Sexually transmitted diseases in pregnancy

Sexually transmitted diseases are common complications of pregnancy and may have significant maternal/fetal effects. Knowledge of the symptoms and physical examination features, methods of diagnosis, indications for screening, and appropriate treatment options are essential for obstetric/gynecologic health care providers.     

Sexually transmitted diseases in HIV-positive patients

The complex interaction between sexually transmitted diseases (STDs) and HIV has been demonstrated in many epidemiological studies and clinical trials over the last number of years. Herpes simplex virus, human papilloma virus, and syphilis are all accepted to have different manifestations, effects, and therapeutic responses in HIV positive patients. These and other issues are discussed in this article.     

Sexually transmitted diseases in Ulaanbaatar, Mongolia

INTRODUCTION: Anterior ischemic optic neuropathy (AION) describes a defect of the optic nerve leading to irreversible loss of vision in most cases. Pathophysiology of this disease is manifold and has been discussed as a posthemorrhagic complication as well as a neurological complication after operations with cardiopulmonary bypass. METHODS: On the basis of two cases, the clinical picture is described in relation to the available literature. Preoperative risk factors, operative data, cardiopulmonary-bypass, postoperative complications and clinical symptoms are discussed together with ophthalmologic findings in order to elucidate the pathophysiology of this process. RESULTS: There is no reliable and effective treatment of anterior ischemic optic neuropathy. Neither corticosteroids, osmotic diuretics, hemodilution nor surgical decompression of the optic nerve have proved successful. Hence, measures to avoid ischemic optic neuropathy have priority. The following risk factors were determined: History of glaucoma or other ophthalmological problems, prolonged cardiopulmonary bypass-time and myocardial ischemia, general oedema during cardiopulmonary bypass, excessive hemodilution with low hemoglobin and hematocrit, hypo- or hypertension, systemic hypothermia, need for vasoactive medication. CONCLUSIONS: Influenced by a variety of factors, pathophysiological microvascular changes provoke anterior ischemic neuropathy with sudden painless loss of vision, irreversible in most cases. Since therapeutic trials have failed, prevention of possible causes is the only way to avoid this rare but severe complication of cardiac surgery.     

Sexually transmitted diseases and reproductive health in women

The effects of recombinant basic fibroblast growth factor (bFGF), insulin-like growth factor (IGF)-II and transforming growth factor (TGF)-beta 1 on dental pulp cells were investigated by light and transmission electron microscopy after their implantation for 1 and 3 weeks at central sites of mechanically exposed pulps in dog molar and canine teeth. The implants were Millipore filters that have been soaked with solutions containing 100 or 500 ng/ml of bFGF or IGF-II or 100 ng/ml of TGF-beta 1. Control filters were soaked with dog albumin. No changes in cell organization or matrix synthesis were seen after implantation of control filters. Groups of columnar, polarized cells with numerous mitochondria and Golgi elements or elongated cells unassociated with any matrix deposition were demonstrated after 1 or 3 weeks, respectively, in close proximity to the filters that had been soaked with bFGF solution; at a distance from these implants enhanced formation of an osteotypic matrix was seen beneath the exposure site. No particular response was found in close proximity to the filters that had been soaked with IGF-II solution after 1 or 3 weeks implantation but thick zones of osteodentine were found beneath the exposure site and at adjacent circumferential dentine sites. Numerous elongated, polarized cells with long cytoplasmic extensions invading the filter pores were consistently seen after 1 week in close proximity to the filters that had been soaked with TGF-beta 1 solution. After 3 weeks implantation of these filters, deposition of a tubular matrix surrounding the implants was seen in association with the highly elongated odontoblast-like cells, while enhancement of circumferential dentine formation was also found at adjacent peripheral sites. These experiments demonstrate that TGF-beta 1 when implanted for short term periods at central pulp sites exerted dentine-specific effects, inducing differentiation of odontoblast-like cells and stimulating primary odontoblasts. Implantation of bFGF and IGF-II did not result in reparative dentine formation, but did stimulate osteotypical matrix deposition at a distance from the implants.     

