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1.
Can Bull Med Hist ; 37(2): 319-359, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32822549

RESUMEN

Hypochondriac or phobic reactions to venereal disease, specifically syphilis, have invited over three centuries of medical reification and nosological reframing. This bibliographic overview establishes that the early specification and psychiatricization of early modern concepts of melancholy and hypochondriasis, imaginary syphilis or syphilophobia, animated the early respective territorializations of venereology, infectiology more broadly, neurology, and mental medicine. Together with mercuriophobia and a wider emergent clinical sensitivity to sexual angst, the diagnosis, while evidently only sporadically made, functioned as a durable soundboard in the confrontation of emergent medical rationale with various confounders and contenders: medically literate and increasingly mobile but possibly deluded patients; charlatans and putative malpractitioners; self-referral laboratory serology (after 1906); and eventually, through psychoanalysis, the patient's unconscious. Requiring medical psychology early on, syphilology became and remained self-conscious and circumspect, attentive to the casualties of overdiagnosis, overtreatment, and iatrogenesis. Finally, patient apprehension led to makeshift forms of "moral treatment," including fear-instilling and placebos.


Asunto(s)
Hipocondriasis/historia , Trastornos Fóbicos/historia , Sífilis/historia , Historiografía , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Trastornos Fóbicos/terapia , Enfermedades de Transmisión Sexual/historia , Enfermedades de Transmisión Sexual/psicología , Sífilis/psicología
2.
Int J STD AIDS ; 31(7): 613-618, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32366180

RESUMEN

The sexual health services in the Birmingham and Solihull area of the United Kingdom, called Umbrella, has been offering home-based testing for sexually transmitted infections to patients since August 2015. The aim of this service evaluation was to evaluate the uptake, return rate and new diagnosis rates of home-based testing in comparison with clinic-based testing for human immunodeficiency virus (HIV), syphilis (STS) and hepatitis B. Home-based testing, although popular, had low uptake amongst high-risk groups such as men who have sex with men (MSM), compared to the clinic-based group (1% versus 11%, p < 0.001). This resulted in low positivity rates for HIV (0.02%) and STS (0.17%) and no new cases of hepatitis B in the home-based group. Therefore, our results show that home-based testing is not a cost-effective method of testing for HIV and likely this is also the case for hepatitis B and STS. Our recommendation would be to encourage uptake of home-based testing in high-risk groups such as MSM and Black Africans to improve the diagnosis rates of HIV, STS and hepatitis B. Alternatively, the continuation of home-based blood testing in the Birmingham and Solihull area will need to be reviewed by Umbrella as a cost-saving strategy for the service in the future.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Hepatitis B/diagnóstico , Hepatitis B/prevención & control , Tamizaje Masivo/métodos , Autocuidado/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/prevención & control , Sífilis/diagnóstico , Sífilis/prevención & control , Adolescente , Adulto , Autoevaluación Diagnóstica , Femenino , Infecciones por VIH/psicología , Hepatitis B/psicología , Virus de la Hepatitis B , Humanos , Masculino , Estudios Retrospectivos , Enfermedades de Transmisión Sexual/psicología , Sífilis/psicología , Serodiagnóstico de la Sífilis , Treponema pallidum , Reino Unido , Adulto Joven
3.
Artículo en Inglés | MEDLINE | ID: mdl-31878079

RESUMEN

OBJECTIVE: To study the prevalence of depression and related factors among men who have sex with men (MSM) in Shenzhen China. METHODS: Using a cross-sectional design, convenient sampling was applied to recruit participants at the AIDS(Acquired Immune Deficiency Syndrome)voluntary counseling and testing (VCT) clinic and gay clubs in 2015, thereby collecting data on sociodemographics, serological information, sexual behaviotablers, and depression. Descriptive analyses were conducted to determine the distribution of the measured variables. A chi-square test was applied to test the association between different levels of factors and depression status, alongside a binary logistic regression for multivariate analysis of depression. RESULTS: A total of 334 MSM completed the survey. Their mean age was 29.88 ± 7.56, and 35.6% had at least college education; 44.9% considered themselves to be homosexual, and 43.4% considered themselves bisexual. The median score of depression was 12, with 116 people (34.7%) depressed. A total of 267 took the serological test. Of these 267, 60 (22.5%) were reported HIV(Human Immunodeficiency Virus) positive, 33 (12.4%) were syphilis positive, and none were hepatitis C positive. The multiple logistic regression analysis showed that a lack of awareness of AIDS knowledge (OR(Odds Ratio): 2.636, 95% CI(confidence interval): 1.384-5.020), peer education (OR: 1.752, 95% CI: 1.055-2.190), and lack of heterosexuality (OR: 1.805, 95% CI: 1.080-3.018) increased the odds of depression. CONCLUSION: Raising awareness of AIDS and strengthening peer education can improve depression among men who have sex with men.


