exclusively. Prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 15.4%. However, men who reported only female partners had a 4.6% prevalence, whereas men who had only male partners had a 30.4% prevalence. Logistic regression analysis demonstrated an association of anti-HBc prevalence with age, marital status, sexual preference, seropositivity for HIV, and antibodies to herpes simplex virus type 2. CONCLUSIONS: These data demonstrate that coinfection with HBV is common in the HIV-positive men studied. The highest prevalences of HBsAg and anti-HBc were observed among homosexual men. These results highlight the need to intensify safe-sex education campaigns and to promote hepatitis B vaccination especially among this population group.

[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.

[Incorporating molecular tests into the practice of public health]. / La incorporación de las pruebas moleculares en la práctica de la salud pública.

Public Health has evolved in accordance with basic scientific and technologic advances. Molecular biology has provided sophisticated laboratory techniques and fine diagnostic tools that are being exploited in the area of Public Health in order to deepen our knowledge of the natural history of diseases, identify populations at risk, diagnose infectious process and different pathologies in the early stages of the illness and limit the damage produced by a late diagnosis. The modern molecular techniques provide a promising insight into the identification and measurement of molecular structures linked to the pathological process, the genotypic identification of infectious agents, the level of exposure and the susceptibility at individual as well as population levels. This paper describes its applications in the area of Public Health and highlights its limits and potential risks.

Prevalence, incidence, and determinants of syphilis in female commercial sex workers in Mexico City.

GOAL: To determine the prevalence and the incidence of serologic markers for syphilis, and the characteristics associated with the risk of infection in female commercial sex workers in Mexico City. To identify female commercial sex workers at greater risk of infection with syphilis. STUDY DESIGN: The authors performed a cross-sectional study of 3,100 female commercial sex workers who sought human immunodeficiency virus testing at a National Council on AIDS clinic between January 1992 and April 1993. The authors collected information about socioeconomic and demographic characteristics, history of sexually transmitted diseases, sexual practices, and preventive measures against such diseases. All of the women provided a blood sample for identification of infection markers and in a subgroup of 1,802 women, repeat samples were obtained to estimate the rate of seroconversion to syphilis. RESULTS: Prevalence of syphilis was 8.2%, with an incidence of 2.4 per 100 person years. A positive linear relation between age and time working in commercial sex and prevalence of infection markers was observed. Women with less education, born in states other than Mexico City, and who worked on the street had significantly greater risks of infection with syphilis. CONCLUSIONS: Frequency of infection by both estimators is relatively low in the women studied. Characteristics related with periods of exposure such as age and time working in commercial sex, as well as socioeconomic and demographic characteristics, such as place of birth, education, and type of work site, were significantly related to the frequency of infection.

PIP: The goal of this study was to determine the prevalence and the incidence of serologic markers for syphilis and the characteristics associated with the risk of infection in female commercial sex workers (CSWs) in Mexico City. It also sought to identify female CSWs at greater risk of infection with syphilis. The authors performed a cross-sectional study of 3100 female CSWs who sought human immunodeficiency virus testing at a National Council on AIDS clinic between January 1992 and April 1993. The authors collected information about socioeconomic and demographic characteristics, history of sexually transmitted diseases, sexual practices, and preventive measures against such diseases. All of the women provided a blood sample for identification of infection markers, and in a subgroup of 1802 women repeat samples were obtained to estimate the rate of seroconversion to syphilis. Prevalence of syphilis was 8.2%, with an incidence of 2.4/100 person-years. A positive linear relation between age and time working in commercial sex and prevalence of infection markers was observed. Women with less education, born in states other than Mexico City, and who worked on the street had significantly greater risks of infection with syphilis. Frequency of infection by both estimators is relatively low in the women studied. Characteristics related to periods of exposure such as age and time working in commercial sex, as well as socioeconomic and demographic characteristics, such as place of birth, education, and type of work site, were significantly related to the frequency of infection.

[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.

[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.

Historical account of venereal diseases in Mexico.

This paper reviews the history of sexually acquired diseases in Mexico. It is divided into four major chronological sections which discuss social attitudes and values, the development of services and of official policy, and historical epidemiology.

PIP: During the pre-conquest period of 1325-1521, Mexico was inhabited by more than 80 distinct ethnographic groups, disconnected, and with cultures less developed than those of the Aztec and Maya. Male polygamy was accepted only among nobles, although warriors received sexual services from groups of women who lived isolated from society. Adultery committed by a woman was punishable by death. Venereal diseases were recognized in both sexes even though medicine within these cultures was based upon magical and supernatural ideas. Women experiencing fetid secretions from their genitals or any type of visible lesion were segregated or forced to live outside of town until cured. Urinary pain was treated in both sexes potions derived from herbs and roots, while genital inflammation received plasters. Polygamy was eliminated during the Spanish colonial occupation of 1521-1810, although soldiers and officials were allowed to have large numbers of servants. Prostitution was tolerated with an increase in venereal diseases which were most likely syphilis, chancroid, lymphogranuloma venereum, gonorrhea, and other inflammatory urogenital disorders reported among the conquerors and the female population from 1529. The female indigenous population was the most vulnerable to infections during this period. Problems with STDs intensified in the 17th century due to the arrival of a large number of highly promiscuous, unsanitary immigrants who lived in crowded conditions. A bando was ultimately proclaimed in Mexico City in 1776 on the functioning of public houses and surveillance of the women who worked in them. The first formal regulations and sanitary inspections of female prostitutes were implemented during the 1860s as a means of protecting the French, Austrian, and Belgian soldiers who had helped invade Mexico. Literature produced in Mexico at the end of the 19th and beginning of the 20th centuries dealt mainly with moral and legal affairs regarding public houses as well as the diagnosis and treatment of STDs. Prevention was a fundamental aspect of the fight against STDs during the Mexican Revolutionary period. The first anti-venereal disease dispensary was established in Mexico City in 1921. The Department of Public Hygiene later intensified its campaign against STDs and extended it to the whole country. Specific dates of subsequent measures taken are provided, followed by a discussion of AIDS in Mexico, one of 15 countries with the highest number of AIDS cases in the world.

[Prevalence of antibodies to Pneumocystis carinii in subjects with high risk behavior for AIDS]. / Prevalencia de anticuerpos contra Pneumocystis carinii en sujetos con prácticas de alto riesgo de SIDA.

P. carinii pneumonia affects more than 80% of patients with AIDS in developed countries. In Mexico this complication has been described in 12 to 23% of patients with AIDS, and it has been proposed that competitive disease such as TB and the low life expectancy of AIDS patients in Mexico are the possible explanations of this low percentage. However, in Mexico the frequency with which the population at risk of contracting AIDS is exposed to P. carinii is unknown. Therefore, we looked for P. carinii antibodies in a group of blood samples obtained in an AIDS detection center in Mexico City. A Western blot analysis was performed on 157 blood samples from homosexual and bisexual men and on 21 from female partners of HIV positive men. Positive results were obtained for 76.9% of the samples. No difference was observed in the frequency of P. carinii antibodies between HIV positive and negative individuals. Also, no differences by sex or age were found. Prevalence of P. carinii antibodies in this group is 76.9%, similar to that found in a comparable group in the U.S.

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.