Thyroid function in malignant lymphoma

Thyroid function was studied in 36 patients with various stages of malignant lymphoma. Stage IVB patients exhibited characteristic changes in thyroid biochemistry in the form of lowered triiodothyronine (T3) and elevated free thyroxine (FT4), but normal thyroxine. Moreover, the concentration of thyroxine-binding prealbumin and albumin was lowered, whereas thyroxine-binding globulin was normal. Thyroid-stimulating hormone was slightly elevated but showed a normal increase after administration of thyrotrophin-releasing hormone. Patients with less extensive disease differed only slightly from the controls. The results agree with previous studies of patients suffering from other chronic diseases. The mechanisms underlying the hormonal changes have been only partially elucidated. When investigating patients with disseminated malignant disease for thyroid disease, the above mentioned changes in thyroid biochemistry must be borne in mind. Single analyses of FT4 and T3 may give rise to a false assumption of hyper- or hypothyroid states in patients who are in fact euthyroid.

In vitro comparison and evaluation of seven gastric closure modalities for natural orifice transluminal endoscopic surgery (NOTES)

BACKGROUND AND STUDY AIMS

Secure transluminal closure is the most fundamental prerequisite for the safe introduction of natural orifice transluminal endoscopic surgery (NOTES). The aim was to compare acute strength of various gastrotomy closure techniques in an in vitro porcine stomach model by assessing leak pressures.

METHODS

Standardized gastrotomies were closed manually, without the use of an endoscope, by one of seven NOTES closure devices: (i) T tags, (ii) purse string modified T tags, (iii) Eagle Claw VIII, (iv) Resolution clips, (v) flexible stapler; (vi) purse string suturing device, and (vii) flexible Endostitch. After closure, each specimen was fixed on the experimental apparatus and the pressure was gradually increased. By linking the pressure gauge and two cameras, the leak location and pressure could be determined in detail. We began by collecting gold standard reference values, by testing 15 gastrotomies closed with interrupted surgical sutures; these were associated with a mean leak pressure of 206 mmHg (SD 59). Using a noninferiority design, a sample size of 11 specimens for each NOTES closure technique was determined.

RESULTS

The Resolution clips ( P = 0.0285), Eagle Claw VIII ( P = 0.0325), flexible stapler ( P < 0.001) and flexible Endostitch ( P = 0.002) produced noninferior closures in comparison with the predetermined gold standard; T tags ( P > 0.6775), purse string modified T tags ( P > 0.999), and the purse string suturing device ( P = 0.9875) resulted in inferior closures.

CONCLUSIONS

The Eagle Claw VIII, Resolution clips, flexible stapler and flexible Endostitch produced noninferior closures in comparison with surgical closure in this model. These techniques seem to be the prime candidates for further testing in animal experiments before human trials can be initiated.

Risk factors for genital HPV DNA in men resemble those found in women: a study of male attendees at a Danish STD clinic

OBJECTIVES

Genital infection with certain types of human papillomavirus (HPV) is the most important risk factor for cervical cancer. The male sexual partner is supposed to be the vector of the infection. However, the knowledge of risk factors for genital HPV DNA in men is limited. The objective of this paper is to study the risk factors for HPV infection in men and to compare them with those found in women, including the study of whether there are different risk profiles for oncogenic and non-oncogenic HPV types.

METHODS

From a sexually transmitted diseases (STD) clinic in Denmark, 216 men were consecutively included. A personal interview was done and material for genital HPV DNA detection was obtained with swabs. HPV DNA was detected by polymerase chain reaction (PCR). Odds ratios (OR) for HPV as well as for oncogenic and non-oncogenic types separately were computed with a 95% confidence interval (CI) by means of unconditional multiple logistic regresssion.

RESULTS

The most important predictors of any HPV were lifetime number of sex partners (OR = 4.3; 95% CI 1.4 to 13.1 for 25-39 v 1-9 partners), young age, and being uncircumcised. The most important risk factor for oncogenic HPV types was lifetime number of partners, whereas number of partners in the past year and ever having genital warts were risk factors for the non-oncogenic HPV types. Young age predicted risk of both oncogenic and non-oncogenic HPV types.

