Validation of diagnostic algorithms for syndromic management of sexually transmitted diseases

Objective To validate our revised syndromic algorithms of the management of sexually transmitted diseases and determine their sensitivity,specificity,positive predictive value and cost-effectiveness.Methods Patients with either urethral discharge,vaginal discharge or genital ulcer,were selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province,China,They were managed syndromically according to our revised flowcharts.The etiology of the syndromes was detected by laboratory testing.The data were analyzed using EPI INFO V6.0 software.Results A total of 736 patients were enrolled into the study.In male patients with urethral discharge,the sensitivities for gonococcal and chlamydial infections were 96.7% and 100%,respectively,using the syndromic approach.The total positive predictive value was 73%.In female patients with vaginal discharge,the sensitivity was 90.8%,specificity 46.9%,positive predictive value 50.9%,and negative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach.In patients with genital ulcer,the sensitivities were 78.3% and 75.8%,specificities of 83.6% and 42.9%,and positive predictive values of 60.0% and 41.0% for the diagnosis of syphilis and genital herpes, respectively,using the syndromic approach,Cost-effectiveness analysis indicated that the average cost of treatment for a patient with urethral discharge was RMB 46.03 yuan using syndromic management,in comparison with RMB 149.19 yuan by etiological management.Conclusions The syndromic management of urethral discharge was relatively effective and suited clinical application.The specificity and positive predictive value for syndromic management of vaginal discharge are not satisfactory.The revised flowchart of genital ulcer syndrome could be suitable for use in clinical settings.Further validation and revision are needed for syndromic approaches of vaginal discharge and genital ulcer.     

Evaluation of antiretroviral therapy results in Blantyre,Malawi

We performed a cross sectional study to evaluate treatment results of the paying antiretroviral therapy clinic of Queen Elizabeth Central Hospital, Blantyre. The only antiretroviral therapy was a fixed drug combination of stavudine, lamivudine and nevirapine.

Methods

Interviews, laboratory tests (CD4 count, viral load, nevirapine plasma levels, transaminases) and data extraction from files. 422 (59 %) of the patients who started antiretroviral therapy since 2000 were lost to follow up. The 176 patients enrolled in the study had good virological and excellent clinical treatment results. The most common side effect was peripheral neuropathy. Nevirapine plasma levels were remarkably high and associated with successful virological treatment results. Two simple adherence questions pertaining to the use of medication in the previous 8 days corresponded well with nevirapine levels. The most important reasons for non-adherence were shortage of drugs in the hospital pharmacy and personal financial constraints.

Conclusions

1. Many patients were lost to follow up.
2. High nevirapine levels contributed to good therapy results in those studied.
3. Simple adherence questions predicted sub-therapeutic nevirapine levels.
4. Antiretroviral drug supply needs to be uninterrupted and free of charge, to prevent avoidable non-adherence.

     

性传播感染知识（二）——男性性传播感染的主要表现

由于生殖器解剖结构的差异，男性与女性在患性传播感染疾病（如淋病和衣原体感染）时的表现不同，本文主要讨论男性尿道、附睾、睾丸和前列腺的感染。肛门和口也会有症状，因为这些症状在男性更常见，尤其是发生在男同性恋者中。     

Evaluation and management of selected sexually transmitted diseases

Sexually transmitted diseases (STDs) represent some of the oldest and most prevalent infectious diseases of humans. Currently and with changes in lifestyles, the short list of STDs has grown to currently comprise 21 different infections and infestations. In this review, we concentrate on those infections that are common and which require special approach and handling. Gonorrhea and nongonococcal urethritis comprise more than half of STDs. The approach and management of these patients is briefly outlined. The important role contact tracing and education play in improving preventive practices of these infections is emphasized. Syphilis is presented in a simplified approach touching on presentation, diagnosis and treatment.     

Treatment of sexually transmitted chlamydial infections

Tetracycline hydrochloride, 500 mg orally four times a day for seven days, remains the treatment of choice for C trachomatis infections in men and nonpregnant women. Either erythromycin, 500 mg orally four times daily for seven days, or an equivalent dosage of another erythromycin product is an alternative treatment for patients who cannot tolerate tetracycline and for pregnant women. These two treatment regimens can be generalized to include nongonococcal urethritis and mucopurulent cervicitis. However, other treatment regimens that are effective against C trachomatis may not be effective for treating nongonococcal urethritis or mucopurulent cervicitis not caused by C trachomatis. The optimal treatment for pregnant women with C trachomatis infections and women with acute PID has not been established. Additional treatment trials with both groups of patients are needed to determine the effectiveness of antimicrobial agents in addition to those currently used, to establish the appropriate dose of each antimicrobial agent, and to clarify the appropriate duration of treatment. All individuals who are sexual partners of patients with nongonococcal urethritis, mucopurulent cervicitis, and acute PID (within the 30 days prior to onset of their symptoms or time of positive clinical evaluation findings) should be examined for sexually transmitted disease and treated promptly with a regimen effective against uncomplicated gonorrhea and chlamydial infections. Prompt treatment of sexual partners reduces the rate of treatment failure due to reinfection, reduces the transmission of infection, and reduces the frequency of occurrence of adverse sequelae of infection.     

