Fitz-Hugh-Curtis Syndrome in a Male Patient.

We report the case of a 38-year-old Middle Eastern man with intractable right upper quadrant (RUQ) abdominal pain and several emergency department visits during the last seven years, with extensive and repeated radiologic and endoscopic workups proven negative for biliary or upper gastrointestinal disease. He presented to our outpatient surgical clinic in March 2023 complaining of worsening RUQ and epigastric pain and was scheduled for a robotic cholecystectomy for presumed biliary dyskinesia following a repeat cholescintigraphy (hepatobiliary iminodiacetic acid) scan. During a cholecystectomy, extensive bilobar perihepatic adhesions were found, indicative of Fitz-Hugh-Curtis syndrome (FHCS). A thorough lysis of adhesions was performed along with a wedge liver biopsy, with subsequent histological examination showing chronic cholecystitis, perihepatic mesothelial fibrosis with mild subcapsular hepatic steatosis, and no evidence of liver fibrosis. The patient was examined in the clinic two weeks after surgery with complete resolution of symptoms. This case highlights the importance of considering FHCS in the differential diagnosis of male patients presenting with refractory RUQ abdominal pain despite a negative workup. Early recognition and prompt treatment can prevent unnecessary extensive, repeat testing and delays in intervention in these patients.

The impact of the COVID-19 pandemic on chlamydia infection in South Korea: a comparison between the pre-pandemic and during-pandemic periods.

Background: Prior to COVID-19 pandemic, a yearly upward trajectory in the number of chlamydia infection cases was observed in South Korea. However, in response to the COVID-19 pandemic, Korea implemented several public health and social measures, which were shown to have an impact on the epidemiology of other infectious diseases. This study aimed to estimate the impact of the COVID-19 pandemic on the incidence and number of reported chlamydia infections in South Korea. Methods: Using the monthly number of reported chlamydia infection data between 2017 and 2022, we compared the trends in the reported numbers, and the incidence rates (IR) of chlamydia infection stratified by demographic characteristics (sex, age group, and region) in the pre- and during COVID-19 pandemic period (January 2017-December 2019 and January 2020-December 2022). Results: We observed an irregular downward trajectory in the number of chlamydia infection in the during-pandemic period. A 30% decrease in the total number of chlamydia infection was estimated in the during-pandemic compared to the pre-pandemic period, with the decrease greater among males (35%) than females (25%). In addition, there was a decrease in the cumulative incidence rate of the during COVID-19 pandemic period (IR: 0.43; 95% CI: 0.42-0.44) compared to the pre-pandemic period (IR: 0.60; 95% CI: 0.59-0.61). Conclusions: We identified decrease in the number of chlamydia infection during COVID-19 pandemic which is likely due to underdiagnosis and underreporting for the infection. Therefore, strengthening surveillance for sexually transmitted infections including chlamydia is warranted for an effective and timely response in case of an unexpected rebound in the number of the infections.

Distribución de virus de papiloma humano de alto riesgo oncogénico y otras infecciones de transmisión sexual en mujeres paraguayas con y sin virus de la inmunodeficiencia humana

El virus de papiloma humano de alto riesgo oncogénico (VPH-AR) es causa necesaria pero no suficiente para la ocurrencia de cáncer de cuello uterino (CCU). Mujeres portadoras del virus de inmunodeficiencia humana (VIH) presentan mayor riesgo de desarrollar lesiones precursoras del cáncer de cuello de útero, por ello, el objetivo del presente trabajo prospectivo de corte transversal fue determinar la frecuencia de VPH-AR y otras infecciones de transmisión sexual-ITS (condilomas, sífilis, virus del herpes simple, gonorrea, citomegalovirus, hepatitis B) en 218 mujeres con y sin VIH que acudieron al Programa Nacional de Lucha contra el SIDA (PRONASIDA) desde julio 2017 hasta marzo 2021. Se encontró que 16/54 (29,6%) mujeres VIH-positivas presentaron infección por VPH-AR en comparación a 41/164 (25%) mujeres VIH-negativas (p>0,05). En relación a la edad, mujeres VIH positivas presentaron una frecuencia comparable de infección por VPH-AR (30 años 30,2%), a diferencia de mujeres VIH negativas donde hubo una disminución significativa de la infección por VPH-AR luego de los 30 años (30 años 18,8%, p= 0,028). Esto podría explicarse por la inmunosupresión observada en mujeres VIH positivas que podría favorecer infecciones persistentes, sugiriendo que deben ser controladas más cercanamente. Además, se observó mayor frecuencia de otras ITS en mujeres VIH positivas (29,6% vs 15,8%, p=0,026), lo cual sugiere que aparte del monitoreo más cercano, es fundamental fortalecer la educación sobre factores de riesgo para la ITS sobre todo VPH y VIH, así como la realización de prevención primaria por vacunación contra el VPH.