Asunto(s)
Depresión/epidemiología , Conducta Sexual/psicología , Adulto , China/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Prevalencia , Sífilis/epidemiología , Sífilis/psicología
4.
Sex Health ; 16(6): 580-586, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31699208

RESUMEN

Background Amidst an increase in STI rates among men who have sex with men (MSM) and transgender women (TGW), there is little research on STI knowledge, risk perception and concern about infection in these populations. METHODS: This mixed-methods study explored these constructs among 60 racially and ethnically diverse MSM and TGW who regularly engage in condomless anal intercourse with multiple partners. RESULTS: Participants had a mean age of 40.63 years. Most (95%) identified as a man and as gay or homosexual (73%); 55% were college graduates. Almost half the respondents reported a prior STI. Participants correctly answered a mean of 55.36% and 76.90% STI and HIV knowledge items respectively. STI knowledge was positively correlated with education and prior HIV tests, and was higher among those with a prior STI. During in-depth interviews, some participants expressed concerns about limited knowledge of STIs and syphilis. Half reported low concern about syphilis infection, due to prior treatment that was perceived as relatively simple, lack of STI infection in the past, erroneous information about transmission routes or simply not thinking about it. CONCLUSIONS: Among this high-risk sample who perceived themselves to be at low risk of infection, knowledge was primarily gained through being diagnosed and treated for an STI rather than from acquiring knowledge to prevent STI infection. Participants expressed interest in increasing their STI knowledge and recognised the importance of regular STI testing. Dissemination of targeted information about STI prevention, routinising of STI testing and STI self-testing might contribute to decreasing STI infection rates among this population.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/psicología , Enfermedades de Transmisión Sexual/psicología , Personas Transgénero/psicología , Adulto , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , Factores de Riesgo , Enfermedades de Transmisión Sexual/transmisión , Sífilis/psicología , Sífilis/transmisión , Personas Transgénero/estadística & datos numéricos , Sexo Inseguro/psicología , Sexo Inseguro/estadística & datos numéricos
5.
Rev. bras. enferm ; 72(5): 1326-1332, Sep.-Oct. 2019. tab, graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1042149

RESUMEN

ABSTRACT Objective: to develop and evaluate an application for syphilis control in pregnant women. Method: methodological research developed between March and November of 2016 in two phases: bibliographic survey of the years 2012 to 2016 in the databases PubMed, CAPES and Scopus and application development. Eight users participated in the usability test and five doctors and five nurses working in prenatal care participated in the evaluation. Results: the application contains informative video, information about the disease, map of health clinics, agenda function and anonymous notification. The evaluation of the objective, function and relevance was considered adequate with value higher than 0.80 in all items of the Content Validity Index. Final considerations: the application makes easier the routine of health services in the context of health promotion, in the convocation and treatment of pregnant women and their partners.


RESUMEN Objetivo: desarrollar y evaluar una aplicación para el control de la sífilis en gestantes. Método: Investigación metodológica desarrollada en el período de marzo a noviembre de 2016, en dos fases: levantamiento bibliográfico de los años 2012 a 2016 en las bases de datos PubMed, CAPES y Scopus y desarrollo de la aplicación. Participaron de la prueba de usabilidad ocho usuarios y de la evaluación cinco médicos y cinco enfermeras que actuaban en el prenatal. Resultados: la aplicación contiene vídeo informativo, información sobre la enfermedad, mapa de los puestos de salud, función de agenda y notificación anónima. La evaluación del objetivo, función y relevancia se consideró adecuada con un valor superior a 0,80 en todos los ítems del Índice de Validación de Contenido. Consideraciones finales: la aplicación facilita la rutina de los servicios de salud en el contexto de promoción de la salud, en la convocatoria y tratamiento de gestantes y sus parejas.


RESUMO Objetivo: desenvolver e avaliar um aplicativo para o controle da sífilis em gestantes. Método: pesquisa metodológica desenvolvida no período de março a novembro de 2016, em duas fases: levantamento bibliográfico dos anos de 2012 a 2016 nas bases de dados PubMed, CAPES e Scopus e desenvolvimento do aplicativo. Participaram do teste de usabilidade: oito usuários e da avaliação cinco médicas e cinco enfermeiras que atuavam no pré-natal. Resultados: o aplicativo contém vídeo informativo, informações sobre a doença, mapa dos postos de saúde, função de agenda e notificação anônima. A avaliação do objetivo, função e relevância foi considerada adequada com valor superior a 0,80 em todos os itens do Índice de Validação de Conteúdo. Considerações finais: o aplicativo facilita a rotina dos serviços de saúde no contexto de promoção da saúde, na convocação e tratamento de gestantes e seus parceiros.


