Sexually Transmitted Diseases/Infections

This article combines local oral reminiscences with recent epidemiological literature to sketch a historical context
around the onset and expansion of the HIV-1 epidemic in southern Uganda and north-western Tanzania. The local
historical imagination has associated the appearance of AIDS in two ways. First, with specific socio-economic
structures and circumstances common in the region since the 1960s and their enhancement during the 1970s
due to economic changes at national and global levels. Second, the epidemic is associated with changes in the
epidemiological situation. Local perspectives are supported by recent phylogenetic research and circumstantial
historical evidence, on the basis of which a hypothesis on the expansion of HIV-1 in East Central Africa (southern
Uganda, north-western Tanzania, Rwanda) is presented.

Human Papillomaviruses (HPVs) are involved in the etiology of anogenital and head and neck cancers. The HPV DNA prevalence greatly differs by anatomical site. Indeed, the high rates of viral DNA prevalence in anal and cer-vical carcinomas contrast with the lower fraction of cancer cases attributable to HPVs in other anatomical sites, chiefly the vulva, the penis and head and neck. Here we analyzed 2635 Formalin Fixed Paraffin Embedded surgical samples that had previously tested negative for the presence of HPVs DNA using the SPF10/DEIA procedure, in order to identify the presence of other PVs not explicitly targeted by standard molecular epidemiologic approaches. All samples were reanalyzed using five broad-PV PCR primer sets (CP1/2, FAP6064/FAP64, SKF/SKR, MY9/MY11, MFI/MFII) targeting the main PV main clades. In head and neck carcinoma samples (n = 1141), we recovered DNA from two BetaHPVs, namely HPV20 and HPV21, and from three cutaneous AlphaPVs, namely HPV2, HPV57 and HPV61. In vulvar squamous cell carcinoma samples (n = 902), we found one of the samples containing DNA of one cutaneous HPV, namely HPV2, and 29 samples contained DNA from essentially mucosal HPVs. In penile squamous cell carcinoma samples (n = 592), we retrieved the DNA of HPV16 in 16 samples. Our results show first that the SPF10/DEIA is very sensitive, as we recovered only 2.1% (55/2635) false negative results; second, that although the DNA of cutaneous HPVs can be detected in cancer samples, their relative contribution remains anyway minor (0.23%; 6/2635) and may be neglected for screening and vaccination purposes; and third, their contribution to malignancy is not necessarily warranted and needs to be elucidated.

BACKGROUND. Some patients who test positive for sexually transmitted infections (STIs) fail to return for results and treatment. To target improvement actions, we need to find out who these patients are. This study aimed to explore factors associated with failure to return within 30 days (FTR30) after testing among patients with positive results in a free STI testing centre in Paris.

METHODS. All patients with at least one positive result between October 2016 and May 2017 and who completed a self-administered questionnaire were included in this cross-sectional study (n = 214). The questionnaire included sociodemographic factors, sexual behaviour and history of testing. Factors associated with FTR30 were assessed using logistic regression models.

RESULTS. More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (22%). Men who had sex with men represented 36% of the study population. The FTR30 rate was 14% (95% CI [10–19%]). In multivariate analysis, previous HIV testing in younger persons (aOR: 3.36, 95% CI [1.27–8.84]), being accompanied by another person at the pretest consultation (aOR: 3.45, 95% CI [1.36–8.91]), and lower self-perceived risk of HIV infection (aOR: 2.79, 95% CI [1.07–7.30]) were associated with a higher FTR30. Testing for chlamydia/gonorrhoea without presumptive treatment was associated with a lower FTR30 (aOR: 0.21, 95% CI [0.07–0.59]).

CONCLUSIONS. These factors that affect failure to return are related to the patient’s representations and involvement in the STI screening process. Increasing health literacy and patient empowerment could help to decrease failure to return after being tested positive for HIV/STI.

