GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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C ONTENTS List of abbreviations…………………………………………………………………………….… 2 Chapter 1. Introduction………………………………………………………………..… 4 Chapter 2. Objectives and methods………………………………………………... 18 Chapter 3. Prevalence and risk factors of STI…………………………………….. 22 3.1. Pattern of sexually transmitted diseases and risk factors among women attending an STD referral clinic in Nairobi, Kenya………………………….... 22 3.2. Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field?………………………………….…… 32 Chapter 4. Health-seeking behavior and sexual behavior in Nairobi………….…… 37 4.1. Healthcare-seeking behavior and sexual behavior of patients with STDs in Nairobi, Kenya…………………………………………………………….….. 37 4.2. Health-seeking behavior and sexual behavior among primary health care patients in Nairobi, Kenya………………………………………………….…... 46 Chapter 5. Diagnosis and management of sexually transmitted infections…….… 56 Chapter 6. Prevention of sexually transmitted infections including HIV……. 68 6.1. Syphilis control during pregnancy: Effectiveness and sustainability of a decentralized program……………………………………………………….…. 68 6.2. Partner notification of pregnant women infected with syphilis in Nairobi, Kenya………………………………………………………………………….….. 73 6.3. A randomized, placebo controlled trial of monthly azithromycin prophylaxis to prevent STIs and HIV-1 in Kenyan sex workers: study design and baseline findings……………………………………………….….……………... 80 6.4. STIs and vaginal douching in a population of female sex workers in Nairobi, Kenya……………………………………………………………….…... 91 Chapter 7. Conclusions…………………………………………………………….…… 99 Chapter 8. Final remarks………………………………………………………….…. 108 References……………………………………………………………………………………….… 111 Annex WHO Collaborating Center on HIV/AIDS, Nairobi, Kenya…………………... 126 Summary…………………………………………………………………………………………... 128 Résumé…………………………………………………………………………………………….. 131 Samenvatting………………………………………………………………………………….…... 135 Acknowledgements……………………………………………………………………………….. 139 Contents 1
AIDS Acquired Immune Deficiency Syndrome BV Bacterial vaginosis CI Confidence Intervals CIN Cervical Intraepithelial Neoplasia CT Chlamydia trachomatis DSMB Drug safety and monitoring board EC European Commission ELISA Enzyme-linked Immunosorbent Assay FAO Food and Agriculture Organization FHI Family Health International FP Family Planning FSW Female sex workers GoK Government of Kenya GUD Genital Ulcer Disease HD Haemophilus ducreyi HGSIL High-grade SIL HIV Human Immunodeficiency Virus HSV Herpes simplex virus ICRH International Center for Reproductive Health KSh Kenyan Shilling LED Leukocyte esterase dipstick LGSIL Low-grade SIL MoH Ministry of Health M-PCR Multiplex PCR NASCOP National Aids Control Program NCC Nairobi City Council NG Neisseria gonorrhoeae NG/CT Neisseria gonorrhoeae / Chlamydia trachomatis NGO Non-governmental Organization NS Not significant OR Odds Ratio PCR Polymerase chain reaction PHC Primary health care PID Pelvic Inflammatory Disease L IST OF A BBREVIATIONS List of Abbreviations 2
Page 1: GHENT UNIVERSITY STI PREVENTION AND
Page 5 and 6: 1.1. Sexually Transmitted Infection
Page 7 and 8: countries, the rate of reporting co
Page 9 and 10: district of Uganda randomized villa
Page 11 and 12: By identifying where significant
Page 13 and 14: 4.5%, 3.9%, 67.7% and 30.1% while t
Page 15 and 16: female primary health care or anten
Page 17 and 18: The research data have been publish
Page 19 and 20: 2.1. OBJECTIVES 2.1.1. General obje
Page 21 and 22: 2.2.3. Laboratory procedures The mi
Page 23 and 24: C HAPTER 3 PREVALENCE AND RISK FACT
Page 25 and 26: After registration by the clinic cl
Page 27 and 28: The majority of the women were infe
Page 29 and 30: eing single, ever having been treat
Page 31 and 32: prevalence found in a family planni
Page 33 and 34: 3.2. Declining Syphilis Prevalence
Page 35 and 36: Training Nurses at the antenatal cl
Page 37 and 38: We believe that the observed declin
Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
Page 41 and 42: Table 1: Demographic data of 471 pa
Page 43 and 44: women. Overall, significantly fewer
Page 45 and 46: Stigmatization by health staff also
Page 47 and 48: 4.2. Health-Seeking Behavior and Se
Page 49 and 50: Between September and November 1998
Page 51 and 52: Table 2: Healthcare-seeking behavio
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Thirteen women had engaged in sex w
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Men reported more extramarital affa
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C HAPTER 5 DIAGNOSIS AND MANAGEMENT
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discharge and abdominal pain-two co
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Data were entered and analyzed in S
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One of the peripheral health center
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Evaluation of Algorithms The result
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In this study of symptomatic women,
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C HAPTER 6 PREVENTION OF SEXUALLY T
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Table 1: Syphilis Rapid Plasma Reag
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One should keep these problems in m
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The use of mailed reminders did not
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Table 1: Characteristics of women w
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studies, indicating that couples ar
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6.3. A Randomized, Placebo-controll
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esistance patterns in bystander flo
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In univariate analysis, the odds ra
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Widows, divorcees and separated wom
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They did not report much condom use
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The low prevalence of the other STD
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There is some evidence that frequen
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Table 1. Characteristics of HIV- po
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A significantly higher prevalence o
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There is now considerable evidence
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patients. The analysis revealed hig
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contributory factor may be that mal
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use in Kenya. In a supplement of Se
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with intensive behavioral change in
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C HAPTER 8 FINAL REMARKS STIs illus
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to protect themselves and be empowe
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Bell G, Ward H, Day S et al. Partne
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Fleming D and Wasserheit J. From ep
Page 117 and 118:
Jackson DJ, Rakwar JP, Chohan B et
Page 119 and 120:
Manning B, Moodley J, Ross SM. Syph
Page 121 and 122:
Oberlander L, Elverdam B. Malaria i
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Serwadda D, Gray R, Wawer M et al.
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Van Dam J, Anastasi MC. Male Circum
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WHO Collaborating Center on HIV/AID
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S UMMARY Sexually transmitted infec
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notification. Innovative and locall
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connaissance des femmes sur la sant
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Nous avons démontré que le coût
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vonden we een hoge prevalentie van
Page 139 and 140:
We hebben aangetoond dat de kost va
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