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Adulto , Sífilis/prevención & control , Sífilis/terapia , Aplicaciones Móviles/normas , Brasil , Sífilis/psicología , Trazado de Contacto/métodos , Desarrollo de Programa/métodos , Aplicaciones Móviles/tendencias
6.
AIDS Res Ther ; 16(1): 28, 2019 09 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533749

RESUMEN

BACKGROUND: Limited data are available regarding correlates of regular sexually transmitted infections (STIs) and HIV screening among female sex workers (FSW) in Sub-Saharan Africa. In this study, we aimed to assess the frequency of regular syphilis and HIV screening and the psychosocial correlates associated with screening among FSW in Uganda. METHODS: This cross-sectional correlational study was conducted among 441 FSW, aged 17-49 years. We enrolled FSW through peer referrals and ascertained self-reported data on number of serological tests for HIV, syphilis and other STIs in the prior 12 months using an interviewer-administered questionnaire. In addition, we assessed attitudes, norms, social influences and self-efficacy towards 3-monthly Syphilis and 6-monthly HIV testing. We estimated the correlates of regular STI and HIV testing using negative binomial regression. RESULTS: Of the respondents 420 (95.2%) reported to have ever taken an HIV test with 297 (67.4%) testing two or more times in the prior 12 months. Over half of the respondents (59%) reported ever taking a syphilis test with only 62 (14.1%) reporting testing three or more times in the prior 12 months. After adjusting for socio-demographics, attitude and norms, high perceived self-efficacy was associated with a 33% increase in the likelihood of repeated HIV testing [prevalence ratio (PR), 1.33, 95% confidence interval (CI) 1.15-1.53] while low perceived confidence was associated with a 25% decrease in the likelihood of repeated HIV testing (PR, 0.75, 95% CI 0.63-0.89). Similarly low attitudes and norms were associated with a decrease of 52.6% (PR, 0.47, 95% CI 0.37-0.61) and 47% (PR, 0.53, 95% CI 0.41-0.69) in the likelihood of repeated syphilis testing respectively. CONCLUSION: Compared to HIV, uptake of repeated syphilis testing was very low. Correlates of HIV testing include; perceived self-efficacy amidst barriers and perceived confidence for HIV and low attitudes and accepting norms for syphilis. Health campaigns should emphasize overcoming barriers to HIV testing while promoting attitudes and norms including integration of serological syphilis testing and other STIs into HIV services.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/psicología , Trabajadores Sexuales/psicología , Enfermedades de Transmisión Sexual/diagnóstico , Sífilis/diagnóstico , Adolescente , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Enfermedades de Transmisión Sexual/psicología , Sífilis/epidemiología , Sífilis/psicología , Uganda/epidemiología , Adulto Joven
7.
Rev Bras Enferm ; 72(5): 1326-1332, 2019 Sep 16.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31531658

RESUMEN

OBJECTIVE: to develop and evaluate an application for syphilis control in pregnant women. METHOD: methodological research developed between March and November of 2016 in two phases: bibliographic survey of the years 2012 to 2016 in the databases PubMed, CAPES and Scopus and application development. Eight users participated in the usability test and five doctors and five nurses working in prenatal care participated in the evaluation. RESULTS: the application contains informative video, information about the disease, map of health clinics, agenda function and anonymous notification. The evaluation of the objective, function and relevance was considered adequate with value higher than 0.80 in all items of the Content Validity Index. FINAL CONSIDERATIONS: the application makes easier the routine of health services in the context of health promotion, in the convocation and treatment of pregnant women and their partners.


Asunto(s)
Aplicaciones Móviles/normas , Sífilis/prevención & control , Sífilis/terapia , Adulto , Brasil , Trazado de Contacto/métodos , Femenino , Humanos , Masculino , Aplicaciones Móviles/tendencias , Embarazo , Desarrollo de Programa/métodos , Sífilis/psicología
8.
Midwifery ; 78: 58-63, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31374436

