Acute cytomegalovirus proctitis and epididymitis acquired via sexual transmission in an immunocompetent patient: a case report

BACKGROUND

We present a case report of an immunocompetent host with presumed sexually transmitted cytomegalovirus proctitis and epididymitis, where there currently is a sparsity of published data.

CASE PRESENTATION

A 21-year-old previously healthy Caucasian individual was admitted for severe rectal and testicular pain in the setting of proctitis and epididymitis. Serology and rectal pathology confirmed acute primary cytomegalovirus infection.

CONCLUSIONS

This report details his diagnostic workup and highlights cytomegalovirus as a rare cause of sexually transmitted disease among immunocompetent persons.

Neisseria gonorrhoeae infection in female sex workers in an STI clinic in Nairobi, Kenya

Background

Gonorrhea caused by Neisseria gonorrhoeae is the second most prevalent curable sexually transmitted infection worldwide. Female Sex Workers (FSWs) are at a higher risk of contracting gonorrhea due to their risky sexual behaviors like inconsistent condom use and multiple sexual partners. We determined the prevalence and risk factors associated with gonorrhea and its antimicrobial susceptibility pattern among symptomatic FSWs attending Sexual Workers Outreach Program (SWOP) city clinic in Nairobi, Kenya.

Methods

Using convenience sampling, we recruited 379 female sex workers from SWOP City clinic in Nairobi County. We administered a semi-structured questionnaire to collect data on socio-demographics and behavioral risk factors associated with gonorrhea. We also conducted three focus groups. Two endocervical swabs were collected from each participant by the attending physician for the laboratory identification of Neisseria gonorrhoeae. An antimicrobial susceptibility test was performed using the disc diffusion method.

Results

Twenty-four out of 379 (6.3%) participants tested positive for gonorrhea by PCR. The significant risk factors associated with gonorrhea were having multiple sexual partners in the previous two weeks, primary education, and being in the age group of 38–49 years (p < 0.05).

From the qualitative data, sex work disclosure, and difficulty in engaging protected sex with their partner, and unprotected sex with their clients due to more money from the client, PREP, and alcohol use made the female sex workers vulnerable to gonorrhea exposure and or risky sexual behavior. The culture-positive sample result yielded complete (100%) resistance to all the antimicrobials used.

Conclusion

Neisseria gonorrhoeae infection is prevalent among symptomatic FSWs in Nairobi. Multiple sexual partners, being in age group 38–49 years and having primary education were the factors associated with gonorrhea among the study participants. Based on our identification of a highly resistant isolate, we strongly recommend increasing capacity for culture-based diagnosis and susceptibility testing.

Determinants of knowledge on sexually transmitted infections among students in public higher education institutions in Melaka state, Malaysia

Introduction

The increasing trend of sexually transmitted infections (STIs) among the young population is a significant public health problem. This study aimed to determine the level of knowledge on STIs among students in higher education institutions and its predicting factors, in Melaka.

Methodology

A cross-sectional study was conducted among 600 students from higher education institutions in Melaka aged between 18 to 30 years old. Multistage sampling of the institutions was performed. Valid and reliable self-administered questionnaire in the national language, Bahasa Malaysia, was used as to collect data on sociodemographic, personal background, knowledge on STIs and sources of information for STIs. Univariate, bivariate and multivariate analyses were conducted using IBM SPSS software version 25.

Results

The response rate for this study was 88%. The mean knowledge score was 24.1 ±5.1 out of 38. HIV was the most known STIs while gonorrhoea, trichomoniasis and chlamydial infections were among the least known STIs. Oral intercourse was the least known sexual activity that could transmit STIs. Higher proportion of respondents had correct knowledge on control and preventive measures of STIs (between 78% and 95%) compared to correct knowledge on sign and symptoms of STIs (between 8.5% and 67.8%). More than 90% of the respondents were unaware that a person infected with STIs could be symptom free. Four variables were identified as the determinants of the knowledge on STIs, which were level of education, place of stay, history of sexual and reproductive health education and involvement in STIs awareness programs (F (4,445) = 11.405, p <0.001, R² = 0.093).

Conclusions

The knowledge on STIs among students in higher education institutions was unsatisfactory. The existing sexual education programs can be strengthened by delivering more information on other STIs rather than focusing on HIV only. The future program should focus on students of diploma and/or skill certificate and staying off-campus.

Burden of preconception morbidity in women of reproductive age from an urban setting in North India

Background

There is a growing interest in the life course approach for the prevention, early detection and subsequent management of morbidity in women of reproductive age to ensure optimal health and nutrition when they enter pregnancy. Reliable estimates of such morbidities are lacking. We report the prevalence of health or nutrition-related morbidities, specifically, anemia, undernutrition, overweight and obesity, sexually transmitted infections (STIs) or reproductive tract infections (RTIs), diabetes or prediabetes, hypothyroidism, hypertension, and depressive symptoms, during the preconception period among women aged 18 to 30 years.

Methods

A cross-sectional study was conducted among 2000 nonpregnant married women aged 18 to 30 years with no or one child who wished to have more children in two low- to middle-income urban neighborhoods in Delhi, India, in the context of a randomized controlled trial. STIs and RTIs were measured by symptoms and signs, blood pressure by a digital device, height by stadiometer and weight by a digital weighing scale. A blood specimen was taken to screen for anemia, diabetes, thyroid disorders and syphilis. Maternal depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression analysis was performed to identify sociodemographic factors associated with individual morbidity.

Results

Overall, 58.7% of women were anemic; 16.5%, undernourished; 26%, overweight or obese; 13.2%, hypothyroid; and 10.5% with both symptoms and signs of STIs/RTIs. There was an increased risk of RTI/STI symptoms and signs in undernourished women and an increased risk of diabetes or prediabetes in overweight or obese women. An increased risk of undernutrition was also observed in women from lower categories of wealth quintiles. A decreased risk of moderate to severe anemia was seen in overweight women and those who completed at least secondary education.

Conclusions

Our findings show a high burden of undernutrition, anemia, RTIs, hypothyroidism and prediabetes among women in the study. This information will aid policymakers in planning special programs for women of reproductive age.