This study examines the prevalence of suspected cervical cancer (established through the use of visual inspection with Lugol's Iodine – VILI) among outpatients attending Surat Municipal Institute of Medical Education & Research Hospital, India. A cross-sectional study was conducted on 356 patients; 178 with an established sexually transmitted disease (STD) and 178 patients without. Patients with positive results were investigated with cervical biopsy; out of 356 patients, 21.91% patients with STD and 12.35% patients without STD tested positive for VILI respectively (p = .017). The factors found to be significantly associated with a positive VILI test were STD, marital status, oral contraceptive pill use, a complaint of PV bleeding, white discharge on speculum examination (PS) and cervical erosion on PS. On applying multiple logistic regression, STD, age of patient in years, parity, OC pill use, a complaint of PV bleeding and cervical erosion on PS were found to be significant predictors of VILI positivity among the patients. STD patients are 2.5 times more likely to test positive for VILI than patients without STD. In Indian populations comparable to ours, opportunistic screening should be considered in gynaecology outpatient clinics for women presenting with complaints related to STDs.

Background: No reports exist on genotype-specific human papillomavirus (HPV) acquisition in girls after first sex in sub-Saharan Africa, despite high HPV prevalence and cer-vical cancer incidence. Methods: We followed 503 HP-unvaccinated girls aged 15-16 years in Mwanza, Tanzania, 3-monthly for 18 months with interviews and self-administered vaginal swabs. Swabs were tested for 13 higHRisk and 24 low-risk HPV genotypes. Incidence, clearance and duration of overall HPV and genotype-specific infections were calculated and associated factors evaluated. Results: A total of 106 participants reported first sex prior to enrolment (N ¼ 29) or during follow-up (N ¼ 77). One was HIV-positive at the final visit. The remaining 105 girls contributed 323 adequate specimens. Incidence of any new HPV genotype was 225/100 person-years (pys), and incidence of vaccine types HPV-6,-11,-16 and-18 were 12, 2, 2 and 7/100 pys, respectively. Reporting sex in the past 3 months and knowing the most recent sexual partner for a longer period before sex were associated with HPV acquisition. Median time from reported sexual debut to first HPVinfection was 5 months, and infection duration was 6 months. Conclusion: This is the first description of HPV acquisition after first sex in sub-Saharan Africa where the incidence of cervical cancer is amongst the highest in the world. HPV incidence was very high after first sex, including some vaccine genotypes, and infection duration was short. This very high HPV incidence may help explain high cervical cancer rates, and supports recommendations that the HPV vaccine should be given to girls before first sex.

INTRODUCCIÓN Con el objetivo de brindar una actualización sobre los aspectos epidemiológicos y de prevención de las Infecciones de Transmisión Sexual (ITS) se presenta una revisión de la situación actual en el mundo con los datos existentes en la Organización Mundial de la Salud (OMS) que destacan la casuística de cuatro enfermedades curables: clamidia, tricomoniasis, sífilis y gonorrea que tienen una incidencia anual cercana a los 500 millones de casos nuevos, distribuida por regiones de la OMS. También se presenta la información epidemiológica del Centro de Control de Enfermedades y Prevención de los Estados Unidos de Norte américa (CDC) que destaca la gran prevalencia de la infección por el virus papiloma humano (VPH) con 79 millones de personas seguida del herpes virus 24 millones de personas. Las ITS se han ido incrementando en su número oficial, llegando a ser 30 reconocidas en la actualidad destacándose como emergentes la Hepatitis C y la infección por Mycoplasma genitalium. Por otro lado, se revisan los factores epidemiológicos divididos en sociales, comportamiento, demográficos e institucionales que influyen en la persistencia y difusión de estas ITS. Finalmente se revisan y destacan las pautas de prevención y control enfocadas tanto en la prevención primaria como secundaria, destacándose además de los aspectos educativos y cambio de comportamiento, el uso de vacunas, circuncisión masculina, uso de condón, como también la necesidad de cambios en el manejo institucional, control de la prostitución clandestina y la aplicación del tratamiento epidemiológico de los contactos, enfatizándose que se requiere una intervención no solo curativa sino socioeducativa. Palabras clave: Infecciones transmisión sexual, epidemiología y prevención (Fuente:DeCS-BIREME). With the aim of providing an update on the epidemiological aspects and prevention of sexually transmitted infections (STIs) presents a review of the current situation in the world with existing data on the world's Health Organization (who) highlighted the case of four curable diseases: chlamydia, trichomoniasis, syphilis, and gonorrhea that have an annual incidence of close to 500 million new cases distributed by who regions. Also presents the epidemiological information from the Center for Disease Control and prevention of the United States of North america (CDC) noted the high prevalence of infection by the virus of human papillomavirus (HPV) with 79 million people followed by herpes virus 24 million people. STIs are have been increasing in its official number, becoming recognized 30 today highlighting how emerging Hepatitis C and the infection with Mycoplasma genitalium. On the other hand are reviewed the epidemiological factors divided into social behavior, demographic and institutional that influence the persistence and spread of these STIs. Finally checked and include both focused on primary prevention and secondary prevention and control guidelines stressing the educational aspects and change of behavior, the use of vaccines, male circumcision, condom use, as also the need for changes in institutional management, control of clandestine prostitution and the application of epidemiological treatment of contacts , emphasizing is that required not only curative intervention but socio-educational.