RESUMEN

OBJECTIVE: to establish the incidence of syphilis in a group of childbearing women and their newborn babies in Romania and to identify the major risk factors of materno-fetal transmission in order for midwives to develop strategies to help prevent congenital syphilis. MATERIAL AND METHODS: a descriptive study of a group of 982 childbearing women who gave birth during a three-month period at an Obstetrics and Gynaecology Hospital in Romania. The women completed a questionnaire, which consisted of three sections: general data, general knowledge of syphilis and birth and pregnancy data. After admission to hospital, the women were investigated for syphilis using serological tests. RESULTS: there was a syphilis frequency of 0.91649% (n = 9) among the surveyed women. Among the nine infected women, two were not aware that they had a syphilis infection when initially admitted to hospital. The maternal profile with the highest risk of being diagnosed with syphilis was a young woman who had not had adequate prenatal care, who had elementary sex education and who lacked knowledge of personal health and hygiene. A significant percentage of the respondents, namely 11.9% (n = 117), were aged 15 to 20. CONCLUSIONS: in certain population groups, syphilis is still an important health care problem, especially in vulnerable individuals, such as childbearing women and newborns babies. More attention needs to be paid to primary prevention; the number of cases of congenital syphilis could be reduced by more involvement of midwifes and family doctors in antenatal care.


Asunto(s)
Parto/psicología , Roma/psicología , Sífilis/psicología , Adolescente , Adulto , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Embarazo , Factores de Riesgo , Roma/estadística & datos numéricos , Rumanía/epidemiología , Encuestas y Cuestionarios , Sífilis/complicaciones , Sífilis/epidemiología
9.
Sex Transm Infect ; 95(5): 336-341, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31010954

RESUMEN

OBJECTIVE: While men who have sex with men (MSM) are disproportionately affected by Peru's overlapping HIV and STI epidemics, there are few data on how partnership-level and network-level factors affect STI transmission in Peru. We explored partnership-level and network-level factors associated with gonorrhoea/chlamydia (Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT)) and/or syphilis infection among MSM in Peru. METHODS: We present the results of a cross-sectional secondary analysis of MSM (n=898) tested for syphilis and NG/CT infection as part of the screening process for two STI control trials in Lima, Peru. Participants completed questionnaires on demographics, sexual identity and role, characteristics of their three most recent sexual partners (partner sexual orientation, gender, role, partnership type, partner-specific sexual acts) and 30-day sexual network characteristics (number of sexual partners, partnership types, frequency of anal/vaginal intercourse). Participants were tested for syphilis and urethral, rectal and oropharyngeal NG/CT. Differences in network characteristics were analysed with χ2 and Kruskal-Wallis tests. RESULTS: Approximately 38.9% of participants had a new STI diagnosis (syphilis (rapid plasma reagin ≥16): 10.6%; NG/CT: 22.9%; syphilis-NG/CT coinfection: 5.4%). Condomless anal intercourse (CAI) was not significantly associated with an STI diagnosis. Gay-identified participants with exclusively homosexual networks had a higher prevalence of STIs (47.4%) than gay-identified MSM with only heterosexual/bisexual partners (34.6%, p=0.04), despite reporting fewer sexual partners (any partners: 2, 1-4 vs 3, 2-6; p=0.001; casual partners: 1, 0-3 vs 2, 1-4; p=0.001) and more stable partnerships (1, 0-1 vs 0, 0-1; p=0.003) in the last month. CONCLUSIONS: Network size and the number of casual sexual partners were associated with NG/CT infection among MSM in Peru. Despite reporting fewer sexual risk behaviours (smaller network size, more stable partnerships, less CAI), MSM with homosexual-only sexual networks had a higher prevalence of NG/CT and syphilis. These findings suggest network composition among MSM in Peru plays an important role in the risk for STI acquisition.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Minorías Sexuales y de Género/estadística & datos numéricos , Sífilis/epidemiología , Adulto , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/prevención & control , Infecciones por Chlamydia/psicología , Estudios Transversales , Femenino , Gonorrea/diagnóstico , Gonorrea/prevención & control , Gonorrea/psicología , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Trabajadores Sexuales/estadística & datos numéricos , Conducta Sexual , Parejas Sexuales , Sífilis/diagnóstico , Sífilis/prevención & control , Sífilis/psicología , Adulto Joven
10.
BMC Infect Dis ; 19(1): 124, 2019 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-30727950

