Socioecological differences in factors associated with inconsistent condom use with female sex workers and casual partners: an observational study of heterosexual men attending an anonymous HIV testing clinic in Singapore.

Sexual practices among heterosexual men may differ between female sex workers (FSWs) and casual partners. We surveyed 203 heterosexual men and investigated the attributes associated with inconsistent condom use among them. Lower educational attainment was positively associated with inconsistent condom use with FSWs (adjusted prevalence ratio (aPR) 2.63; P = 0.018) and casual partners (aPR 1.55; P = 0.022), whereas early age of sexual debut (aPR 3.00; P = 0.012) and alcohol use during sex (aPR 7.95; P < 0.001) were positively associated with inconsistent condom use with FSWs. Socioecological factors may explain such differences.

Quality improvement: experience of a sexually transmitted infection clinic in Singapore.

SUMMARY: Over the past two years, the Department of Sexually Transmitted Infection Control Clinic (DSC) in Singapore has embarked on a programme to review and enhance its quality improvement programmes. A thorough review of its day-to-day operations was conducted, infection control processes and standard operating procedures. It capitalized on its use of computerized medical records to improve documentation and patient screening. DSC introduced risk-management protocols and revised patient, staff and workplace safety guidelines. These measures have resulted in benefits such as reduced prescription errors, fewer patient complaints and active clinical practice improvement programmes. In January 2008, DSC, along with its parent hospital the National Skin Centre, became the first ambulatory health-care facility in Singapore, and also among the first few outside the United States to be accredited by the Joint Commission International.

An epidemiological and knowledge, attitudes, beliefs and practices study of sexually transmitted infections in older men.

INTRODUCTION: This study was conducted to determine the disease patterns of sexually transmitted infections (STI) in older men, as well as to gather information on their knowledge, attitudes, beliefs and sexual practices. METHODS: A prospective study was carried out from January to June 2005 in men aged 50 years or older who attended the Department of STI Control clinic. RESULTS: There were 104 men enrolled. The majority (92.3 percent) were Chinese, and 62.5 percent were aged between 50 and 59 years, 25.9 percent between 60 and 69 years, and 11.5 percent aged 70 years or older. The patients were predominantly heterosexual, and had fairly low levels of education--85.6 percent of the patients had received primary or secondary school level of education. Majority (79.8 percent) of the men had been sexually active in the preceding six months, and 37.3 percent had paid sex during that time. 29.8 percent of men reported having taken drugs such as sildenafil (Viagra, Pfizer, New York, NY, USA) or similar drugs such as vardenafil (Levitra, Bayer, Wuppertal, Germany) or tadalafil (Cialis, Eli Lilly, Indianapolis, IN, USA). 56.7 percent of the men had active infections, with non-gonococcal urethritis (15.4 percent), genital warts (12.5 percent) and gonorrhoea (10.6 percent) being the commonest. Generally, condom usage was accepted as an effective way to prevent transmission of STI. However, many of the men surveyed felt that condom usage reduced their sexual pleasure, and 38.5 percent felt that condoms were inconvenient. There were also areas of human immunodeficiency virus (HIV) knowledge that were lacking. Most patients listed the media as their main source of knowledge about STI and HIV. CONCLUSION: Older males attending the clinic remain at significant risk of STI and targeted educational efforts are warranted.

Genital herpes in a sexually-transmitted infection clinic in Singapore: a 1-year retrospective study.

INTRODUCTION: This study describes the clinical features of genital herpes seen in a sexually-transmitted infection (STI) clinic in Singapore and the characteristics of the affected population. The distribution of herpes simplex virus (HSV) subtypes within the population, correlation of HSV culture result with duration of disease and prescribing habits of doctors were also examined. MATERIALS AND METHODS: This is a retrospective study of cases of genital herpes seen at the Department of Sexually-transmitted Disease Control (DSC) clinic over a 1-year period. All records of clinically diagnosed HSV genital infections at the DSC clinic in 2001 were retrieved and reviewed and the data collated. RESULTS: There were 324 cases of genital herpes, of which 153 (47.2%) were first-episode and 171 (52.8%) were recurrent HSV infections. There were 259 males and 65 females; their mean age was 35.2 years (range, 17 to 75 years). Of the 241 cases with positive culture results, 28 (11.6%) tested positive for herpes simplex virus type 1 (HSV-1) and 213 (88.4%) were positive for herpes simplex virus type 2 (HSV-2). HSV-1 accounted for 19.3% of first-episode and 4.7% of recurrent infections. HSV-2 accounted for 80.7% of first-episode and 95.3% of recurrent infections. Cultures taken from lesions < or = 4 days, between 5 and 7 days and > 7 days of onset were positive in 79.2%, 75.7% and 75% of cases, respectively. Oral acyclovir was prescribed more commonly in females (53.8%) than in males (21.6%). CONCLUSION: Genital herpes is a common STI seen at the DSC clinic. HSV-2 is the most common cause of genital herpes and accounts for most of the recurrent cases seen.

Sexually transmitted infections in Singapore teenagers.

