2007～2011年珠海市性病流行情况分析

目的：了解2007～2011年珠海市性病的发病趋势和流行特点,为开展性病防治工作提供科学依据。方法：通过国家疾病预防控制信息系统,收集并分析珠海市19个性病哨点医院2007～2011年全年上报的病例信息。结果：2007～2011年珠海市累计上报性病病例15 186例,年均发病率为203.55/10万,发病率呈逐年上升趋势;病种构成上,衣原体感染报告数最多,占28.32%,其次为梅毒,梅毒与衣原体感染率每年增幅最大;性别分布上,男女比例1.45∶1,但有逐年缩小趋势;年龄分布上,20～34年龄段人群居多,占58.92%;职业分布上,工人、商业服务和家务待业者居多;香洲区为性病高发地区。结论：2007～2011年间,珠海市性病数逐年上升,尤其梅毒上升速度显著,应积极开展更有针对性的防治工作,控制以梅毒为主的各种性病的流行。     

Study of STD clinic attenders in England and Wales, 1978. 1. Patients versus cases.

A study was carried out to quantify and describe patients seen in sexually transmitted diseases clinics in England and Wales during 1978. Nine per cent of male patients were homosexual and 58% of female patients were under 25 years compared with only 42% of heterosexual men. Homosexual men had a higher mean number of cases per patient during the year than heterosexual men or women, largely because thay were more likely to have multiple episodes of disease. Female patients also had a higher mean number of cases than heterosexual men, because they often had several concurrent infections. There were 100,000 fewer patients than cases (322,000 compared with 432,000); 41% were seen in clinics in London. These findings show that current statistics for STDs are inadequate. Some quantification and categorisation of patients treated would be useful in analysing the trends in the incidences of the STDs.     

Study of STD clinic attenders in England and Wales, 1978. 1. Patients versus cases

A study was carried out to quantify and describe patients seen in sexually transmitted diseases clinics in England and Wales during 1978. Nine per cent of male patients were homosexual and 58% of female patients were under 25 years compared with only 42% of heterosexual men. Homosexual men had a higher mean number of cases per patient during the year than heterosexual men or women, largely because thay were more likely to have multiple episodes of disease. Female patients also had a higher mean number of cases than heterosexual men, because they often had several concurrent infections. There were 100,000 fewer patients than cases (322,000 compared with 432,000); 41% were seen in clinics in London. These findings show that current statistics for STDs are inadequate. Some quantification and categorisation of patients treated would be useful in analysing the trends in the incidences of the STDs.     

Rising incidence of genital herpes over two decades in a sexually transmitted disease clinic in north India

Genital herpes, which was considered to be a minor sexually transmitted disease (STD) in the past in developing countries, is rapidly increasing; in contrast, bacterial STDs are declining. This changing trend of various STDs prompted us to analyze our data retrospectively to see whether a similar change is occurring in this part of India as well. The records of sexually transmitted diseases (STDs) clinic attendees from January 1977 to December 2000 were analyzed. The demographic profile of patients with genital herpes was also considered for analysis. STDs were diagnosed clinically and by appropriate laboratory tests wherever applicable. VDRL test was done in all patients, and HIV antibody detection was performed from 1987 onwards. The incidences of chancroid, donovanosis, and gonorrhea were 12.2%, 6.3%, and 16.9%, respectively, from January 1977 to December 1985. The figures for the same decreased to 2.5%, 0.9%, and 2.3%, respectively, from January 1993 to December 2000. The decreasing incidence of the above bacterial STDs is statistically significant (p<0.001). However, there was an approximately two-fold increase in the incidence of genital herpes in recent years (20.5%) in comparison to the figures from the late 70s (11.4%). Molluscum contagiosum also showed an upward trend (1% in 1977-85 vs. 9.8% in 1993-2000). Condylomata accuminata remained almost unchanged (21.4% in 1977-85 vs. 20% in 1993-2000). To conclude, a significant increase in the number of viral STDs and a decline in the bacterial diseases were observed in recent years in comparison to the figures from the late 70s. This may be due to awareness of HIV, success of control programs, syndromic management of STDs, and adoption of safer sexual practices, which prevent bacterial STDs more efficiently than viral ones.     