RESUMEN

BACKGROUND: Syphilis screening can be successfully integrated into antenatal clinics, and potentially avert significant morbidity and mortality to unborn infants. A minority of male partners report for testing and treatment, increasing the likelihood of reinfection. We conducted a qualitative study to understand factors influencing male partners to seek treatment after syphilis notification by their pregnant partners. METHODS: A purposeful sample of 54 adults who participated in the STOP (Syphilis Treatment of Partners) study was stratified by gender (24 women, 30 male partners) and enrolled for in-depth interviews which were audio recorded, transcribed, and analyzed using the thematic approach. RESULTS: The participants' median age (IQR) was 32 years (25-44), 87% were married, and 57.4% (31/74) had attained secondary education. Fourteen of 22 (63%) female participants reported that they sometimes experienced domestic violence. Male participant's knowledge of syphilis and their perception of their valued role as responsible fathers of an unborn baby facilitated return. Female's fear of partner's violence and poor communication between partners, were barriers against delivery of the notification forms to partners and subsequent treatment of partners. For men, fear of injection pain, perceptions of syphilis as a genetic disease and as a woman's problem, busy work schedules, poor access to good STD services, shared facilities with women in clinics, as well as HIV-related stigma were important barrier factors. CONCLUSIONS: The return to the clinic for treatment of male partners after partner notification by infected pregnant women, was low due to limited knowledge about syphilis, fear of painful injection, fears of domestic violence, lack of communication skills (individual characteristics) and syphilis disease characteristics such as signs and symptoms. This, combined with health services characteristics such as structural barriers that hinder male partner treatment, low access, low capacity, work/time challenges, inadequate laboratory services and low clinic personnel capacity; threatens efforts to eliminate mother-to-child infection of syphilis. Improved public messaging about syphilis, better services, legal and policy frameworks supporting STD notification and treatment in resource-constrained settings are needed for effective STD control. TRIAL REGISTRATION: Clinicaltrials.gov NCT02262390 ., Date Registered October 8 2014.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Complicaciones Infecciosas del Embarazo/psicología , Sífilis/psicología , Adulto , Trazado de Contacto , Femenino , Humanos , Violencia de Pareja , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Mujeres Embarazadas/psicología , Parejas Sexuales , Factores Socioeconómicos , Sífilis/tratamiento farmacológico , Sífilis/prevención & control , Sífilis/transmisión , Uganda
11.
Tijdschr Psychiatr ; 61(10): 720-724, 2019.
Artículo en Holandés | MEDLINE | ID: mdl-31907916

RESUMEN

In the last few years, an increasing worldwide incidence in syphilis has been reported, mostly in the United States and Western Europe. Neurosyphilis is characterized by a wide differential diagnosis, which too often causes the disease to remain undetected for a long time. We report a case of a male patient with manic psychotic symptoms, in whom neurosyphilis was identified after elaborate diagnostic investigations. We give an overview of the disease process and correlations with psychiatric symptoms, diagnostics, screening and treatment.


Asunto(s)
Neurosífilis/diagnóstico , Trastornos Psicóticos/diagnóstico , Trastorno Bipolar/diagnóstico , Diagnóstico Diferencial , Pruebas Diagnósticas de Rutina , Humanos , Masculino , Persona de Mediana Edad , Neurosífilis/tratamiento farmacológico , Neurosífilis/psicología , Trastornos Psicóticos/etiología , Sífilis/psicología , Serodiagnóstico de la Sífilis
12.
Artículo en Inglés | MEDLINE | ID: mdl-32133205

RESUMEN

Introduction: In Japan, syphilis notifications have increased. Men who have sex with men (MSM) in Tokyo have contributed substantially to the increase in syphilis notifications. We thus aimed to determine the correlates of incident syphilis among them. Methods: MSM who attended a Tokyo clinic that serves sexual minorities were recruited in a case-control study in 2015. A case was seropositive for primary/secondary/asymptomatic syphilis at enrolment visit and seronegative at prior visit or had oral ulcers positive for Treponema pallidum DNA at enrolment. For each case, two controls seronegative at enrolment and prior visit were selected. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to assess for correlates of case status. Results: Among 35 cases, the median age was 37 (range = 21-63) years and was similar to the 71 controls. Among HIV-positive participants (26 cases and 67 controls), cases were independently associated with higher frequency of anal or oral sex (OR = 3.4; 95% CI = 1.4-8.6; increase per category from < 1/month, ≥ 1/month but < 1/week, to ≥ 1/week) and no or inconsistent condom use during anal or oral sex (OR = 3.0; 95% CI = 1.1-8.3; increase per category from using every time, occasionally, to never), adjusted for residency and time between visits. Discussion: Modifiable behaviours were associated with incident syphilis, and dissemination of prevention messages are needed.


Asunto(s)
Factores de Riesgo , Minorías Sexuales y de Género/estadística & datos numéricos , Sífilis/diagnóstico , Adulto , Estudios de Casos y Controles , Coinfección/epidemiología , Humanos , Japón/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Asunción de Riesgos , Minorías Sexuales y de Género/psicología , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Sífilis/epidemiología , Sífilis/psicología
13.
Medicine (Baltimore) ; 97(1S Suppl 1): S46-S53, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29893747

RESUMEN

BACKGROUND: The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016. METHODS: The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate. RESULTS: Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%). DISCUSSION: Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.