Associations of sexually transmitted infections and bacterial vaginosis with abnormal cervical cytology: A cross-sectional survey with 9090 community women in China

Background

Although it is well acknowledged that persistent infection with high-risk human papillomavirus types in genital sites plays a crucial role in the development of squamous cell cervical carcinoma, there is no unanimous consensus on the association between non-HPV sexually transmitted infections and abnormal cervical cytology.

Methods

In the present study, we evaluated cervical cytology status, sexually transmitted infections and bacterial vaginosis status, and collected social-demographic information among recruited participants to explore the association of STIs and bacterial vaginosis with abnormal cervical cytology.

Results

9,090 women’s specimens were successfully tested, with a total of 8,733 (96.1%) women had normal cytology and 357 (3.9%) women exhibited abnormal cytology. The prevalence of HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, and bacterial vaginosis was significantly higher in the ≥ASC-US group than the NILM group (P<0.05). Women with Neisseria gonorrhoeae infection (AOR = 5.30, 95% CIs = 1.30–21.51, P = 0.020) or bacterial vaginosis (AOR = 1.94, 95% CIs = 1.08–3.47, P = 0.026) exhibited an increased risk of abnormal cervical cytology after adjusted for carcinogenic HPV-positive status.

Conclusions

Our results demonstrated that Neisseria gonorrhoeae infection in genital sites and/or bacterial vaginosis may independently increase the risk for cervical cytology abnormalities after adjusted for carcinogenic HPV-positive status. Besides, these results improved our understanding of the etiology of abnormal cervical cytology and may be useful for the management of women with ASC-US cytology.

Oral Transmission of Sexually Transmissable Infections: A Narrative Review

Over the last few decades, behavioral changes in sexual practices have made oral transmission of traditional sexually transmissible infections increasingly recognized. Patients harboring a sexually transmissible infection may first present lesions on the oral cavity, as these may be visible and interfere with basic functions such as speech or swallowing. Moreover, the oral cavity may function as a reservoir for future spread of these infections. In order to successfully control this problem, a greater focus on oral sex should be persued, along with promotion of the use of condom and education on safe oral sex practices. Furthermore, examination of the oral cavity should is essential when evaluating any patient suspected of harboring a sexually transmissible infection. In this article, oral transmission of several viral and bacterial infections is reviewed, including human papillomavirus infection, genital herpes, syphilis and gonorrhea, among others.

Problems of Adolescents Sexuality

Recent discussions highlighted adolescents’ sexual behaviour, but published studies concentrate on specific problems or subgroups of patients without addressing factors related to sexuality. To obtain a broad picture we studied two groups of adolescents attending genito-urinary medicine/sexually transmitted disease (STD) clinics in contrasting areas of Britain, inner London and Swansea. These were evaluated for referral pattern, sexual partner, contraception, obstetric history, sexually transmitted disease, and cervical cytology findings.

Over half the adolescents referred themselves but few doctors other than general practitioners referred patients. Sexual partners were regarded by males as casual but by females as regular. Only 66% (81) of females practised contraception. Adolescents had more STD's than the total clinic population except for genital herpes simplex infection, and a high prevalence of genital warts in females has important future implications.

The main conclusions were that there is a need for sexually related education targetted at adolescents and their health care providers, especially doctors.

Sexually transmitted infections of the lower gastrointestinal tract

The World Health Organization estimates that there is greater than one million new cases of sexually transmitted infections (STIs) every day. In many countries, STIs are at an unprecedented high, including the USA, where nearly 20 million new cases were reported in 2016. Although morbidity associated with STIs is usually seen in the context of genitourinary disease, these pathogens may also affect the gastrointestinal tract and cause anal pain, abdominal pain, or diarrhea. It is important to recognize patterns of injury associated with these pathogens, especially those that may mimic other gastrointestinal diseases, such as idiopathic inflammatory bowel disease (IBD). This review focuses upon STIs of the lower gastrointestinal tract, organized by the most common site of involvement: the anus, rectum, and colon.

Underserved populations and bacterial and protozoal sexually transmitted infections: a lost health-care opportunity

OBJECTIVE

The purpose of our review is an update about the burden of sexually transmitted infections (STIs) among various types of underserved populations, such as migrants, substance abusers, homeless and incarcerated inmates. First-line test and treatment based on the latest available evidence according to the revised guidelines of Centers for Disease Control and Prevention have also been considered.

MATERIALS AND METHODS

We performed a comprehensive research using scientific databases such as Medline and Pubmed, followed by a review of citations and reference list. A consultation with other experts in the management of the various subpopulations was also conducted.

RESULTS

Health-care is often influenced by social determinants, which play a vital role in the diffusion of STIs. The consequence is a socio-economical and ethnic disparity in the rate of STIs. Early screening and treatment of STIs should be implemented in clinical practice, starting from marginalized social groups, which are the most affected by this health problem.

CONCLUSIONS

In the literature, there are very few papers containing information on STIs prevalence in various types of underserved populations, such as migrants, substance abusers, homeless and incarcerated inmates. The availability of more accurate epidemiological data is needed. In these groups, the most relevant barrier is the lower perception of health-care need, with an underestimation of risk and symptoms of STIs, causing a retard of diagnosis and health-care provision and use. For these populations, targeted interventions are needed, particularly on unaware people, responsible for most STIs transmissions.

Diagnosis of trichomoniasis in men by urine cytology

BACKGROUND

Trichomonas vaginalis is a rare finding in urine cytology specimens, especially those from men; only 2 case reports have been described in the literature. The authors of the current report sought to determine the incidence and clinical significance of this finding in urine cytology in males.

METHODS

The authors' cytopathology archives were queried for urine cytology specimens that contained Trichomonas over a 30-year period. Clinical information from men with Trichomonas-positive urines was reviewed retrospectively. Slides were reviewed, and the morphologic characteristics of the organisms were recorded.