High prevalence of sexually transmitted diseases in a rural area in Mozambique.

OBJECTIVE--To assess the extent of the sexually transmitted diseases (STDs) problem in a rural area of Mozambique. METHODS--A cross sectional study among pregnant women and patients presenting with genital complaints. Laboratory confirmation was done for gonorrhoea, chlamydial infection, active syphilis, trichomoniasis and HIV infection. SETTING--A primary health care setting in Vilanculos, Inhambane province, Mozambique. RESULTS--Evidence of one or more of the above STDs was found in 51% of 201 pregnant women, 56% of 85 women and 62% of 77 men with genital complaints. Neisseria gonorrhoea or Chlamydia trachomatis were found in 16% of pregnant women, 23% of female patients and 28% of male patients; genital ulcer disease was present in 6%, 28% and 36%, of respectively pregnant women, female and male patients. The prevalence of active syphilis was about the same in the three groups of study subjects, that is 15%. HIV infection was found in 4% of the male patients; no HIV infection could be detected in the female groups. CONCLUSION--STDs were a major health problem in this rural area in Mozambique. Though HIV infection was still low, the high prevalence of STDs indicates that the potential is there for an explosive spread of the HIV/AIDS epidemic.     

Changing patterns in sexually transmitted disease syndromes in Kenya after the introduction of a syndromic management program

OBJECTIVE: The objective of this study was to evaluate patterns in sexually transmitted disease (STD) syndromes after the introduction of an STD syndromic management program. STUDY: We used the HIV sentinel surveillance in patients with STDs (1990-2001) to compute the proportions of STD syndromes (as a proportion of all patients with STDs) before and after the introduction of the syndromic management program. RESULTS: A decline in the proportion of genital ulcer disease (GUD), urethral discharge (UD), and vaginal discharge (VD) was observed from the baseline (1990-1994) to the year 2000 (P <0.0001). GUD declined from 27.6% at baseline to 11.0% in 2000; UD from 31.8% at baseline to 22.2% in 2000; and VD from 36.7% at baseline to 20.1% in 2000. Similar declines for these syndromes were also observed in sex and age groups. The proportions of GUD, UD, and UV increased again in 2001. CONCLUSIONS: These changing patterns of STD syndromes were coincident with the introduction of the STD syndromic management program in 1995 and the termination of free STD medication in 2001.     

An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients

The HIV epidemic has dramatically altered the field of sexually transmitted diseases (STDs). HIV infection is unique among sexually transmitted diseases because it can modify the clinical presentation and features of other STDs. Conversely, other STDs can affect the transmission of HIV. This review is the third part of a series that has provided a general overview of STDs. In this article, genital ulcer diseases (genital herpes, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale), human papillomavirus infection (anogenital warts and subclinical infections), molluscum contagiosum, human herpesvirus 8 infection, viral hepatitis, and ectoparasitic infestations (scabies and pediculosis pubis) are discussed as they occur in HIV-infected hosts. Additional features as they relate to HIV-infected patients, such as epidemiology and transmission, are discussed when applicable. Learning objective: At the conclusion of this learning activity, participants should improve their understanding of sexually transmitted diseases in the HIV-infected host.     

A clinico-epidemiological study of donovanosis

Researchers conducted a retrospective study of confirmed cases of donovanosis, a sexually transmitted disease (STD), between January 1980- December 1987 at the STD clinic at the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India to determine if a change in the disease's trend occurred. 6.6% of all STD cases at the clinic had donovanosis, especially among 20-30 year olds. This compared to 5.4% in 1968-1969. Incidence did fall, however, to 3.6% in 1987. Incidence among males gradually increased from 1980-1982 then gradually fell. This decline was proportional to the total number of STD patients. All but 1 female reported not having sex outside of marriage. A low of 25% of both husbands and wives of married pairs had donovanosis. The most frequent clinical type of donovanosis was fleshy exuberant then either necrotic or sclerotic types. It affected mainly the genitalia, Syphilis was the most likely associated STD in both sexes. Even though there was a gradual decline in donovanosis, it still made up a major share of all STDs despite the availability of effective treatment (co-trimoxazole, chloromycetin, doxycycline, and tetracycline). In this same time period, a 7.2% and 1.7% increase in other STDs among female and male teenagers respectively occurred, yet, except for 1 case, there were no cases of donovanosis among teenagers. A possible explanation for the inability of this clinic to control donovanosis could be poor contact tracing.     