Asunto(s)
Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Asunción de Riesgos , Trabajadores Sexuales , Sífilis/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Condones/estadística & datos numéricos , Escolaridad , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Derechos Humanos , Humanos , Persona de Mediana Edad , Organizaciones , Prueba de Papanicolaou , Prevalencia , Trabajo Sexual/psicología , Trabajadores Sexuales/psicología , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Sífilis/diagnóstico , Sífilis/psicología , Factores de Tiempo , Adulto Joven
14.
Rev Neurol (Paris) ; 174(5): 313-318, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29631855

RESUMEN

OBJECTIVE: The aim of this study was to describe the clinical, biological and radiological characteristics of patients with syphilitic vasculitis, and to assess the outcome after treatment. METHODOLOGY: A retrospective review was carried out based on the records of patients with ischemic stroke, and reactive CSF TPHA and VDRL results. None of these patients showed symptoms of any other diseases or had received high doses of penicillin. RESULTS: A total of 53 patients with stroke met the diagnostic criteria for syphilitic arteritis. Their average age was 41±12 years. Nine patients had a history of genital ulcer (17%), and the median duration of illness after presenting a chancre was 8 [range: 1-14] years. A prodromal syndrome was seen in 27 patients (50.9%) and included changes in mental status in 14 patients (26.4%), seizures in 10 cases (18.9%), headache in eight (15.1%) and memory loss in seven (13.2%). Neurological events included focal motor deficits in 29 cases (54.7%), ataxia in 11 (20.8%) and movement disorders in 15 (28.3%). HIV serology was performed in 31 patients and proved negative in every case. Disease evolution was generally favorable: 12 patients (22.6%) were autonomous at the time of hospital discharge; 29 (54.7%) had partially recovered; and only seven (13.2%) still had signs of severe sequelae. CONCLUSION: A diagnosis of syphilitic stroke should be suspected in young patients as a manifestation of syphilis, and tests for neurosyphilis should be routine in neurology departments to make a prompt diagnosis, thereby preventing psychological sequelae.


Asunto(s)
Accidente Cerebrovascular/etiología , Sífilis/complicaciones , Adulto , Isquemia Encefálica/epidemiología , Isquemia Encefálica/etiología , Estudios Transversales , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/psicología , Neurosífilis/complicaciones , Neurosífilis/epidemiología , Neurosífilis/psicología , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/psicología , Sífilis/epidemiología , Sífilis/psicología , Tomografía Computarizada por Rayos X , Vasculitis del Sistema Nervioso Central/etiología
15.
AIDS Behav ; 22(4): 1113-1121, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29159593

RESUMEN

This paper estimates population-based prevalence of HIV, syphilis, HSV-2 and factors influencing HIV infection using a national sample of 1914 female sex workers (FSWs) in 7 regions in Tanzania. Additionally, HIV incidence was estimated by comparing biological HIV results with self-reported HIV status. The average HIV prevalence among FSWs in all 7 regions was 28%, ranging from 14% in Tabora to 38% in Shinyanga. HIV incidence was found to be 13 per 100 person-years. Syphilis prevalence was 8% with significantly higher burden found in Iringa (11%), Mbeya (13%), and Shinyanga (12%). Nearly 60% of the study population was infected with HSV-2. The high HIV prevalence and incidence coupled with suboptimal condom use indicate an urgent need to roll out the "Treat-All" approach and provide antiretroviral therapy to FSWs living with HIV regardless of their CD4 count. In addition, antiretroviral-based prevention technologies such as oral pre-exposure prophylaxis and microbicides should be piloted and evaluated.


Asunto(s)
Infecciones por VIH/epidemiología , Herpes Genital/epidemiología , Profilaxis Pre-Exposición , Trabajadores Sexuales/psicología , Trabajadores Sexuales/estadística & datos numéricos , Sífilis/epidemiología , Adulto , Femenino , Infecciones por VIH/psicología , Herpes Genital/psicología , Herpesvirus Humano 2/aislamiento & purificación , Humanos , Incidencia , Prevalencia , Sexo Seguro , Sífilis/psicología , Tanzanía/epidemiología
16.
Med Mal Infect ; 47(7): 470-476, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28943166