CONCLUSIONS

Most risk factors for HPV DNA detection in men resemble those found in women. As in women, the risk factor profile for the oncogenic HPV types was different from that of the non-oncogenic HPV types.

[Handling of Chlamydia infections in young men aged 15 to 25 years by general practitioners. A questionnaire study]

INTRODUCTION

Urogenital chlamydia is still common in the young. The late risks are well-documented. Most of the infections are diagnosed in general practice. The aim was to assess general practitioners' handling of urogenital chlamydial infections in young people aged 15-25 years.

METHODS

Two groups of GPs were selected at random and were asked to complete a questionnaire before and after a "State-of-the-Art" was sent to all GPs from the National Board of Health. The questionnaire covered questions about 1) the test indication; 2) advice on the infection diagnosed; 3) contact tracing; and 4) first choice of treatment for uncomplicated infection in non-pregnant women.

RESULTS

There was no difference between the two groups in the answers to questions 1) to 3), but an obvious change towards single-dose treatment in question 4), not because of the "State-of-the-Art", but rather because of the intensive marketing of the simple treatment regime.

DISCUSSION

Implementation of new knowledge in general practice does not work only through national guidelines from the authorities to general practice, but is wholly dependent on central and local collaboration and GPs having the chance to discuss it between themselves.

Partner notification in HIV-1 infection: a population based evaluation of process and outcomes in Scotland

OBJECTIVES

To evaluate the process and outcomes of HIV partner notification (PN) activity in Scotland.

DESIGN

Retrospective population based study.

SUBJECTS

114 adults newly diagnosed with HIV infection (index patients) in Scotland between September 1995 and August 1996.

SETTING

Healthcare settings in which all 114 new HIV diagnoses were made: 42 (37%) from genitourinary medicine; 32 (28%) infectious diseases; 18 (16%) general practice; and 22 (19%) from other sites.

MAIN OUTCOME MEASURES

Number of partners notified and tested up to 9 months after initial diagnosis.

RESULTS

Of 114 index patients (IPs), information on current partners was available for 102 (89%). PN was not appropriate for 47 of the 102 IPs. The remaining 55 IPs identified 63 current partners at risk, of whom 51 were notified: 44 underwent HIV testing, which yielded 11 new HIV positive diagnoses. Information on previous partners was available for only 56 IPs (49%). PN was not appropriate for 30 of the 56 IPs; the remaining 26 IPs identified 46 previous partners at risk, of whom 12 were notified: four were tested, but yielded no new diagnoses.

CONCLUSIONS

Notification of current partners was performed well and was an effective strategy for identification of HIV positive individuals at a presymptomatic stage. Notification of previous partners was limited. Partner notification was attempted in a wide range of healthcare settings. Given the clinical effectiveness of antiretroviral therapy, partner notification as a tool towards early diagnosis of HIV disease deserves renewed attention.

Human papillomavirus infection in Danish female sex workers. Decreasing prevalence with age despite continuously high sexual activity

BACKGROUND

The prevalence of the human papillomavirus (HPV) has been found to decrease with age, but whether this applies to all populations is not clear. Knowledge about the generalizability of this age dependency is important to understand the natural history of the infection, but may also have implications in relation to the use of HPV testing in cervical cancer screening.

GOAL

To study the prevalence and risk factors for HPV infection in a selected population of female sex workers and to compare the results with persons with different sexual habits from two other populations in the same geographic area.

STUDY DESIGN

A case-control study among 188 female sex workers from Copenhagen. Data were obtained by personal interviews. Cervical material was collected by a self-administered lavage kit, and HPV testing was done by means of GP5+/6+ primers based on HPV, polymerase chain reaction, enzyme immunoassay.

RESULTS

Among sex workers, age was the most important risk factor for HPV infection. Number of private sex partners in the last 4 months was also a significant risk factor, and a protective effect of condom use was indicated.

