Oral Kaposi's sarcoma in a non-HIV homosexual White male.

This paper reports the exceedingly rare occurrence of oral Kaposi's sarcoma in a non-HIV Caucasian White male. The lesion presented as a 8 mm vascular nodule on the buccal mucosa on the left. He was homosexual. The lesion was removed and histological examination confirmed Kaposi's sarcoma. The patient has been tested on 10 occasions for HIV from December 1998 to March 2004 and has been negative. The patient remains alive and well with no evidence of recurrence.

Prevalence of asymptomatic chlamydial urethritis in military recruits in the Celje region, Slovenia.

The aim of this research was to evaluate the prevalence of asymptomatic chlamydial urethritis in military recruits in the Celje region (population 300,000), Slovenia. A first-void urine specimen was tested for Chlamydia trachomatis using the polymerase chain reaction assay. The research was supported by a questionnaire to obtain information on sexual behaviour of the participants. In the cross-sectional study from 1999 to 2001, 1272 asymptomatic recruits were included. None had received antibiotics in the previous two weeks. The mean age was 19.9 years. At the time of their first sexual experience the mean age was 16.6 years, whereas the age of their female sexual partners was 17.1 years. During their first sexual intercourse 77% of recruits used contraception (condom, diaphragm, contraceptive pill), most of those a condom (86%). The prevalence of asymptomatic chlamydial urethritis was 2.6% (95% confidence interval: 1.7 to 3.5). The mean age of those infected was 19.8 years. At the time of their first sexual experience the mean age was 16.2 years, whereas the age of their female sexual partners was 16.9 years. During their first sexual intercourse 57% of infected subjects used protection, half of which was a condom. Those who never or only occasionally used condoms were at a greater risk of being infected with C. trachomatis (adjusted odds ratio 2.04).

Syphilis in Slovenia--on the threshold of the European Union.

The epidemiological situation of early syphilis (ES) in Slovenia is the subject matter of this report. After almost 25 years of decrease in Slovenia, ES is increasing again. The incidence of ES increased from 0.10 per 100,000 inhabitants in 1992 and 1993 to 1.82 in 1994 and 1.90 in 1995. In the years 1996-1998 there was a slight decrease at 1.25-1.45. The higher incidence of infections with ES is presumably the consequence of changed social conditions in the states of the former Eastern bloc and Yugoslavia, and of changing living conditions, and illegal prostitution in Slovenia. AIDS and HIV in Slovenia is still at an early stage and there is no apparent link into the same social groups as syphilis. The current epidemiological situation of sexually transmitted infections (STIs) in Slovenia and the conditions existing to the south and east of Slovenia warrant strict surveillance of STIs by the medical services.

Epidemiology of syphilis in Bulgaria, 1990-1998.

There have been great political, social and economic changes in Bulgaria since 1990 with higher incidences of syphilis when compared with the previously controlled morbidity of syphilis. There has been a 7-fold increase in 1998 compared with 1990. The male/female ratio remained the same 1.2:1. A higher number of cases was reported in cities than in villages and small towns, 80.68% in 1990; 73.4% in 1998. The number of employed patients with syphilis has decreased during the years--from 75.5% in 1990 to 44% in 1998, with a corresponding increase in syphilis in the unemployed. The age group at highest risk is 20-24 years, 28.7% in 1991; 24% in 1998. The least affected group are those older than 55--the incidence being 6.34% in 1990; 2.6% in 1997 and 4% in 1998. The prevalence of the different stages of early infection remained the same. The incidence of congenital syphilis increased from 1 in 1990 and 1991 to 21 in 1996, 29 in 1997 and 35 in 1998.

Sexually transmitted infections in the Russian Federation, the Baltic States and Poland.

