Gonorrhea and female infertility in rural Uganda

Population decline induced by gonorrhoea and tuberculosis transmission: Micronesia during the Japanese occupation, 1919-45

The islands of Yap in Micronesia survived a period of severe depopulation during the Japanese occupation from 1919 to 1945. Using data from historical documents, supplemented by ethnographic evidence, we calibrate a simulation model that accounts for this phenomenon. Our model tracks the reproduction histories of a synthetic cohort of women in Yap, including effects of infertility due to gonorrhoea as well as tuberculosis mortality, and predicts the net reproduction rate (NRR). In this particular case and throughout history, human migrations and associated social and cultural interactions have frequently been accompanied by dramatic changes in patterns of disease transmission and substantial demographic consequences. Despite the broad emphasis on mortality as a measure of demographic consequences in the historical and contemporary literature, there are important instances where life expectancy at birth, fertility rates, and total population size are important demographic consequences. We find that gonorrhoea may have significantly contributed to depopulation during the Japanese occupation of Micronesia, due to repeated infections and high risk of sterility. Results of our model suggest that gonorrhoea alone could have reduced the net reproduction rate by 82%, whereas deaths from tuberculosis may have contributed to a 17% decline.

Fertility in Kenya and Uganda: a comparative study of trends and determinants

Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent, from some eight births per woman to around five. During the same period, fertility in Uganda declined by less than 10 per cent. An analysis of the proximate determinants shows that the difference was due primarily to greater contraceptive use in Kenya, though in Uganda there was also a reduction in pathological sterility. The Demographic and Health Surveys show that women in Kenya wanted fewer children than those in Uganda, but that in Uganda there was also a greater unmet need for contraception. We suggest that these differences may be attributed, in part at least, first, to the divergent paths of economic development followed by the two countries after Independence; and, second, to the Kenya Government's active promotion of family planning through the health services, which the Uganda Government did not promote until 1995.

HIV transmission through social and geographic networks in Uganda

Long distance drivers and prostitutes at trading centres and towns have been targeted as groups that engage in risky sexual behaviours that promote HIV transmission. While towns and stops along highways have been linked to HIV transmission, the role of small urban and rural centres have been overlooked. There is need to study socio-geographical mating networks because situations not deemed to be risky may be an important aspect of HIV transmission.

Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin

One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria. All gonococcal strains were isolated from appropriate pre-treatment swabs. Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates. In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15%. Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit. Seventy-three (100%) patients showed clinical cure and elimination of N. gonorrhoeae from the respective site of infection. Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females. No adverse reactions were reported by any patient. Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Seroepidemiological study of gonorrhoea in Ethiopian women. 2. Socioeconomic picture

OBJECTIVES

To determine aetiological factors associated with the prevalence of gonorrhoea in Ethiopian women to enable subsequent formulation of intervention policies.

SUBJECTS

1851 Ethiopian women: 50% symptomatic, 50% asymptomatic.

SETTING

Gynaecological outpatient departments, antenatal, postnatal and family planning clinics (Ethiopian Family Guidance Association (EFGA)), in two teaching hospitals and a mother and child health centre in Addis Ababa, Ethiopia.

METHODS

Using the indirect haemagglutination test with gonococcal pilus antigen, sera were tested for the presence of gonococcal antibodies indicating past or present infection. The socioeconomic facts were analysed against gonococcal seropositivity of these women.

RESULTS

Gonococcal infection was associated with very early age at first marriage and first coitus, more than one sexual partner and marital status/profession. The highest prevalence and titres were found in bargirls (100%) prostitutes (89%) and sellers of local beer (85%). The lowest prevalence and titres were found in the highest income group, those married over the age of 18 years, those with only one husband or sexual partner, and those with a sexual life of less than 5 years duration.

CONCLUSIONS

National measures which could contribute to reduction and control of gonorrhoea include effective raising of the age of first marriage and first coitus, as has already been defined by law; the education of all girls up to fifth grade or equivalent; the provision of financial support to prevent widows and divorcees from drifting into prostitution; regular health checks and treatment of prostitutes; and education of men. While gonorrhoea per se is a major public health problem, our findings must have serious implications in the wider context of possible transmission of HIV through the community.

The significance and scope of reproductive tract infections among Third World women

Due to biomedical, behavioral and societal factors, reproductive tract infections are widespread in the Third World. Without early diagnosis and accurate therapy, their complications severely compromise women's health, fertility and productivity; infant health and survival; and the effectiveness of family planning programs. Clinicians and public health planners can address these treatable syndromes through research and services in socially acceptable settings including family planning, prenatal and MCH clinics. Specific approaches are discussed.

Sexually transmitted diseases among randomly selected attenders at an antenatal clinic in The Gambia

One hundred randomly selected women attending a free government antenatal clinic in the town of Bakau, The Gambia, were examined. Vaginal swabs were taken for microscopical examination for Trichomonas vaginalis and for culture on Sabouraud's medium. Cervical swabs were taken for culture of Neisseria gonorrhoeae and Chlamydia trachomatis and, in 50 cases, Herpesvirus hominis; in addition, urethral swabs were taken for culture of N gonorrhoeae. Serum samples were tested for antibodies to Treponema pallidum by the Venereal Diseases Research Laboratory (VDRL) test and T pallidum haemagglutination assay (TPHA), and to C trachomatis and H hominis by microimmunofluorescence. The prevalence of infection with Candida albicans was found to be 35%, T vaginalis 32%, C trachomatis 6.9%, N gonorrhoeae 6.7%, T pallidum 1%, and H hominis 0%. IgG antibodies at a titre of at least 1/16 to C trachomatis serotypes D-K were found in 29.4%, and to serotypes A-C in a further 10.6%. IgG antibodies at a titre of at least 1/16 to H hominis type I were found in 94%, and to type II in 53%, although a proportion of the latter probably represent cross reacting antibodies to type I.

Sexually transmitted diseases and infertility

In the past decade, involuntary childlessness has become a major problem in many areas of the world. At the same time evidence confirms a link between sexually transmitted diseases (STDs) and the burgeoning infertility problem. STDs can adversely affect fertility by three primary mechanisms: (1) pregnancy wastage; (2) neonatal deaths; and (3) obstruction of either male or female reproductive ducts. STD control programs have been effective in preventing sequelae of disease, including infertility. The first step in developing such a program is to identify the magnitude and distribution of the problem, and to identify the specific agents most commonly involved. Subsequently, an STD control program emphasizing the prevention of infertility, can be incorporated into the existing health care system whenever STDs are an important cause of infertility.