CONCLUSION

The HPV prevalence is declining in sex workers with age despite continuously high sexual activity, most likely indicating that an immune response is acquired over time.

Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. International Valaciclovir HSV Study Group

A randomized, double-blind study of valaciclovir for suppression of recurrent genital herpes was conducted among 1479 immunocompetent patients. Patients were randomized to receive valaciclovir (250 mg, 500 mg, or 1 g once daily, or 250 mg twice daily), acyclovir (400 mg twice daily), or placebo, for 1 year. All valaciclovir dosages were significantly more effective than placebo at preventing or delaying recurrences (P < .0001). There was a dose-response relationship (P < .0001) across the once-daily valaciclovir regimens. Twice-daily valaciclovir and acyclovir were similar in effectiveness. Subgroup analysis showed that patients with a history of < 10 recurrences per year were effectively managed with 500 mg of valaciclovir once daily. One gram of valaciclovir once daily, 250 mg of valaciclovir twice daily, or 400 mg of acyclovir twice daily were more effective in patients with > or = 10 recurrences per year. Safety profiles of all treatments were comparable. Thus, valaciclovir is highly effective and well tolerated for suppression of recurrent genital herpes. Once-daily regimens offer a useful option for patients who require suppressive therapy for management of genital herpes.

Opportunistic screening for Chlamydia trachomatis cervicitis: the value of cytobrush specimens for detection by PCR compared with cell culture

Endocervical sampling for microbiological and pathological screening is laborious and expensive due to different sampling devices and techniques. The purpose of this study was to examine if the routine procedure could be simplified by using a cytobrush for concurrent cytology and sampling for Chlamydia trachomatis detection using the PCR method or cell culture. As a sampling device control we used a conventional rayon swab.

RESULTS

Culture: Out of 873 paired endocervical specimens, C. trachomatis was isolated in 68 swab specimens and in 65 cytobrush specimens (overall detection rate 8.4%). The cytobrush proved less suitable than the swab for the isolation of C. trachomatis as 31.5% of the cytobrush samples showed cytotoxicity to the cultured cells vs 0.9% of the swab samples. PCR: In a random sample of 427 paired endocervical specimens, C. trachomatis was detected in 45 pairs without any difference between the two sampling devices. The sensitivity of PCR was 93.8% vs 89.6% and 87.5% in cultured swab and cultured cytobrush specimens, respectively. The cytobrush can therefore be recommended as a cervical sampling device if a PCR assay is used for the detection of C. trachomatis, but not if the cell culture method is used, due to high cytotoxicity. Furthermore, the same cytobrush may be used for cervical cytological sampling and thereafter placed in transport medium for subsequent C. trachomatis detection if the PCR technique is used.

[Contact tracing as a part of HIV infection prevention. Current practice and attitudes of general practitioners and hospital physicians; preliminary results]

All doctors that had reported a newly-identified HIV infected person to the national HIV surveillance unit during a nine months period were traced and interviewed for one year later. The results of the interviews that related to 102 out of 195 (52%) reports were compared between the 48 interviewed general practitioners (GPs) and the 33 interviewed hospital doctors (HDs). Both GPs and HDs found it difficult to give a positive HIV test result and wanted to co-work with trained counsellors for the partner notification (PN) process. It was neither a routine for all GPs nor for all HDs to ask the patients about sexual behaviour and to discuss safe sex, and screening for other STD's was rarely performed. The number of partners notified was low. HIV reporting doctors in Denmark seem motivated for PN. The outcome of PN can only be measured to a certain level as long as exposed partners are neither obliged to be tested nor to be counselled and as long as information about counselling and testing can not be shared between doctors in different settings.

