Disease prevalence in women attending the STD clinic in Mumbai (formerly Bombay), India

Prevalence of trichomoniasis infection among adults in Nigerian community settings

BACKGROUND

Trichomonas vaginalis (TV) is a sexually transmitted pathogen. The study was conducted to determine its prevalence among 300 adult patients in 4 public health facilities in the Nsukka District of Enugu State, Nigeria.

METHOD

The researchers collected high vagina swabs and urine samples were collected from 150 men and 150 women, respectively. The specimens were scrutinized for color, odor of discharge and urine, and motile trichomoniasis.

RESULTS

The prevalence of the TV was 45.0% (135/300) with women showing the highest prevalence (63.7%). Among the patients attending the University of Nigeria, Nsukka Medical Center, the prevalence was the highest at 31.9%. TV infection was more common among older adults aged 38 to 47 years (39.3%), married adults (76.3%), and those with secondary education (68.9%). Urogenital analysis reported that males with pains during urination were 51.0% and males with penile tingling were 12.2%. The highest vaginal Hydrogen ion concentration level of 6.8 was observed in women aged 38 to 47 years. Additionally, the results reported that Vaginal candidiasis, Bacterial vaginosis, and Herpes simplex virus type 2 antibodies were not independently associated with TV infection. In the unadjusted analysis, the odds of TV infection were higher in men (8.1), while Chlamydia trachomatis infection was higher in women (8.8). Among the adults diagnosed with herpes simplex virus type 2 antibodies, the odds of TV infection were 3.9 for both men and women. Men with penile human papillomavirus infection had lower odds of TV infection (1.9), while women with vaginal human papillomavirus infection had higher odds of TV infection (2.2).

CONCLUSION

The prevalence of TV infection is high among sexually active adults in the Nigerian community. It is therefore crucial to implement the increased public health actions such as regular and early diagnosis to reduce its prevalence.

Human immunodeficiency virus seroprevalence among patients attending a sexually transmitted disease clinic in West Bengal, India

Sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV) infection have become a major public health problem globally as well as in India. Prevalence of STIs varies across different high risk groups including the population with sexually transmitted diseases (STDs). Individuals with STDs are at a higher risk of acquisition of HIV through the sexual route than the other routes. The tendency of HIV infection was studied in attendees aged 15-49 years in an STD clinic in West Bengal from 2004 to 2008. Blood samples were collected consecutively from 250 attendees per year (a total of 1,250 samples over 5 years) from an STD clinic during 12 weeks (October-December) every year. HIV sero-status was screened using ELISA, and positive samples were subjected to rapid assay and confirmed by Western blot. Overall HIV seropositivity in STD patients was 1.28% (women, 1.04%; men, 1.48%). Data from 5 consecutive years showed a prominent decline from 2.40% (2004) to 0.0% (2007) and a minor increase (1.6%) in 2008, which was not statistically significant (χ(2) = 4.6, df = 4, P > 0.05). The highest seroprevalence (1.66%) was observed in the 25-29 age group, and the lowest (0.87%) was observed in the 40-44 age group. The overall decreasing tendency of HIV infections signifies the efficiency of current interventions. Focused intervention for the 25-29 age group may help in decreasing HIV infections further.

C. trachomatis in female reproductive tract infections and RFLP-based genotyping: a 16-year study from a tertiary care hospital

Presence of Chlamydia trachomatis in endocervix was determined in 2466 women attending a tertiary care hospital in New Delhi, India over a period of 16 years, using a monoclonal-based direct immunofluorescence assay, tissue culture isolation, and a conventional PCR assay. Chlamydia antigen could be detected in 391 out of 2466 (15.85%) of patients studied; in 27.27% women with PID, 16.74% women with cervicitis, 16.03% women with infertility, and 12.06% women with adverse pregnancy outcomes, respectively. There was a statistically significant decreasing trend in Chlamydia antigen positivity between the years 1994–1999 and 2000–2004; the apparent decline in antigen positivity between the years 2000–2004 and 2005–2010 was not statistically significant. Antigen detection assay detected equal number of positives as the PCR assay; tissue culture isolation demonstrated lower positivity. In a few representative specimens from cervicitis patients, genotyping was done using RFLP pattern analysis of C. trachomatis MOMP gene amplified by PCR assay, all of these belonged to Chlamydia trachomatis serovar E.

Prevalence of sexually transmitted diseases in female sex workers in a city in the interior of São Paulo, Brazil

Changes in the profile of sexually transmitted diseases have increased the need for their detection, particularly where there is a concentration of individuals with risk behavior, so that diagnosis and immediate treatment can be translated in the reduction of resulting problems. The objective was to identify the prevalence of sexually transmitted diseases in female sex workers in a medium-sized city in São Paulo state. This population prevalence study was conducted in 2008 on 102 females. The prevalence was 71.6%. When considered separately and in association, the highest values found were: HPV (67.7%) and Chlamydia (20.5%). HPV typing showed oncogenic genotypes. The prevalence of syphilis was 4.0% and of trichomoniasis 3.0%. No cases of hepatitis B or gonorrhea were identified. It was concluded that the prevalence of sexually transmitted diseases in the studied group was high, since approximately two thirds of the women showed some type of disease under this classification.

