[Prospective study of sexually transmitted infections in Dakar, Senegal]. / Etude prospective des infections sexuellement transmissibles à Dakar.

The objectives of this study conducted from January to December 2001 at our reference centre for sexualy transmitted infections (STI) were to determine the epidemiological profile of men who consulted our facility for symptomatic STI, describe the clinical manifestations of STI, and propose recommendations for improving therapeutic management of STI in tropical areas. A total of 100 men consulting for symptomatic STI were included over the one-year study period. In addition to administering a standardized questionnaire to each patient, a thorough clinical examination especially of the urogenital tract was performed and blood and urethral discharge specimens were obtained for analysis at the Reference STI laboratory of Institut d'Hygiène Sociale (IHS). Analysis of study data demonstrated that the mean age of patients was 25 years, that 52% were single, and that level of education was generally low (primary school for 37% and secondary school for 27%). However it should be pointed out that 12% of patients had a university level education. Most patients were Wolof people living in or around Dakar and working in the trades sector (shopkeeper, artists, tailors, drivers, and seamen). Thirty-seven percent of patients reported previous STI involving urethral discharge in 34% and genital ulcer in 3%. Risk factors included sex with random partners in 51% including 31% with prostitutes, more than two partners at the time of the study in 34%, and regular alcohol use in 44%. Neisseria gonorrhoea was by far the most frequent infectious agent found in urethral discharge specimens (52%). Genital ulcer was found in only 13 cases. Eight of 13 patients with genital ulcers had positive syphilis serology suggesting that syphilis was the most frequent aetiology. The other aetiologies were uncommon STI, ie., condyloma (n=3), balanitis (n=2), venereal lymphogranuloma (n=1) and secondary syphilis (n=1). Serology was positive for HIV in 4% of patients. The epidemiologic profile of the patients in our study was similar to those previously reported in the literature. However it is interesting to note the non-negligible number of cases of STI transmission involving illegal prostitution, the high incidence of mismanagement of STI by the health care workers who provided initial treatment, the poor availability of drugs used for treatment of STI therapy in the centre's Banako Initiative (BI) pharmacy, and the frequency of condom non-use by patients with STI.

Human T-cell leukaemia/lymphoma virus type 1-associated infective dermatitis in Africa: a report of five cases from Senegal.

BACKGROUND: Infective dermatitis (ID) is a rare dermatological condition of childhood that has been linked to human T-cell leukaemia/lymphoma virus type 1 (HTLV-1). Most cases have been reported in the Caribbean. Although several million people are estimated to be infected by HTLV-1 in sub-Saharan Africa, no case of ID has been reported in this area. OBJECTIVES: To identify and to describe cases of HTLV-1-associated ID in Senegal, West Africa. METHODS: Over a 3-year period, a serological test for HTLV-1 was performed at a dermatological centre in Dakar, Senegal, in children who presented with a picture suggestive of ID. Complementary haematological, immunological and virological investigations were performed in infected children and in their mothers. RESULTS: Five patients with typical HTLV-1-associated ID were identified, of ages 17, 5, 4, 3 and 3 years; two patients belonged to the same family. They all presented with repeated flares of superinfected dermatitis involving typical sites of ID (mainly the scalp, external ears, nares and eyelids), associated with nasal discharge, and less commonly with a nonspecific papular rash on the face or trunk. Although oral antibiotic therapy always gave effective control of the symptoms, recurrences were constant. A persisting dry dermatitis of the retroauricular folds was common between flares. Infection in the oldest patient was associated with a chronic adult T-cell leukaemia/lymphoma. The mothers of three patients, and the grandmother of another, were all infected by HTLV-1 strains belonging to the Cosmopolitan molecular subtype, with a perfect nucleotide identity of long-terminal repeat and env gp21 genomic regions within each family. CONCLUSIONS: We present the clinical and virological features of the first reported African cases of HTLV-1-associated ID. When compared with data from the Caribbean, infectious features seemed particularly prominent. ID appears to be overlooked in sub-Saharan Africa, where it might be easily confused with common pyoderma. Breast feeding appears to be the origin of HTLV-1 contamination of the children.

Diagnosis of sexually transmitted infections in female prostitutes in Dakar, Senegal.

OBJECTIVE: To study the validity and performance of a number of rapid indicators for the diagnosis of sexually transmitted infections (STIs) in female prostitutes in Dakar, Senegal; characteristics of these indicators were rapidly obtainable, easy to perform, accurate, useful at district level, and reasonable cost. METHODS: An STI prevalence study in female prostitutes (n = 374) seen at the STD clinic in Dakar, Senegal was done; a history, clinical examination, simple laboratory tests, and "gold standard" microbiological tests were performed. For a number of sociodemographic data, actual or past symptoms of STI, clinical signs, and rapid laboratory tests, validity variables, performance characteristics, and likelihood ratios for detection of gonococcal or chlamydial cervical infection were determined. RESULTS: Cervical infection (chlamydial or gonococcal) was present in 24.9% of prostitutes; 46% had trichomoniasis and 29.4% had syphilis. Young age, abnormal vaginal discharge, endocervical mucopus, a positive leucocyte esterase test on urine, and 10 or more leucocytes in Gram stained smears of vaginal, cervical, or urine samples were significantly associated with cervical STI. Some of the rapid indicators had high sensitivity, others high specificity but none had acceptable overall validity. None of the indicators had at the same time a sensitivity above 50% and a positive predictive value above twice the background prevalence of cervical infection. 10 or more leucocytes in the cervical smear had a likelihood ratio of 1.83 increasing pretest probability of 24.9% to post-test probability of 38%, the best result obtained by any of the rapid indicators. CONCLUSIONS: Rapid indicators of cervical STIs are insufficiently valid, which largely restricts their usefulness to high STI prevalence situations for instance, in prostitute populations and in STD patient management.

[Importance of culture media choice in the isolation of Haemophilus ducreyi. Experience in Senegal]. / Importance du choix d'un milieu de culture dans l'isolement de Haemophilus ducreyi. Expérience du Sénégal.

Genital ulcerations typify one of the major reasons clients seek STD consultation in developing countries. The usual etiologies are syphilis, chancroid and herpes. The ideal diagnostic approach is to undertake complete laboratory examination that are rarely possible in structure destitute of laboratory analysis possibilities which is the case for most of the STD transmission agents. Chancroid is caused by Haemophilus ducreyi, a short Gram negative bacteria. The bacteriological diagnosis is based on direct examination, isolation and identification of the bacteria. The nutritive exigence of the bacteria required 3 medium of isolation (PPLO base Pasteur), GC base (GIBCO) and Muller Hinton base (Becton & Dickinson, with "chocolate" agar) have been tested from the chancre samples of 108 male patients who had a median age of 31 years. Direct exams were positive in 66 cases (61%) and culture exams positive in 53 cases (49%). The Muller Hinton base with "chocolate" agar produced the best results and seems to be the medium of choice for isolated strains in Senegal. The culture mediums currently used in Europe are apparently inappropriate for the germ culture in Senegal. We have also observed that all the isolated strains were producers of beta-lactamase. Antibiotic treatment before the sample swab is taken seems to have an inhibiting effect on the culture. Direct examination with a sensibility of 94.3% and a specificity of 70.9% remains sufficient in routine presumptive diagnosis in endemic areas.