High-risk human papillomavirus (HPV-HR) is a necessary but not sufficient cause for cervical cancer (CC). Women carriers of human immunodeficiency virus (HIV) present an increased risk for the development of cervical cancer precursor lesions, therefore, the objective of the present prospective cross-sectional study was to determine the frequency of HPV-HR and other sexually transmitted infections-STIs (condylomas, syphilis, herpes simplex virus, gonorrhoea, cytomegalovirus, hepatitis B) in 218 women with and without HIV who attended the Ministry of Health from July 2017 to March 2021. It was found that 16/54 (29.6%) HIV-positive women had HPV infection compared to 41/164 (25%) HIV-negative women (p>0.05). In relation to age, HIV-positive women had a comparable frequency of HPV infection (30 years 30.2%), unlike HIV-negative women whom above 30 years of age presented a significant decrease in HPV-AR infection (30 years 18.8%, p:0.028). This could be explained by the immunosuppression observed in HIV-positive women which could favour persistent infections, suggesting that they should be controlled more closely. In addition, other STIs were observed to be more frequent in HIV-positive women (29.6% vs 15.8%, p:0.026), which suggests that apart from closer monitoring, it is essential to strengthen education on risk factors for STIs, especially HPV and HIV, as well as the implementation of primary prevention by vaccination against HPV.

A comprehensive HPV-STI NGS assay for detection of 29 HPV types and 14 non-HPV sexually transmitted infections.

BACKGROUND: Sexually transmitted infections (STIs) are prevalent throughout the world and impose a significant burden on individual health and public health systems. Missed diagnosis and late treatment of STIs can lead to serious complications such as infertility and cervical cancer. Although sexually transmitted co-infections are common, most commercial assays target one or a few STIs. The HPV-STI ChapterDx Next Generation Sequencing (NGS) assay detects and quantifies 29 HPVs and 14 other STIs in a single-tube and single-step PCR reaction and can be applied to tens to thousands of samples in a single sequencing run. METHODS: A cohort of 274 samples, previously analyzed by conventional cytology/histology and Roche cobas HPV Test, were analyzed by ChapterDx HPV-STI NGS assay for detection of 43 HPV and STI. A set of 43 synthetic control DNA fragments for 43 HPV and STI were developed to evaluate the limit of detection, specificity, and sensitivity of ChapterDx HPV-STI NGS assay. RESULTS: The assay was evaluated in this study, and the limit of detection was 100% at 50 copies for all targets, and 100%, 96%, 88% at 20 copies for 34, 8, and 1 target, respectively. The performance of this assay has been compared to Roche cobas HPV test, showing an overall agreement of 97.5% for hr-HPV, and 98.5% for both, HPV16 and HPV18. The assay also detected all HPV-infected CIN2/3 with 100% agreement with Roche cobas HPV results. Moreover, several co-infections with non-HPV STIs, such as C. trachomatis, T. vaginalis, M. genitalium, and HSV2 were identified. CONCLUSIONS: The ChapterDx HPV-STI NGS assay is a user-friendly, easy to automate and cost-efficient assay, which provides accurate and comprehensive results for a wide spectrum of HPVs and STIs.

Characteristics of pelvic inflammatory disease caused by sexually transmitted disease - An epidemiologic study.