Prevalence of Chlamydia infection among women visiting a gynaecology outpatient department: evaluation of an in-house PCR assay for detection of Chlamydia trachomatis

Background

Screening women for Chlamydia trachomatis infection in developing countries is highly desirable because of asymptomatic infection. The existing diagnostic methods in developing countries are not effective and their sensitivity fall below 45.0% which leads to further spread of infection. There is an urgent need for improved and cost effective diagnostic tests that will reduce the burden of sexually transmitted infections in the developing world.

Methods

Prevalence of C. trachomatis infection among women visiting gynaecology department of Hindu Rao hospital in Delhi, India was determined using Roche Amplicor Multi Well Plate kit (MWP) as well as using in-house PCR assay. We used 593 endocervical swabs for clinical evaluation of the in-house developed assay against Direct Fluorescence Assay (DFA; Group I n = 274) and Roche Amplicor MWP kit (Group II, n = 319 samples) and determined the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the in-house developed assay.

Results

We detected 23.0% positive cases and there was a higher representation of women aged 18-33 in this group. An in-house PCR assay was developed and evaluated by targeting unique sequence within the gyrA gene of C. trachomatis. Specificity of the reaction was confirmed by using genomic DNA of human and other STI related microorganisms as template. Assay is highly sensitive and can detect as low as 10 fg of C. trachomatis DNA. The resolved sensitivity of in-house PCR was 94.5% compared with 88.0% of DFA assay. The high specificity (98.4%) and sensitivity (97.1%) of the in-house assay against Roche kit and availability of test results within 3 hours allowed for immediate treatment and reduced the risk of potential onward transmission.

Conclusions

The in-house PCR method is cost effective (~ 20.0% of Roche assay) and hence could be a better alternative for routine diagnosis of genital infection by C. trachomatis to facilitate improved screening and treatment management.

Community-based prevention leads to an increase in condom use and a reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) and female sex workers (FSW): the Frontiers Prevention Project (FPP) evaluation results

Background

India has an estimated 2.0 million to 3.1 million people living with HIV; it has the highest number of HIV-positive people in Asia and ranks third in the world. The Frontiers Prevention Project (FPP) was implemented in 2002 to conduct targeted prevention intervention geared towards female sex workers (FSW) and men who have sex with men (MSM) in the state of Andhra Pradesh (AP). This paper reports the overall changes in behaviour and STI outcomes between 2003/4 and 2007 and also describes the changes attributed to the FPP.

Methods

The evaluation used two cross-sectional surveys among MSM and FSW at 24 sites in AP. Surveys were implemented using a similar methodology. Univariate analyses were conducted by comparing means: baseline vs. four-year follow-up and FPP vs. non-FPP. For both MSM and FSW, random and fixed-effects logit regression models at the site level were estimated for condom use with last partner, syphilis sero-positivity and HSV 2 sero-positivity. In addition, for FSW we estimated models for condom use with regular partner, and for MSM we estimated models for condom use with last female partner.

Results

Among MSM, fixed-effects analysis revealed that FPP was positively correlated with the probability of condom use with last female sexual partner and negatively correlated with the individual probability of sero-positivity to syphilis and HSV 2. Among FSW, the FPP intervention was significantly correlated with increased condom use with regular partners and with lower probability of STI sero-positivity.

Discussion

Important changes in behaviours related to an increase in prevention activities translated to reductions in STI sero-prevalence in AP, India. In contrast with non-FPP sites, the FPP sites experienced an intense community approach as part of the FPP intervention, and the general increase in condom use and its effect on STI sero-prevalence reflected the efficacy of these intense prevention activities focused on key populations in AP.

Prevalence of Trichomonas vaginalis infection among young reproductive age women in India: implications for treatment and prevention

BACKGROUND

Trichomonas vaginalis infection is the most common curable sexually transmissible infection (STI) worldwide. The present study describes the burden and correlates of T. vaginalis infection among young reproductive age women in Mysore, India.

METHODS

Between November 2005 and March 2006, sexually active women aged 15-30 years were recruited from low-income peri-urban and rural neighbourhoods of Mysore, India. Participants were interviewed and offered a physical examination and testing for T. vaginalis, bacterial vaginosis, vaginal candidiasis, Neisseria gonorrheoea and herpes simplex virus type-2 antibodies.

