Seroprevalence of hepatitis C virus in haemophiliacs in Jamaica.

Haemophilic patients (n = 90) and household contacts (n = 40) were tested for serological markers of hepatitis B virus (HBV), hepatitis C virus (HCV) and elevated serum aminotransferases using commercially prepared reagents. Of the haemophiliacs 41% (37/90) tested positive for antibodies to HCV (anti-HCV); 36% (32/90) antibodies to hepatitis B core antigen (anti-HBc); 54% (49/90) antibodies to hepatitis B surface antigen (anti-HBs) and 2% (2/90) hepatitis B surface antigen. On the other hand, 29% (26/90) of the patients and 90% (36/40) of the household contacts tested negative for all of the viral markers. Anti-HCV positivity in the haemophilic patients correlated positively with anti-HBc (p < 0.025). Increasing age (odds ratio 2.09; p < 0.01), severity of disease (odds ratio 6.2; p < 0.05) and the requirement for transfusion (odds ratio 3.2; p < 0.05) were risk factors for anti-HCV positivity. The presence of anti-HBc (odds ratio 3.8; p < 0.01) and coinfection with HCV and HBV also correlated positively with age (odds ratio 2.5; p < 0.01). The provision of anti-HCV screened donor blood and virally inactivated blood products for treatment of all haemophilic patients are goals that must be achieved.

Prevalence of viral and bacterial sexually transmitted pathogens in Jamaican pregnant women

In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19 percent of the women had at least one pathogen: C. trachomatis was found in 16 percent, HTLV-1 in 2 percent, HIV-1, HBV and N. gonorrhoeae each in 0.5 percent C. trachomatis infection was more prevalent in women less than 20 years of age (31 percent) than in those 20 years and older (16 percent, OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica(AU)

Chlamydial infections in selected populations in Jamaica - abstract

The importance of Chlamydial trachomatis as a cause of genital tract infection in Caribbean countries is largely unknown. Two hundred and sixteen cervical and urethral specimens were collected from patients attending a Sexually Transmitted Disease Clinic, a Gynaecology Clinic and a Family Plannin Clinic, in Kingston. Specimens were tested for chlamydiae by direct immuno-fluorescence and cell methods. These were also investigated for N. gonorrheae infections. Seventy-two of 138 patients (52 percent) at the STD Clinic were positive for chlamydia; 28 of 50 (56 percent) from the Gynaecology Clinic and 11 of 28 (39 percent) from the Family Planning Clinic were positive. The prevalence of C. trachomatis (52 percent) was higher than that of N. gonorrheae (11.2 percent) in all groups. The results indicate that C. trachomatis is a common cause of genital tract infections in Jamaica (AU)

Chlamydial infections in selected populations in Jamaica

The importance of Chlamydia trachomatis as a cause of genital tract infection in Caribbean countries is largely unknown. Two hundred and sixteen cervical and urethral specimens were collected from patients with cervicitis and urethritis attending a Sexually Transmitted Diseases (STD) Clinic, a Gynaecology Clinic and a Family Planing Clinic in Kingston. Specimens were tested for chlamydiae by direct immunofluorescence and cell culture methods. They were also investigated for N. gonorrhoeae infections. Seventy-two of 138 patients (52.2 percent) at the STD Clinic were positive for chlamydiae; 28 of 50 ((56.0 percent ) from the Gynaecology Clinic and 11 of 28 (39.3 percent) from the Family Planning Clinic were positive. The prevalence of C. trachomatis (52.3 percent) was higher than that of N. gonorrhoeae (11.1 percent) in all groups. The results indicate that C. trachomatis is a common cause of genital tract infections in Jamaica(AU)

Response of chlamydial non-gonococcal urethriti (NGU) to treatment with rosythromycin - abstract