Sexually transmitted diseases: laboratory diagnosis

Betel chewer's mucosa (BCM) was first described and defined in 1971. Its clinical appearance is characterised by a brownish-red discolouration of the oral mucosa with an irregular epithelial surface that has a tendency to desquamate or peel off. The buccal mucosa is most frequently affected. The prevalence of BCM varies between 0.2% and 60% in different studies from South and Southeast Asia. Women are more frequently affected than men. Betel chewer's mucosa may be found together with other oral mucosal lesions such as leukoedema, leukoplakia and ulceration. The histological features are characteristic. The epithelium is often hyperplastic, and brownish amorphous material derived from the betel quid may be demonstrated not only on the epithelial surface but also intra- and inter-cellularly. Ballooning of epithelial cells may occur. The etiology is traumatic and possibly chemical. Betel chewer's mucosa is most likely not precancerous. Differential diagnoses include cheek biting, with which it has a number of similarities, and other predominantly white lesions that may have taken up stains from tobacco and other substances. The natural history of BCM should be studied in more detail and its association with other oral mucosal diseases, particularly of a precancerous nature, should be the aim of further investigations.     

Sexually transmitted diseases in the age of AIDS

Progressive noninfectious anterior vertebral fusion (PNAF) is a rare but well-defined entity of unknown cause. We report the MRI findings in a 5-year-old in whom PNAF was associated with a lipoma of the filum terminale.     

Sexually transmitted diseases. Present problems-future prospects

The tools of molecular biology have brought us to a new level of understanding of the epidemiology and pathophysiology of sexually transmitted diseases, which has been augmented and concentrated by the challenge of HIV/AIDS. We enter the next millennium with an unprecedented knowledge of these infections, but lacking the resources and drive to apply this broadly, especially where most needed in the areas of socioeconomic deprivation. We may develop cures or vaccines for complex viral infections, but for whom? Eventually, the knowledge will flow and disseminate, but will practice change?     

Sexually transmitted diseases. Gonorrhoea: symptoms and treatment

This article continues our series looking at common sexually transmitted infections. It focuses on gonorrhoea, its symptoms and treatment. The nursing management and patient's experience are discussed in a case study.     

Sexually transmitted diseases and HIV. A female perspective

Sexually transmitted diseases have the greatest impact on the health of women. They are frequently asymptomatic, so screening for infection is important in preventing the long-term sequelae which include infertility, ectopic pregnancy, and chronic pelvic pain. HIV continues to increase in the female population and the gynecologic complications associated with it are unique to this population. Use of zidovudine in pregnant HIV-infected women has substantially decreased the rate of vertical transmission of HIV infection. The epidemiologic synergy between HIV and STDs is well recognized and prevention of one is dependent on prevention of the other.     

Sexually transmitted diseases: United States, 1995

Over the past two decades, the United States has experienced some dramatic changes in the rates of three "classic" sexually transmitted diseases (STDs) as well as the introduction of a variety of newer and more complex STD organisms. Rates of primary and secondary syphilis increased through the mid-1980s to a record high of 20.3 cases per 100,000 population in 1990. Since then, rates have dropped 69 percent to 6.3, the lowest rate in 35 years. Gonorrhea rates increased steadily between 1950 and 1975, plateaued between 1975 and 1978, before beginning a gradual but quite steady decline. In 1995 the rate of gonorrhea reached a 30-year low of 149.5 per 100,000. Rates of chlamydial infections, however, have increased more than 55 since 1984 as screening programs proliferated and reporting improved. These infections are commonly found in sexually active adolescents and young adults, and for every case detected in men, there are approximately six detected in women. Rates of syphilis (primary and secondary) and gonorrhea are concentrated primarily in southern states, while chlamydial infections appear to be more widespread geographically. Despite the availability of diagnostic tests and effective treatment regimens for many infectious diseases, STDs continue to target certain populations. They disproportionately affect the poor, inner-city residents and minority groups. The consequences of the diseases are many and varied, and risk of sterility, ectopic pregnancy, fetal death and/or blindness are markedly increased among women with STDs. In addition, risk of HIV infection appears to be increased among persons with a history of having an STD.     

