HIV and HTLV-I infections in the Americas: a regional perspective.

With over 143,000 cases of AIDS reported to the World Health Organization from 145 countries and with an estimated 5 to 10 million people worldwide infected with HIV, AIDS has become firmly established as a global pandemic. In the region of the Americas over 100,862 cases of AIDS have been reported with indigenous transmission documented in 45 to 46 countries. While North America has the highest annual number of AIDS cases per population, with 72 cases/million, the Caribbean subregion has a disproportionately high number of cases, with annual rates as high as 200 to 300 cases/million population for some countries. Despite differences in absolute number of cases, there has been a remarkable similarity in the temporal rate of increase of AIDS in the countries of the Americas, reflecting delayed introduction of the virus to some areas with an early exponential increase similar to that observed initially in the United States. Although the modes of transmission of HIV are the same throughout the region, evidence of increasing bisexual and heterosexual transmission, particularly in the Caribbean subregion, has resulted in a lower male-to-female ratio of AIDS cases and increased perinatal transmission. Clinically, a resurgence of diarrheal diseases, respiratory infections, and tuberculosis has been documented in association with HIV infection in many tropical countries of the Americas. With relatively high rates of HTLV-I infection already established in the Caribbean subregion, the overall public health problems of the Americas will be markedly potentiated by further spread of these 2 human retroviruses. If HIV infection continues to penetrate the poor and less advantaged populations in Latin America and the Caribbean, the potential exists for a massive epidemic in the Americas that may rapidly parallel the situation in Africa.

PIP: The article describes in detail the extent and nature of HIV and HTLV-1 infections, and AIDS in the Americas. Surveillance statistics are provided for general populations, homosexual and bisexual men, IV-drug users, female prostitutes, hemophiliacs, heterosexual partners of HIV-infected persons, blood donors, and pregnant women. As of publication, over 100,862 AIDS cases have been reported in the region, with indigenous transmission documented in 45-46 countries. Clinical manifestations of HIV infection and AIDS are discussed. North America claims the highest annual AIDS cases per population at 72/million, while the Caribbean subregion has a disproportionately high number of cases, with annual rates reaching 200-300/million for some countries. The temporal rate of increase of AIDS cases has, however, been fundamentally comparable for all countries of the Americas. While HIV transmission modes are the same throughout the region, increasingly lower male-female ratios of AIDS cases, and more cases of perinatal transmission especially in Caribbean countries. Diarrheal disease, respiratory infections, and tuberculosis have also been documented as associated with HIV infection in many tropical countries of the Americas. Further, relatively high rates of HTLV-1 infection in the Caribbean will only exacerbate already significant public health problems faced by some countries of the region. Should HIV continue infiltrating poor, disadvantaged populations of Latin America and the Caribbean, HIV infection levels and AIDS could reach epidemic proportions similar to that witnesses in Africa.

Yaws in the Americas.

Until the middle of this century, yaws was a major public health problem in the Americas Region of the World Health Organization. All countries located between the tropics of Cancer and Capricorn reported cases of yaws. From 1950 to 1957, major programs for the eradication of yaws were implemented throughout the region, and yaws rapidly ceased to be a threat. As of 1983, sporadic cases continued to occur in limited geographic areas of Colombia, French Guyana, Guyana, and Suriname.

Pelvic inflammatory disease in the United States. Incidence and trends in private practice.

The National Ambulatory Care Survey, conducted by the National Center for Health Statistics (Rockville, Md.), provides national estimates for conditions diagnosed by office-based private practitioners in the United States. The Venereal Disease Control Division of the Centers for Disease Control (Atlanta, Ga.) obtained data from the National Ambulatory Care Survey for the years 1973-1976 and analyzed the epidemiology of pelvic inflammatory disease in women who sought care from private physicians. More that 7.5 million office visits for pelvic inflammatory disease were made over the four-year period (average, 1.89 million visits pe year). All races other than white bear a disproportionate burden of pelvic inflammatory disease. Since the advent of the National Gonorrhea Screening Program in 1972, the number of visits to private physicians for pelvic inflammatory disease has apparently declined.

Pelvic inflammatory disease in the United States. Epidemiology and trends among hospitalized women.

The Hospital Discharge Survey, conducted by the National Center for Health Statistics (Rockville, Md.), provides national estimates for conditions causing hospitalization in short-stay hospitals in the United States. The venereal Disease Control Division of the Centers for Disease Control (Atlanta, Ga.) obtained survey data for 1970-1975 and analyzed the epidemiology of pelvic inflammatory disease (PID) in women hospitalized for this disease. An average of greater than 211,000 female patients older than 10 years of age were hospitalized annually for PID. Acute salpingitis occurred predominantly in women younger than 30 years of age. Women of all races other than white had a PID rate 3.3 times greater than that of white women. Data obtained from the Commission on Professional and Hospital Activities were used for determination of the trend in hospitalizations for PID. In all races other than white, the trend appears stable; however the trend among white women is increasing.

Pelvic inflammatory disease, 1980.