RESULTS

Of the 898 participating women, 76 had a T. vaginalis infection (8.5%, 95% confidence interval [95% CI]: 6.7-10.5%). Nearly all (98%) participants were married and most reported their spouse as their main sex partner. The mean age at marriage was 16.9 years (s.d. 2.9 years) and two-thirds of the sample reported having first sexual intercourse before the age of 19 years. Risk factors independently associated with T. vaginalis infection included early age at first intercourse (adjusted odds ratio [OR] 2.09; 95% CI: 1.09-4.00), concurrent bacterial vaginosis (OR 8.21; 95% CI: 4.30-15.66), vaginal candidiasis (OR 2.40; 95% CI: 1.48-3.89) and herpes simplex virus type-2 infection (OR 3.44; 95% CI: 1.97-6.02).

CONCLUSION

The burden of T. vaginalis infection at 8.5% is relatively high among a community sample of young reproductive aged women. Because this infection increases the risk of HIV transmission and is associated with adverse pregnancy outcomes, there is a need for increased screening and treatment of this easily curable sexually transmissible infection in India.

Comparison of an in-house PCR assay, direct fluorescence assay and the Roche AMPLICOR Chlamydia trachomatis kit for detection of C. trachomatis

To improve the control of Chlamydia trachomatis infection in India, a rapid, specific and cost-effective method is much needed. We developed an in-house PCR assay by targeting a unique genomic sequence encoding a protein from the C. trachomatis phospholipase D endonuclease superfamily that produces an amplified fragment of 368 bp. The specificity of the primers was confirmed using genomic DNA from other sexually transmitted disease-causing and related micro-organisms and from humans. The assay was highly sensitive and could detect as low as 10 fg C. trachomatis DNA. Clinical evaluation of the in-house-developed PCR was carried out using 450 endocervical specimens that were divided in two groups. In group I (n=274), in-house PCR was evaluated against the direct fluorescence assay. The resolved sensitivity of the in-house PCR method was 97.22 % compared with 88 % for the direct fluorescent antibody assay. In group II (n=176), the in-house PCR was compared with the commercial Roche AMPLICOR MWP CT detection kit. The resolved sensitivity of the in-house PCR assay reported here was 93.1 % and the specificity was 97.46 %, making it a cost-effective alternative for routine diagnosis of genital infection by C. trachomatis. The method should facilitate early detection leading to better prevention and treatment of genital infection in India.

Prevalence and incidence of sexually transmitted infections among South Indians at increased risk of HIV infection

Sexually transmitted infections (STIs) have been identified as cofactors of HIV transmission. Greater understanding of local STI burdens can assist in the development of more effective STI and HIV prevention strategies. The aim of this study is to determine the prevalence and incidence of STIs among South Indian men and women identified to be at increased risk for HIV infection. Individuals at increased risk for HIV infection were enrolled in a prospective longitudinal study in Chennai, India (n = 480) between August 2002 and December 2003. Participants were enrolled from patients seeking services at an sexually transmitted disease (STD) clinic and a confidential HIV testing and counseling program. The most common prevalent STIs were herpes simplex virus (HSV)-2 (50% of women, 29% of men), syphilis (11% of women, 8% of men), and Trichomonas vaginalis (6% of women). At enrollment, women, participants with no schooling, participants with greater than four sex partners, and single participants were found to be at increased risk for HSV-2 infection (p < 0.05). The two most common incident STIs at 12 months were HSV-2 with 12% of men and 8% of women testing positive and hepatitis B with 2% of men and 5% of women testing hepatitis B surface antigen (HBsAg) positive. In this cohort of South Indian men and women with a high background prevalence of HSV-2, suppressive therapy against herpes replication may have a substantial impact in reducing both HSV-2 transmission and HIV acquisition. With the high incidence of STIs, targeted prevention and clinical management strategies among individuals practicing high risk behaviors may help to slow the continued spread of HIV in India.

In vitro haemolytic and cytotoxic activity of soluble extract antigen of T. vaginalis isolates from symptomatic and asymptomatic women

Human Trichomonas vaginalis infection ranges from asymptomatic to mild, moderate or severe clinical manifestations. The reasons for diverse symptomatology have been found to vary in several attributes and both parasite and host factors appear to play a role in the pathogenesis. The present study reports the in vitro haemolytic and cytotoxic activity of crude soluble extract (CSE) antigen of T. vaginalis isolates from 15 symptomatic and 15 asymptomatic women. The haemolytic activity following the interaction of CSE antigen with human erythrocytes and cytotoxic activity by adding CSE antigen to normal human vaginal epithelial cells was significantly higher with the use of CSE antigen of isolates from symptomatic women as compared to those from asymptomatic women. Furthermore, cytotoxic effect was found to be pH dependent. The study demonstrates, for the first time, the significant effect of parasite antigen of isolates from symptomatic women as compared to those from asymptomatic women in inducing haemolytic and cytotoxic effect and supports the earlier report that contact-independent mechanism(s) may be playing a role in establishing symptomatic trichomoniasis.