Background: Sexually transmitted infections are among the most common causes of illnesses in the world and have far reaching health, social and economic consequences. They are important because of their magnitude, potential complications and interactions with HIV/AIDS. Though the problem may be generally similar to other developing countries, there is scarce information on the incidence and prevalence of sexually transmitted infections in Ethiopia. This study was then aimed to determine the magnitude of sexually transmitted infections among patients visiting a clinic in Gondar town, Northwest Ethiopia. Methods: Medical records of patients who visited the clinic from January 2011 to December 2011 were reviewed. Sociodemographic and clinical data were extracted using data extraction form. The data were entered and analyzed using SPSS version 16 statistical package. Descriptive statistics and Chi-square tests were carried out. Results: A total of 1071 clients visited the clinic during the study period. Among these, 383 (35.8%) had complained symptoms of sexually transmitted infections. The mean (SD) age of the patients was 26.8 ± 7.4 years. The commonest chief complaints were vaginal discharge (38.4%) and urethral discharge (13.6%). Seventy seven percent of the cases did not bring their sexual partners for treatment. Conclusion: There was a high magnitude of STIs in the clinic according to the syndromic approach. However, the actual prevalence of STIs and the associated factors in the community need to be determined through further studies. The results of this study also urge the need for evaluation of the syndromic approach and test for antimicrobial resistance.

Background: The incidence of sexually transmitted diseases (STDs) is increasing among adolescents all around the world. There may be differences
in knowledge and attitudes among different cultures and ethnic populations. The aim of this study is to determine knowledge, attitudes
and behaviour of Turkish Cypriot adolescents related to STDs.
Objectives: To assess knowledge of STDs, attitudes towards sexual behaviour and STDs among the secondary school students.
Methods: A cross sectional study, with a sample size of 423 students, was conducted by using a semi-structured questionnaire. Simple random
sampling method was applied during the selection of the sample.
Results: The mean age of all participants was 15.61±1.22, 211 (49.88%) of them were male and 212 (50.12%) female. The majority of students
(91.25%) stated that they had some knowledge about STDs; hovewer, 8.75% of the participants did not have any knowledge at all. Most of
them, 42.32% described school as a source of information on STDs, nonetheless, only 7.57% of the group cited health care professionals as the
information source. The majority of students (97.64%) has never been treated for STDs. Among 423 applicants, 93.14% indicated that they would
have appreciated information about STDs during the high school years.
Conclusions: There is a general understanding that the students are willing to participate and are in need of seminars that will be held about
STDs during high school attendance. Furthermore, awareness raising educational events on this matter should be reviewed and revised in order
to come up with more powerful ways of fighting against STDs transmission in this young population group of Turkish Cypriot (TC) community.