Risk factors for HPV infection in women from sexually transmitted disease clinics: comparison between two areas with different cervical cancer incidence

We have compared risk factors for human papillomavirus (HPV) infection in very sexually active women [attenders of clinics for sexually transmitted diseases (STDs)] living in 2 areas with a 4-fold difference in cervical cancer incidence, i.e., Greenland and Denmark. The results were compared with findings of HPV infection in men attending the STD clinics during the same period. Overall, 204 Greenlandic women (GW), 187 Danish women (DW), 103 Greenlandic men and 216 Danish men were included. A similar age distribution was found in the 2 female populations. The GW reported significantly more sexual partners, earlier first intercourse and more STDs, but HPV was less frequently detected in the GW (25%) than in the DW (35%). However, this could be explained by a difference in the age pattern of HPV prevalence seen in the 2 areas. In each geographical area, the age pattern of HPV prevalence in men was very similar to that seen in women. The most important risk factors for HPV detection were the same in both female populations, i.e., age, years since first sexual intercourse and number of partners in the last years. In conclusion, the pattern of risk factors for HPV infection was the same in STD women from a high-risk area and a low-risk area for cervical cancer. Our results also show that the use of an overall HPV prevalence for comparing populations is meaningless, even in populations with similar age distribution.

[Sexual abuse assessed by forensic examinations]

Within a period of three years, 175 women and three men, with a median age of 25 years, underwent a medico-legal examination after sexual assault. Penal penetration (vaginal, anal and/or oral) was the case in 78% of the victims, more often if the victim had been under the influence of alcohol, and if the assailant was known to the victim. Only 52% of the raped victims were recommended follow up with an examination for and counselling about sexually transmitted diseases (STDs). Among those referred to an STD clinic 48% attended. Denmark is the only Nordic country without public services for rape victims. A police report is therefore a prerequisite for a medico-legal examination.

Seroreactivity to human papillomavirus type 16 virus-like particles is lower in high-risk men than in high-risk women

Seroreactivity to human papillomavirus type 16 (HPV-16) virus-like particles (VLPs) in men attending clinics for sexually transmitted diseases (STDs) in Denmark (n = 219) and Greenland (n = 88) was compared with seroreactivity in women attending the same clinics and was furthermore related to epidemiologic variables and concurrent HPV DNA detection. Risk factors for male seropositivity in Denmark were lifetime number of sex partners, a history of STDs, and sexual preference and in Greenland were ever having had syphilis and years at school. Although men reported significantly more sex partners, the mean seroreactivity was significantly lower in men than in women: 0.50 and 0.75, respectively, in Denmark and 0.53 and 0.86 in Greenland (P = .0001). Male seropositivity was not correlated with concurrent HPV DNA detection, but only 15 Danish and 6 Greenlandic men had HPV-16 DNA. Presence of HPV-16 VLP antibodies appears to be a biomarker for exposure to genital HPVs in men but is less sensitive than in women.

[Knowledge, attitude and behavior among patients with Chlamydia. Perspectives for prevention]

Patients with chlamydial infections (Ct) attending the outpatient Venereal Disease Clinic of Copenhagen from July 1-November 30 1995 were asked to fill in a questionnaire focusing upon knowledge, attitude and behaviour related to sexually transmitted diseases (STDs) in order to strengthen the future prevention of Ct. The questionnaire was answered by 37 men and 35 women with a median age of 27 and 21 years and a median number of three and two sexual partners within the last six months, respectively. Half of the patients had previously had an STD, and 92% had been tested for HIV, of whom one homosexual man was known HIV-positive. Notification about exposure from a partner was the reason for attending for 24%. All but one were in favour of partner notification, but only 6% wanted provider referral. During last intercourse condoms had neither been used with a steady partner by 75% especially by the young and women, who thought themselves safe, nor with a casual partner by 52% especially among the young and men, mainly because of thoughtlessness or perception of low risk. Before the actual STD diagnosis only 49% were able to name one symptom and 35% one complication related to Ct. A majority (79%) stated, that fear of catching another Ct would lead to better protection, and 70% found that more information would have a preventive effect. Future Ct prevention programs in Denmark should include intensified chlamydial screening and partner notification together with centrally produced mass media information supplemented by individual counselling.

Markers of sexually transmitted diseases in seminal fluid of male clients of female sex workers

OBJECTIVES

To screen for certain STD markers in a group of male clients of female sex workers.

