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Clin Infect Dis ; 28(5): 1086-90, May 1999.
Artigo em Inglês | MedCarib | ID: med-1381


Individuals presenting consecutively with genital ulcers in Kingston, Jamaica, underwent serological testing for human immunodeficiency virus (HIV) infection , chlamydial infection, and syphilis. Ulcer material was analyzed by the multiplex polymerase chain reaction (M-PCR) analysis DNA from herpes simplex virus (HSV), Haemophilus ducreyi, and Treponema pallidum was detected in 158 (52.0 percent), 72 (23.7 percent), and 31 (10.2 percent) of 304 ulcer specimens. Of the 304 subjects, 67 (22 percent) were HIV-seropositive and 64 (21 percent) were T. pallidum-seroactive. Granuloma inguinale was clinically diagnosed in nine (13.4 percent) of 67 ulcers negative by M-PCR analysis and in 12 (5.1 percent) of 237 ulcers positive by M-PCR analysis (P = .03). Lymphogranuloma venereum was clinically diagnosed in eight patients. Compared with M-PCR analysis, the sensitivity and specificity of a clinical diagnosis of syphilis, herpes, and chancroid were 67.7 percent, 53.8 percent, and 75 percent and 91.2 percent, 83.6 percent, and 75.4 percent, respectively. Reactive syphilis serology was 74 percent sensitive and 85 percent specific compared with M-PCR analysis. Reported contact with a prostitute in the preceding 3 months was associated with chancroid (P = .009), reactive syphilis serology (P = .011), and HIV infection (P = .007). The relatively poor pleads for syndromic management of genital ulcers in Jamaica. Prevention efforts should be intensified.(Au)

Adulto , Feminino , Masculino , Humanos , Doenças dos Genitais Femininos/microbiologia , Doenças dos Genitais Masculinos/microbiologia , Infecções por HIV/complicações , Úlcera/microbiologia , HIV-1 , HIV-2 , Jamaica , Linfogranuloma Venéreo/complicações , Linfogranuloma Venéreo/diagnóstico , Reação em Cadeia da Polimerase , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , Simplexvirus/isolamento & purificação , Treponema pallidum/isolamento & purificação , Úlcera/complicações , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/complicações , Doenças dos Genitais Masculinos/diagnóstico , Haemophilus ducreyi/isolamento & purificação , Herpes Genital/complicações , Herpes Genital/diagnóstico
West Indian med. j ; 47(suppl. 2): 47, Apr. 1998.
Artigo em Inglês | MedCarib | ID: med-1840


The purpose of this study was to determine the aetiology of genital ulcers (GUD) in STD clinic attenders, using state-of-the-art diagnostic tests, and to compare this with clinical diagnosis. Patients attending an STD clinic in Kingston, Jamaica for a new STD complaints were screened for GUD and clinically diagnosed. Swabs of ulcers were taken and tested for T. pallidum (TP), herpes simplex virus (HSV), and H. ducreyi (HD), using polymerase chain reaction (PCR). Sera were tested for syphilis and HIV infection. Of 4873 patients screened, 304 (6.2 percent) had GUD. In patients with ulcers, 158 (52 percent) were HSV (+), 73 (24 percent) were HD (+), and 31 (10 percent) were TP (+). Dual infections were identified in 20 (7 percent) ulcers. Clinically, herpes was diagnosed in 85/158 (54 percent) of HSV (+) ulcers, chancroid in 54/72 (75 percent) of HD (+) ulcers, and syphilis in 21/31 (68 percent) of TP (+) ulcers. Over three-quarters of GUD in Kingston had defined aetiology for herpes, chancroid or syphilis using PCR, with herpes being the commonest. Uniformly, clinical diagnosis performed poorly and Jamaican algorithms for the management of GUD will need to take into account the findings of this study, and should include counselling for herpes.(AU)

Humanos , Condiloma Acuminado , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Masculinos/etiologia , Herpes Simples/diagnóstico , Sífilis/diagnóstico , Jamaica
West Indian med. j ; 46(3): 67-71, Sept. 1997.
Artigo em Inglês | MedCarib | ID: med-1989


Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8 percent of 23,050 patients had GUD, men (9.3 percent) more often than women (4.2 percent; p < 0.001). In 1990/91 the prevalence rate was 12.8 percent with increased rates for both men (18.2 percent) and women (6.8 percent; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8 percent and 7.8 percent of the patients; syphilis, in 12.9 percent and 18.8 percent; chancroid, in 12.4 percent and 13.3 percent; viral warts, in 5.7 percent and 6.3 percent; lymphogranuloma venereum, in 4.1 percent and 3.9 percent; and granuloma inguinale, in 3.6 percent and 2.3 percent. In men the rate for syphilis was 19 percent in 1990/91 and 8 percent in 1982/83 (p=0.001); and for genital herpes it was 7 percent in 1990/91 and 17 percent in 1982/83 (p=0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4 percent of cases in 1982/83 (particularly in men), and in 47.6 percent of cases in 1990/91. GUDs faciltate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and should be addressed effectively by stregthening the STD/HIV control programme.(AU)

Adulto , Feminino , Humanos , Masculino , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Úlcera/epidemiologia , Herpes Genital/epidemiologia , Fatores de Risco , Jamaica/epidemiologia , Infecções por HIV/transmissão , Doenças Sexualmente Transmissíveis/prevenção & controle , Estudos Transversais , Prevalência
Kingston; s.n; 1995. 318 p.
Tese em Inglês | MedCarib | ID: med-3013


Genital chlamydial infection has evolved as the leading sexually transmitted disease, both in the developed and the developing countries. The impact of genital chlamydial infection as a public health problem in the Caribbean is probably as high as in industrialized countries. Accurate statistics are therefore needed to obtain knowledge of the epidemiology of this disease. A prevalence study was carried out in Jamaica on persons attending different health facilities and locations. This was to ascertain the prevalence of chlamydial antibodies and of chlamydial infection in these selected populations. Microbiological methodologies employed were the microimmunofluorescent technique (MIF) for detecting antichlamydial antibodies, the direct immunofluorescent test (DFA) for detecting chlamydia antigens in specimens, and also isolation of C. trachomatis by culture in McCoy cells. A total of 1228 sera were tested for antichlamydial antibody resulting in the following seroprevalence rates. Prostitutes -95.3 percent, gynaecology patients -60.0 percent, family planning clinic attendess -59.8 percent, blood donors -52.6 percent, sexually transmitted diseases (STD) clinic patients -70.1 percent, pregnant women -25.0 percent. The 95.3 percent seroprevalence rate observed in prostitutes was significantly higher than that found in the other groups. From 1641 patients, specimens including urethral, endocervical, conjunctival and nasal swabs were cultured for C. trachomatis. The organism was isolated from 18.5 percent to 59.3 percent in this study group; in pregnant women 18.5 percent (n=200), neonates 24.0 percent (n=100), prostitues 24.8 percent (n=129), student 33.9 percent (n=103), family planning clinic attendess 34.0 percent (n=238), gynaecology patients 45.8 percent (n=170) and STD patients 59.3 percent (n=701). The seroprevalence of C. trachomatis is high in Jamaican population, although the rate of infection was found to be much lower. A wide cross-section of the Jamaican population in different age groups from different strata of the society and having different behavioural patterns was found to be infected with C. trachomatis. The prevalence of C. trachomatis infection was not influenced significantly by demographic factors or socioeconomic status, since both chlamydial antibody and C. trachomatis were demonstrated in all age groups and in individuals from different strata of the society with different behavioral patterns. (AU)

Humanos , Adulto , Adolescente , Feminino , Masculino , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/diagnóstico , Jamaica/epidemiologia , Fatores Socioeconômicos , Infecções por Chlamydia/prevenção & controle , Doenças dos Genitais Femininos , Doenças dos Genitais Masculinos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/etiologia , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle , Comportamento Sexual , Prevalência
J Acquir Immune Defic Syndr ; 7(3): 310-6, Mar. 1994.
Artigo em Inglês | MedCarib | ID: med-8236


Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1 percent (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7 percent) heterosexual men, 3 of 5 (60 percent) homosexual/bisexual men, and 9 of 484 (1.9 percent) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaints of genital ulcers [odds ratio (OR) 7.3; 95 percent confidence interval (CI) 1.4-72], past history of genital ulcer (OR)4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to the complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR,3.2; CI, 1.1-9.5), and history of genital ulcer (OR 2.9; CI, 1.0-8.0). (AU)

Humanos , Adulto , Masculino , Feminino , HIV-1 , Infecções por HIV/epidemiologia , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Masculinos/complicações , Genitália/lesões , Estudos Transversais , Infecções por HIV/etiologia , Jamaica/epidemiologia , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/complicações , Úlcera