Disclosure of sexually transmitted infections (STIs) to sexual partners is critical to the prevention, treatment, and control of STIs. We examine personal intra and interpersonal influences on willingness to disclose STI status among college-aged men. Participants (n = 1064) were aged 17 to 24 years and recruited from a variety of university and community venues. Using independent-samples t test, Pearson χ 2 test, and binary logistic regression, we examined the relationship between willingness to disclose an STI and intrapersonal and interpersonal factors, including age, masculinity values, interpersonal violence, partner cell phone monitoring, alcohol and/or drug use, condom use, number and characteristics of sex partners, and previous STI. Results reveal that among college-aged men, type of sex partner and masculinity values are significant variables in predicting whether or not an individual is willing to disclose. These data can inform STI control programs to more effectively address the complex issues associated with STI disclosure to sex partners.

Few analytic opportunities have allowed us to evaluate the role that specific sexual acts and male latex condoms play in the acquisition of external anal warts (EAW) using longitudinal data. The acquisition of EAWs occurs from epithelial contact with other HPV-infected surfaces, and hence is dependent upon sexual behaviour. Our objectives were to classify the relative importance of condom use, receptive anal intercourse (RAI) and prior history of EGWs on acquisition of EAWs. The observational Multicenter AIDS Cohort Study followed 2925 men over nine semiannual study visits for behavioural and physical examinations with laboratory testing. The main outcome measure was the occurrence of examiner-diagnosed EAWs in a homosexual population. EAWs were diagnosed among 10% of men studied across 22,157 visits reviewed for this study. Men with history of EGWs were more likely than those previously unaffected to have developed EAWs (cOR = 2.4 (2.0, 2.9)), as were men who reported multiple anoreceptive intercourse partners (e.g., compared with men who reported no RAI partners, men with 1, 2–5, ≥6 RAI partners had crude risk ratios 1.0 (0.8, 1.3), 1.6 (1.2, 2.1), 3.9 (2.7, 5.8), respectively). These relations persisted after other demographic and sexual risk factors were controlled for in the analyses. Consistent condom usage showed no protective effect for EAWs in our crude or adjusted analyses. Patient education messages should be tailored to reflect our uncertainty about the protective nature of condoms for the development of anal warts, but to continue to assert the protective effects of a limited lifetime number of sexual partners and the heightened risk for wart recurrence once infected.

This quantitative descriptive cross sectional study
explored factors influencing sexual risk behaviours among
youths in senior secondary schools in Ethiopia. Data were
collected using structured questionnaires. Religious attachment,
living with friends, living alone, parental control, level of
parental education, peer pressure and number of friends who had
experienced sex were some of the factors noted to influence
youths to engage in sexual risk behaviours. The findings of this
study have implications for both practice and policy
development.  They will enable healthcare workers to identify
youths at risk of engaging in sexual risk behaviours and
subsequently motivate them using health promotion strategies to
engage in safe sexual practices. Adopting such an approach will
prevent or at least minimise risk of youths being infected with
sexually transmitted diseases, such as HIV/AIDS.

Female sex workers (FSW) and men who have sex with men (MSM) has been reported as population groups with an average number of sexual partner higher than the general
population. Because of this, and because their partners are from different groups in the population, FSW and MSM are key for STIs transmission dynamics.

This chapter provides an overview on STI among MSM and FSW from two developing countries: Ecuador and India. We aim to present a panorama of syphilis and herpes simplex virus type 2 (HSV 2) sero-prevalence and trends during a 4 year period, in two high-level vulnerable groups from two countries with very different economies, cultural and social norms. We will explore the similarities and differences in the trends on STI in MSM and FSW, allowing the readers the reflection on individual and contextual factors that may contribute to these trends in STI sero-prevalence in each population.