METHOD

Condoms with seminal fluid were collected at 10 "massage parlours" in Copenhagen. The seminal fluid samples were examined for HIV antibodies, markers of hepatitis B virus (HBV), Chlamydia trachomatis, and Mycoplasma genitalium.

RESULTS

All samples (n = 332) were negative for HIV antibodies. Out of 327 samples examined for HBV markers 32 (9.8%) were positive for HBV core antibodies, one of which was also positive for HBV antigen. C trachomatis could be demonstrated in six out of 122 (4.9%) samples and M genitalium in one out of 122 samples.

CONCLUSIONS

The finding of a C trachomatis prevalence of 4.9% is considerable higher than expected in men with a presumed age of 35-55 years. The demonstration of a prevalence of HBV markers of 9.8% indicates that these clients have an increased risk of HBV infection, a finding that further consolidates the recommendation of HBV vaccination of sex workers. As shown in this study, STD transmission in commercial sex may also have the client as the source.

Valaciclovir versus aciclovir in patient initiated treatment of recurrent genital herpes: a randomised, double blind clinical trial. International Valaciclovir HSV Study Group

OBJECTIVE

To compare the efficacy and safety of twice daily valaciclovir with five times daily aciclovir in the treatment of an episode of recurrent genital herpes simplex virus (HSV) infection in immunocompetent individuals.

METHODS

739 patients with a history of recurrent genital HSV infection received either oral valaciclovir (500 mg twice daily) or aciclovir (200 mg five times daily) for 5-days for treatment of their next recurrent episode in a controlled, randomised, double blind trial. Patients self initiated therapy at the first signs and/or symptoms of the HSV recurrence, then were assessed in clinic on five occasions over 7 days, and twice weekly thereafter until lesions had healed. Safety was evaluated through adverse experience reports and haematology and biochemistry monitoring.

RESULTS

No significant differences were detected between valaciclovir and aciclovir for the primary endpoint, the duration of all signs and symptoms which included lesion healing and pain/discomfort. The hazard ratio [95% confidence interval] for valaciclovir v aciclovir was 0.93 [0.79, 1.08]. Lesion healing time was similar in each treatment group (hazard ratio valaciclovir v aciclovir 0.96 [0.80, 1.14]). The odds ratio of valaciclovir v aciclovir in preventing the development of vesicular/ulcerative lesions was 1.08 [0.82, 1.42]. Percentages of patients in whom all HSV cultures were negative were similar in the valaciclovir and aciclovir groups at 59% and 54% respectively; for patients having equal to or more than one positive culture result after treatment initiation, cessation of virus shedding was similarly rapid for the two treatments (hazard ratio 0.98 [0.75, 1.27]). The safety profiles of valaciclovir and aciclovir were comparable with adverse experiences being infrequent and generally mild.

CONCLUSION

This study has demonstrated that valaciclovir 500 mg twice daily is equivalent in efficacy to aciclovir 200 mg five times daily as episodic treatment of recurrent genital HSV infection. Valaciclovir maintains the established efficacy and safety of aciclovir but offers a much more convenient twice daily dosing regimen.

[Psoriasis treatment at the Dead Sea]

During the years 1975 to 1993 a total of 192 patients from Copenhagen with psoriasis, were sent to the Dead Sea, Israel, for a four week treatment of sun exposure and bathing. Total or almost total remission was obtained in 73% and significant improvement in 20% of the 163 patients at the post-treatment hospital control. A patient questionnaire filled in by 233 patients at the treatment centres in 1989-1991 showed that 88% of the patients were very satisfied with their stay. The length of remission was one to three months for 55% of the patients. Climate therapy is a valuable alternative treatment with an efficacy comparable to topical treatments for psoriasis.

Partner notification for HIV infection in Denmark: attitudes and preliminary results

OBJECTIVES

To examine attitudes, experience and preliminary results of partner notification (PN) for HIV infection in Denmark among the doctors who inform one of their patients about being HIV infected.