Production and characterization of monoclonal antibodies to Chlamydia trachomatis

In order to develop an indigenous and reliable immunodiagnostic assay for Chlamydia trachomatis in India, monoclonal antibodies (MAbs) were developed. Serovar D of C. trachomatis (which was previously isolated from the genital tract of infected women) was propagated, purified, and used for production of monoclonal antibody. A total of 12 murine hybrid clones producing immunoglobulin G (IgG) class monoclonal antibodies to C. trachomatis (species-specific, B serogroup-specific, and serovar-specific) were developed. Enzyme-linked immunosorbent assay (ELISA) was used to screen developed murine MAbs with C. trachomatis antigen. Dot-ELISA was used to check the specificity of clones and was used for selecting hybridomas that produced anti-C. trachomatis MAb. There was no cross-reactivity of species-specific, B serogroup-specific, and D serovar-specific anti-major outer membrane protein (MOMP) monoclonal antibodies with other species of Chlamydiae i.e., C. pneumoniae and C. psitacci. Immunoblotting was done for further characterization of six of these clones, i.e., B2.2 and D5.1 (B serogroup-specific), D10.4 and G1.5 (species-specific), and H5.6 and E4.2 (D serovar-specific). Three of these clones D10.4 (species-specific), B2.2 (B serogroup-specific), and H5.6 (D serovar-specific) which reacted with 40 kd MOMP protein in Immunoblotting were used for further screening to detect C. trachomatis in endocervical specimens. The percent positivity with these clones for detection of C. trachomatis antigen by enzyme immunoassay (EIA) was 45% with D10.4, 43% with H5.6, and 35% with B2.2, while 46% of the specimens were found positive by cell culture method. This indicates a high prevalence of C. trachomatis infection in the female genital tract. The sensitivity and specificity of developed anti- MOMP monoclonal antibody in EIA for chlamydial antigen detection was 91.3% and 94.4% for D10.4 clone (species-specific), 91.30% and 98.1% for H5.6 (D serovar-specific) and 75.00% and 99.07% for B2.2 (B serogroup-specific) compared to cell culture method.

Containing HIV/AIDS in India: the unfinished agenda

India's HIV epidemic is not yet contained and prevention in populations most at risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as measured through surveillance of antenatal and sexually transmitted disease clinics is the chief source of information on HIV in India, but these data cannot provide real insight into where transmission is occurring or guide programme strategy. The factors that influence the Indian epidemic are the size, behaviours, and disease burdens of high-risk groups, their interaction with bridge populations and general population sexual networks, and migration and mobility of both bridge populations and high-risk groups. The interplay of these forces has resulted in substantial epidemics in several pockets of many Indian states that could potentially ignite subepidemics in other, currently low prevalence, parts of the country. The growth of HIV, unless contained, could have serious consequences for India's development. India's national response to HIV began in 1992 and has shown early success in some states. The priority is to build on those successes by increasing prevention coverage of high-risk groups to saturation level, enhancing access and uptake of care and treatment services, ensuring systems and capacity for evidence-based programming, and building in-country technical and managerial capacity.

Syphilis in adults

Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.

Prevalence and risk factors of chlamydia and gonorrhea among rural Nepali women

OBJECTIVES

The epidemiology of sexually transmitted infections (STI) in rural, developing world populations is poorly understood. We estimated the prevalence and risk factors of Neisseria gonorrhoeae and Chlamydia trachomatis in a female population in rural Nepal.

METHODS

We conducted a cross sectional study in a sample of 1177 postpartum women participating in a micronutrient supplementation trial in Nepal. Urine samples were collected to test for the two infections using the ligase chain reaction (LCR).

RESULTS

C trachomatis was detected in 1.0% (95% confidence intervals (CI): 0.4 to 1.5) and N gonorrhoeae in 2.3% (95% CI: 1.2 to 3.4) of women. None of the women tested positive for both. Self report of all three symptoms of lower abdominal pain, pain and burning on urination, and vaginal discharge was associated with the presence of gonorrhoea (odds ratio (OR): 12.1, 95% CI: 1.3 to 115.0). Neonatal eye discharge was associated with maternal gonococcal infection (OR = 5.2, 95% CI: 1.1 to 24.9). Incidence of low birth weight was not related to these maternal infections, but very preterm delivery (<32 weeks) was higher among women positive for gonorrhoea (OR = 4.7, 95% CI: 1.0 to 22.0). In a multivariable analysis, low body mass index (<18.5) and cattle ownership were associated with gonorrhoea (p <0.05), whereas woman's literacy was associated with chlamydia (p = 0.06).

CONCLUSION

We found the rates of N gonorrhoeae and C trachomatis to be low among women in this rural population of Nepal.