SOCIO-ECONOMIC FEATURES OF SEXUALLY TRANSMITTED INFECTIONS AMONG MSM IN GEORGIA.

The aim of our study was to investigate correlation between socio-Economic conditions and prevalence of Sexually Transmitted Infections among gay individuals (men who have sex with men, MSM) in Georgia. The study was conducted in 5 main cities in different regions of Georgia (Tbilisi, Batumi, Kutaisi, Zugdidi, and Telavi). During 2015-2019, social workers, LGBT community and non-governmental organizations (NGOs), conducted screening of MSM for STI, which was achieved by disseminating required information through electronic and print media, resulting in maximum involvement of MSM in screening programs for STI disseminating. A specially designed questionnaire/survey has been used to investigate the correlations between the following parameters, such as: age, educational attainment (non-completed secondary, secondary, non-completed High School, completed High School), economic income (extremely low, low, middle, high), awareness of STI (yes/no), sources of information (healthcare worker, internet/media, sex partner, social workers and/or NGOs (supporters of LGBT community, others), residence type (urban/rural); frequency of safe sex (using condoms for the last 6 months), number of sexual partners (>3) and etc., among the persons involved in the study. The following prevalence rates of STIs among the MSM population in Georgia during 2015-2019 were defined: for syphilis it appeared to be approximately 25.76%; for gonorrhea - 18.63%, and for chlamydia - 21.98%, respectively. The results of current study indicated that low-income levels and educational attainment are the key socioeconomic risk factors leading to high rates of STI prevalence among MSM. On the contrary, STI rates were inversely correlated with the level of education of the studied population. The odds ratio (OR) for syphilis between with the low and high incomes groups was 1.18 (p=0.023); for gonorrhea, the OR between the above stated groups s was 1.32 (p=0.001); for chlamydia OR was not significant - 0.89 (p=0.118). OR for syphilis between informed and uninformed about STI groups was 1.92 (p<0.001); the OR between the same groups was 2.24 (p<0.001), and in the case of chlamydia - 1.59 (p<0.001). Analysis of information obtained MSM from the selected sources over years showed that the contribution of the social and electronic media was decreased (50.5% to 38.1%, p<0.001) as well as the contribution of the social workers and/or non-governmental (LGBT community supporters) organizations (24,2% to 15.5%, p<0.001); that was mainly due to the acquisition of qualified information from medical workers (from 12.0% to 25.0%, p<0.001) and the high level of reliability of sexual partnership (from 13.2% to 21.1%, p<0.001). The OR for syphilis cases between the Rural/Urban groups was OR=1.60 (p=0.002); for gonorrhea, the OR between the same groups was 1.74 (p<0.001); and for chlamydiosis, the OR was 1.80 (p<0.001). Low-income levels and educational attainment are considered as main socio-economic risk-factors for high STI prevalence observed among the MSM. Healthcare workers and sexual partners are viewed as the main and reliable sources of sexual health information in MSM group. Although the obtained findings need further investigation and confirmation, preliminary results show that screening and prevention programs together with extensive dissemination of sexual health information may decrease prevalence of STI among MSM. And all are of great importance.

Prevalence and risk factors of tinea pedis in Georgian Defense Forces.

INTRODUCTION: Tinea pedis is a widely spread infection among military personnel. The aim of the research was to determine the prevalence of tinea pedis and its associated risk factors in Georgian Defense Forces. METHODS: A cross-sectional study including interviews and clinical and laboratory examination was performed among randomly selected Georgian soldiers and civilians, after getting the signed consent form from them. In the selected population with clinical evidence of tinea pedis, scrapings were taken for direct microscopic examination. Statistical Package for Social Sciences V.22.0 was used for ststistical analysis. RESULTS: Out of 729 soldiers, tinea pedis was clinically observed in 46.64% (n=340) and laboratory-confirmed in 25.24% (n=184) of cases, while out of 279 civilians, tinea pedis was found in 21.86% (n=61) and approved in 13.98%(n=39). Multivariate analysis demonstrated that tinea pedis is correlated with the age and military ranks but is not associated with the length of military service. Using a communal shower (OR=1.04, 95% CI 1.01 to 1.07) and having tinea pedis before military service (OR=3.27, 95% CI 1.79 to 5.96) increase the chances of tinea pedis development, though using two or more pairs of the military boots interchangeably decreases the spread of disease (OR=0.21, 95% CI 0.15 to 0.29). CONCLUSIONS: According to our research analysis, the prevalence of tinea pedis among Georgian militaries is significantly higher than that in the civilians. It is necessary to develop a large-scale strategy and to implement appropriate preventive measures to minimise the discomfort caused by this disease.