METHOD

The doctors who had reported to the national HIV surveillance unit about a new-identified HIV infected person, during a 9 months period, were searched for one year later. The traced doctors were interviewed. The results of the interview related to 102 out of 195 (52%) reports were compared between the 48 interviewed general practitioners (GPs) and the 33 interviewed hospital doctors (HDs). The proportion of traced reporting doctors were higher among GPs than among HDs.

RESULTS

Both GPs and HDs found it difficult to give a positive HIV test result and wanted trained counsellors to work with them in the PN process. Less experience and fewer post-graduate courses about HIV may explain the GPs' lack of confidence to follow-up asymptomatic HIV positive patients. It was neither a routine for all the GPs or for all HDs to ask about patient behaviour nor to discuss safe sex with their index patients, and screening for other sexually transmitted diseases were seldomly performed. The numbers of partners notified, especially by the doctors were low.

CONCLUSIONS

HIV reporting doctors in Denmark are motivated for PN. Educational programmes about counselling and care of HIV infected patients should, however, be offered at intervals, especially to GPs. The outcome of PN can only be measured to a certain level as long as exposed partners are neither obliged to be tested nor to be counselled and as long as information about counselling and testing can not be shared between doctors in different settings.

Hepatitis B core antibody screening in a high prevalence group: comparison of three enzyme immunoassays using receiver operating characteristic analysis

Selected sera from 296 homosexual men were screened by 3 commercially available anti-HBc enzyme immunoassays (EIA). All patients could be classified either as non-immune to hepatitis B, or with current or previous hepatitis B infection. Using the cut-off optical density values (O.D. values) recommended by the respective manufacturers, the results from these three assays were identical for 83% of the serum samples. For anti-HBc reactivity, the ratio (percentage) was calculated using O.D. sample x 100 divided by the O.D. cut-off value. Employing these ratios, sensitivities and specificities for the three assays were compared. All assays performed well when analyzed by receiver operating characteristic curves with area under the curves of 96-97%. A higher specificity, with only a marginal loss of sensitivity could be achieved by lowering the cut-off to 55% for the Enzygost EIA, to 85% for the Enzygost-monoclonal EIA and to 60% for the Corzyme EIA. Using the modified cut-off values, the results with the three assays agreed for 93% of the serum samples.

Azithromycin levels in cervical mucus and plasma after a single 1.0g oral dose for chlamydial cervicitis

OBJECTIVE

To determine the kinetics of azithromycin in cervical mucus and plasma.

SUBJECTS AND METHODS

Azithromycin concentrations were determined in plasma and mucus samples from 20 women with cervical chlamydial infection one, seven and fourteen days after a single oral 1.0 g dose.

RESULTS

In mucus, all measurable azithromycin concentrations were above the minimal inhibitory concentration against Chlamydia trachomatis on day 7 as well as on day 14.

CONCLUSION

The high cervical mucus concentrations of azithromycin can explain the high clinical and microbiological efficacy.

[Asymptomatic sexually transmitted infections among HIV-tested persons]

We have prospectively determined the frequency of asymptomatic sexually transmitted diseases (STD) among patients seeking an HIV-test. In 246 patients, we observed 32 cases (13%) of asymptomatic STD, predominantly infections caused by Chlamydia trachomatis or human Papillomavirus. STD screening is of significance among patients seeking an HIV-test.

Risk behaviours for HIV infection and sexually transmitted diseases among female sex workers from Copenhagen

In 1990-91, 237 female sex workers from Copenhagen were enrolled in a larger study performed in 9 European countries. None of 206 women accepting serological testing was HIV-infected despite the fact that 36 (17.5%) were injecting drug users (IDU). Whereas 95% of the women always used condoms with clients over the last 6 months, this proportion was 25% and 9% respectively for casual and regular non-paying partners (P < 0.0001 for both comparisons). Those reporting at least one STD over the last year had more non-paying sexual partners than the others (P < 0.01) and the frequency of STD was lower in women who always used condoms with non-paying partners (7% vs 31%, P = 0.01). Women working on the street were more often IDU than others (78% vs 7%, P < 0.001). Independently of drug use, street prostitutes also tended to have more clients (P = 0.007) and more STD (P = 0.05). The striking differences in condom use with clients as compared to non-paying partners and the association between STD and sexual behaviours with such partners but not with clients show that specific interventions should be designed to promote safer sex with non-paying partners.

