Sexually transmitted diseases in Africa: time for action.

PIP: Sexually transmitted diseases (STDs) are major public health problems which often lead to serious complications and sequelae, including infertility. Infection with STDs also facilitates the transmission of HIV, making the early diagnosis and care of STDs integrated into other services one of the most cost-effective strategies to prevent the spread of HIV. The direct and indirect costs of STDs worldwide are considerable. Sub-Saharan Africa ranks first in STD yearly incidence compared to other world regions. The World Health Organization has estimated that every year in Africa there are 3.5 million cases of syphilis, 15 million cases of chlamydial disease, 16 million cases of gonorrhea, and 30 million cases of trichomoniasis. STDs are a high public health priority especially because of their widespread prevalence and treatability. Herpes simplex virus infection and human papillomavirus infection are growing problems in sub-Saharan Africa. While STDs are caused by more than 20 microorganisms, they present themselves mainly in 4 syndromes and may therefore be treated syndromically. Africa must implement effective and comprehensive integrated activities against the STD epidemic. Elements of such a strategy will include disease prevention, screening and case finding, and the early diagnosis and treatment of cases.^ieng

Global prevalence and incidence estimates of selected curable STDs.

OBJECTIVES: To update the WHO global and regional estimates of the prevalence and incidence of syphilis, gonorrhoea, chlamydia, and trichomoniasis. METHODS: Prevalence estimates for syphilis, gonorrhoea, chlamydia, and trichomoniasis were generated for each of the nine UN regions for males and females between the ages of 15 and 49 in 1995 based on an extensive review of the published and unpublished medical literature since 1985. Incidence estimates were based on the prevalence figures and adjusted to take into account the estimated average duration of infection for each disease in a particular region. The latter was assumed to depend upon a number of factors including the duration of infection in the absence of treatment, the proportion of individuals who develop symptoms, the proportion of individuals treated, and the appropriateness of treatment. RESULTS: In 1995 there were over 333 million cases of the four major curable STDs in adults between the ages of 15 and 49--12 million cases of syphilis, 62 million cases of gonorrhoea, 89 million cases of chlamydia, and 170 million cases of trichomoniasis. Geographically, the vast majority of these cases were in the developing world reflecting the global population distribution. CONCLUSIONS: STDs are among the most common causes of illness in the world. Estimates of the global prevalence and incidence of these infections are limited by quantity and quality of data available from the different regions of the world. Improving global STD estimates will require more well designed epidemiological studies on the prevalence and duration of infection.

Use of the life table to eliminate from the active record Hansen's disease patients out of control and of unknown whereabouts: a six-year experience using this method in the state of Rio Grande do Sul.

Three criteria for the withdrawal of Hansen's disease patients of unknown whereabouts from the active record are presented, based on patients' age, number of years they have been out of control, and probability of their being alive, calculated according to a regional mortality table. In the first criterion, patients who have been lost and who according to their life table have a lower than 50% mathematical probability of being alive were given "statistical discharge." In the second and third criteria, Mitsuda-negative patients who had been lost for more than 20 years and Mitsuda-positive patients who had been lost for more than ten years and who had not been included in the first criterion were given "statistical discharge." During the six years in which the method was used in the state of Rio Grande do Sul, Brazil, 506 patients of unknown whereabouts were withdrawn from the active record, four of whom were found to be alive with the disease in progress. The results that have been achieved suggest an accuracy rate of about 100% for the first criterion of "statistical discharge" and about 98% for the other two criteria.

Leprosy classification for use in control programs.

Some classifications of Leprosy currently in use are reviewed and the difficulties of their application in field work are analysed. While it is recognized the scientific value of these classifications in order to identify precisely the clinical, bacteriological, histological and immunological aspects of the disease, an alternative simplified classification is suggested, to be used in control programmes. In this classification clinical forms that require the same public health action are put together. Thus, clinical forms are reduced to three basic groups. The clinical and laboratory criteria which define each group are presented, as well as the correlation between this simplified classification and the classic one.

Seroprevalence of HIV, hepatitis B virus, and syphilis in women at their first visit to public antenatal clinics in Vitória, Brazil.

BACKGROUND: In some countries, HIV infection in pregnancy has become a common complication of pregnancy. GOAL: To determine the seroprevalence of HIV, hepatitis B virus, and syphilis among pregnant women, and to assess risk factors for these infections. STUDY DESIGN: A cross-sectional study was performed. METHODS: Pregnant women attending antenatal clinics of Vitória Municipality from March to December 1999 were included in this study after giving written informed consent. The women were systematically interviewed. During the interview, their demographics and patterns of risk behavior were explored. A blood sample was collected for testing HIV, hepatitis B virus, and syphilis. RESULTS: The participants in this study were 1608 pregnant women. The prevalence of HIV infection was 0.8% (95% CI, 0.4-1.2), hepatitis B virus carriers 1.1% (95% CI, 0.8-1.3), and syphilis 3% (95% CI, 2.6-3.5). The potential risk behaviors were found to be a history of STDs (6.5%), condoms never used (52.8%), prostitution (0.5%), noninjection drug use (6.3%), blood transfusion (1.5%), and intravenous drug abuse (0.7%). CONCLUSION: These results show the necessity of implementing programs aimed at preventing transmission of these infections in women and their children.

Leprosy classification for use in control programs.

Neste trabalho, os autores apresentam uma revisao nos tipos de classificacao de hanseniase, atualmente em uso, alem de uma analise das dificuldades que surgem na sua aplicacao no trabalho de campo. Embora os autores reconhecam o valor cientifico dessas classificacoes, utilizadas para identificar, de modo preciso, os aspectos clinicos, bacteriologicos, histologicos e imunologicos da hanseniase, ao mesmo tempo sugerem uma classificacao mais simplificaca, como alternativa, para ser aplicada em programas de controle. Nesse novo sistema, as formas clinicas, que exigem o mesmo tipo de acao sanitaria publica foram classificadas juntas, sendo reduzidas, portanto, a tres grupos basicos. Os autores apresentam ainda os criterios clinicos e de laboratorio assim como a correlacao entre os sistemas de classificacao simplificado e classico