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The overall HIV prevalence was 29%. Table 2 : Reason for seeking medical care spontaneously Among women less than 20 years, mentioned with probing.* Main Reason After Probing 28% were HIV positive, whereas this n % n % rate was 27% in the 20 years to 29 Vaginal discharge 106 20 364 70 years age group, 38% in the 30 years Abdominal pain 141 27 249 48 to 39 years age group, and 26% in Vaginal itch Dysuria 114 0 22 316 159 61 31 the 40 years to 49 years age group. Fever 0 36 7 The HIV prevalence was significantly Other 159 31 85 17 *Responses exceed 100% because of multiple problems higher in the age group of 30 years to 39 years compared with other age groups (P = 0.04). The prevalence of STDs among pregnant and non-pregnant women is shown in Table 3. The HIV prevalence among nonpregnant women was 34% compared with 23% among pregnant women (P =0.01). Pregnant women also had significantly more candidiasis (P = 0.02) and significantly less genital ulcers (P =0.03) than pregnant women. In 22% of the patients, none of the STI pathogens could be identified. CIN was found in 13% of women (95% CI, 9.8-15.8), of whom 8.4% had CIN I, 3.2% had CIN II, and 1.2% had CIN III carcinoma in situ. Table 3. Prevalence of reproductive tract Infections per pregnancy status and number of sex partners*** Non-pregnant women Pregnancy Status No. of Sex Partners* Pregnant women One Less than one (n=289) (n=197) (n=463) (n=57) n % n % n % n % HIV 97 (34)** 23 (23)** 125 (27)** 26 (46)** Neisseria gonorrhoeae 18 (6) 9 (5) 22 (5)** 11 (19)** Chlamydia trachomatis 8 (3) 13 (7) 18 (4) 5 (9) Trichomonas vaginalis 39 (24) 40 (29) 66 (23)** 16 (41)** Candida albicans 92 (32)** 82 (42)** 166 (36) 17 (30) Bacterial vaginosis 37 (22) 21 (15) 50 (18) 11 (28) RPR positive 19 (7) 11 (6) 23 (5)** 7 (12)** Genital warts 13 (5) 17 (9) 27 (6) 3 (5) Genital ulcers 44 (15)** 18 (9)** 56 (12) 8 (14) Cervical intraepithelial neoplasia * past 3 months ** P < 0.05 37 (14) 23 (13) 52 (12) 9 (17) *** not all test results were available for all women Risk Factors for Sexually Transmitted Diseases The relation between risk factors and the major STDs is shown in Table 4. The behavioral risk factors significantly associated with HIV in univariate analysis were first sexual intercourse on or before the age of 15 years, more than one partner in the last 3 months, PREVALENCE AND RISK FACTORS OF STI 27
eing single, ever having been treated for an STD, pregnancy, an uncircumcised partner, and ever having used a condom. After multivariate analysis including all these variables, only the number of partners in the previous 3 months (P = 0.02) and an uncircumcised partner (P = 0.01) remained statistically significant. Table 4 : Odds Ratios and 95% Confidence Intervals (CI) for risk factors and sexually transmitted infections* HIV Gonorrhea Chlamydia Syphilis CIN Single/widow/divorced/separated 1.1 (0.7-1.8) 1.8 (0.7-4.7) 1.9 (0.7-5.4) 0.8 (0.3-2.0) 0.8 (0.4-1.5) History of STD 1.1 (0.7-1.8) 0.9 (0.4-2.3) 0.2 (0.1-1.1) 2.1 (0.9-4.7) 2.2 (1.2-4.0)* History of condom use 1.5 (1.0-2.3) 2.2 (0.9-5.3) 1.6 (0.6-4.1) 2.3 (1.0-5.4) 1.2 (0.7-2.2) Younger than 20 years 0.8 (0.4-1.6) 0.9 (0.3-3.3) 2.6 (0.8-8.7) 1.6 (0.5-4.6) 1.6 (0.7-3.8) Age at first sex < 15 years 1.5 (0.9-2.3) 0.9 (0.4-2.5) 0.2 (0.0-0.9)* 1.4 (0.6-3.5) 0.9 (0.4-1.7) >One sex partner last 3 months 2.3 (1.1-4.8)* 5.6 (1.7-18.2)* 3.5 (0.9-13.2) 1.0 (0.3-3.2) 1.3 (0.5-3.5) >= 1 new sex partners (3 months) 0.8 (0.4-1.7) 2.1 (0.4-3.5) 0.7 (0.2-2.9) 3.8 (1.3-10.9)* 0.9 (0.3-2.2) Partner circumcised 0.5 (0.3-0.9)* 2.2 (0.7-6.7) 0.6 (0.2-2.0) 