Relative and seasonal incidences of the sexually transmitted diseases. A two-year statistical review.

In the United States statistics on sexually transmitted diseases (STDs), other than gonorrhoea and syphilis, are meagre. In this study the relative and seasonal incidences of most STDs in an American clinic where 34,938 patient visits were recorded over a two-year period (1975-76) are assessed. Gonorrhoea was the most common STD in male and female patients combined (18%), while nongonococcal urethritis (NGU) was most common in men (23%), and vaginitis (trichomonal 7.5%, yeast 7.1%, and non-specific 7.1%) was the most common in women. A significantly higher incidence of NGU occurred in Caucasian (63%) than in black (42%) men (P less than 0.005). No other STD was diagnosed in more than 5% of patients, and 31% had normal findings on clinical examination and investigation, and could be described as the 'worried well'. Two or more STDs co-existed in 4.2% of patients. In 1976 the incidence of genital herpes and scabies decreased in contrast to other STDs and total patient visits, which increased. A seasonal peak in late summer and early autumn was observed for most STDs. These observations indicate the importance of a comprehensive approach when attempting to compile accurate statistics on selected epidemiological aspects of sexually transmitted diseases.     

广州市性病监测10年流行动态分析

目的 调查分析广州市近10年性传播疾病（STDs)的流行趋势。方法 以广州市STDs监测系统收集的STD流行病学资料为依据进行回顾性分析。结果 流行在全国处于较高的水平，在过去的10年间，广州市的STDs平均发病率为277．3／10万。男性发病率始终高于女性，分别为335．3／10万和219．3／10万。梅毒、尖锐湿疣、生殖器疱疹、非淋菌性尿道（宫颈）炎持续上升。淋病则处于稳定下降状态，10年间下降24．5％。软下疳、性病性淋巴肉芽肿和HIV／AIDS则处于极低的发病状态，平均发病率均低于0．5／10万。83．69％的性病患者处于20－39岁的性活跃期年龄组，15岁以下儿童性病患者在10年内上升1．36倍，非婚性传播占总性病患者的62．8％。结论 加强性病知识及性教育，提倡安全性行为，争取在一个10年内使STDs流行在广州市得到控制。     

Prevalence of sexually transmitted infections among clients of female commercial sex workers in Thailand

BACKGROUND: Clients of commercial sex workers are considered at high risk for the acquisition and transmission of sexually transmitted diseases (STDs). Identification and treatment of infections in this group could help to reduce the transmission of STDs. GOAL: To ascertain the prevalence of sexually transmitted organisms in male clients of female sex workers in Thailand by analysis of seminal fluid collected after intercourse. STUDY DESIGN: Used condoms were collected from 291 male clients attending a brothel in Hat Yai, Thailand during a 7-day period. Nucleic acid was extracted from seminal fluid and tested by polymerase chain reaction for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus (HSV) and HIV sequences. RESULTS: Overall, 17 (6%), 47 (16%), and 2 (1%) of specimens were positive for C trachomatis, N gonorrhoeae and T vaginalis respectively. HSV sequences were found in 24 (8%) of the specimens: 14 specimens (5%) with HSV type 1, and 11 specimens (4%) with HSV type 2. HIV RNA was detected in two samples (1%). Overall, 75 specimens (26%) were positive for one or more infections, and more than one pathogen was detected in 16 specimens (5%). CONCLUSION: This study reports a high rate of STDs among clients of female sex workers in Thailand. Consequently, this population is a significant risk for transmitting STDs to commercial sex workers and to other noncommercial partners. Strategies that target this population of men are needed to reduce STD and HIV transmission.     