The efficacy of roxythromycin 150 mg twice daily was evaluated for treatment of NGU caused by Chlamydia trachomatis in an adult outpatient setting with a high non-compliance level. Eligible patients were male adults (> 18 years) attending a sexually transmitted diseases (STD) clinic in Kingston with uncomplicated NGU. Chlamydial aetiology was identified by direct immunofluorescence and tissue culture techniques using monoclonal antibodies for final confirmation. In a 14-week study, 245 cases of NGU were identified of which 178 (72.7 per cent) were Chlamydia-positive. The results showed that C. trachomatis was eradicated from 87.2 per cent of the 125 patients finally evaluable. The prevalence of C. trachomatis is high in genital infections in Jamaica. These results indicated that roxythromycin was a suitable alternative for treatment in view of reports of resistance to tetracycline. A distinct advantage of roxythromycin was the twice daily dosage compared with four times daily for tetracycline, in treating a common sexually transmitted disease in a population group with a high non-compliance rate (AU)

Seroprevalence of chlamydia trachomatis, hepatitis B and retroviruses in female STD patients and pregnant women in Jamaica - abstract

The seroprevalence of chlamydia trachomatis (Ct), hepatitis B (HBV), human immunodeficiency nirus (HIV) and human T-lymphotropic virus-type 1 (HTLV-I) was investigated in a high-risk group, patients from a sexually transmitted diseases clinic and prostitutes, as well as a low-risk group, antenatal group. In the STD group 100 sera were tested. Seropositivity for Ct was 82 percent,for HBsAg 3 percent, HBcAb 23 percent, HIV-Ab 2 percent and HTLV-1 Ab 8 percent. Among the 76 prostitutes, the seropsitivity was even higher: Ct 97 percent, HBsAg 8 percent, HBc,Ab 41 percent, HIV-Ab 9 percent and HTLV-1 Ab 17 percent. The antenatal women studied as a normal control population had lower levels: Ct 52 percent, HBsAg 0.7 percent, HBcAb 9 percent, HIV-Ab 0.7 percent and HTLV-1 Ab 2.8 percent. It is noteworthy that the seroprevalence for all the STDs investigated was markedly higher in the promiscuous group. Although the level for Ct antibodies was in the antenatal women, even this group showed a high prevalence of this very commonly occurring STD. (AU)

Blood-borne sexually transmitted infections among substance abuse patients in Jamaica

OBJECTIVE: The objective of this study was to determine the prevalence of blood-borne sexually transmitted infections (STI) including the human immunodeficiency virus (HIV), human T-cell lymphotropic virus type-1 (HTLV-1), hepetitis B virus (HBV) and syphillis in residents of a detoxification/rehabilitation unit in Jamaica. METHODS: The records of 301 patients presenting, over a 5-year period, for treatment of substance abuse were reviewed for demographic and laboratory data. The laboratory results were compared with those of 131 blood donors who were used as representative of the general population. The substances used were alcohol, cannabis and cocaine. None of the subjects was an intravenous (IV) drug user. Female substance abusers were at higher risk than males for STI. The prevalence of STI in substance abusers did not differ significantly from that in blood donors (12 percent v 10 percent). The prevalence of syphilis in substance abusers was significantly higher than in blood donors (6 percent v 3 percent; p < 0.05). The prevalence of syphilis was dramatically increased in female substance abusers and female blood donors (30 percent; p < 0.001 and 13 percent; p < 0.05, respectively) compared with males. An increased frequency of HTLV-1 was observed in female compared to male substance abusers. Unemployment was identified as a risk factor for sexually transmitted disease in substance abusers. CONCLUSION: These results support the policy of screening patients in detoxification units for STI and indicate a need for gender specific approaches in the control of substance abuse and STI in Jamaica.(Au)

Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic

The prevalence of sexually transmitted diseases (STD) and risky behaviour patterns were studied in 165 adolescents attending a STD clinic in Jamaica. A standardised structured questionnaire, clinical algorithms for STD and serological tests for HIV and syphilitic infection were applied. High prevalences of risky behaviour including young age at onset of sexual activity, especially in boys, (mean age 12.5 ñ 2.5 years); unprotected sexual intercourse (only 4 percent used condoms consistently); multiple sexual partners (mean 3.8 ñ 2.4 and 1.8 ñ 1.2 for boys and girls, respectively were found. Marijuana, used by 60 percent of the boys, was an independent risk factor for dysuria (adjusted Odds Ratio (OR), 2.0; 95 prcent CI, 1.6 - 3.4). Repeated episodes of STD (33 percent), coinfection with HIV (1.2 percent), syphilis (1.2 percent) and teenage pregnancy (13 percent) were prominent findings. Educational strategies which promote behaviour intervention at an early age, frequent and consistent use of condoms, abstinence or delayed onset of sexual activity are essential to reducing the HIV/AIDS and STD risk in adolescents in Jamaica.(Au)

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted (STD) clinics in Jamaica, we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphillis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63 percent of cases of NGU but high prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71 percent vs 58 percent; x2=4.78; odds ratio OR=1.76; P<0.05) and previous history of gonococcal infection (83 percent vs 42 percent; x2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occured in 5.2 percent of cases of NGU and 50 percent and 90 percent, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.(Au)

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35 percent, 47 percent, and 55 percent in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95 percent confidence interval (CI) = 1.2 - 3.9; p= 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95 percent CI = 1.4 - 10.6; p= 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95 percent CI = 1.8 - 6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence if C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk. (AU)

Genital Chalmydia trachomatis (serotypes D-K) infection in Jamaican commercial street sex workers

OBJECTIVE: To determine in the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmuofluorescence (MIF) test. RESULTS: The DFA detect C trachomatis in 16 percent (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24 percent (31/129) and 25 percent (33/129) respectively. The overall prevalence of current chalmydial infection detected by the isolation techniques used was 25 percent (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95 percent, 61/64) was found in CSSW compared with blood donors (53 percent, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9 percent) and Candida albicans (7 percent) were found in comparatively low frequencies, while Trichomonas vaginalis (0 percent) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequeles of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.(AU)

The effectiveness of the Gram stain of high vaginal swabs in the diagnosis of bacterial vaginosis at the University Hospital of the West Indies [abstract]

OBJECTIVE: To correlate the gram-stain of high vaginal swabs (HVS) with the diagnosis of bacterial vaginosis (BV) and to compare this with bacterial culture reports to determine whether any useful additional information is gained by culture. METHODS: HVS submitted to the microbiology laboratory (UWI) from patients diagnosed clinically with vaginal infection were used in this study. Specimens were submitted from the Family Planning, Gynaecology and Antenatal clinics at the University Hospital of the West Indies. Swabs were placed in Stuart's Transport Medium and taken to the microbiology laboratory within 24 hours. The specimens were subjected to standard bacteriological procedures of culture on blood and MacConkey agar and microscopic procedures of wet prepartion and gram stain. The gramstain was recorded on a specially designed data sheet for each patient with a standardized scoring method for the evaluation of gram-stained smears based on the recognition of both presence and amount of significant morphotypes. This result was then compared with the bacterial culture, available a few days later, to see the degree of correlation and to determine whether any relevant additional information was gained. Almost 60 percent of the specimens collected yielded no pathogens on culture. However, one-third of this 60 percent was diagnosed as BV by standardized scoring method. One-third of all specimens submitted yielded yeast (Candida albicans and yeast not-Candida albicans) on culture and by gram stain. Streptococcus group B was isolated in < 4 percent of all specimens and a miscellaneous group of organisms including Klebsiella sp, Pseudomonas sp and anaerobic Streptoccus made up the rest of bacterial isolates. CONCLUSIONS: The standardized scoring method of evaluating the HVS gram stains yielded a more accurate and rapid diagnosis of BV than the traditional culture method. This is worthy of further study, as implementation of this method would result in considerable cost and time saving. (AU)

The prevalence of genital chlamydial infection in the Jamaican population

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)

The prevalence of genital chlamydial infection in the Jamaican population

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.