RESULTS

Trichomonas was detected in 73 of 60,000 urine cytology specimens (0.1%). The patients included 45 women and 28 men. Men with Trichomonas in their urine ranged in age from 28 to 87 years (mean age, 67 years; median, 71 years). Trichomonas organisms were round to oval, with eccentric nuclei and cytoplasmic granules. Acute inflammation was observed in 6 of 7 cases. Clinical history was available in 13 of 28 men. Lower urinary tract symptoms were reported in 10 of 13 men, most commonly hematuria; and urethral strictures were identified by cystoscopy in 3 of 13 men. Clinical follow-up was available for 10 of 13 patients; of these, 8 (80%) had received treatment with metronidazole based on urine cytology results.

CONCLUSIONS

This study is the largest series of Trichomonas infection in men diagnosed by urine cytology in the literature. Most men had no prior diagnosis of trichomoniasis and received specific antibiotic therapy based on their urine cytology results. Urine cytology may represent the initial diagnostic test for Trichomonas in men, and accurate cytologic diagnosis may prevent undesired adverse outcomes for them and their partners. Cancer Cytopathol 2017;125:55-59. © 2016 American Cancer Society.

Fatal attraction: sex, sexually transmitted infections and HIV-1

The predominant mode of HIV-1 transmission globally is from sexual practices. The risk of HIV-1 transmission by sexual means is a function of infectivity, susceptibility and mode of transmission (type of sexual practice). In addition, transmission may be enhanced by the presence of sexually transmissible infections (STIs). An understanding of the interplay between sexual practices, STIs and HIV-1 may facilitate the development of effective treatment and prevention strategies. These topics are the subject of this review.

Associated Risk Factors of STIs and Multiple Sexual Relationships among Youths in Malawi

BACKGROUND

Having unprotected sex with multiple sexual partners (MSP) is the greatest risk factor for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among youths. Young people with MSPs are less likely to use a condom and the greater the risk for STIs. This study examines the associated risk factors of STIs and multiple sexual partnerships among youths aged 15-24 years.

DATA AND METHODS

The Malawi Demographic Health Survey 2010 data was used. Out of a sample of 2,987 males and 9,559 females aged 15-24 years, 2,026 males and 6,470 females were considered in the study. Chi square test and logistic regression techniques were performed. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.

FINDINGS

The results indicate that 1,399 (69.0%) males and 2,290 (35.4%) females reported multiple sexual partnerships (MSP). Within the rural area, females (n = 1779) were more likely to report MSP than males (n = 1082) and within the urban areas, a higher proportion of females (n = 511) still reported MSP, with males (n = 316). About 78% rural females aged 20-24 years, and about 79% rural males aged 15-19 years reported MSP. The likelihood of MSP was higher among females in the poorest households (OR = 1.31), being married (OR = 5.71) and Catholic males (OR = 1.63), who were married (OR = 1.59). Catholic males (OR = 1.82) in the rural areas, who were married (OR = 1.80) and rural females in the northern region (OR = 1.26) were more likely to have MSP. The odds ratios were higher among urban females in the poorest (OR = 3.45) households who were married (OR = 4.22).

CONCLUSIONS

Having more than one sexual partner increases the risk of STIs and sexuality education programs should be introduced that emphasize the danger that surrounds MSP.

The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa

BACKGROUND

Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women.

METHODOLOGY/PRINCIPAL FINDINGS

Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes.

SIGNIFICANCE

This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

Interruption of CXCL13-CXCR5 axis increases upper genital tract pathology and activation of NKT cells following chlamydial genital infection

BACKGROUND

Regulation of immune responses is critical for controlling inflammation and disruption of this process can lead to tissue damage. We reported that CXCL13 was induced in fallopian tube tissue following C. trachomatis infection. Here, we examined the influence of the CXCL13-CXCR5 axis in chlamydial genital infection.

METHODOLOGY AND PRINCIPAL FINDINGS

Disruption of the CXCL13-CXCR5 axis by injecting anti-CXCL13 Ab to BALB/c mice or using Cxcr5-/- mice increased chronic inflammation in the upper genital tract (UGT; uterine horns and oviducts) after Chlamydia muridarum genital infection (GT). Further studies in Cxcr5-/- mice showed an elevation in bacterial burden in the GT and increased numbers of neutrophils, activated DCs and activated NKT cells early after infection. After resolution, we noted increased fibrosis and the accumulation of a variety of T cells subsets (CD4-IFNγ, CD4-IL-17, CD4-IL-10 & CD8-TNFα) in the oviducts. NKT cell depletion in vitro reduced IL-17α and various cytokines and chemokines, suggesting that activated NKT cells modulate neutrophils and DCs through cytokine/chemokine secretion. Further, chlamydial glycolipids directly activated two distinct types of NKT cell hybridomas in a cell-free CD1d presentation assay and genital infection of Cd1d-/- mice showed reduced oviduct inflammation compared to WT mice. CXCR5 involvement in pathology was also noted using single-nucleotide polymorphism analysis in C. trachomatis infected women attending a sub-fertility clinic. Women who developed tubal pathology after a C. trachomatis infection had a decrease in the frequency of CXCR5 SNP +10950 T>C (rs3922).

CONCLUSIONS/SIGNIFICANCE

These experiments indicate that disruption of the CXCL13-CXCR5 axis permits increased activation of NKT cells by type I and type II glycolipids of Chlamydia muridarum and results in UGT pathology potentially through increased numbers of neutrophils and T cell subsets associated with UGT pathology. In addition, CXCR5 appears to contribute to inter-individual differences in human tubal pathology following C. trachomatis infection.

Cytology and clinical spectrum of sexually transmitted infections in Lebanese women as revealed by Pap smear: a cross-sectional study from 2002-2006

To study the cytology profile of cervical smears and the respective prevalence and incidence of certain cervico-vaginal infections detectable by routine Pap smear cytology in Lebanese women from 2002 to 2006. Pap smear cytology results were compiled from the archives of the Institut National de Pathologie for the period extending from 2002 until 2006. This study covered 118,230 cervical specimens obtained from Lebanese women attending clinics and hospitals in all the five districts of Lebanon; prevalence and incidence rates for infections detectable by routine Pap smear examination were determined. A rise in prevalence of these infections by 2.1 percent (2,555) from 2002 to 2006 was revealed. A doubling of Pap smears showing HPV-associated changes was detected (1.4 percent in 2002 to 2.9 percent in 2006), and a simultaneous almost 7-fold increase of Atypical Squamous Cells of Undetermined Significance (ASCUS) cytology was detected during this period; the rise in ASCUS cytology was age-dependent. Moreover, a 60 percent increase in prevalence of bacterial vaginosis (2.3 percent in 2002 to 3.7 percent in 2006) and a more than 3-fold decline in Trichomonas vaginalis infection (1 percent in 2002 to 0.3 percent in 2006) were also noted in this population during this period. An increase in the prevalence and incidence of cervico-vaginal infections detectable by Pap smear cytology in Lebanese women was revealed from 2002 to 2006. Such changes could point to recent modifications of sexual and health behaviours in the Lebanese community.