PIP: The term pelvic inflammatory disease (PID) is used to refer to diseases caused by acute ascending genital tract infection. Over 500 of the world's leading researchers met at the Center for Disease Control, Atlanta, Georgia, in April 1980, to review many facets of PID from their various perspectives. Since PID occurs more frequently among women younger than 25, its economic and social consequences are very serious. The risk of PID increases among women who use IUDs; in some Asian countries illegally induced abortions are among the most common causes of PID: in some African countries PID is associated most frequently with female circumcision. The microbiologic causes of PID are highly controversial. An accurate differential diagnosis of PID is very difficult since the clinical symptoms and signs are highly variable; laparoscopy is essential for accurate diagnosis. Antimicrobial treatment requires an extremely accurate microbiologic diagnosis; there is a great need for careful, therapeutic studies. Prevention of PID is tied to the design and implementation of control policies for sexually transmitted diseases.^ieng

Frequency and distribution of salpingitis and pelvic inflammatory disease in short-stay hospitals in the United States.

Pelvic inflammatory disease is not a reportable condition in the United States. Based on data extracted from the Hospital Discharge Survey conducted by the National Center for Health Statistics, this article presents estimates of the frequency and distribution of PID in short-stay hospitals from 1970 through 1975.

PIP: Estimates of the frequency and distribution of pelvic inflammatory disease (PID) in short-stay hospitals in the US as measured by the Hospital Discharge Survey (HDS) of the National Center for Health Statistics are presented. Annual estimates of International Classification of Diseases codes for acute salpingitis, chronic salpingitis, unspecified salpingitis and PID for 1970-75 were pooled and the results presented as mean annual numbers for the period. The probable errors of the estimates ranged from a low of +or- 2.3% to a high of +or- 30.0%, and depended on the magnitude of the estimate. Overall, there were 212,611 diagnoses of salpingitis and PID yearly, of which 146,115 were PID and 66,496 were salpingitis. Chronic salpingitis (23,555 cases) was diagnosed about twice as frequently as acute salpingitis (12,961 cases), but almost 1/2 of cases were not specified. When the diagnosis was acute salpingitis, it was the principal cause for admission in 81% of all cases, compared to a corresponding rate of 38% for chronic salpingitis. Diagnosed salpingitis was the principal cause for admission in 53% of cases, compared to 70% for PID. Overall the 2 conditions were the principal reasons for hospital admission in 65% of cases. The mean and median days of hospital stay for patients with salpingits or PID as the principal diagnosis were 6.6 and 6.2 days, respectively. The median age of women with a principal diagnosis of acute salpingitis was 23 years while for chronic salpingitis it was 29 years. The overall rate of hospitalization for salpingitis and PID was 199/100,000 population . For white women the rate of 154 and for all other races it was 509/100,000. In 204,596 cases in which marital status was known, the highest risk groups were separated and divorced women, with rates of 867.4 and 617.9 respectively. Among women, 10.3 of every 1000 hospital admissions, excluding those for pregnancy, were necessitated by salpingitis or PID. The group at highest risk was 20-24 years of age, while the risk in women over 40 was quite low. Salpingitis and PID were the cause of 1 in every 11 hospital admissions in women aged 20-24 in races other than white. The overall frequency of hospital deaths among women with diagnoses of salpingitis or PID was 4.3/1000 hospitalized women. Surgery was performed on 42.3% of patients with principal diagnoses of salpingitis or PID and 76.1% of women with secondary diagnoses. 54.3% of the hospitalized women underwent operations, of whom 45.6%, or 52,634 women, underwent hysterectomies.

Selective mass treatment in a venereal disease control program.

To control syphilis among prostitutes and seasonal farm workers in Fresno County, California, we developed a program of selective mass treatment of prostitutes. From August 1976 to July 1977, 512 women entered the program. Overall, 4.6 per cent of women treated prophylactically for syphilis were actually infected. Compared to cases in the previous year, infectious syphilis cases among prostitutes and seasonal farm workers decreased 51.3 per cent and 26.8 per cent, respectively.

Treatment of cardiovascular syphilis.

The English literature on the treatment of cardiovascular syphilis with penicillin was reviewed. To date there have been no controlled randomized clinical trials to demonstrate that penicillin therapy prolongs life expectancy, alleviates symptoms, or arrests the disease process. In spite of many shortcomings in the published data, penicillin is safe and free of severe reactions. Most authors agree that significant subjective improvement in the patient's status occurs following penicillin treatment. Once the patient has become symptomatic penicillin may have little efficacy. The optimal dosage and duration of therapy have never been established. Because of its low cost, ease of administration, and lack of toxicity, it should be given to all patients with cardiovascular syphilis in hope of arresting the effects of the disease on the heart and great vessels.

Treatment of late benign syphilis: review of the literature.

The English literature on the treatment of late benign syphilis with penicillin was reviewed. To date there have been no controlled randomized therapeutic trials to support the efficacy of this therapy. This disease responds rapidly to all antisyphilitic drugs including arsphenamine and heavy metals. There are ample case reports and 2 major therapy studies which demonstrate the safety and beneficial effects of penicillin in individual patients. Although the exact dosage and duration of therapy are open to speculation, it is wise to treat patients with late benign syphilis with doses of penicillin judged to be effective for concomitant neuro-or cardiovascular syphilis.