INTRODUCTION: Pelvic inflammatory disease (PID) is an infection of the upper genital organs, diagnosed by clinical findings. The nucleic acid amplification test (NAAT) identify sexually transmitted (STD) pathogens from endocervical swabs, via real time PCR. This study explored the prevalence of STD detected by NAAT for women with PID. We also aimed to identify predictive characteristics for positive test. MATERIAL & METHODS: This retrospective cohort study explored the prevalence of positive NAAT for women with clinically diagnosed PID, 2016-2019, in a secondary referral center. The primary outcome was the prevalence of positive STD tests and specific pathogens. The secondary outcome was predictive clinical and laboratory parameters for positive NAAT. RESULTS: Among the 610 women in our cohort, 103 had a positive STD PCR, which accounts for 17%. Most of the patients had Urea parvum (39.4%) Mycoplasma hominis (17.2%) or Urea urealyticum (15.7%). Other pathogens with lower incidence were Chlamydia trachomatis (9.8%), Trichomonas vaginalis (3.4%), Mycoplasma genitalium (2.1%) and the lowest rate was for Neisseria gonorrhea (1.5%). CONCLUSION: In our population, we found lower prevalence of Chlamydia trachomatis and Neisseria gonorrhea compared to other large populations. This may be due to a high prevalence of married and religious women and also due to administration of a wide range of empirical antibiotic treatment, even for a low suspicion of PID. The study also gives reassurance that our empirical antibiotic protocol is adjusted to the endemic PID pathogens found in our population.

Neisseria gonorrhoeae Multivalent Maxibody with a Broad Spectrum of Strain Specificity and Sensitivity for Gonorrhea Diagnosis.

Gonorrhea is one of the most common, but still hidden and insidious, sexually transmitted diseases caused by Neisseria gonorrhoeae (gonococci). However, the diagnosis and treatment of gonorrhea are hampered by antigenic variability among gonococci, the lack of acquired immunity, and antimicrobial resistance. Further, strains resistant to cephalosporins, including ceftriaxone, the last line of defense, represent a growing threat, which prompted us to develop gonococci-specific diagnostic antibodies with broad-spectrum binding to gonococci strains to generate gonorrhea-detecting reagents. This study reports the identification of gonococci antibodies via bio-panning on gonococci cells using scFv-phage libraries. Reformatting the lead scFv-phage Clones 1 and 4 to a multivalent scFv1-Fc-scFv4 maxibody increased the sensitivity by up to 20-fold compared to the single scFv-Fc (maxibody) alone. Moreover, the multivalent maxibody showed broader cross-reactivity with clinical isolates and the ceftriaxone antibiotic-resistant World Health Organization (WHO) reference strain L. In contrast, the selected antibodies in the scFv-phage, maxibody, and multivalent maxibody did not bind to N. sicca, N. meningitides, and N. lactamica, suggesting the clinical and pharmaceutical diagnostic value of these selected antibodies for gonorrheal infections. The present study illustrates the advantages and potential application of multivalent maxibodies to develop rapid and sensitive diagnostic reagents for infectious diseases and cancer.

Epidemiological characteristics of sexually transmitted diseases from 2005 to 2017 in Mengla County， Yunnan Province / 上海预防医学

Objective:To determine the epidemiological characteristics and incidence trends of sexually transmitted diseases （STD） in Mengla County of Yunnan Province， and provide evidence for future prevention and control of STD. Methods:STD case information from 2005 to 2017 was extracted from the National Notifiable Infectious Disease Report Information System. Data were collected by year and disease type，and the incidence rate， epidemic characteristics and suspicious contact history of STD were statistically analyzed. Results:A total of 1 251 STD cases were reported in Mengla county from 2005 to 2017， including 490 gonorrhea， 483 syphilis， 216 condyloma acuminatum， 16 genital chlamydial infection and 46 genital herpes. The average annual incidence of STD was 35.57/100 000. The majority of STD cases were 20-29 years old （n=541，43.25%）， married （n=603，48.20%）， Han people （n=638，50.10%）， with education of middle school （n=536，42.85%）， and occupation of farmers （n=702， 56.12%）. The 42.61% of STD cases had non-marital sexual contact history， in which the proportion was significantly higher among male （55.05%） than female （28.98%）. In addition， the proportion of non-marital sex among STD cases increased gradually by year and significantly differed. Conclusion:The epidemic status of STD in Mengla county is relatively low. However， STD incidence increased gradually by year， which warrants more and specific measures on the STD control and prevention.