Perianal dermatoses among men who have sex with men: A clinical profile of 32 Indian patients

INTRODUCTION

A wide range of perianal dermatoses including different forms of sexually transmitted infections can occur in men who have sex with men (MSM).

OBJECTIVE

To determine the relative frequencies and types of perianal lesions in a group of men from eastern India who had a history of receptive anal intercourse.

METHODS

This was a cross-sectional clinical observational study. Consecutive MSM, presenting with perianal symptoms to the Sexually Transmitted Disease clinic of a tertiary care hospital of eastern India were studied.

RESULTS

A total of 32 patients (age 15-54 years, mean 38.5 years) were evaluated. Perianal wart was the most common (16, 50%) lesion detected, followed by fissure (3, 9.4%), herpes simplex infection (2, 6.2%), molluscum contagiosum (2, 6.2%), abscess (1, 3.1%), condyloma lata (1, 3.1%), candidiasis (1, 3.1%), furuncle (1, 3.1%), gonococcal infection (1, 3.1%), irritant contact dermatitis (1, 3.1%), and perianal psoriasis (1, 3.1%). Two patients had perianal tuberculosis. Four patients (12.5%) were HIV positive and syphilis was found in one.

CONCLUSION

A variety of dermatoses and infections can present in the perianal area of MSM, the most common being perianal wart. A thorough genital and perianal exam should be a part of a physical examination in these patients.

[The many manifestations of Behçet's disease]

A 19-year-old woman with a Syrian background complained of genital ulcers. Sexually transmitted disease was excluded. She was also suffering from oral aphthae and had been treated by a dermatologist for acne. The diagnosis of Behçet disease was made primarily on clinical grounds. Pathological examination of skin biopsies confirmed the diagnosis. The patient was successfully treated with corticosteroids. Behçet's disease is a chronic autoimmune vasculitis, often characterized by oral ulcers. The symptoms are often non-specific and the disease has exacerbations and remissions. This often makes its diagnosis difficult. Its exact cause is unknown but the immune system and genetic factors may play a role. Although diagnosis is made mainly on clinical grounds, laboratory tests and pathology examination may contribute to the establishment of the differential diagnosis.

[Abnormal cervicovaginal cytology in women with rheumatoid arthritis]

BACKGROUND

Patients with rheumatoid arthritis (RA) are at increased risk of infections and cancer. A link between RA and abnormal cervicovaginal cytology has rarely been reported.

OBJECTIVE

The aim of this study was to review cervicovaginal cytology results in women with RA and compare them with a control population. Sexual behavior also was investigated.

MATERIAL AND METHOD

Cervicovaginal cytology results of 95 women with RA were compared to those of a control population of 1,719 women attending at the same hospital and followed until June 2009. Records of RA patients were reviewed to obtain clinical data, particularly sexual behavior.

RESULTS

Of 95 RA patients, 13/95 had an abnormal cervicovaginal cytology result, compared with 120/1,719 controls. Twelve/13 had squamous intraepithelial lesions (SIL), compared with 27/120 controls. There was no significant difference in sexual partners between women with RA and controls. Women with RA without abnormal cervicovaginal cytology had less sexual partners than those with RA and abnormal cytology. Two women with RA and abnormal cervicovaginal cytology had a history of condylomata and herpes genital. Three/13 women with RA developed abnormal cervicovaginal cytology after 12 to 36 months initiating their illness. None from them had ever received immunosuppressants.

CONCLUSIONS

Women with RA have an increased prevalence of abnormal cervical cytology, compared with a control population. It may be related to chronic inflammatory disease and sexual behavior.

[Leucoplakia vesicae in females: diagnosis and treatment]

Sixty patients suffering from leucoplakia vesicae (LV) were examined using cystoscopy with biopsy of the urinary bladder wall, blood enzyme immunoassay for detection of antibodies to agents of sexually transmitted infections (STI), uroflowmetry, culture analysis of cervical canal and mucosa samples for STI. As shown by a pathomorphological examination of the vesical mucosa biopsy specimens, long-term persistence of pathogenic (chlamydia, trichomonades) and opportunistic (mycoplasma, ureaplasma, fungi) flora underlies development of LV. Morphogenesis of LV is characterized by hyperplastic reactions of urothelium and its metaplasy in laminated squamous keratosic epithelium, often with para- and dyskeratosis, developing in the presence of inflammatory reactions in the lamina in the presence of persisting infection. In LV, specific infection agents are often found in the urogenital tract. The spectrum of these agents is identical for samples from the cervical canal and vesical mucosa from leucoplakia foci. Vesical mucosa is most frequently contaminated with Mycoplasma hominis (57.2%), Candida albicans (51.4%), Ureaplasma urealiticum (37.1%) and Trichomonas vaginalis (22.9%). Associations of the infection agents are detected in 70% of LV patients. Persistent dysuria is a basic clinical symptom of leucoplakia. The following therapeutic measures should be taken: transurethral coagulation of the vesical mucosa, intravesical therapy, immunocorrection, antibacterial treatment by standard schemes or according to the isolated flora sensitivity.

American College Health Association annual Pap test and sexually transmitted infection survey: 2006

OBJECTIVE

The authors describe the cervical cytology and sexually transmitted infection (STI) testing patterns of US college health centers.

PARTICIPANTS AND METHODS

A total of 128 self-selected US college health centers-representing more than 2 million college students-completed an online survey during February and March 2007.