Patterns and trends of sexual behavior, HIV testing, and HIV prevalence among all sexually transmitted disease clinic attenders in Denmark

BACKGROUND AND OBJECTIVES

Persons attending a sexually transmitted disease (STD) clinic have shown to be at a higher risk for HIV infection than the population in general. We evaluate the patterns of HIV prevalence and testing in relation to reported risk behavior.

STUDY DESIGN

Data have been collected on all new attenders at the Danish STD clinics. The study period was January 1, 1990 through March 1992.

RESULTS

Testing for HIV was accepted by 74% and more often by women than men and more outside Copenhagen than in the city itself. Acceptance was lowest among homo/bisexual men seen in Copenhagen. The HIV prevalence was highest among homo/bisexual men with drug use (10.0%) and lowest among heterosexual men (0.3%) and women (0.2%). Among heterosexuals the test activity increased over time, and the test activity increased and the prevalence of HIV antibodies decreased with the number of reported sex partners. Among heterosexuals HIV infection was associated with not being born in Denmark and age (> or = 30 years old in women and > or = 35 years old in men).

CONCLUSION

These results are relevant for the national HIV surveillance programs and campaigns, and stress the importance of offering HIV testing to all persons attending for an STD examination.

[Effect of a safe-sex campaign on women attending a clinic of venereology. Sex behavior and prevalence of sexually transmitted diseases in women examined at the Venereaklinik in Copenhagen in 1984 and 1988]

Consecutive female patients attending the Copenhagen Venereal Disease Clinic were interviewed about sexual behaviour in 1984 (981 women) and in 1988 (684 women). Details of symptoms, age at coitarche, number of sexual partners, contraceptive methods, and obstetric history were recorded together with the results of the venereological examination. A substantially higher proportion of women used condoms in 1988 (51%) than in 1984 (11%), but otherwise the safe sex campaigns had had a limited effect on the sexual behaviour in this group of women until 1988. The prevalence of gonorrhea decreased significantly (from 22% to 6%, p < 0.01), whereas an increase in the prevalence of genital warts was observed (from 4% to 10%, p < 0.01).

Mycoplasma genitalium: a cause of male urethritis?

BACKGROUND

Male urethritis may be caused by mycoplasmas. Since Mycoplasma genitalium has previously been isolated from the urethra of two men with non-gonococcal urethritis (NGU), it was the aim of the study further to elucidate its role by measuring the prevalence of this organism in men with NGU.

MATERIAL AND METHODS

The polymerase chain reaction was used. Two different sequences of the gene coding for the main adhesin MgPa were amplified. Urethral, rectal, and throat samples from 99 male sexually transmitted disease (STD) patients with and without urethritis were studied.

RESULTS

M genitalium DNA was demonstrated in 17/99 (17%) of the urethral swabs, but in none of the rectal and throat swabs. Significantly more patients with urethritis (13/52) were positive for M genitalium DNA than were patients without urethritis (4/47) (p < 0.03). In those with urethritis M genitalium DNA was found more often in Chlamydia trachomatis negative NGU (12/34) than in those with chlamydial NGU (1/14) (p = 0.05). Attempts to culture M genitalium from the PCR positive specimens were unsuccessful.

CONCLUSION

M genitalium DNA was found significantly more often in male STD patients with non-chlamydial NGU than in men with chlamydial urethritis (p = 0.05) and in men without urethritis (p = 0.003), suggesting that M genitalium may be a cause of NGU. M genitalium DNA was not demonstrated in any of the throat or rectal swabsindicating that the urogenital tract is probably the primary site of infection or colonisation of this species.