Current challenges and opportunities to providing sexually transmitted disease services in STD clinics: A public health leadership perspective.

OBJECTIVE: To assess leaders' perceptions of challenges and opportunities to providing sexually transmitted disease (STD) services in public health departments. DESIGN AND SAMPLE: Semi-structured interviews were conducted in 2017 with health directors and other designated leaders in 19 public health departments who have an STD clinic. Purposive sampling accounted for geographical differences, providing balanced representation of urban, suburban, and rural agencies in North Carolina. MEASUREMENT: Audiotaped interviews were transcribed verbatim. All transcripts were independently coded, with cross comparison and agreement between researchers. Rigorous thematic and content analyses were performed. RESULTS: Perceived stigma, funding constraints, and client-centered issues were identified as the greatest challenges to providing services. Opportunities to improve these services were offering comprehensive screening methods, quality improvement, and public health accreditation. Focused training on revenue and billing practices for staff was acknowledged as the most needed technical assistance. A "culture of free services", perceived by clients and staff, was revealed throughout several themes. CONCLUSIONS: Leaders in publicly funded STD clinics face many challenges and opportunities to providing clinical services. Health directors often serve as change agents and improving the sexual health of communities remains a priority. Results of this study will assist in crafting future policy and practice for STD clinics in the public health sector.

Trends in the Prevalence of Anogenital Warts Among Patients at Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, United States, 2010-2016.

BACKGROUND: Approximately 90% of genital warts are caused by human papillomavirus (HPV) types 6 and 11. In the United States, HPV vaccination has been recommended for girls and women aged ≤26 years, and since 2011, for boys and men aged ≤21 years and for gay, bisexual, and other men who have sex with men (MSM) aged ≤26 years. METHODS: Data were obtained from 27 clinics participating in the STD Surveillance Network. Trends in the annual prevalence of anogenital warts (AGW) from 2010-2016 were described by sex and by the sex of sex partners. RESULTS: During 2010-2016, significant declines in the prevalence of AGW were observed in women aged <40 years, men who have sex with women only (MSW) aged <40 years, and MSM of all age categories. An inflection in trend in 2012 was noted for MSW aged 20-24 or 25-29 years and for MSM aged 20-24 years. CONCLUSIONS: The observed declines in the prevalence of AGW suggest that HPV morbidity is declining among populations attending STD clinics, including MSW, MSM, and women. Declines in younger age groups are consistent with what would be expected following the implementation of HPV vaccination. However, declines were also observed in older age groups and are not likely to be the result of vaccination.

Specific Binding to Differentially Expressed Human Carcinoembryonic Antigen-Related Cell Adhesion Molecules Determines the Outcome of Neisseria gonorrhoeae Infections along the Female Reproductive Tract.

The gonococcal Opa proteins are an antigenically variable family of surface adhesins that bind human carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1), CEACAM3, CEACAM5, and/or CEACAM6, cell surface glycoproteins that are differentially expressed on a broad spectrum of human cells and tissues. While they are presumed to be important for infection, the significance of various Opa-CEACAM-mediated cellular interactions in the context of the genital tract has remained unclear. Here, we observed that CEACAM1 and CEACAM5 are differentially expressed on epithelia lining the upper and lower portions of the human female genital tract, respectively. Using transgenic mouse lines expressing human CEACAMs in a manner that reflects this differential pattern, we considered the impact of Opa-CEACAM interactions during uncomplicated lower genital tract infections versus during pelvic inflammatory disease. Our results demonstrate that Opa-CEACAM5 binding on vaginal epithelia facilitates the long-term colonization of the lower genital tract, while Opa protein binding to CEACAM1 on uterine epithelia enhances gonococcal association and penetration into these tissues. While these Opa-dependent interactions with CEACAM-expressing epithelial surfaces promote infection, Opa binding by neutrophil-expressed CEACAMs counterbalances this by facilitating more effective gonococcal clearance. Furthermore, during uterine infections, CEACAM-dependent tissue invasion aggravates disease pathology by increasing the acute inflammatory response. Together, these findings demonstrate that the outcome of infection is determined by both the cell type-specific expression of human CEACAMs and the CEACAM specificity of the Opa variants expressed, which combine to determine the level of gonococcal association with the genital mucosa versus the extent of CEACAM-dependent inflammation and gonococcal clearance by neutrophils.