CLINICAL AND ANAMNESTIC CHARACTERISTICS OF DEVELOPMENT OF ANTISPERM IMMUNITY IN INFERTILE MEN.

The aim of the research was to establish connection between the roles of infertility duration, patient age, various extragenital and genital pathologies in ASA pathogenesis. The work is based on retrospective analysis of 496 outpatient cards, which covered detailed anamnestic data and results of past complex clinico-laboratory tests. Criteria for inclusion in the study was infertility during marriage for at least 18 month, high concentration of ASA-s in booth blood and sperm. It was found that there is no statistically significant connection between the ASA and past illnesses, profession, family history, accompanying autoimmune diseases and extragenital pathologies. Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis compared to other STDs, cause statistically significant increase of ASAs concentration in blood serum, as well as in ejaculate (p<0,001). Testicle associated pathologies plays an important role in development of antisperm immunity, especially orchitis and epididymitis, during which statistically insignificant increase of levels of ASA has been detected in blood, as well as in semen (p<0,001). Thus, we can conclude that, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, orchitis and epididymitis causes malfunction of blood-testicular barrier, which resulted in inflammatory and toxic damage of spermatogenic epithelium, which in turn plays significant role in the development of autoimmune infertility.

Humoral immunity status if infertile men antisperm antibodies and various pathologies of reproductive organs.

The aim of the research was to study humoral immunity status of infertile men with high concentration of antisperm antibodies in blood plasma, sexually transmitted diseases (STD) and various pathologies of reproductive system. Analysis of 496 outpatient cards has been conducted. It was found, that patients with high levels of ASA >150 mg/l, or average 100-150 mg/l, had statistically significant (p=0,001) high content of Ig A and Ig G relative to the control group. Men with serum ASA concentration >100 mg/l, had statistically insignificant increased levels of all 3 types of immunoglobulins relative to the control group. Patients infected with Chlamydia trachomatis proved to have decreased IgA and IgG, 0,95±0,12 and 6,64±0,5 respectively (p<0,001). As for the patients infected with Ureaplasma urealyticum, decreased levels in Ig A and Ig M have been reported as 0,75±0,29 and 1,08±0,08 respectively (p<0,05). In the course of prostate gland inflammation statistically significant deficiency of Ig A and IgG was evident relative to the control group, 0,75±0,10 g/l and 5,94±0,54 g/l respectively (p<0,001). As for the males with varicocele, Ig A and Ig M decrease is noticeable relative to the control group, 1,06±0,21 g/l and 0,61±0,19 g/l respectively (p<0,05).

[Analysis of spreading the sexually transmitted disorders in Georgia].

According statistical data in Georgia sexually transmitted disorders represent one of the most important medical and social problems. Main causes of this are hard social and economic condition of the country, changing sexual-behavioral stereotypes, drugs and alcohol abuse, political perturbation, as well as unprecedented decrease in financing prevention programs of STD by government. The purpose of given research is statistical analysis of spread of sexually transmitted disorders in Georgia, in particular, among the people included in risk group; finding trends and in accordance with this, working out recommendations for improvement of situation in given field of medicine. Essays showed that through 2000-2012 years among STD revealed in the group of increased risk chlamidiosis was the most common. There is an objective trend of increasing the level of morbidity with chlamidiosis and trichomoniasis, however the speed of increasing morbidity with trichomoniasis probably does not correspond the reality. In the same time morbidity with gonorrhea and syphilis is decreasing, however in the result of significant decrease in STD prevention program scale data validity concerning syphilis might be doubtful. Coming out of this in the field of health care related to STD optimization of laboratory diagnostics management is essential; perfection of methods of epidemiologic control; increasing the scales of prevention programs as well as initiation of researches related to antimicrobial resistance of gonococci. Authors consider essential taking steps for optimization of management of laboratory diagnostics and perfection of methods of epidemiologic control and increasing scales of preventive programs.

Influence of epididymitis on reproductive function.