RESULTS

Almost 13% of cervical cytology results were abnormal; most of these were atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions. In women, 2.9% of chlamydia tests and 0.4% of gonorrhea tests were positive. Human immunodeficiency virus (HIV) and syphilis tests were positive in 0.1% and 0.3% of students tested, respectively. Herpes simplex virus type 1 (HSV-1) accounted for 59.9% of genital herpes infections.

CONCLUSIONS

College health centers are important sources for Pap and STI test data. Pap tests frequently yield low-grade abnormalities, and screening tests for chlamydia and especially gonorrhea are infrequently positive. Rates of HIV and syphilis in this population are low, raising concerns about positive predictive value when screening low-risk students. A majority of genital herpes infections are caused by HSV-1.

Connecting the dots: when the risks of HIV/STD infection appear high but the burden of infection is not known--the case of male Latino migrants in the southern United States

Between 1990 and 2000, the number of Latinos in Alabama, Arkansas, Georgia, North Carolina, South Carolina, and Tennessee, states that had no or small Latino populations in 1990, increased by more than 300% on average. Several of these states (referred to as rapid growth states) have high AIDS/STD case rates. Compared to Latinos in states with well-established Latino populations and Latinos nationwide, those in rapid growth states are more often males, young, foreign-born, and recent arrivals who travel without females. The typical Latino in rapid growth states is a young male migrant. Although these migrants may be at risk of HIV/STD infection, little is known about the risk factors that affect them. To clarify this picture, a database search was conducted to identify studies of HIV/STD infection and/or risk factors among rural and urban-based Latino migrants in the six rapid growth states. This qualitative review examines ten studies that were conducted in Alabama, Georgia, North Carolina, and South Carolina. Five of the studies screened for HIV and/or syphilis infection and provide some information on risk factors; five studies describe risk factors only. Most of those studies that describe risk factors provide evidence that male Latino migrants in rural and urban settings of rapid growth states are vulnerable to HIV/STD infection through heterosexual contacts. However, many of the studies fail to provide sufficient information on other risk factors, and all but one of the studies that screened migrants for HIV or STD infection were conducted between 1988 and 1991. There is an urgent need for updated information on HIV/STD infection and the social-behavioral and situational risk factors that affect male Latino migrants in rapid growth states of the South.

[Summary of the practice guideline 'Vaginal discharge' (first revision) from the Dutch College of General Practitioners]

The 1996 practice guideline of the Dutch College of General Practitioners (NHG) on vaginal discharge has been updated. Most women who visit their doctor with complaints about vaginal discharge do not have an increased risk of a sexually-transmitted disease. Investigations into vaginal discharge comprise history taking, physical examination and microscopic analysis in the laboratory of the general practitioner. Additional investigation into Chlamydia, gonorrhoea and Trichomonas infection is only necessary if the patient history reveals an increased risk of a sexually-transmitted disease. A Candida infection or bacterial vaginosis should only be treated if the patient experiences bothersome complaints. Treatment of a Candida infection consists of a vaginally applied imidazole compound. Bacterial vaginosis can be treated with oral administration of metronidazole. Patients with vaginal fluor can be examined and, if necessary, treated by their general practitioner. Referral to a gynaecologist is rarely necessary.

Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya

OBJECTIVE

The objective of this study was to assess the risk factors for and persistence of Mycoplasma genitalium (MG) in a highly exposed female population in Kenya.

STUDY DESIGN

Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age, were enrolled. Every 2 months, cervical samples were collected for MG, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by polymerase chain reaction.

RESULTS

At enrollment, 16% were infected with MG. Seventy-seven subjects acquired 107 MG infections, giving an incidence of 22.7 per 100 women-years. Incident CT (adjusted hazard ratio [HR] = 2.4; 95% confidence interval [CI] = 1.5-4.0), GC (HR = 2.0; 95% CI = 1.2-3.5), and HIV infection (adjusted HR = 2.2; 95% CI = 1.3-3.7) were associated with an increased risk of MG. Seventeen percent, 9%, and 21% of MG infections persisted 3, 5, and >or=7 months, respectively.

CONCLUSION

The high incidence of MG, greater than that for both CT (14.0%) and GC (8%), association with common sexually transmitted infection risk factors, and persistence in the female genital tract supports its role as a common sexually transmitted infection in Kenyan women.

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.

Low Prevalence of Penile Wetness Among Male Sexually Transmitted Infection Clinic Attendees in London

OBJECTIVE

To determine the prevalence of penile wetness among STI clinic attenders in London.

STUDY DESIGN

A total of 480 consecutive men were examined clinically to detect whether penile wetness, defined as the clinical observation of a uniform diffuse layer of moisture on the surface of the glans and coronal sulcus, was present.

RESULTS

Penile wetness was observed in 30 (6.3%), including 29 (8.3%) of uncircumcised and 1 (0.8%) of circumcised men (Relative risk 10.54 (95% CI 1.45-76.6, P = <0.001) (Fisher's Exact test) and in 14/34 (41.2%) of men with balanitis. Penile wetness was observed in 9.2% Asian, 7% Caucasian, 3% of black men, and 6.3% of homosexuals, and in 14/34 (8.2%) of men with clinical balanitis compared with 8/244 (3.3%) with no STI diagnosis (P = <0.001).

CONCLUSIONS

The prevalence of penile wetness was low in this population of STI clinic attenders in London, much lower than in Durban, South Africa. Further studies of male genital hygiene are warranted.

[Chancroid]

Chancroid is caused by the bacterium Haemophilus ducreyi. It is a sexually transmitted disease causing a soft chancre with a necrotic base and purulent exudate. The incidence of this illness is very low in Denmark and is probably underestimated. The bacterium is very fragile in transport, and culture is often negative. The chance of demonstrating the bacterium is greatly enhanced by the use of molecular techniques. In this case, we report on a specific PCR test for H. ducreyi that was used to establish the diagnosis in a 40-year-old male.

Prevalence of sexually transmissible pathogens in semen from asymptomatic male infertility patients with and without leukocytospermia

OBJECTIVE

To determine the prevalence of pathogens that cause sexually transmitted infections (STIs) in semen from asymptomatic male infertility patients with and without leukocytospermia (LCS), and associations between STIs, inflammatory markers, and other semen variables.

DESIGN

Retrospective, controlled study.