Hepatitis A outbreak in Barcelona among men who have sex with men (MSM), January-June 2017: A hospital perspective.

BACKGROUND & AIMS: Acute hepatitis A is transmitted mainly via the faecal-oral route and/or contaminated aliment. Furthermore, several outbreaks in the men who have sex with men (MSM) population classified hepatitis A as a sexually transmitted disease (STD). We aimed to clarify an ongoing hepatitis A outbreak in Barcelona with respect to patients' characteristics and viral phylogenetic analysis. METHODS: We prospectively analyzed 46 cases of hepatitis A infection that were registered in our hospital between January and June 2017. We evaluated demographics data, risk factors, presenting symptoms, sexual orientation, comorbidities and further STD infections. The phylogenetic correlation of the current circulating viruses among them and other hepatitis A strains was assessed by sequencing of the VP1/P2A region. RESULTS: Most patients were male (44, 96%) with median age 33.5 years (range 28-50). Thirty-one (67%) were MSM and 18 (39%) required hospitalization. Molecular phylogenetic analyses revealed that all patients were infected by hepatitis A subgenotype IA strains. Moreover, current strains comprised 3 distinct clusters, previously reported in ongoing outbreaks in the United Kingdom, Berlin and the Netherlands. However, these strains were phylogenetically diverse to those previously reported in Barcelona metropolitan region. CONCLUSIONS: Ongoing hepatitis A outbreak in Barcelona affects primarily the MSM community and is phylogenetically linked to current hepatitis A outbreaks described in other European countries. As a result of the high admission rate, these outbreaks may impact the admission pattern of referral liver units. Control measures, for example vaccinations programs tailored to the MSM community, must be taken to control further spreading.

Performance evaluation of a DNA chip assay in the identification of major genitourinary pathogens.

BACKGROUND: To prevent the recurrence of genitourinary infections and to reduce the risks of their complications, accurate and rapid diagnosis are required. STDetect® Chip is a DNA chip which allows for the simultaneous detection of 13 major genitourinary pathogens in a single vaginal swab or urine specimen. We evaluated the analytical performance of the STDetect® Chip for detecting target pathogens that commonly cause genitourinary infections. METHODS: The target pathogens of the STDetect® Chip are Chlamydia trachomatis, Candida albicans, Enterococcus faecalis, Gardnerella vaginalis, Mycoplasma hominis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Staphylococcus aureus, Klebsiella pneumoniae, Trichomonas vaginalis, and Herpes simplex virus types 1 and 2. Performance of the STDetect® Chip for the detection of target pathogens was evaluated comparing with the result of direct sequencing and conventional multiplex PCR assay. And precision tests for STDetect® Chip were performed with quality control materials. RESULTS: The STDetect® Chip showed high sensitivities (95.1%-100%), specificities (93.4% to 100%), concordance rates (95.0%-100%), positive predictive values (69.8%-100%), and negative predictive values (93.1%-100%) in its identification of 13 target pathogens. The STDetect® Chip had a particularly excellent concordance rate (96.5%) for the 4 major pathogens, C. albicans, G. vaginalis, M. hominis, and U. urealyticum, compared with direct sequencing. Comparing to multiplex PCR assay, STDetect® Chip showed better sensitivity for detecting M. hominis (97.0% vs. 54.5%) and U. urealyticum (93.2% vs. 65.9%). In precision tests, coefficients of variations for signal intensities were ranged from 11.2% to 26.2%. CONCLUSION: The STDetect® Chip showed excellent analytical performance, and its result was in good agreement with that obtained by direct sequencing.