PIP: This paper examines the prevalence of sexually transmitted infections (STIs) in the Russian Federation, the Baltic States, and Poland. The International Union against Sexually Transmitted Infections organized a number of visits to the Eastern European countries aimed at reducing the spread of STIs. A highly developed state system for the control and surveillance of syphilis and other STIs in the Russian Federation was based on clinical dermatovenereology. However, a national AIDS program was developed in 1987. This program was administratively and operationally separate from dermatovenereology service and had been originally focused on the compulsory screening and medical management of HIV infection. In Poland, the dermatovenereology service is well developed and highly Westernized, more than in any other Eastern Bloc country. Furthermore, the management of STIs is within the scope of dermatovenereologists, most of who are women and senior physicians trained under the former Russian system. The dermatovenereology services were provided through primary care centers.^ieng

Epidemiology of syphilis and gonorrhoea in eastern Poland in the years 1988-1997.

Because of the sexually transmitted diseases (STDs) epidemic in the former Soviet Union and the possibility of a rise in early syphilis and gonorrhoea in the eastern region of Poland it seemed important to calculate the incidence rates for early syphilis and gonorrhoea for 3 border regions (east, west and south) and the central part of the country in the last 10 years. In addition, data were analysed on patients and their sexual partners (from Poland and abroad), and the country where the contact took place obtained from 14 Provincial Skin-VD Out-Patients' Clinics of eastern Poland. The results from 1988/89 and 1996/97 were compared. It was shown that early syphilis morbidity significantly decreased in western and southern Poland, fell in the central part and rose in the east slightly. Gonorrhoea morbidity significantly decreased in all regions. However, the number of provinces with early syphilis and gonorrhoea incidence rates in the 1990s of the same value or higher than in the 1980s, or of the whole of Poland clearly increased in eastern and central regions. The early syphilis and gonorrhoea morbidity in east Poland in the 1990s in relation to 1980s was marked by significant increase in the percentage of the foreigners treated (12.2 vs 1.8, P<0.001 for early syphilis, and 10.0 vs 2.3, P<0.001 for gonorrhoea) and in sexual contacts with foreigners reported by Polish patients (23.7 vs 0.8, P<0.01 for early syphilis and 17.7 vs 4.3, P<0.01 for gonorrhoea). Of the foreign contacts reported in 1996/97 by early syphilis and gonorrhoea patients, 60.4% and 82.2%, respectively, were casual. Contact with foreigners took place, mainly, in the former Soviet Union. The study illustrates that there may be a danger of an increase in the incidence of syphilis and gonorrhoea in Poland due to the epidemics in the neighbouring countries.

PIP: This study examines the epidemiology of syphilis and gonorrhea in eastern Poland from 1988 to 1997. Data on patients and their sexual partners were obtained from 14 provincial skin-VD outpatient clinics of eastern Poland. The results from 1988-89 and 1996-97 were compared. It was shown that early syphilis morbidity significantly decreased in western and southern Poland, fell in the central part, and rose slightly in the east. Gonorrhea morbidity significantly decreased in all regions. Early syphilis and gonorrhea morbidity in east Poland in the 1990s was marked by a significant increase in the percentage of foreigners treated and in sexual contacts with foreigners reported by Polish patients. Among the foreign contacts reported in 1996-97 by early syphilis and gonorrhea patients, about 60.4% and 82.2%, respectively, were casual. Contact with foreigners took place mainly in the former Soviet Union. This study illustrates that there is a probability of an increase in the incidence of syphilis and gonorrhea in Poland due to the epidemics in neighboring countries.

Task force for the urgent response to the epidemics of sexually transmitted diseases in eastern Europe and central Asia.

In summary, members of the TF/STD: share the common goal of reducing the STD burden and slowing the spread of HIV in the most affected and vulnerable countries in eastern Europe and central Asia contribute financially, technically, or in kind to the implementation of a joint strategy which aims: to create an enabling environment for STD prevention and control, and to strengthen the local capacity for STD prevention and care engage in a continuous exchange of information, collaborative partnerships, and coordination of activities at regional as well as country level through the TF/STD and in-country interagency working groups, respectively concur with the priority areas for international support consisting of advocacy and policy, STD drugs, condoms, educational materials, training, applied research, and surveillance meet twice a year to review implementation progress and the need for additional assistance as advocates of TF/STD, call on partners and other organisations to join in this important new initiative.

