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Table 3. HIV status of rapid plasma reagin seropositive women and their partners Partner HIV + Partner HIV - Total HIV + women 7 (8%) 13 (14%) 20 HIV - women 4 (4%) 68 (74%) 72 Total 11 81 92 Of the 12,414 women tested at delivery, 7644 (62%) had already been screened for syphilis during pregnancy. Of them, 228 (3%) were reported RPR reactive and almost all of them (98%) had been treated during pregnancy. Information on partner notification and treatment was available for 215 (94%) of the RPRpositive women. About 67% of the partners had received treatment while their spouses were pregnant. RPR-positive women whose partners had been treated during pregnancy had less adverse obstetrical outcome, defined as low birth weight and stillbirth, than women whose partners were not treated (7% vs. 19%, OR 3.0, 95% CI 0.9-10.0, P- value 0.09). The women reported several reasons for non-treatment of their Table 4. Reasons for non- treatment of partners by women’s marital status. partners (Table 4). The main reason for non-treatment of married Reason for partner not being treated Single n=21 (%) Married n=50 (%) P partners was not feel sick. Single Not feeling sick Not informed 1 (5) 8 (38) 27 (54) 4 (8) 0.000 0.004 women more often did not inform Casual partner 9 (43) 1 (2) 0.000 their partners or could not trace the Unknown treatment status 3 (14) 18 (36) 0.1 casual partner. Over 17% (12/71) of the women had not informed their partners because of fear of violence or being blamed for the illness. Significantly more partners of married women were treated during the index pregnancy (135/185 vs. 9/29, P
studies, indicating that couples are more accepting and compliant with partner treatment recommendations when they are framed in the context of reproductive health (Desormeaux 1996, Jenniskens 1994). In Rwanda, pregnant women were more likely to refer partners than non-pregnant women with an STD (33% vs. 20%) (Steen 1996). In an earlier study from Kenya, 50% of partners of pregnant women with syphilis were treated in the same antenatal clinic as the index patients (Jenniskens 1995). In Haiti, 41% of the partners of pregnant women with STDs, were treated mainly as a result of index referral (Desormeaux 1996). The referred partners are, with few exceptions, the regular partners of tile index case. Others have also shown difficulties of tracing casual contacts, which may play an important role in continued transmission (Steen 1996, Day 1998). Moreover, none of the women in our Study referred more than one sexual partner for treatment despite the fact that 33% of RPR seroreactive women admitted having had more than one sexual partner in the past year. Women with syphilis are said to be more promiscuous than other STD patients as reported by Andrus et al. who stated that patients who had syphilis had a larger number of sexual encounters with persons who subsequently could not be identified unlike patients who had gonorrhea. Unmarried women were also less likely to refer a sexual partner for treatment. This suggests that more innovative methods and strategies are needed for reaching casual partners. There are several possible areas for improving partner referral. Improved counseling of index patients is the most straightforward method. Educational messages at the community level emphasizing the importance of partner treatment might also improve partner referral rates. More innovative approaches are needed to identify the more epidemiologically important casual partner. One strategy could be active tracing by specially trained staff (provider referral) as opposed to notification by the index patient (patient referral) (Potterat 1991). However, the logistics and cost of active tracing pose serious limitations to this approach, and this is not only in resource-poor settings. In the UK, only 20 % of all sexual contacts of patients with gonorrhea could be actively traced and subsequently screened (Bell 1998). A combination of different methods might be helpful in further reducing the syphilis seroprevalence that has been shown to decrease among pregnant women in Kenya (Temmerman 1999). All tracing programs however should take into account possible implications on the harmony of the family. As shown in other studies, women who inform their spouse of having an STD often face violence or even break-up of marriages or are blamed for bringing the disease to PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 78
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GHENT UNIVERSITY STI PREVENTION AND
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AIDS Acquired Immune Deficiency Syn
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1.1. Sexually Transmitted Infection
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countries, the rate of reporting co
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district of Uganda randomized villa
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By identifying where significant
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4.5%, 3.9%, 67.7% and 30.1% while t
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female primary health care or anten
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The research data have been publish
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2.1. OBJECTIVES 2.1.1. General obje
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2.2.3. Laboratory procedures The mi
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C HAPTER 3 PREVALENCE AND RISK FACT
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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
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: Table 1: Characteristics of women w
Page 81 and 82: 6.3. A Randomized, Placebo-controll
Page 83 and 84: esistance patterns in bystander flo
Page 85 and 86: In univariate analysis, the odds ra
Page 87 and 88: Widows, divorcees and separated wom
Page 89 and 90: They did not report much condom use
Page 91 and 92: The low prevalence of the other STD
Page 93 and 94: There is some evidence that frequen
Page 95 and 96: Table 1. Characteristics of HIV- po
Page 97 and 98: A significantly higher prevalence o
Page 99 and 100: There is now considerable evidence
Page 101 and 102: patients. The analysis revealed hig
Page 103 and 104: contributory factor may be that mal
Page 105 and 106: use in Kenya. In a supplement of Se
Page 107 and 108: with intensive behavioral change in
Page 109 and 110: C HAPTER 8 FINAL REMARKS STIs illus
Page 111 and 112: 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.
Page 125 and 126: Van Dam J, Anastasi MC. Male Circum
Page 127 and 128: 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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