瑞士日内瓦的性传播疾病发病率增加

背景:据报道,过去几年间在西欧的一些大城市性传播疾病(如梅毒和淋病)出现局部爆发。本研究旨在明确在日内瓦是否亦有相似的发病趋势,以及有关H IV感染的情况。方法:回顾1999—2004年间日内瓦的梅毒、淋病、沙眼衣原体及H IV感染的发病率。结果:图表显示1999—2004年间日内瓦的     

Changing patterns of sexually transmitted infections in India

Sexually transmitted infections (STIs) are more dynamic than other diseases prevailing in the community. Their epidemiological profile varies from country to country and from one region to another within a country, depending upon ethnographic, demographic, socioeconomic and health factors. The clinical pattern is also a result of the interaction among pathogens, the behaviours that transmit them and the effectiveness of preventive and control interventions. We reviewed the changing patterns of different STIs (excluding HIV infection) in India and their various risk factors. A MEDLINE search was undertaken using the key words 'sexually transmitted infections, epidemiology, India'. Related articles were also searched. In addition, a manual search for many Indian articles, published in journals that are not indexed was also carried out. Wherever possible, the full article was reviewed. If the full article could not be traced, the abstract was used. Most of the published data are institution based. There is a paucity of community-based data, except for information obtained from high risk groups such as commercial sex workers, truck drivers, hotel workers and drug abusers. From the literature search undertaken, it was observed that during the 1960s and 1970s, bacterial infections including syphilis, chancroid and gonorrhoea were the major STIs, while viral infections caused by herpes simplex virus and human papillomavirus were so rare that they merited publication as case reports. Since the 1980s, the spread of human immunodeficiency virus (HIV) with subsequent behavioural (sexual and healthcare) change, the indiscriminate and prophylactic use of over-the-counter broad-spectrum antibiotics, upgradation of health services at the primary level and the success of 'syndromic' approach of treatment, has resulted in major changes in epidemiological patterns. As in developed countries, there has been a rise in viral and chlamydial infections and a relative fall in the incidence of traditional infections. This has forced a reappraisal of the importance of sexual and healthcare behaviours, since the control of incurable viral STIs depends to a great extent on societal efforts at primary prevention and counselling rather than their early diagnosis and treatment, which is an effective strategy against curable bacterial STIs.     

545例性病门诊女性就诊者性传播感染的临床调查

目的探讨性传播感染的流行病学特点,为合理防治女性性传播感染提供依据。方法对性病门诊女性就诊者进行临床流行病学调查和实验室检查。结果545例就诊者中,支原体、梅毒和尖锐湿疣（CA）的感染率分别为66.42％、25.69％和20.18％;≥40岁者和＜40岁者、初中及以下学历者和高中及以上学历者的梅毒感染率分别为33.50％、21.16％、33.01％和15.88％。仅5.00％的梅毒患者出现皮损。结论性病门诊女性就诊者的支原体、梅毒和CA的感染率较高,其中梅毒以隐性感染为主。≥40岁者、低学历者的梅毒感染率明显高于＜40岁者、学历相对高者。     

阴道分泌物——原因、诊断及治疗

阴道分泌物是医生在许多医疗服务(初级保健、妇科学、计划生育和泌尿生殖医学)中常见的一个症状。阴道分泌物可以是生理性的，也可以是病理性的。尽管异常的阴道分泌物常促使妇女去进行性传播感染(STIs)疾病的筛查，但阴道分泌物不足以预测STI是否存在。本文重点论述阴道分泌物的原因、诊断以及最常见感染病因的治疗。     

Self-reported sexually transmitted infections among female university students

Aim

To investigate the occurrence of self-reported sexually transmitted infections (STIs) and associated factors among female university students requesting contraceptive counselling.

Material and methods

Cross-sectional study. Female university students (n = 353) completed a waiting-room questionnaire in connection with contraceptive counselling at a Student Health Centre in Uppsala, Sweden.

Results

Ninety-three (26.3%) female students had experienced an STI. The three most frequently reported STIs were chlamydia trachomatis, condyloma, and genital herpes. The experience of an STI was significantly associated with the total number of sexual partners (OR 1.060, 95% CI 1.030–1.091, P < 0.001), being heterosexual (OR 4.640, 95% CI 1.321–16.290, P = 0.017), having experienced an abortion (OR 2.744, 95% CI 1.112–6.771, P = 0.028), not being HPV-vaccinated (OR 2.696, 95% CI 1.473–4.935, P = 0.001), and having had intercourse on first night without using a condom (OR 2.375, 95% CI 1.182–4.771, P = 0.015).

Conclusions

Contraceptive counselling should also include information about primary and secondary prevention of STI, such as the importance of correct use of a condom and STI testing, to prevent a further spread of STIs.