INTRODUCTION: This is a review of sexual knowledge, behaviour and the extent of sexually transmitted infections (STI), including human immunodeficiency virus (HIV) infection, in Singapore adolescents. METHODS: Data were retrieved from relevant studies, reports and statistics concerning STI and HIV in Singapore. RESULTS: For many reasons, adolescents are at a higher risk of acquiring STI and HIV infections. Adolescents in Singapore are still relatively conservative in their sexual attitudes and behaviour. Most of those who had sex never used condoms. Fortunately, the incidence of STI and HIV infections among adolescents is relatively low. However, this may be changing, and there is a proportion of individuals who exhibit higher risk behaviours. CONCLUSIONS: In this age of rapidly changing morals and values, accurate information and skills need to be provided to young people to ensure that they are adequately prepared to protect themselves from acquiring STI/HIV infection.

Sexually transmitted diseases in the older population in Singapore.

BACKGROUND: Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. AIM: To study the distribution and types of STDs in older persons, defined in our study as individuals aged 50 years or older. METHOD: Retrospective analysis of surveillance data for diseases notified under the Infectious Disease Act, which include syphilis, gonorrhoea, non-gonococcal urethritis (NGU), vaginal discharge and chancroid. Human immunodeficiency virus (HIV) infections were not included. Data from notifications of diseases, such as genital herpes and genital warts, which are not compulsory, were also analysed. Period of study was from January 1996 to December 2000. RESULTS: During the study period, STD notifications for persons aged 50 years and older accounted for 7.6% of all notifications. Among these older persons, males were predominantly affected. The most common disease notified in older persons was gonorrhoea (600 cases), followed by non-infectious syphilis (578 cases) and NGU (339 cases). There were 76 cases of infectious syphilis. The age-specific disease rates for this group of older patients were as follows (number of cases per 100,000 patients per year): gonorrhoea-17.61, non-infectious syphilis-16.96, infectious syphilis-2.23, NGU-20.66, genital warts-6.92 and genital herpes-7.33. CONCLUSION: Although STDs occur mainly in the young, it affects a small but significant proportion of persons aged 50 years and older. A better understanding of the epidemiology of STDs in these population is important for reducing STD morbidity and improving STD care.

The epidemiology and treatment of anogenital warts in Singapore: a retrospective evaluation.

INTRODUCTION: A retrospective study in the referral centre for sexually transmitted infections (STIs) in Singapore to describe the epidemiology and treatment outcome of patients with anogenital warts. SUBJECTS AND METHODS: We reviewed the case records of 301 patients with anogenital warts who were seen over a 1-year period (1999). We also attempted to interview every patient by telephone to find out if they had any clinical recurrences for which treatment was sought elsewhere. RESULTS: There were 255 males and 46 females with a mean age of 34 years. Two hundred and nineteen (72.8%) presented with symptoms lasting 12 weeks or less. In males, warts occurred most frequently in the preputial cavity (52.5%) and on the penile shaft (40.8%). In females, they occurred most frequently on the external genitalia (91.3%). Two hundred and thirty-five males were treated with cryotherapy and 69% (95% CI, 62.6% to 74.8%) achieved clinical resolution after a mean of 6 treatment cycles. Seven males were treated with podophyllin 0.25% in ethanol and 71% (95% CI, 29.0% to 96.3%) were clinically cured after a mean of 4 treatment cycles. Thirty-nine females were treated with cryotherapy and 67% (95% CI, 49.8% to 80.9%) achieved clinical cure after a mean of 4 treatment cycles. Of the 290 patients treated at the centre, 212 (73%; 95% CI, 67.3% to 77.8%) patients (184 males, 28 females) achieved clinical cure after a mean of 7 weeks (range, 1 to 34 weeks); 90% (95% CI, 86.0% to 93.2%) of them by 15 weeks. Seven-two patients defaulted follow-up and 6 responded partially to treatment. Of the 212 patients who achieved clinical cure, 195 were interviewed by telephone, on an average, 17.7 months after clinical resolution. Thirty-seven (19%; 95% CI, 13.7% to 25.2%), all males, relapsed clinically after a mean of 100 days (range, 5 to 329 days); 90% (95% CI, 84.6% to 93.6%) relapsed by 228 days. CONCLUSIONS: Podophyllin 0.25% in ethanol was the most cost-effective treatment for males. One in 5 patients had a recurrence of their warts and most had their recurrence within 8 months of initial resolution.

Effects of Angiotensin II on the Spontaneous Activity of Rostral Ventrolateral Medullary Cardiovascular Neurons and Blood Pressure in Spontaneously Hypertensive Rats.

The interactive role of rostral ventrolateral medulla (RVL) cardiovascular neurons and brain angiotensin II (Ang II) in regulating the arterial blood pressure was examined by recording simultaneously the spontaneous activity of these spinal projecting neurons and the arterial blood pressure in the pentobarbital-anesthetized spontaneously hypertensive rat (SHR) and its normotensive control, the Wistar Kyoto rat (WKY). It was found that Ang II elicited dose-dependent excitatory responses in a subpopulation of RVL cardiovascular neurons, followed by a subsequent increase in blood pressure. These effects of Ang II were significantly greater in SHR than in WKY. The effects were attenuated or abolished by co-administration of Ang II antagonist, [Sar(1), Ile(8)]-Ang II to RVL using bilateral microinjection attenuated the blood pressure effects of intracerebroventricularly administered Ang II by as much as 70%. These results indicated that spinal projecting RVL cardiovascular neurons are important in mediating the pressor action of Ang II. The enhanced sensitivity and responsiveness of RVL cardiovascular neurons to Ang II may be pertinent to the genesis of hypertension in adult SHR. Copyright 1996 S. Karger AG, Basel