0.9 (0.3-2.6) 0.9 (0.4-1.9) Pregnant 0.7 (0.4-1.1) 1.1 (0.4-2.8) 2.4 (0.9-6.7) 1.4 (0.6-3.4) 1.0 (0.6-1.9) Bacterial vaginosis Trichomonas Candida Genital ulcer Genital warts Single/widow/divorced/separated 1.9 (1.0-3.8) 1.5 (0.8-2.8) 1.1 (0.7-1.7) 1.3 (0.7-2.4) 1.4 (0.6-3.3) History of STD 0.6 (0.3-1.2) 0.8 (0.4-1.5) 1.1 (0.7-1.8) 1.1 (0.6-2.0) 1.3 (0.6-3.2) History of condom use 1.4 (0.7-2.5) 1.4 (0.8-2.4) 0.8 (0.5-1.1) 1.3 (0.8-2.3) 0.7 (0.3-1.6) Younger than 20 years 0.7 (0.2-1.8) 0.8 (0.3-1.8) 0.6 (0.3-1.2) 1.2 (0.5-2.7) 3.2 (1.2-8.1)* Age at first sex < 15 years 0.7 (0.4-1.5) 1.1 (0.6-2.1) 1.2 (0.8-1.9) 1.8 (1.0-3.3) 0.7 (0.3-1.9) >One sex partner last 3 months 1.9 (0.7-5.1) 1.6 (0.7-3.7) 0.9 (0.4-1.9) 1.4 (0.5-3.8) 0.8 (0.2-3.2) >= 1 new sex partners (3 months) 0.6 (0.2-1.5) 1.3 (0.6-2.9) 0.8 (0.4-1.5) 0.6 (0.2-1.5) 1.1 (0.3-3.6) Partner circumcised 1.4 (0.6-3.3) 1.1 (0.5-2.2) 0.6 (0.4-1.0) 1.5 (0.8-3.2) 0.7 (0.3-1.8) Pregnant 0.7 (0.4-1.4) 1.7 (1.0-3.1) 1.5 (1.0-2.3) 0.6 (0.3-1.2) 2.1 (0.9-4.9) All Odds ratio adjusted for age, marital status, history of STD, history of condom use, age at first sex, number of sex partners and circumcision of partner. * P< 0.05 ** Among 520 female patients, Nairobi, Kenya The only risk factors for gonococcal infection was the number of sex partners in the last 3 months (P = 0.001). Women with chlamydial infection had significantly less history of first sexual intercourse when younger than 16 years (P = 0.04). RPR seroreactivity was associated in univariate analysis with the number of sex partners, having had a new sex partner, and ever having been treated for STD. After multivariate analysis including those variables, only having a new partner in the last 3 months remained statistically significant. The only factor associated with CIN was history of an STD (P = 0.03). Bacterial vaginosis, trichomonas infection, candidiasis, and genital ulcers were not associated with any of the risk factors. Young age was strongly associated with presence of genital warts in multivariate analysis (P = 0.007). PREVALENCE AND RISK FACTORS OF STI 28
Page 1 and 2: GHENT UNIVERSITY STI PREVENTION AND
Page 3 and 4: AIDS Acquired Immune Deficiency Syn
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: The majority of the women were infe
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
Page 53 and 54: Thirteen women had engaged in sex w
Page 55 and 56: Men reported more extramarital affa
Page 57 and 58: C HAPTER 5 DIAGNOSIS AND MANAGEMENT
Page 59 and 60: discharge and abdominal pain-two co
Page 61 and 62: Data were entered and analyzed in S
Page 63 and 64: One of the peripheral health center
Page 65 and 66: Evaluation of Algorithms The result
Page 67 and 68: In this study of symptomatic women,
Page 69 and 70: C HAPTER 6 PREVENTION OF SEXUALLY T
Page 71 and 72: Table 1: Syphilis Rapid Plasma Reag
Page 73 and 74: One should keep these problems in m
Page 75 and 76: The use of mailed reminders did not
Page 77 and 78: Table 1: Characteristics of women w
Page 79 and 80:
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
Page 95 and 96:
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
Page 109 and 110:
C HAPTER 8 FINAL REMARKS STIs illus
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to protect themselves and be empowe
Page 113 and 114:
Bell G, Ward H, Day S et al. Partne
Page 115 and 116:
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
Page 123 and 124:
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
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We hebben aangetoond dat de kost va
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