In their review article, Clark et al. claim, "Neonatal circumcision is medically necessary and ethically imperative" [1].  This represents a double contradiction of, among others, the positions of the American Academy of Pediatrics [2], the British Medical Association [3], the Canadian Paediatric Society [4], and the Royal Australasian College of Physicians [5].

To justify such a dramatic conclusion, the authors need to make a strong case.  This is all the more true given the authors' far-reaching intent to examine the medical evidence, give an ethical analysis, and develop guidelines to implement mandatory neonatal circumcision in sub-Saharan Africa.  Unfortunately the authors stumble so badly on the first two steps that the third step becomes irrelevant.  We will evaluate the accuracy and quality of the "medical evidence" Clark et al. use in their analysis by parsing the facts from the fantasy, providing an overview of the risk-benefit analyses of circumcision, and providing our own modest proposal.

Resumen: l objetivo de este artículo consiste en deconstruir ciertos imperativos heteronormativos consolidados en Argentina durante el siglo XX alrededor de dos enfermedades de transmisión sexual. La estrategia metodológica fundamental utilizada se concentra en el análisis discursivo y contextual de los dispositivos legislativos instaurados en este país para hacer frente a dos enfermedades de transmisión sexual que, si bien compartieron la centuria, su emergencia y purulencia estuvieron distanciadas en el tiempo de aparición: la sífilis y el SIDA. Al respecto, el texto se enfoca sobre las discursividades jurídico-políticas organizadas en torno a ellas con el propósito de echar luz sobre la funcionalidad de la normativa sanitaria de ambas en los mandatos de sexualidad dominantes. Y, de la misma manera, exhuma el rol imputado a las disidencias reforzadoras —según la ortodoxia— del esquema de normalidad/anormalidad sexual. En definitiva, desde una perspectiva que involucra gran parte del siglo XX, el presente artículo explora el enfoque biopolítico sobre el cual se sustentó la regulación en Argentina, hacia la década de 1930, de las enfermedades venéreas —emblema, por entonces, de la heterosexualidad— con la sífilis en un lugar protagónico; y, en los años de 1990 del SIDA, asociado inicialmente a la homosexualidad.

Abstract: the goal of this article is to deconstruct some heteronormative imperatives which were consolidated in Argentina during the 20th century. The fundamental methodological strategy used focuses on discursive and contextual analysis of the legislative mechanisms established in this country to deal with two sexually transmitted diseases that, although they shared the century, had an emergence and purulence which were distant in time: syphilis and AIDS. In this regard, the text focuses on the legal-political discursivities organized around them to shed light on the functionality of the health regulations of both to the dominant sexuality mandates. And, in the same way, exhumes the role attributed to dissent reinforcing —according to orthodoxy— the sexual normality/abnormality scheme. In short, from a perspective that involves much of the twentieth century, this article explores the biopolitical approach on which the regulation was sustained, by the 1930s, of venereal diseases —then an emblem of heterosexuality— with syphilis in a leading position; and, in the 90s of AIDS, initially associated with homosexuality.