RESUMEN

OBJECTIVE: To explore knowledge on syphilis, sexual behaviors, and attitudes in men living with HIV in southwestern France. PATIENTS AND METHODS: In the ANRS CO3 Aquitaine Cohort of people living with HIV (PLHIV), a self-administered questionnaire was proposed to all male PLHIV attending one of the seven participating clinics between September 22 and October 24, 2014. The 15 questions explored patient knowledge about syphilis disease, attitudes, and behaviors during sexual intercourse. RESULTS: Among 302 patients surveyed, 101 reported at least one episode of syphilis. A history of syphilis was associated with awareness that syphilis was on the rise in men who have sex with men (MSM) in the Aquitaine region (46% vs. 22%, P<0.0001). Knowledge that syphilis could be transmitted by oral sex was low in both patients with (37%) and without (20%) a history of syphilis (P=0.0045). Patients with a history of syphilis more often used recreational drugs (RR 1.6; P=0.0028). Among 160 patients who had sexual intercourse with a man in the past 12 months, 23% reported using condoms for oral intercourse and 80% reported using condoms for anal intercourse. Sixty-two per cent of MSM declared being ready to change their practice if informed about the rise in syphilis. CONCLUSIONS: This survey revealed important information gaps in PLHIV about syphilis and related behavior. The reported receptiveness of this population to behavioral change may help inform educational interventions.


Asunto(s)
Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Sífilis/psicología , Adulto , Condones/estadística & datos numéricos , Francia/epidemiología , Infecciones por VIH/epidemiología , Humanos , Drogas Ilícitas , Conducta en la Búsqueda de Información , Masculino , Persona de Mediana Edad , Asunción de Riesgos , Autoinforme , Conducta Sexual , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Sífilis/epidemiología , Sífilis/transmisión , Sexo Inseguro
17.
Int J STD AIDS ; 28(10): 975-984, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28632469

RESUMEN

Even with technological advances in point-of-care rapid testing for HIV, hepatitis, and syphilis, individuals may still find the experience of submitting to testing, and receiving results, to be stressful. Participants completed the rapid test experience questionnaires to assess stress both prior to and after the specimen collection. Participants completed the risk behavior assessment, the coping strategies indicator, and the Barratt impulsivity scale. Participants chose which rapid tests they wanted using a list administered via computer. Logistic regression analysis was used to model self-reported stress prior to testing and after testing. A total of 1097 individuals completed testing. Individuals who scored high on avoidance reported a stressful experience at pretest (OR = 1.15, CI = 1.04, 1.26) while higher educational attainment was associated with no stress at both time points. Injection drug users, avoidant, and impulsive individuals experience stress either before or after rapid testing. Education appears to be protective against stressful testing.


Asunto(s)
Consumidores de Drogas/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Hepatitis C/diagnóstico , Tamizaje Masivo/psicología , Sistemas de Atención de Punto , Pruebas en el Punto de Atención/estadística & datos numéricos , Estrés Psicológico , Sífilis/diagnóstico , Adaptación Psicológica , Adulto , California , Consumidores de Drogas/psicología , Miedo , Femenino , Infecciones por VIH/psicología , Hepatitis C/psicología , Humanos , Masculino , Sífilis/psicología , Adulto Joven
18.
Hist Psychiatry ; 28(2): 195-208, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28468551

RESUMEN

In the late nineteenth and early twentieth centuries, the unspoken fear of syphilis played a significant role in the development of beliefs about female sexuality. Many women were afraid of sexual relationships with men because they feared contracting syphilis, which was, at that time, untreatable. Women also feared passing this disease on to their children. Women's sexual aversion, or repression, became a focus for Freud and his colleagues, whose theory of psychosexual development was based on their treatment of women. This article examines the case of Dora, the memoirs of Mabel Dodge Luhan and other sources to argue that the fear of syphilis was a significant factor in upper- and middle-class women's avoidance of heterosexual relationships. The fear of syphilis, in turn, became a significant factor in the psychoanalytic construction of female sexuality. The social suppression of the fear of syphilis has had a profound impact on theories of women's development. The implication for psychiatry is that our models of psychological development occur within a sociocultural milieu and cannot escape suppressed aspects of our culture.


Asunto(s)
Histeria/historia , Psicoanálisis/historia , Sexualidad/historia , Sífilis/historia , Miedo/psicología , Femenino , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Histeria/etiología , Sexualidad/psicología , Sífilis/psicología
19.
BMC Infect Dis ; 17(1): 269, 2017 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-28403825