In our study 54 patients were diagnosed epididymitis caused by STI and in 6 (11.1%) cases inflammatory process spread on seminal vesicles which negatively affected the state of male reproductive function. After having unilateral epididymitis pathospermia developed in 76% of cases and infertility - in 55.6%. In patients who had unilateral acute epididymitis, infertility caused by urethritis of chlamidial aetiology developed in 70.4% of cases, infertility caused by urethritis of mycoplasmatic (ureaplasma) genesis - in 62.9% of cases and infertility caused by gonorrheal urethritis - in 29.6% of cases. At this moment following alterations of ejaculate are revealed: volume reduction, decrease in spermatozoid number, reduction of ability to move, increase in teratomatous forms, spermagglutination, etc. The best way for prevention of pathospermia and infertility is using modern and adequate treatment methods directed to maximally effective suppression of acute inflammatory process in epididymis and then restoration of its functions.

Illicit drugs use in Georgian students; pilot study rigorously following criteria of European School Project on Alcohol and Other Drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. This summary presents key results from the Alcohol Use in Georgian Students, pilot study rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD). The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. 22% of the surveyed students perceive cannabis to be easily available, and boys consider cannabis slightly more accessible than girls do, the gender difference is rather big (31% vs.13%). Amphetamines and ecstasy are not perceived to be as easily available as cannabis. On average, 33% of the boys and 8% of the girls have tried illicit drugs at least once during their lifetime (20% for all students). After cannabis, ecstasy is in second position, being mentioned by 7.5% of the students and the figure for amphetamines is about 2%. Lifetime use of crack was reported by fewer students (1.1%) and the rate for heroin was even lower (1%). Lifetime cocaine and heroine experiences were reported by 0.6% of the students on average. Just as few reported experience of GHB and anabolic steroids or drug use by intravenous administration. Since cannabis is the most frequently used illicit drug, it could be worthwhile to have a closer look at this substance. Use of cannabis in the past 12 months was reported by 17% of the boys and 3% of the girls (10% for all students) while use in the past 30 days was stated by 6.5% of the boys and 0.8% of the girls (3% mean). Using drugs is less problematic in Tbilisi adolescents but still needs urgent public health interventions. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study results show the importance of knowledge on these issues and therefore including the healthy lifestyle subject in school curricula. The need to repeat this exercise at regular intervals is important in order to be aware of newer trends and to serve as a basis for policy direction and change.

Alcohol use in Georgian students; pilot study rigorously following criteria of European school project on alcohol and other drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries. In the article the results of the pilot study of Alcohol Use among Georgian Students, rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD) are presented. The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers. The survey revealed that alcoholic beverages, especially beer and wine are considered easily available; 73% found beer and 70% wine easy to obtain. 90% of the surveyed students have tried alcohol at least once during their lifetime. 80% have done so in the last 12months and 40% in the past 30 days. Gender differences become apparent when frequency of use is considered: boys have used alcohol more often than girls. 7.5% of the students state that, they never drink alcohol at all. Wine and beer are the two most important types of beverage for the students. On average, 40% of students on the latest drinking day consumed wine and 38% - beer. Champagne and spirits consumed 29% and 22% of students, respectively. On average, half of the students have been intoxicated, at least once during their lifetime, to the point of staggering when walking, having slurred speech or throwing up. 40% reported intoxication in the last 12 months and 12% in the past 30 days. Another way to measure drunkenness is to ask about a specific amount of alcohol consumed within a certain period of time. The students were asked if they had had five drinks or more on one occasion during the past month; this is referred to here as "heavy episodic drinking", 40% reported this; more boys than girls did so (45% versus 33%). More than half of the questioned students had consumed at least one glass of alcohol at the age of 13 or younger, and 25% had been drunk at that age. Having been intoxicated during the past 30 days, in turn, co-varies both with anticipating more positive consequences from drinking and with having experienced more negative personal consequences when drinking. Alcohol remains the number one problem. The fact that more than 90% of respondents have had drunk alcohol at least once and that more than 43% have had their last drink at home and more than 27% at friend's home, indicates the great reflection of the cultural acceptance of alcohol within Georgian society and within Georgian families. The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts. Availability, not only in physical terms but also in financial terms, is another factor. Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities. The study showed the importance of knowledge of alcohol use and the necessity including the healthy lifestyle subject in school curricula.