Contribution of sexually transmitted diseases and socioeconomic factors to perinatal mortality in rural Ghana

BACKGROUND: The infant mortality rate is higher in sub-Saharan Africa than in other developing regions. The purpose of this study was to evaluate the association of sexually transmitted diseases (STDs) and socioeconomic and obstetric factors with perinatal mortality in rural Ghana. METHODS: Perinatal mortality data were collected from 154 patient records of the outpatient and inpatient gynecology department of a rural Ghanaian setting in 1997. All women attended the antenatal care unit of the hospital at least once before delivery, where they were screened for common STDs, including syphilis, gonorrhea, and trichomoniasis. Patients' socioeconomic characteristics and previous obstetric complications were recorded. RESULTS: The rate of perinatal mortality at the Holy Family Hospital in the Berekum district of Ghana was 13.7% in 1997 (154 of 1123 documented births). Characteristics of mothers whose infants died in the perinatal period and who had attended antenatal care at least once were as follows: prior obstetric complications, 108 patients (70.1%); average age, 25 years (range: 16-42 years); average number of previous sexual partners, three; prevalence of STDs, including gonorrhea, trichomoniasis, or syphilis, 83 patients (53.8%); history of other chronic diseases, 13 patients (8.5%); and illiteracy, 66 patients (42.8%). The number of previous sexual partners and illiteracy were higher in the STD-positive women. CONCLUSIONS: Sexually transmitted diseases and previous obstetric complications seemed to contribute considerably to perinatal mortality in rural Ghana.     

The prevalence of symptomatic sexually transmitted diseases and human immunodeficiency virus infection in outpatients in Lilongwe, Malawi.

In June 1989 a pilot study on the prevalence of STDs was performed at Kamuzu Central Hospital, Lilogwe, Malawi. Among unselected out-patients an STD prevalence of 4.4% was found. The patients were predominantly males (82.7%), the age was predominantly 20-35 yr. The distribution of the diagnoses was dominated by a relatively large proportion of "ulcer-diseases" (syphilis, chancroid and lymphogranuloma venereum) making up 67% of the patients. Almost two thirds of the patients were HIV-positive (62.4%). No significant difference was found in HIV-infection prevalence when patients with ulcer diseases were compared with patients with discharges. Among the patients with gonorrhoea a prevalence of penicillinase-producing Neisseria gonorrhoeae of 53% was found. It is concluded that a plan for the management of STDs is urgently needed as it is of paramount importance to combat STDs in order to prevent the spread of HIV-infection.     

Multiple partners and partner choice as risk factors for sexually transmitted disease among female college students.

Multiple sexual partners and partner choice are believed to increase the risk of sexually transmitted disease (STD), but these behaviors had not previously been assessed outside of clinical populations. In this study, a cross-sectional survey among single, white, female students in their senior year of college was conducted to measure the association between behavioral risk factors and the acquisition of self-reported STDs during college. The usable response rate was 47.2% (n = 467). The combined prevalence of chlamydial infection, gonorrhea, genital herpes, human papillomavirus (HPV) infection, syphilis, and trichomoniasis during a 3.5-year period was 11.7%. There was a strong association between number of sexual partners and having an STD: those women with 5 or more sexual partners were 8 times more likely to report having an STD than those with only 1 partner, even after adjusting for age at first intercourse (odds ratio = 8.1; 95% confidence interval = 1.99, 32.64). The prevalence of a history of STDs increased with more causal partner choice and earlier age at first intercourse, but neither factor was independently associated with a history of STDs. Of the respondents, 23% always used condoms. Future research should focus on identifying ways of effectively changing high-risk sexual behavior.     

Providing low-cost sexually transmitted diseases services in two semi-urban health centers in Central African Republic (CAR): characteristics of patients and patterns of health care-seeking behavior.