SETTING

Academic Medical Center.

PATIENT(S)

Two hundred and forty-one male infertility patients undergoing routine semen analysis: 132 with LCS, and 109 without LCS.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The DNA from STI pathogens (human papillomavirus [HPV], cytomegalovirus [CMV], herpes simplex virus [HSV], human herpesvirus type 6 [HHV-6], Epstein-Barr virus [EBV], hepatitis B virus [HBV], and Chlamydia trachomatis [CT]), routine semen parameters, and markers of accessory gland and epididymal function and inflammation.

RESULT(S)

The DNA from STI pathogens was detected in 45/241 (18.7%) of the samples (CMV, 8.7%; HPV, 4.5%; HHV-6, 3.7%; HSV, 3.7%; CT, 2.5%; EBV, 0.4%; and HBV, 0%), with no difference in prevalence between the LCS and non-LCS groups. The DNA of STI pathogens in semen was associated with a decrease in sperm concentration, motile sperm concentration, total sperm count, and neutral alpha-glucosidase concentration, whereas LCS was associated with a decrease in total sperm count, percent normal forms, and fructose concentration.

CONCLUSION(S)

The DNA of STI pathogens was detected in semen from a high percentage of asymptomatic male infertility patients, and was associated with poor semen quality. Efforts to diagnose and treat subclinical genital-tract infections should be intensified.

Predictors of Gonorrhea Reinfection in a Cohort of Sexually Transmitted Disease Patients in Alberta, Canada, 1991–2003

OBJECTIVE

The objective of this study was to identify characteristics associated with reinfection in sexually transmitted disease (STD) patients in Alberta, Canada.

METHODS

A retrospective cohort of 5,701 STD patients with gonorrhea diagnosed between 1991 and 2003 were followed for incident gonorrhea. Rates of reinfection were estimated and multivariate logistic regression was used to identify patient characteristics associated with reinfection.

RESULTS

There were 568 reinfections in 460 individuals, with reinfection occurring at a median of 9.2 months with an incidence rate of 2.34 per 100 person-years (95% confidence interval [CI], 2.09-2.59). The highest risk of reinfection was found in patients of black ethnicity (adjusted hazard ratio [aHR], 3.31; 95% CI, 2.27-4.81), aboriginal ethnicity (aHR, 2.64; 95% CI, 1.96-3.56), those reporting homo-/bisexual practice (aHR, 2.05; 95% CI, 1.40-3.02), or treated at an STD clinic (aHR, 1.49; 95% CI, 1.15-1.94).

CONCLUSION

The recognition of key demographic and behavioral characteristics can help focus interventions for patients at higher risk of gonorrhea reinfection.

Predicting Subsequent Infection in Patients Attending Sexually Transmitted Disease Clinics

OBJECTIVE/GOAL

The objective of this study was to identify characteristics associated with subsequent infection in patients attending a sexually transmitted disease (STD) clinic.

STUDY DESIGN

Records were retrospectively reviewed for patients from public STD clinics in 4 cities for 12 months after their initial visit to assess subsequent infection with gonorrhea, chlamydia, mucopurulent cervicitis, nongonococcal urethritis, pelvic inflammatory disease, primary or secondary syphilis, or trichomoniasis.

RESULTS

Among 64,463 patients, 33.9% had an initial STD and 7.0% had a subsequent STD. Patients with an initial STD had significantly higher probability of a subsequent STD than patients without (12.0% vs. 4.4%). A subsequent STD was significantly more likely for both sexes for those with an initial STD, who were symptomatic at initial visit, reporting exchange of sex, or under age 20 as well as for men reporting sex with men.

CONCLUSIONS

Patients with an initial STD were more likely to return with a subsequent STD. Routinely collected information such as initial diagnosis or age can help identify patients at increased risk of a subsequent STD.

Nested Case–Control Study of Cervical Mucosal Lesions, Ectopy, and Incident HIV Infection Among Women in Cape Town, South Africa

OBJECTIVE

The objective of this study was to test whether cervical mucosal lesions and ectopy increase women's susceptibility to HIV infection.

STUDY DESIGN

HIV-seronegative women ages 35 to 65 years (n = 5773) enrolled into a cervical cancer screening trial were followed for up to 36 months. All HIV seroconverters (n = 86) in the cohort were compared with randomly selected controls (n = 324) who did not seroconvert. Magnified photographs of the cervix taken during speculum examination at enrollment were evaluated for cervical mucosal lesions and ectopy using standard criteria.

RESULTS

The presence of mucosal lesions (observed among 19% of controls) was associated with increased risk of HIV seroconversion (adjusted odds ratio [AOR] = 1.93; 95% confidence interval [CI] = 1.07-3.48). Ectopy extending over >20% of the cervix was also associated with HIV seroconversion (AOR = 2.18; 95% CI = 1.01-4.69).

CONCLUSIONS

Visible lesions of cervical mucosa and cervical ectopy may be markers of increased susceptibility to HIV infection among women. Protection of the mucosa of the cervix may provide an important approach for new HIV prevention technologies.

Illustrated instructions for self-collection of anorectal swab specimens and their adequacy for cytological examination

BACKGROUND

Self-collection of anorectal swab specimens would facilitate screening for anal cancer precursors and sexually transmitted rectal infections among men who have sex with men (MSM). However, pictorial guides for self-collection were not previously available.

GOALS

Develop and field test a set of illustrated self-collection instructions.

DESIGN

Cross-sectional study of community-recruited MSM who were naïve with regard to collection of specimens for anal cytology.

RESULTS

Among 222 self- and clinician-collected swab pairs provided by mostly human immunodeficiency virus (HIV)-1 seronegative MSM (median age, 31.5 years), most specimens were adequate for cytologic evaluation, though self-collected swabs were less likely to be so (83% versus 92%, P = <0.001). The illustrated instructions were reportedly essential, but having used them, men rated their understanding of the self-collection procedure as very high.

CONCLUSIONS

Provided with illustrated instructions, most MSM who are naïve to the technique can self-collect anorectal swab specimens that are suitable for screening.