Analisis of External Quality Assessment of Neisseria Gonorrhoeae Identification and Validation in STD Laboratories of Zhuhai Area / 现代检验医学杂志

Objective To recognize the ability to identify and validate N .gonorrhoeae in Zhuhai STD laboratories to timely find out the factors or problems influencing the results.Methods Samples were uniformly delivered to STD laboratories in 2011~2014.The laboratories identified and validated N .gonorrhoeae and PPNG.Test results were analyzed and evaluation results were fed back to participating laboratories.Results 220 samples were delivered to STD laboratories in four years. The average percentage of qualified labs was 88.6% (39/44).The coincidence rates for N .gonorrhoeae quality control sam-ples respectively were 78.8% (26/33),90.3% (28/31),87.9% (29/33)and 100% (33/33)in 2011 ~ 2014.The coinci-dence rates for PPNG respectively were 80.8% (21/26),78.6% (22/28),86.2% (25/29)and 100% (33/33).Conclusion Through the construction of STD standardization laboratory and the external quality assessment every year,the STD labora-tories of Zhuhai area improved the ability to validate and identify N .gonorrhoeae obviously.But several laboratories had some problem,such as careless technicians and inaccurate reports.So quality control should be still strengthened.

Multiple partners and condom use among students at a South African University.

The prevalence of HIV in sub-Saharan Africa is the highest in the world. Young people, including university students, are at risk. Many sexually active young people have multiple partners, but little is known about how university students who have multiple partners differ from those who do not. This study examined such differences among randomly selected first-year students at a university in the Eastern Cape Province, South Africa, who completed a confidential questionnaire via audio computer-assisted self-interviewing. Of 201 participants, 93 (46.3%) reported sexual intercourse in the previous 3 months. Of those, 52 (55.91%) reported sexual intercourse with more than one partner in the past 3 months. Controlling for gender, students who reported multiple partners were younger at first coitus, had a greater number of lifetime coital partners, and reported more frequent coitus and unprotected coitus but a lower proportion of condom-protected coital acts in the past 3 months than did those reporting only one partner. However, those reporting multiple partners and one partner did not differ in religiosity, drinking problems, or victimization by childhood sexual abuse. HIV/sexually transmitted disease risk reduction interventions must address unprotected coitus and failure to use condoms among university students reporting multiple partners.

Human papillomavirus infections among Hungarian female sex workers.

The purpose of this study was to assess the human papillomavirus (HPV) prevalence in cervical, oropharyngeal and anal samples of the high-risk population of Hungarian female sex workers (FSWs). HPV testing of swab specimens from FSWs (n = 34) using polymerase chain reaction (PCR) methodology was performed. Results were compared with control group (n = 52) matched for age. Questionnaires were used to obtain data regarding participants' sexual behaviour. Data were analysed using SPSS. HPV DNA was detected in at least one location in a great majority of FSWs (82.4%), compared with 46.2% of the general female population (P < 0.05). Both the cervical and the anal samples of sex workers showed higher infection rates than those of controls (64.7% vs. 34.6% and 50.0% vs. 15.4%, respectively, P < 0.05). High-risk HPV prevalence was also significantly higher in sex workers (55.9% vs. 25.0%, P < 0.05). A significantly higher proportion of FSWs had a history of genital warts (26.5% vs. 3.8%, P < 0.05). The results suggest that condom use may not result in adequate protection from HPV infection. The high infection rates among FSWs should be viewed as a priority group for HPV and cervical cancer prevention programmes since they are sources of HPV infection for the general population.

The effects of environmental factors on persons living with HIV/AIDS.