Task force for the urgent response to the epidemics of sexually transmitted diseases in eastern Europe and central Asia.

In summary, members of the TF/STD: share the common goal of reducing the STD burden and slowing the spread of HIV in the most affected and vulnerable countries in eastern Europe and central Asia. Contribute financially, technically or in-kind to the implementation of a joint strategy which aims: -- to create an enabling environment for STD prevention and control, and -- to strengthen the local capacity for STD prevention and care; engage in a continuous exchange of information, collaborative partnerships and coordination of activities at regional as well as country level through the TF/STD and in-country interagency working groups, respectively; concur with the priority areas for international support consisting of advocacy and policy, STD drugs, condoms, educational materials, training, applied research and surveillance; meet twice a year to review implementation progress and the need for additional assistance; as advocates of TF/STD, call on partners and other organizations to join in this important new initiative.

PIP: The unprecedented rise in syphilis and other sexually transmitted diseases (STDs) in large parts of eastern Europe and central Asia poses a significant threat of an immediate HIV epidemic in the region. Because of this problem, the WHO Europe and the Joint UN Program on HIV/AIDS created an international task force (TF) to mobilize an urgent and well-coordinated multiagency response to the crisis. The participating agencies during its first meeting came up with the TF mission and tasks. The mission of the TF includes 1) ensuring external support to the region in both timely and well coordinated manner; 2) ensuring mobilization of international and national resources; and 3) ensuring that the local capacity to respond to the STD epidemics is enhanced. Overall, the TF shall undergo activities that will help reduce the STD epidemics in the eastern Europe and central Asia.

Sexually transmitted diseases. Management and prevention strategies around the world.

Since 1982, the advance of HIV/AIDS infection has radically altered the management of STDs around the world. Prevention, especially in developing countries is paramount. A scientific basis for treatment coupled with epidemiology and case management is required. Discussion to the merits of different forms of treatment, classical clinical, etiological and syndromic management, and their evaluation, is described.

Balanitis.

Balanitis, inflammation of the glans penis, is a frequently presenting genital disorder. It may be infectious and sexually transmissible, or commonly represents a noninfectious dermatologic condition. Accurate diagnosis is essential for management.

Molluscum contagiosum.

In this article, the natural history of molluscum contagiosum is described by various authorities covering the last 200 years. Molluscum contagiosum may present a therapeutic challenge, but clinical methods of treatment are described. Molluscum contagiosum should alert the clinician to the possibility of HIV infection. The differential diagnosis in HIV infection is discussed.

Internationalism in sexually transmitted infections.

PIP: The International Union Against the Venereal Diseases and the Treponematoses (IUVDT) became the International Union Against Sexually Transmitted Infections (IUSTI) at the Union's 37th General Assembly, held in Melbourne, Australia. The name change reflects the increasing use by international donor organizations of the term sexually transmitted infections (STIs). STIs are a major problem in Africa, South East Asia, India, Russia, and the European countries which were formerly within the Communist bloc. The epidemic of syphilis together with HIV increases daily in Eastern Europe and Russia. There have, however, been some successes in developing countries with the syndromic method, the promotion of sexual health, and the prevention of STIs. While the UK has the largest body of fully trained sexually transmitted disease (STD) specialists in the world, comparatively few of them participate in large international commitments. These specialists should instead become more involved with STIs in areas of need. Furthermore, more aid should be provided by governmental, nongovernmental, and charitable sources. IUSTI is willing to cooperate with any efforts to fight STDs anywhere in the world.^ieng

Azithromycin in gonorrhoea.

The clinical applications of azithromycin in gonorrhoea, often complicated by simultaneously acquired infection with Chlamydia trachomatis, are reviewed in this paper. Clinical trails from major centres in Europe are compared with a large, more recent US study. At the present time, azithromycin is recommended throughout the world as a useful antibiotic in treatment of gonorrhoea. It has several advantages in that it can be given as single-dose therapy, it can be given where the causative pathogen of urethritis/cervicitis is uncertain, and it is often, therefore, most useful in acute therapy where there is no immediate microbiological back-up. All these considerations are reviewed in detail.