[Dermatologic problems arising during foreign travel]

The skin is a highly exposed organ during vacation times, especially during travel to countries with subtropical and tropical climates. Prolonged stay in these countries significantly increases the risk of contracting rarely seen dermatoses such as leishmaniasis, larva migrans and myiasis. The bites of various flies may provoke itching and excoriations that may be infected with Staphylococcus aureus and/or hemolytic streptococci, resulting in impetigo, furunculosis or erysipelas. Elderly persons spending weeks in the tropical sun may develop drug-induced phototoxic or photoallergic rash due to concomitant medication for cardiovascular or rheumatic diseases. Acute sunburn is considered a short-lasting problem, but in children it increases the risk of malignant melanoma in later years. Also of concern is chronic UV exposure, which increases the risk of premalignant and malignant skin tumors. Finally, mucocutaneous manifestations arising weeks and months after returning from vacation should raise suspicions of sexually transmitted syphilis and HIV.

Improving the accuracy of syndromic diagnosis of genital ulcer disease in Malawi

OBJECTIVES/GOAL

Most resource-poor settings rely on syndromic criteria to diagnose genital ulcer disease (GUD). However, the etiologic pathogens of GUD vary temporally and geographically, and current criteria may not reflect changes in the prevalence of specific pathogens.

STUDY

In 1999, we estimated the prevalence of Treponema pallidum (Tp), herpes simplex virus (HSV), and Haemophilus ducreyi (Hd) in Malawi. We then used regression coefficients of independent correlates of HSV and Hd to develop weighted diagnostic algorithms, in which weights were beta-coefficients corresponding to each factor.

RESULTS

Overall, a decrease in the proportion of sexually transmitted disease attributable to GUD was noted in 7 years. Thirty-five percent were attributable to HSV, 30% to H. ducreyi, and 4% to T. pallidum. Areas under the receiver operating characteristic curves for weighted and unweighted HSV diagnostic algorithms were 67.6% and 66.5%, respectively. There was no significant difference in the explanatory performance of the weighted and unweighted algorithms.

CONCLUSIONS

Unweighted algorithms can therefore be used to improve diagnostic accuracy of GUD.

Sexually Transmitted Infections Among Brothel-Based Sex Workers in Bangladesh: High Prevalence of Asymptomatic Infection

OBJECTIVE AND GOAL: The goal of this study was to study the prevalence of sexually transmitted infections (STIs)/reproductive tract infections (RTIs) among brothel-based sex workers (SWs) in Bangladesh.

STUDY

A cross-sectional study was conducted among SWs in 4 randomly selected brothels. A sociodemographic and behavioral survey and pelvic examination was conducted. Specimens including endocervical swab, high vaginal swab, and blood were collected and were examined for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, bacterial vaginosis candidiasis, and syphilis.

RESULTS

A total of 439 SWs were enrolled and 49.6% had genital symptoms. Among all SWs, 17.5% were positive for N. gonorrhoeae; 15.5% for C. trachomatis; 7.5% for T. vaginalis, and 6.6% had active syphilis. A total of 67.4% SWs were positive for at least 1 cervical and/or vaginal infection.

CONCLUSION

The prevalence of STIs/RTIs among SWs in brothels in Bangladesh is high. An intervention strategy addressing both symptomatic and asymptomatic infections and periodic screening of SWs for RTIs/STIs is essential for successful HIV and STIs prevention programs.

Sexually transmitted diseases causing genital lesions in adolescents

Evaluating the adolescent with a genital lesion requires a thorough knowledge of the common and less-common STDs that cause genital findings. A thoughtful history and complete physical examination are always in order, as is testing for a particular suspected STD and for coexisting STDs, especially HIV.

Vaginal tampons as specimen collection device for the molecular diagnosis of non-ulcerative sexually transmitted infections in antenatal clinic attendees

Self-inserted vaginal tampons for the molecular diagnosis of non-ulcerative STIs were evaluated. Cervical and vaginal swabs, tampons and urines were collected from 185 first-time antenatal clinic attendees. Cultures and nucleic acid amplification assays (NAA) were performed. The sensitivity of PCR on tampons for Trichomonas vaginalis was with 94% (CI 85-98%) significantly higher (P<0.001) than culture (50%, CI 38-62%) or urine (53%, CI 41-65%). Neisseria gonorrhoeae culture had a sensitivity of 64% (CI 36-86%), strand displacement assay (SDA) had a sensitivity of 79% (CI 49-94%) using tampon specimens, 57% (CI 30-81%) using endocervical swabs and 43% (CI 19-70%) using urines. There was no difference in sensitivity of SDA for Chlamydia trachomatis using tampon specimens, urine or endocervical swabs. The specificity approached 100% for all assays on all specimens. NAA on tampons for the detection of T. vaginalis, N. gonorrhoeae and C. trachomatis identified more infections than assays on swabs or urines. This reached statistical significance for T. vaginalis only.

Sexual activities of patients with STDs in the interval between noticing symptoms and presenting for treatment

Examining the patterns of and reasons for sexual behaviors of patients with sexually transmitted diseases (STDs) while symptomatic may help to develop effective prevention strategies for both STDs and AIDS. However, little is known about patients' sexual activities after noticing STD symptoms in China, where AIDS and STDs are spreading rapidly. We conducted a cross-sectional study at four STD clinics in Hefei, China. Patients' reported sexual activities were queried, using a tape recorder and earphones. A consecutive sample of 406 male patients with STDs were interviewed. One hundred sixty-four (40%) men reported having sex after having STD symptoms; 45% were married, 27% were single, and 47% cohabiting or divorced. Their sex partners included spouses, girlfriends, and prostitutes. Only 10% of patients with STDs who had sex after noticing STDs reported frequently using condoms or using them for every act of sex. Approximately 60% had never used a condom. Logistic regression analysis indicated that having sex after noticing STD symptoms was associated with lower education, having a previous STD episode, having low HIV/STD knowledge, and having other urethral discharge not caused by C. trachomatis or gonorrhea. Our findings suggest that male patients with STDs may serve as a bridge population linking the STD, and potentially, HIV epidemic from individuals at higher risk to the general population. Intervention programs including health education and condom promotion need to target both those at high risk and those at apparently lower risk.