In recent years, environmental awareness has received a great deal of public attention. However, little emphasis has been put on the influence of environmental factors (weather, personal attitudes, policies, physical structures, transportation, etc.) on the quality of life of persons infected with HIV/AIDS. The goal of this study was to assess the effect of selected environmental factors on the quality of life of persons affected by HIV/AIDS. To achieve this goal, the Craig Hospital Inventory of Environmental Factors (CHIEF) subscales including Policies, Physical Structure, Work/School, Attitudes/Support, and Service/Assistance were evaluated in patients selected from a STD/HIV clinic in Jackson, MS. They were chosen based on previously diagnosed HIV/AIDS status and age (16-95). Written consents, demographics sheets and self-administered questionnaires were obtained. Data were analyzed using Excel and SPSS software. Interviews started in July 2007 and ended in August, 2007. One hundred and thirteen patients responded. Participants were 72.6% (82) male, 26.5% (30) female and 0.9% (1) transgender. The median age of participants was 38.8 (18-63). Over 50% (65) had some college or higher education, and 35.4% reported annual incomes less than $10,000. Multivariate analysis showed marginal significance between disease diagnosis and gender (p < 0.10), and statistical significance between disease diagnosis and income (p = 0.03). Also, age (p = 0.01) and education (p = 0.03) were significant predictors in one of the subscales. The CHIEF subscales that showed the greatest significance among AIDS respondents were Attitudes and Support, and Government Policies with mean sensitivity scores of 1.39 and 1.42, respectively. The element with the least effect on AIDS patients was the Work/School subscale, with a mean score of 0.74. In general AIDS patients were disproportionately affected in all but one of the five subscales observed. Conversely those with HIV were more affected in the Work/School subscale with a mean score of 1.70. This proved to be the only subscale responsible for causing the greatest degree of perceived barriers for the HIV population. With a mean score of 0.75, Physical/Structural subscale showed the least negative impact on those infected HIV without AIDS. It is therefore recommended that the environmental barriers identified in this study be addressed in order to eliminate/minimize their negative effect and improve the quality of life of HIV/AIDS patients.

Mulheres monogâmicas e suas percepções quanto à vulnerabilidade a DST/HIV/aids / Monogamic women and their perceptions about their vulnerability to DST/HIV/aids

Introdução: o HIV/aids é considerado uma epidemia mundial e atualmente segue quatro tendências: heterossexualização, interiorização, pauperização e feminização. A mulher está especialmente vulnerável a esta epidemia, considerando suas características biológicas e anatômicas específicas, além da pressão exercida pelos parceiros, levando-as a ter um poder de escolha e de tomada de decisão nas relações afetivo-sexuais e reprodutivas, submetendo-se conscientemente a situações de risco para aquisição das DST/HIV/aids. Objetivo: verificar a porcentagem de DST/HIV/aids em mulheres monogâmicas, conhecer as percepções destas quanto à vulnerabilidade aos mesmos agravos e identificar fatores protetores às DST/HIV/aids no grupo estudado. Métodos: estudo transversal, descritivo-exploratório, realizado com 27 mulheres, em abril e maio de 2008, no ambulatório de DST/HIV/aids de um hospitaluniversitário de Fortaleza - CE. Resultados: vinte e quatro (88,9%) mulheres encontravam-se na fase reprodutiva (21 a 49 anos); 16 (59,3%) tinham o ensino médio; e 14 (51,9%) não tinham renda própria, dependendo financeiramente dos seus parceiros. Sete (26,0%) não detinham conhecimento sobre as formas de transmissão das DST/HIV/aids. Somente seis (22,2%) usavam o preservativo masculino "sempre" e 26 (96,3%) afirmaram não uso de drogasinjetáveis. Dezesseis mulheres (59,2%) percebiam-se sem risco para DST/HIV/aids, sendo a justificativa mais frequente a confiança no parceiro único, com 12 (44,4%). Conclusão: promoção do sexo seguro junto às mulheres monogâmicas deve trazer como foco a vulnerabilidade às DST/HIV/aids, visto que essas mulheres podem estar se relacionando com um parceiro que é bígamo.

Introduction: the HIV/aids is considered as a world epidemy and it currently follows four tendencies: heterosexualization, interiorization, pauperization and feminization. The woman is especially vulnerable to this epidemy, considering its specific biological and anatomic characteristics, besides the pressure done by the partners, leading them to have a power of choice in the affective-sexual and reproductive relations, submitting themselves unconsciously to risky situations to get DST/HIV/aids. Objectives: to verify the percentage of DST/HIV/aids in monogamic women; to know their perceptions concerning their vulnerability to the same damages; and to identify protective factors to the DST/HIV/aids in the group studied. Methods: transversal, descriptive exploratory study, conducted with 27 women, in April and May, 2008, in the fi rst aid post of DST/HIV/aids of a University Hospital in Fortaleza-CE.Results: twenty-four (88.9%) women were in the reproductive phase (21 to 49 years old); 16 (59.3%) had high school; and 14 (51.9%) did not have their own salary, depending financially on their partners. Seven did not have knowledge about the ways of transmition of DST/HIV/aids. Only six (22.2%) used the male condoms "always" and 26 (96.3%) affirmed non-use of injectable drugs. Sixteen women (59.2%) noticed themselves without risk for DST/HIV/ aids, being the most frequent justification the confidence in the only partner, with 12 (44.4%). Conclusion: promotion of safe sex together with monogamic women should focus on the vulnerability to DST/HIV/aids, as these women might be having a relationship with a bigamist.

