Gonococcal infection as a cause of acute abdomen.

Gonococcal infection in the postantibiotic era continues to cause disseminated and severe disease in some patients. The differential diagnosis of pain in the lower abdomen in young women is difficult. Our case report described a 19-year-old patient who presented with acute abdomen as a result of Gonococcal infection, assessed as a local complication, pelveoperitonitis: pelvic inflammatory disease. The message of our case report is sexually transmitted infections should invariably be considered in young women and searched for accordingly.

Syphilis and gonorrhoea in the Czech Republic.

Syphilis remains a public health problem in the Czech Republic and worldwide. The Czech Republic--until 1993 a part of Czechoslovakia--has a long tradition in public health activities, and STI surveillance is mainly focused on the infections traditionally called venereal diseases--syphilis, gonorrhoea, chancroid, and lymphogranuloma venereum. Campaigns from the early 1950s, were successful in controlling syphilis and gonorrhoea; and chancroid and lymphogranuloma venereum infections are extremely rare. In late 1980s, a low incidence of newly reported syphilis cases was achieved (100-200 cases annually), while around 6500 cases of gonorrhoea were recorded annually during the same period. Health care and prevention of STI diseases in the Czech Republic are based on close cooperation between clinical departments and laboratory and epidemiological services of Environmental Health Offices. Annual statistics showing data on reported cases of 'venereal diseases', based on ICD-10 codes, are available from 1959. Separate statistical data on other STIs are not available, and aggregated numbers only for Chlamydia trachomatis infections have been presented annually since 2000. Following the political and social changes in the Czech community in 1989, a distinct increase of syphilis was recorded. Between 50% and 60% of notified cases were classified as late latent or of unknown duration. The continuing annual occurrence of congenital syphilis (7-18 cases per year) reported during the 1990s has also been a very serious phenomenon. Cases have been concentrated in large urban areas with a high level of commercial sex activity, and a high proportion of cases is also noted in refugees. While the annual incidence of gonorrhoea gradually decreased from 1994 to 2001 (from 28.5 to 8.9 per 100,000 population), the incidence of syphilis increased in this period from 3.6 to 9.6 per 100,000 population (the highest value was 13.4 in 2001) and in 2000, for the first time in many years, it exceeded the incidence of gonorrhoea.

HIV infection and high risk behavior among patients attending an STD referral clinic in Prague, Czech Republic.

OBJECTIVE: This survey was conducted to determine the prevalence of HIV infection and associated risk behaviour in a high risk population of clients attending an STD clinic in Prague, Czech Republic. METHODS: Between September 1994 and January 1995, clients entering the Apolinar STD clinic in Prague, Czech Republic, were enrolled in a blinded, unlinked HIV antibody seroprevalence study. Non-identifying demographic characteristics, STD diagnoses, HIV risk exposures, and voluntary HIV testing experience were extracted from medical charts. RESULTS: Of 1394 patients for whom serum was available for testing, one was positive for HIV (HIV prevalence 0.07%, 95% confidence interval (CI) 0.01, 0.41%). This person was one of 28 men having sex with men (MSWM) (HIV prevalence among MSWM 3.6%, 95% CI 0.6, 17.7%). Among the 775 male clients, 75.5% had heterosexual unprotected sex, 11.1% had sex with high risk partners or prostitutes, 3.6% were MSWM, 1.0% were injecting drug users (IDUs), 0.7% were both MSWM and IDUs, and 6.8% and 1.8% had other or no recognized risk for HIV/STDs, respectively. Among the 619 female clients, 74.5% had heterosexual unprotected sex, 11.6% were prostitutes, 7.8% had sex with high risk partners, 1.1% were IDUs, and 3.9% and 2.3% had other or no recognised risk, respectively. The 304 adolescent patients (age 11-19 years) differed significantly (p < 0.05) in risk behaviour and STD diagnoses from the 1090 patients who were 20 years and older. Adolescents were significantly more likely to be female (58.6% v 40.5%, OR = 2.1), IDUs (3.6% v 0.4%, OR = 10.2), prostitutes (8.9% v 4.7%, OR = 2.0), and have sex partners with STDs (7.6% v 4.4%, OR = 1.8). The adolescent patients were also significantly more likely to be diagnosed with gonorrhoea (21.1% v 12.3%, OR = 1.9) and non-gonococcal urethritis (27.6% v 17.2%, OR = 1.8), and significantly less likely to have been tested previously for HIV (19.1% v 31.9%, OR = 0.5). CONCLUSIONS: HIV infection is currently uncommon in this population. However, the high rates of unprotected sex, prostitution, injecting drug use, and STDs, especially among adolescents, provide the basis for an epidemic in this population. Aggressive prevention education should be started before adolescence.