La profilaxis pública de las enfermedades venéreo-sifilíticas en España La prostitución fue prohibida en España por Felipe IV, mediante pragmáticas de los años 1623 y 1661, estableciendo lo que se ha denominado un régimen prohibicionista para esta actividad. Obviamente, estas disposiciones y diversas medidas penales promulgadas durante los tres siglos siguientes no sirvieron para que la prostitución desapareciera, pero sí lo hicieron los prostíbulos legales y su ejercicio pasó a ser una actividad fundamentalmente callejera y fuente de gran escán-dalo social 1. En el siglo XIX las medidas sanitarias comienzan a dar fruto en el control de epidemias que cau-saban una enorme mortalidad (en el periodo 1860-1885 la esperanza de vida en España era 29 años) 2 y aumenta la preocupación por las enfermedades venéreas, situación que se incrementará a principios del siglo XX, cuando estas enfermedades sufren una gran expansión como consecuen-cia de la I Guerra Mundial. Aunque ya a finales del siglo XVIII comienzan a surgir propuestas a favor de una tolerancia y re-gulación de la prostitución, que incluiría una vigilancia sanitaria 3 , sólo a mediados del siglo XIX diversas ciudades y provincias españolas comienzan a aprobar normativas y a nombrar médicos para realizar un control sanitario de las prostitutas y de los prostíbulos. La oposición ciudadana, cambios políticos, insuficiencia presupuestaria y problemas organizativos de diversa índole hicieron que los intentos estatales, provinciales y locales para establecer un control higiénico de la prostitución entre 1845 y 1918 no llegaran a ejecutarse o tuvieran una mínima eficacia 1. En este último año, las continuas quejas, especialmente las procedentes de las autori-dades militares, por el aumento de las enfermedades venéreas y la falta de éxito de las medidas para combatirlas, motivan un nuevo intento gubernativo para intentar atajar el problema, mediante una Real Orden, disponiendo que se aprueben y publiquen las Bases para la reglamentación de la profilaxis pública de las enfermedades venéreo-sifilíticas, redactadas por la Inspección General de Sanidad y siendo Ministro de la Gobernación José Bahamonde y de Lanz 4. Se establecía así un régimen o sistema reglamentarista de la prostitución. La época en que se aprobaron estas Bases, conocida como Crisis de la Restauración, se caracteri-zó en España por una intensa agitación política y social, que conllevó grandes dificultades para su puesta en marcha. Además, importantes movimientos internacionales, apoyados por numerosos especialistas y políticos en España, fueron decantándose por la abolición de la prostitución y, con-secuentemente, la desaparición de medidas represivas o de control obligatorio sobre las prostitutas (régimen abolicionista), creándose una continua tensión y alternativas entre las medidas de tipo reglamentarista y abolicionista 1,5-7 .

William Shakespeare's rise to fame coincided with a turning point in the history of the Elizabethan theatre. Although the arts enjoyed support among the English Renaissance nobility, the same could not be said of the clerics. Hence it is that the Puritan oppression pushed the playhouses to the outskirts of London, the home of bear-baiting rings and brothels, on the grounds that they promoted an idle and licentious lifestyle. Little did they realize that it was quite the other way around: the plays from that era drew their inspiration from real life rather than vice versa, primary among their themes being precisely that of promiscuity, namely its most likely consequence in the Bard's day—syphilis. Given that London witnessed at that time an unprecedented influx of immigrants, it is no wonder that they brought along a variety of euphemisms for this sexually transmitted disease which dramatists such as the Bard used extensively in their plays. While there is no doubt that Romania too has fought its own battles with this unforgiving venereal infection, neither the archaic nor the modern autochthonous slang accommodates an equally vast array of argotic synonyms for syphilis. As a result, more often than not, Romanian translators find themselves in the situation where they use a limited number of words and phrases to recreate Shakespeare's numerous euphemisms for this sexually transmitted disease. What the present paper seeks to accomplish is to offer new creative translation alternatives for the Bard's most problematic argotic terms for this venereal infection.

Attitude is a core construct in human behavior and therefore may be regarded as a window to predicting and understanding human behavior. This study examined the pattern of the influence of students’ attitudes towards sexually transmitted infections on their attitudes towards sex. The researchers were inspired by concerns over the rising involvement of youths in sexual activism even though they are well aware of the prevalence and consequences of sexually transmitted infections. The question this study answered therefore was: How does the attitude of students towards sexually transmitted infections influence their attitude towards sex? The study utilized data from a larger survey on psychosocial variables and students’ sexual attitudes to answer this research question. Analysis of the data showed that students with negative attitudes to sexually transmitted infections exhibited permissive attitudes towards sex while those who had a more reserved and positive attitude towards sex were those with more positive attitudes towards sexually transmitted infections. Based on this finding, the researchers proffered approaches in sexuality education and counseling that may be utilized to correct this trend.