BACKGROUND: While treatment of symptomatic sexually transmitted diseases (STDs) has been shown to reduce the incidence of HIV infection, there are few published reports describing the delivery of high quality STD care in Africa. GOAL: To test the feasibility of providing comprehensive, affordable STD services through the existing primary care infrastructure. DESIGN: STD treatment services using a syndromic' approach were established in two semi-urban hospital outpatient departments (OPD) in Central African Republic (CAR). A dedicated paramedical provider took a clinical history, performed an examination, explained the diagnosis and the importance of referring partners, dispensed drugs, and offered partner referral vouchers. A fee-for-service system was used to resupply drugs initially purchased with project funds. RESULTS: Of 9,552 visits by index patients and partners over a 28-month period starting in October 1993, 60% were made by women; of these women, 90% were symptomatic, 77% had "vaginal discharge," 70% "lower abdominal pain," and 7% "genital ulcer." Among men, 64 % were symptomatic, 38 % had "urethral discharge," and 14% "genital ulcer." Half of all symptomatic patients presented within 1 week of the onset of symptoms; 44% of men compared to 18% of women had sought care elsewhere before the clinic visit. The average cost per STD treated with recommended drugs was $3.90. Etiologic data from subpopulations in both sites suggest that a high proportion of patients was infected with an STD. CONCLUSIONS: Comprehensive yet affordable care for STDs in persons (and their partners) who recognize symptoms is feasible and should be widely implemented in primary care systems to prevent the spread and complications of STDs and HIV in Africa.     

威海市某医院498例性传播疾病临床分析

目的了解威海市性传播疾病(简称性病)的发病情况,为制定防控策略提供科学依据。方法对威海市某医院2006-2010年报告的498例性病疫情资料进行临床分析。结果 5年间报告梅毒、淋病、非淋菌性尿道炎、生殖器疱疹及尖锐湿疣共498例,男356例,女142例,33例患两种以上性病;发病构成比先增高后降低,由2006年的14.26/万,先上升至2009年的28.11/万,后降至2010年的21.08/万。梅毒和非淋菌性尿道炎、生殖器疱疹发病比例逐年增高,尖锐湿疣最高,平均为32.60%,淋病逐年下降;21～29岁年龄组为高发人群(44.18%),50岁以上年龄组构成比逐年增高;职业以待业者为主。结论梅毒等发病比例呈上升趋势,高年龄组性病发病比例逐年增高,因此性病的预防与控制工作应有针对性的加大力度。     

Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait

BACKGROUND: Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait. METHODS: All patients seen over a 1-year period (July 2003 to June 2004), who presented with signs and symptoms suggestive of STDs, were included. Sociodemographic details and clinical findings were recorded. The diagnosis of each STD was based mainly on standard World Health Organization (WHO) criteria and available data. Serologic tests for syphilis and human immunodeficiency virus (HIV) were offered to all patients. RESULTS: One thousand and ninety-six patients (1068 male, 28 female) with STDs constituted 2.84% of all new dermatology patients seen; most (866) were in the 21-40-year age group. The STDs were acquired from commercial sex workers in 844 patients (77%). Heterosexual encounter (99.3%) was the most common mode of acquiring STDs. Urethral discharge was noted in 54.1% of patients, followed by genital ulcers (17.8%), papules/growths (16.4%), and urethral/pubic pain without associated discharge/ulcers (5.9%); these were the four most common presenting complaints. Evaluation revealed gonorrhea in 31.5% of patients, nongonococcal urethritis in 23.6%, chlamydia in 4.1%, nonspecific urethritis in 19.5%, concomitant gonorrhea and chlamydia urethritis in 2.7%, genital warts in 13.7%, chancroid in 13.0%, genital herpes in 4.8%, molluscum contagiosum in 2.7%, and lymphogranuloma venereum in 1.4%. CONCLUSIONS: Urethral discharge, gonorrhea, and nonspecific urethritis (presenting with urethral discharge), followed by genital warts, chancroid, and genital herpes (ulcers), were the most common STDs among male patients in the Farwaniya region of Kuwait. Although no case of HIV or syphilis was detected, health authorities and physicians need to remain vigilant.     

Risk factors associated with failure of syndromic treatment of sexually transmitted diseases among women seeking primary care in Addis Ababa

OBJECTIVE: To determine risk factors associated with the failure of syndromic management of sexually transmitted diseases (STDs) among women seeking treatment in primary healthcare centre in Addis Ababa, Ethiopia. METHODS: Women with symptomatic STDs seeking care in a health centre were prospectively enrolled. A total of 259 women were interviewed and underwent clinical examination; 106 were enrolled and received syndromic STD treatment and 91% returned for follow up. Logistic regression analysis was used to identify risk factors associated with treatment failure. RESULTS: Of the 106 women enrolled and presenting with symptomatic STDs 67% were HIV seropositive. Syndromic STD treatment did not result in clinical improvement in 30% of the women. Having genital ulcer disease, genital ulcer disease with genital discharge, genital warts, bacterial vaginosis and plasma HIV-1 load >10,000 copies RNA/ml or being HIV seropositive were all significantly associated with treatment failure. In multivariate analysis, however, only genital ulcer disease was significantly associated with treatment failure. CONCLUSION: In our setting, the association between HIV and genital ulcer disease caused by herpes may, therefore, be the reason for the failure of treatment.     