RESUMEN

BACKGROUND: Heterosexual intercourse accounted for 93% of reported HIV cases in Guangxi, and Guangxi had 10% of China's total number of reported HIV cases. Older men are particularly vulnerable to STIs, for example, 46% of Guangxi's HIV cases were men over 50 years of age. As this is an under-studied population in China, effective prevention and control policies have yet to be developed. Thus, the aim of this study was to use a large-scale cross-sectional survey to understand the demographic and behavior factors associated with HIV and syphilis infections among older male clients of female sex workers (FSWs) in a high epidemic area of rural Guangxi, China. METHODS: A large-scale cross-sectional survey was conducted in 2012 among older male clients of FSWs in low-cost commercial sex venues. Questionnaire interviews were administered to collect sociodemographic and sexual behavior information. Blood samples were collected for HIV and syphilis infection tests. RESULTS: Of the 3485 participants, 2509 (72.0%) clients had a steady sex partner and 976 (28.0%) clients had no steady sex partner. The overall prevalence of HIV and syphilis infection were 3.0% and 3.2%, respectively. Compared to those with a steady sex partner, clients with no steady partner had higher odds of HIV infection (AOR: 1.90, 95% CI: 1.27-2.86), syphilis infection (AOR: 1.53, 95% CI: 1.02-2.30), and having factors associated with HIV or syphilis infection, including non-commercial casual sex encounters in last month (AOR: 3.29, 95% CI: 2.42-4.46), >10 years of commercial sex history (AOR: 1.31, 95% CI: 1.12-1.53), >2 incidents of commercial sex in last month (AOR: 1.53, 95% CI: 1.19-1.96), and aphrodisiac use in last month (AOR: 1.40, 95% CI: 1.16-1.70). Clients with no steady partner had lower odds of having heterosexual intercourse (AOR: 0.66, 95% CI: 0.56-0.79), awareness and knowledge of HIV/AIDS (AOR: 0.75, 95% CI: 0.64-0.88), and having had HIV tests (AOR: 0.65, 95% CI: 0.44-0.98). CONCLUSION: Older male clients of low-cost commercial sex venues in rural southwestern China are at high risk for HIV and syphilis infection, especially those with no steady sex partner. Improved interventions are urgently needed for this neglected risk population.


Asunto(s)
Infecciones por VIH/psicología , Trabajadores Sexuales/psicología , Parejas Sexuales/psicología , Sífilis/psicología , Anciano , China/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Heterosexualidad/fisiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Población Rural , Conducta Sexual , Sífilis/economía , Sífilis/epidemiología
20.
Sex Transm Dis ; 44(4): 249-254, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28282653

RESUMEN

BACKGROUND: The relative effectiveness of in-person versus telephone interviews for human immunodeficiency virus (HIV)/sexually transmitted disease partner services (PS) is uncertain. METHODS: We compared outcomes of in-person versus telephone PS interviews for early syphilis (ES) and newly diagnosed HIV in King County, Washington from 2010 to 2014. We used multivariable Poisson regression to evaluate indices (number of partners per original patient [OP]) for partners named, notified, tested, diagnosed, and treated (ES only). Analyses controlled for OP age, sex, race/ethnicity, sexual orientation, time to interview, place of diagnosis, and staff performing interviews. RESULTS: For ES, 682 and 646 OPs underwent in-person and telephone interviews, respectively. In-person syphilis PS were associated with higher indices of partners named (in-person index [IPI], 3.43; telephone index [TI], 2.06; adjusted relative risk [aRR], 1.68; 95% confidence interval [CI], 1.55-1.82), notified (IPI, 1.70; TI, 1.13; aRR, 1.39; 95% CI, 1.24-1.56), tested (IPI, 1.15; TI, 0.72; aRR, 1.34; 95% CI, 1.16-1.54), and empirically treated (IPI, 1.03; TI, 0.74; aRR, 1.19; 95% CI, 1.03-1.37), but no difference in infected partners treated (IPI, 0.28; TI, 0.24; aRR, 0.93; 95% CI, 0.72-1.21). For HIV, 358 and 489 OPs underwent in-person and telephone interviews, respectively. In-person HIV PS were associated with higher indices of partners named (IPI, 1.87; TI, 1.28; aRR, 1.38; 95% CI, 1.18-1.62), notified (IPI, 1.38; TI, 0.92; aRR, 1.24; 95% CI, 1.03-1.50), and newly diagnosed with HIV (IPI, 0.10; TI, 0.05; aRR, 2.17; 95% CI, 1.04-4.50), but no difference in partners tested (IPI, 0.61; TI, 0.48; aRR, 1.15; 95% CI, 0.88-1.52). CONCLUSIONS: Although in-person syphilis PS were associated with some increased PS indices, they did not increase the treatment of infected partners. In contrast, in-person HIV PS resulted in increased HIV case finding. These data support prioritizing in-person PS for HIV and suggest that in-person PS for syphilis may not have major public health benefit.


Asunto(s)
Trazado de Contacto/métodos , Infecciones por VIH/diagnóstico , Entrevistas como Asunto/métodos , Parejas Sexuales , Sífilis/diagnóstico , Adulto , Femenino , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Distribución de Poisson , Análisis de Regresión , Sífilis/psicología , Washingtón
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