Patterns of mortality among Bangladeshis in England and Wales

OBJECTIVES: To investigate the patterns of mortality among Bangladeshis living in England and Wales. METHODS: An analysis of national mortality data, classified by country of birth, for the latest period (1988-1992), using the method of indirect standardization for deriving standardized mortality ratios (SMRs) with the age- and sex-specific rates for England and Wales as the standard (= 100). The SMRs were derived for Bangladeshi-born men and women aged 20-69 years for major disease entities. RESULTS: The mortality among Bangladeshi men was significantly higher (SMR 118 and 95% CI 111-126) than the levels prevalent in England and Wales. In contrast, the mortality among Bangladeshi women was significantly lower (SMR 71 and 95% CI 61-82). The cancer mortality overall was lower than expected in both sexes, with the exception of cancer of the liver and gall bladder. The mortality from breast cancer (SMR 16 and 95% CI 6-34) and cervical cancer (SMR 51 and 95% CI 14-131) was lower than expected. Bangladeshi men experienced high mortality from diabetes (SMR 685 and 95% CI 529-874), coronary heart disease (SMR 148 and 95% CI 134-163) and cerebrovascular disease (SMR 267 and 95% CI 222-319); they also experienced excess deaths from cirrhosis of the liver (SMR 254 and 95% CI 175-357). CONCLUSIONS: The findings establish significant variations in the recent health experiences of Bangladeshi men living in England and Wales, posing a major challenge for purchasers of care. If the Health of the Nation strategy is to ensure that equity in health and health care is to apply to all those living in this country, the Bangladeshi population needs special targeting.     

Sexually transmitted infections among sex workers in KwaZulu-Natal, South Africa

OBJECTIVE: The purpose of this study was to investigate the prevalence of sexually transmitted infections, including human immunodeficiency virus (HIV), among female sex workers operating at truckstops in the KwaZulu-Natal midlands of South Africa. METHODS: A total of 145 sex workers were recruited from August 1996 to March 1997. A gynecologic examination, including a speculum examination, was performed. Investigations were performed to identify gonorrhea, syphilis, chlamydia (infection), candidiasis, trichomoniasis, bacterial vaginosis, and HIV infection. RESULTS: A total of 50.3% of the sex workers were HIV positive. Infection with Trichomonas vaginalis was present in 41.3% of the women, Candida albicans in 40.6%, Neisseria gonorrheae in 14.3%, and Chlamydia trachomatis in 16.4%. Bacterial vaginosis was present in 71% and active syphilis in 42.1% of the women. CONCLUSION: The high prevalence of sexually transmitted infections, including HIV, clearly highlights the urgent need for interventions. In addition to empowering women with methods they can use and control to reduce their risk of infection, an effective approach to control of sexually transmitted infections also needs to recognize the role of the clients, such as truck drivers, so that they also are targeted for interventions.     

The incidence of cancers among second-generation Irish living in England and Wales

The incidence of ovarian, cervical, lung and prostatic cancer was higher in second-generation Irish living in England and Wales than in all other persons in England and Wales. A higher incidence of ovarian cancer was not found in first-generation Irish. Differences in socioeconomic status did not explain these patterns.     

Sexually transmitted disease acquisition among women infected with human immunodeficiency virus type 1

Recent evidence suggests that sexually transmitted diseases (STDs) enhance the transmission of human immunodeficiency virus (HIV) type 1. In 143 HIV-infected women enrolled in a university-based longitudinal HIV clinic over 16 months (mean), the STD point prevalence was examined at enrollment and the cumulative prevalence was calculated at follow-up. At enrollment, 35 women (25%) had > or = 1 STD. These included trichomoniasis in 16 women (11%); syphilis, 9 (6%); genital herpes, 8 (6%); gonorrhea, 5 (4%); chlamydia, 5 (4%); genital warts, 2 (1%); and pelvic inflammatory disease (PID), 1 (1%). STDs were found in 55 (42%) of the 125 patients who returned for at least one follow-up visit: trichomoniasis in 23 (18%); genital herpes, 20 (12%); gonorrhea, 9 (7%); syphilis, 7 (6%); genital warts, 7 (6%); chlamydia, 5 (4%); and PID, 4 (3%). Despite counseling at both enrollment and follow-up, these women had a very high cumulative prevalence of STDs, indicating persistent high-risk sexual behavior.