Phthirus pubis in a sexually transmitted diseases unit: a study of 14 years

BACKGROUND: There have been few epidemiologic studies of pubic lice in recent times, and the exact incidence is unknown. GOAL: The goal was to determine the trends of pubic lice infestation in a risk group of males and female prostitutes in an STD unit in Spain. STUDY DESIGN: This was a prospective 14-year study, from 1988 to 2001, of all patients attending the STD unit in Gijón (Asturias, Spain), investigating crab lice and other STDs. RESULTS: One hundred ninety-seven patients (2.2%) had pubic lice, with a male/female proportion of 1.8/1. The yearly infestation rate ranged from 1.3% to 4.6%. The mean age was 30.3 years, and 18.8% of patients were older than 35 years. There were more cases involving men who had sex with men (MSM) (P < 0.001) than those involving heterosexual men. Reinfestation occurred in 7.6% of patients, more often in males (P < 0.05) and mainly in MSM (P < 0.01). CONCLUSION: Infestation rates were stable during the period of study, with more older patients involved than reported previously, and infestation frequently was associated with STDs. MSM were infested and reinfested more often than heterosexual men, and in general reinfestations occurred more frequently in males than in females.     

The Bali STD/AIDS study: association between vaginal hygiene practices and STDs among sex workers

OBJECTIVES: To assess the association between genital cleansing practices and the prevalence of sexually transmitted diseases and of sexual health knowledge among female sex workers in Bali, Indonesia. METHODS: Low priced commercial sex workers (CSWs) participated in the Bali STD/AIDS Study, a 3 year educational project evaluating the effect of education on the subsequent use of condoms and the prevalence of STDs and AIDS. Structured interviews, genital evaluation, laboratory evaluation for STDs, and treatment were performed. Vaginal cleansing characteristics including frequency, type, and reasons for use, were evaluated. Associations between these characteristics and the presence of bacterial and viral genital infections were assessed. RESULTS: Of 625 female sex workers evaluated between May and July 1998, 99.1% used substances, such as soap and toothpaste, to clean the vagina at least daily, with 69.3% performing this after each intercourse. The women using such cleansers after each client did not differ from those using them once or less daily in education, AIDS and condom use knowledge, time working as a CSW, or number of clients in the previous day. However, they were younger than those using vaginal cleansers daily or less, and reported lower condom usage in the past week. Several genital symptoms, such as discoloured discharge and odour, were reported less by women with the highest frequency of vaginal cleanser use. Prevalence of genital infections in this population of women was substantial, with bacterial infections more prevalent than viral infections. Infections were not associated with the type of cleanser used, using a genital cleanser on the day of examination, or using a cleanser after each client versus daily or less, except for candida colonisation, which was more prevalent in women cleansing after each client (OR=1.87, 95% CI 1.21, 2.90). However, symptomatic candida vulvovaginitis (positive culture plus presence of symptoms) was not associated with the prevalence of genital cleansing. Women using genital cleansing in part for "infection avoidance" (39.7%) were more likely to have heard of STDs and AIDS, but were less knowledgeable about these infections, compared with women not citing this reason for genital cleansing. CONCLUSION: Commercial sex workers in low priced brothels in Bali have a high rate of genital infections, with lower rates of viral compared with bacterial infections. Genital cleansers, on a daily or after each intercourse schedule, are used routinely. Although genital cleansing after each intercourse was associated with fewer genital symptoms, the prevalence of STDs did not differ significantly based on this frequency, and the women's knowledge of STDs and AIDS was less than that of women cleansing less often. The effect of genital cleansing in general on STD and AIDS prevalence could not be assessed in this population owing to the lack of a non-cleansing cohort. Further study to elucidate the effect of vaginal cleansing practices on STD prevalence and resistance is needed.