Laboratory diagnosis of rotavirus infection in infantile gastroenteritis using the Elisa technique

The magnitude of gastroenteritis and its co-partner malnutrition has been amply identified in Jamaican children under five years but especially in the 6-24 month age group which are the most vulnerable. At present steps are being taken to significantly improve the existing conditions and the results have been very rewarding. Although the nutritional aspect was not emphasised in the analysis of this study it is a fact that malnutrition co-exists with gastroenteritis and the malnourished child is more prone to infection from the causative agents of gastroenteritis. Results of this show that rotaviruses are important aetiological agents of gastroenteritis in Jamaica especially in the "cooler" months of the year. The higher prevalence of rotavirus infection in Jamaican children (5 years and under) in December to March, the cooler months of the year is significant. This could suggest that temperature might play a role in the occurrence of the virus, in addition, there was a definite drop in temperature during those months. This pattern of higher prevalence in winter or cooler months is in accord with findings of other investigators worldwide (King et al, personal communication; Davidson et al; Bryden et a;; Kapikian et al; Middleton et al). From the findings in this study we can conclude that rotavirus appears to be significantly associated with Infantile Diarrhoea in Jamaican children, that there is a higher incidence in the cooler months of the year, and that there is correlation with previous studies by other investigators in different parts of the world in different aspects like clinical factors, age and sex, socio-economic status of the patients also climatological variables. Sensitivity, low cost, reagent stability, ease of procedure are some of the virtues of the ELISA. These factors are in favour of using this technique as a routine laboratory method of rotavirus detection. However, it must be remembered that optimum reproducibility is important, therefore these tests should be rigidly controlled by the inclusion of reference negative and positive antisera at all times and the specificity is further ensured by performing the Blocking Test. Although there are so many advantages in using the ELISA test routinely in a laboratory, there are also disadvantages. Among these are dependence on a foreign source for reagents and the possibility of the occurrence of false positives which calls for a blocking procedure, therefore prolonging the test results. However, the use of the ELISA technique in rotavirus detection would be beneficial to developing countries like Jamaica, if conjugate and control serum could be made available to them routinely by W.H.O. or similar health organization, or these reagents could be obtained from a reliable commercial source at a low affordable cost (Summary)

Epidemiology of non-ulcerative sexually transmitted diseases in a high risk population in Jamaica

The role of ulcerative STDs such as syphilis in facilitating the transmission and acquisition of HIV is well established. Non-ulcerative STDs such as gonorrhoea and Chlamydia infection are considered facilitators of HIV transmission. This study was designed to determine the types of non-ulcerative sexually transmitted diseases and associated risk factors among high-risk Jamaican men and women. A cross-sectional survey was conducted including 510 clients attending an STD clinic in Kingston. A standardised questionnaire was administered and microbiological investigations performed on urethral or cervical swab specimens obtained from each participant. All the subjects were symptomatic; 377 (74 percent) had genital discharge and 197 (39 percent) had dysuria with or without discharge. There were 309 cases of NGU; 115 cases of Candidiasis, 275 confirmed gonococcal infections and 226 cases of Trichomoniasis. Men were two times more likely to have gonococcal infection than women (69 percent vs. 50 percent; p<0.01). History of smoking marijuana was significantly associated with a positive test for gonorrhoea (69 percent vs. 52 percent; p<0.01). Forty one percent of women reported that their partners never used condoms (41 percent vs. 19 percent; p<0.01). Only nine men acknowledged consistent condom use. Those who were first time attendees at the STD clinic (n=263) were more likely to report never using condoms (38 percent vs. 27 percent; p<0.01). These data highlight the need for priority targetting in this high-risk group for counselling and health education in controlling, STD and HIV infection in Jamaica.(AU)