Vacina contra DST: onde estamos e para onde vamos? / Viral STD vaccines: where we are and where we will go?

Introdução: as doenças sexualmente transmissíveis (DST) são uma questão que preocupa os órgãos gestores da saúde. Apesar de as pesquisas mostrarem um aumento na conscientização da população para a prevenção com o uso de preservativos, a cada ano aumenta o número de pacientes infectados por doenças de transmissão sexual. Felizmente, para algumas destas doenças, já foi possível desenvolver vacinas, como o caso da hepatite B e do HPV. Entretanto, para outras doenças como a aids, as pesquisas mostram-se distantes de apresentar resultado conclusivo. Conclusão: a utilização de vacinas tem se apresentado como uma tendência nesta área, e vem sendo apontada como uma das soluções mais viáveis para a prevenção e mesmo para o tratamento destas entidades no futuro.

Introduction: sexually transmitted diseases (STDs) are an issue that concerns the health governing bodies. Despite research showing an increased population awareness to prevent the STD each year increases the number of patients infected with sexually transmitted diseases. Fortunately for some of these diseases, was possible to develop vaccines, like hepatitis B and HPV vaccines. However, for other diseases like aids, research project seems far from conclusive result presenting. Conclusion: the use of vaccines is reported as a trend in this area and has been blamed as one of the best alternatives for the prevention and even treatment of these illnesses in the future.

Historical Changes and the Present Situation of Sexually Transmitted Diseases

STDs (sexually transmitted diseases) refer to a variety of bacterial, viral, and parasitic infections that are acquired through sexual activity including vaginal intercourse, oral sex, and anal sex. The term sexually transmitted infection (STI) is used increasingly because it has a broader range of meaning; a person may be infected and may potentially infect others without showing signs of diseases. Approximately 340 million new cases of STDs occur each year in the world. According to the Korea Centers for Disease Control and Prevention, notified cases of STDs in Korea decreased from 32,872 in 2002 to 12,486 in 2007. Bacterial STDs such as gonorrhea and chlamydial infection declined continuously but syphilis and chlamydial infection increased again. Viral STDs such as genital herpes and condyloma acuminatum increased continuously. Gonorrhea and chlamydial infection are still the two most commonly reported STDs in Korea. Bacterial STDs can be cured. However, the problem is that viral STDs cannot be cured completely at present. Safe sex with proper education and the correct use of condom are important to prevent STDs and unwanted pregnancy. Early diagnosis and screening, proper treatment, and appropriate counseling from qualified physicians are necessary to prevent the complications and spread of STDs. Also, continuous monitoring and strategies of prevention of STDs will be necessary for improvement of the public health.

Diagnosis and Clinical Symptoms of Sexually Transmitted Diseases

Screening and detecting sexually transmitted diseases (STDs) is a form of secondary prevention, which interrupts further transmission as well as progression of the infection and its sequelae. Unfortunately, primary prevention, by means of education and taking safe sex partners, has not been enough to significantly curb the prevalence and high cost of STDs. Bacterial STDs are decreasing in their prevalence whereas the prevalence of viral STDs has increased significantly in recent years. The differential diagnosis for genital ulcers, urethritis, and genital warts is very important. For example, syphilis, chancroid, lymphogranuloma venereum, and herpes simplex for genital ulcer are mistaken for other causes such as Behcet's syndrome, drug eruption, erythema multiforme, amebiasis, trauma, and carcinoma. Confirmatory testings made by cultures, PCR, or serologic studies are important for appropriate treatment and eradication of the disease in both patients and their partners. The physicians treating STDs should make special efforts to be sure that his or her methods of diagnosis and treatment reflect the latest knowledge, since the epidemiologic characteristics and treatment trends are rapidly changing based on newly appearing resistant strains.