[Papules, fungi, protozoa--or cancer? Many skin conditions of the penis can be confirmed with biopsy]

The male genitals can be affected by infections, neoplastic and inflammatory dermatoses. This means that numerous diseases have to be included in differential diagnostic considerations to discriminate premalignant from malignant penile tumors. Basically, penile carcinoma cannot be excluded by clinical examination alone. Apparently clinically benign penile lesions may be the cause of a misdiagnosis persisting of lengthy periods. Therefore, the correct diagnosis should be confirmed by timely biopsy whenever there is a doubt. The identification of known risk factors and the early detection and treatment of all precancerous lesions are indispensable for preventing cancer of the penis.

Is syndromic management better than the current approach for treatment of STDs in China? Evaluation of the cost-effectiveness of syndromic management for male STD patients

BACKGROUND

The syndromic treatment approach has not been evaluated in sexually transmitted disease (STD) clinics in China.

GOAL

The goal was to evaluate and compare the validity and cost-effectiveness of syndromic management with current STD management for men in clinics in Hefei, China.

STUDY DESIGN

Diagnostic accuracy, treatment appropriateness, costs, and effectiveness of current clinical procedures and syndromic management were compared for 406 men attending four STD clinics.

RESULTS

A modified World Health Organization (WHO) syndromic algorithm for urethral discharge yielded 100% sensitivity and a 69% positive predictive value (PPV). A syndromic algorithm for genital ulcers correctly treated all syphilis patients, with a 25% PPV. The average cost (in US dollars) per correct treatment by the current approach was 323.48 dollars for urethritis and 85.65 dollars for syphilis. For the syndromic approach, the average cost per correct treatment was 3.15 dollars for urethritis and 13.54 dollars for syphilis.

CONCLUSION

Syndromic management can provide better treatment for men with STDs at significantly lower cost in resource-poor settings such as China.

Predictors of Papanicolaou smear return in a hospital-based adolescent and young adult clinic

OBJECTIVE

Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits.

METHODS

Participants in this longitudinal cohort study were sexually active young women 12-24 years of age presenting to a hospital-based adolescent clinic. Participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. Logistic regression modeling was used to determine variables independently associated with return.

RESULTS

The outcome measure, return, was available for 439 of 490 participants (90%). Mean participant age (+/- standard deviation) was 18.3 (+/- 2.2) years, 49% were black, 23% were Hispanic, and 51% had Medicaid health insurance. Variables independently associated with return included belief that the Papanicolaou smear will not be painful (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.08, 2.83), belief that return for follow-up will prevent cervical cancer (OR 1.83, 95% CI 1.12, 3.07), likelihood that the doctor will be honest (OR 4.07, 95% CI 1.37, 17.5), and low self-reported impulsivity (OR 1.66, 95% CI 1.06, 2.63). Family history of cervical cancer was associated with decreased likelihood of return (OR 0.28, 95% CI 0.08, 0.78).

CONCLUSION

Specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits. These findings may guide the design of interventions to increase compliance with recommendations for Papanicolaou smear return.

Cancer selection

Cancers are often thought to be selectively neutral. This is because most of the individuals that they kill are post-reproductive. Some cancers, however, kill the young and so select for anticancer adaptations that reduce the chance of death. These adaptations could reduce the somatic mutation rate or the selective value of a mutant clone of cells, or increase the number of stages required for neoplasia. New theory predicts that cancer selection--selection to prevent or postpone deaths due to cancer--should be especially important as animals evolve new morphologies or larger, longer-lived bodies, and might account for some of the differences in the causes of cancer between mice and men.

False positive VDRL (BFP-STS) and systemic lupus erythematosus; new data in clinico-laboratory associations

AIM

To investigate the relationships between clinical features and serological parameters in systemic lupus erythematosus (SLE) patients with false positive venereal disease research laboratory (VDRL) test (BFP-STS) and those without.

METHODS

The records of 74 patients with SLE were reviewed. These were divided on the basis of the presence of a biologically false positive serological test (BFP-STS) (n = 18) or its absence (n = 56). The clinical features and serological parameters were subsequently evaluated in each group.

RESULTS

A biologically false positive serological test was found in 18 patients (24.5%). Clinically, they had a significantly higher frequency of malar rash (P < 0.02), hemolytic anaemia (P < 0.02) and SLE-related antiphospholipid (APL) syndrome (P < 0.02). Neuropsychiatric lupus was more frequent in the group without BFP-STS. Moreover, subacute cutaneous LE (SCLE), Raynaud's phenomenon, livedo reticularis (LR) and cardiopulmonary complications were present only in the latter group. There was no significant association between BFP-STS and other autoantibodies including Extractable nuclear antigen (ENAs), however, there was a significant association with C3 hypocomplementemia (P < 0.05). Half of the patients with BFP-STS were positive for anticardiolipin antibodies (aCL Abs) vs. 28% in the negative group (P = NS).

CONCLUSIONS

The study suggests that the clinical and serological relevance of BFP-STS in lupus patients may vary from those described in relation to other antiphospholipid determinants. Our patients appeared to have sparing of certain major organ systems, yet there was a greater tendency to developing Antiphospholipid (APL) syndrome and hemolytic anaemia.

Six-year follow-up survey of sexually transmitted diseases in Brasilia, the Capital of Brazil

The notification of sexually transmitted diseases (STD) is a prime component of well-designed public health policy. However, peculiar aspects of STD must be taken into account for the correct management of surveillance activities. Here, we describe the distribution of the most common sexually transmitted diseases among patients attended by the gynecological clinics of the principal public hospitals of Brasilia and the Federal District, Brazilian capital, during six years. A total of 142,158 patients had their cervicovaginal samples collected for Papanicolaou preparations and eventual biopsies. Diagnosis was made according to cytological and histological alterations, distinguishing among vaginal infections, and pre-cancerous and cancerous cervical lesions. We also looked at the annual prevalence of the various types of infections and alterations. There was a high prevalence of bacterial vaginosis, trichomoniasis and candidiasis, with suggestive changes over the years. Pre-cancerous and cancerous lesions increased 2.2 fold during the six years. A large proportion of the cases involved late stages of cervical cancer, indicating the necessity of prompt attendance of the population in a routine gynecological prevention program.