Aetiology of genital ulcer disease in patients attending an STD clinic in Kingston, Jamaica

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)

The decentralization of syphilis screening for improved care in Jamaican public clinics: Collaborative Working Group on Decentralization Syphilis Screening

OBJECTIVES: This study examined the decentralization of syphilis screening for improved care in Jamaican public clinics. METHODS: One of every five serum samples tested at the six peripheral sites was frozen and retested at the central laboratory in Kingston. Patient files and laboratory logbooks were compared over a 3-month period. RESULTS: Between May 1993 and December 1994, 15.5 percent of 32913 patients with sexually transmitted disease and 8.3 percent of 8914 women seeking prenatal care were found syphilis seroreactive. Of 2001 samples evaluated, 1933 (96.6 percent) had been correctly reported at the peripheral sites. Of 129 syphilis seroreactors detected at the peripheral sites, 88 (68 percent) were treated the same day and 21 (16 percent) more within 3 days after testing. CONCLUSIONS: Syphilis seroreactors were accurately detected and quickly treated at the peripheral sites. If these efforts can be sustained, Jamaican syphilis rates should decrease.(AU)

Knowledge, attitudes and practices of women regarding pap smears - abstract

The aims of the study were to assess women's knowledge, attitudes and practices regarding cervical cancer and screening, to see how knowledge influences attitudes and how both influence practice, and to examine certain social and demographic correlates. Between January 29, 1996 and February 29, 1996, 209 female patients, aged 19 years and over, were interviewed in the Casualty Department of the University Hospital of the West Indies. A questionnaire measuring knowledge, attitudes and practices regarding Pap smears and cervical cancer and selected characteristics of the patients and their partners were administered by a single interviewer. Quota sampling methodology was employed. Most of the respondents (98 percent) had heard about Pap smears, but the majority did not know that its main purpose is to help in the prevention of cervical cancer, as opposed to its detection. Only a majority of patients knew what the cervix is and that it is the part of the body that Pap smears are concerned with. The majority of respondents had positive attitudes with respect to cervical screening. However, having positive attitudes and possessing knowledge about Pap smears did not significantly influence compliance with screening, and apathy accounted for a significant portion of non-compliance. If a nationwide screening programme is to be successful, patient motivation and behaviour modification will need to be addressed. (AU)

Risk factors associated with STD/HIV seropositivity among female commercial sex workers (FCSWs)-implications for an integrated intervention strategy - abstract

HIV seropositivity is still relatively low in the general population in Jamaica. An initial study in Kingston identified an HIV prevalence of 12 percentage among female commercial sex workers (FCSWs). This study among Montego Bay FCSWs was to determine the prevalence of HIV/STD and identify risk factors associated with HIV seropositivity at initial presentation to a screening service [Women Health Interventions (WHI), ACOSTRAD project]. From August 1994 to October 1995, a detailed sexual history, a full physical examination, voluntary laboratory examination for syphilis and HIV infection were conducted on 143 FCSWs and a questionnaire administered. 25 percent of the FCSWs were seropositive for HIV infection (CI=17.6, 33.0) and 34 percent had a positive serological test for syphilis (CI=26.1, 42.3). Significant associations were found between HIV seropositivity and duration of time in prostitution greater than or equal to 5 years (OR=2.60 CI=1.10, 6.15); living alone with no regular partner (OR=3.90 CI=1.36, 11.21); number of different sex partners (paying and nonpaying) during this last week > two (OR=2.86 CI=1.25, 6.54), number of paying customers this last week> five (OR=2.57 CI=1.10, 5.99). Partners' cocaine use (p=0.003), "ever had syphilis" (p=0.009),"ever had sores on genitals" (0.013), were also significantly correlated with HIV seropositivity. No significant associations were noted with condom use during last sex act, sexual practices, self reported drug use and past history of other common STDs. The seroprevalence of HIV among FCSWs in Montego Bay is high. Strategies to decrease the prevalence of prostitution and create other opportunities for FCSWs are urgently needed (AU)

Genital ulcer audit, Jamaica: patient profile - abstract

Between March and August 1996, 4873 patients (2,181 men and 2,682 women) attending the Comprehensive Health Centre, Kingston, for a new STD complaint were screened for genital ulcer disease (GUD). Prevalence of GUD was 7.3 percent (356/4,873; men 13.4 percent women 2.4 percent). This represented a two-fold decrease in six years. 304 (men 252, women 52) ulcer patients were questioned for demographic and behavioural factors related to STD, clinically assessed for GUD, and tested for HIV infection, syphilis and other GUDs. The employment rate among GUD patients was 77 percent (M 83 percent, F50 percent), 79 percent were single or had a steady visiting partner and 55 percent had completed secondary education. Condoms were reportedly used more than half of the time by 34 percent. Of 280 patients, 17 percent reported no contacts, 53 percent one, and 47 percent two or more in the past month. Of 274 subjects who admitted having sex in the previous three months, 55 percent were with steady partners, 43 percent with casual partners, 27 percent with new partners and 13 percent with prostitutes. A history of bruising was obtained from 50 percent of patients. It was significantly associated with the presence of more than 1 ulcer ( p=0.005), but not with clinical assessment of herpes. 24 percent of patients continued to have sex despite their ulcers and despite the fact that 58 percent of the ulcers were painful. One-third of patients had one ulcer, the rest, two or more. Prevalence of HIV-1 infection was 22 percent (M23 percent, F 19 percent), three times the rate in the general STD population. HIV infection was significantly higher (p<0.002) in patients clinically assessed as having granuloma inguinale, and in those with reactive tests for syphilis (p<0.002). Prevalence of syphilis serology [TRUST + MHA - TP(+)] was 24 percent (M 22 percent, F 33 percent). GUDs continue to be important in the transmission of HIV infection. Creative clinical and community approaches are required for its effective control. (AU)

Community participation as seen by primary health care workers in the parish of St. Catherine, Jamaica

Primary health care workers in the parish of St. Catherine were studied over a six week period (February 2nd to March 18th) to access their knowledge, attitudes and perceptions towards community participation. The categories of workers in the sample were doctors; nurses; community health aides; dental staff; public health inspectors; pharmacist; others, comprising contact investigators, orderlies, nutritionist and laboratory technicians. A questionnaire instrument was administered among 13 health centres in zones 2 and 3 for a total of 80 workers. The majority of workers were female (85 percent), and the significant age distribution was between 20 years and 49 years. While most of the workers said they heard of community participation only 54 percent described their understanding of the concept as clear. There was clearer understanding of the concept among community health aides (CHA's) as compared to nurses. Overall the attitude of the workers towards community participation was high (66 percent). Most workers felt that health workers and communities should share decision-making, but only 54 percent of the workers studied thought that they had the skills needed for community participation. It is evident that there is potential for participation, but primary health care workers need the tools and the necessary skills to be effective in carrying out the bridging role between the health services and the community. There is need for training in community participation in primary health care; better utilization of the expertise of workers who have some training in community participation and more care in the choice of workers so that they work in the areas in which they live (AU)