No change in incidence and prevalence of HIV among intravenous drug users in Copenhagen from 1985 to 1990

During the years 1984 to 1990, 1,029 intravenous drug users (IVDU), equalling approximately one-third of the estimated total IVDU population in the study area, attended the outpatient venereal disease clinic of Copenhagen for an HIV antibody test. Neglecting samples on HIV-positive persons after the first positive test, 665 IVDU were only tested once, whereas 364 IVDU had 613 tests performed after their first HIV antibody negative result. HIV prevalences calculated for each year showed that the prevalence of 20% in 1985 was significantly higher than those of the following years, varying between 9% and 12% without any statistical differences between these years or evidence of an increase or a decrease. HIV incidence was calculated from the results of the 364 IVDU with an initially negative HIV test, from whom 613 subsequent test results were available and of which 20 showed HIV antibodies. The total risk period was 837 years, and the overall incidence 2.4 per 100 person years without any difference between male and female IVDU, but with a tendency of a decreasing incidence with increasing age. The incidence rates per 100 person years were 2.82 in 1984-1987 and 2.38 in 1988-1990, which is not significantly different. A seroconversion rate of 2.42 (1.51-3.65) per 100 IVDU per year was calculated. With an estimated IVDU population of 3,000 persons in Copenhagen, the yearly number of new HIV infected IVDU can then be estimated to 72 persons (45-110), a figure that is 100% higher than that known from the anonymous national HIV reporting system.(ABSTRACT TRUNCATED AT 250 WORDS)

[Contact tracing in HIV infection]

The results of contact tracing in two male and one female HIV antibody positive index cases are described. Altogether 19 sexual partners were reported, of whom 13 were traced. In one case previously unknown HIV infection was diagnosed. Contact tracing for HIV infection in Denmark depends solely upon the cooperation of the index case and upon the willingness of notified partners to appear for counselling and testing. The efficacy of partner notification for HIV infection in Denmark based on the current strategy should be further evaluated.

Hepatitis C virus antibodies in homosexual men and intravenous drug users in Denmark

In order to evaluate the role of sexual transmission and parenteral transmission of hepatitis C virus (HCV) in homosexual men and intravenous drug users (IVDU) serum samples from 147 homosexual men and 126 IVDU were tested for anti-HCV. Anti-HCV was found in two (1.4%) of the homosexual men and in 123 (98%) of IVDU. The presence of anti-HCV could not be correlated to the presence of HBV markers or HIV-antibodies. HCV is widespread among Danish IVDU. Risk of sexual transmission seems low even though sexual contact is a much more prevalent risk factor than needle sharing.

Risk factors for hepatitis B virus infection in heterosexuals attending a venereal disease clinic in Copenhagen

Markers of hepatitis B virus (HBV) infection were measured in 465 non-drug-abusing heterosexually transmitted disease (STD) patients. HBV markers were found in altogether 70 persons, of whom 7 were HBsAg carriers. Those chronically infected were all born in HBV intermediate/high endemic areas. Gonorrhoea was the only STD that was correlated to an increased risk of HBV markers. Number of sexual partners, sex and age was not correlated with HBV infection, irrespective of country of origin. The risk of having HBV markers in an STD clientele in Copenhagen was highly dependent on the country of birth, as the prevalences were 7% (21/307) in persons born in Denmark, 19% (9/47) in those born in other low endemic areas and 36% (40/111) in those born in intermediate/high endemic areas. Falling incidence of gonorrhoea and other STD may render it difficult to point out risk factors indicative of HBV immunization in heterosexual STD patients. In low-risk countries, screening for HBV markers should however be offered to all immigrants and refugees as a part of an HBV immunization program.

Sexual behaviour of women attending an inner-city STD clinic before and after a general campaign for safer sex in Denmark

OBJECTIVES

To examine the sexual behaviour and the prevalence of sexually transmitted diseases (STD) among females attending an inner-city STD clinic before and after safer sex campaigns.

SUBJECTS

In 1984 981 women and in 1988 684 women were interviewed immediately after the venerological examination.

SETTING

Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark.

METHODS

In a face to face interview, details of symptoms, age at coitarche, number of sexual partners (lifetime and during the last year), obstetric history, and contraceptive methods were recorded.

RESULTS

A substantially higher proportion of women used condoms in 1988 than in 1984. A dramatic decrease in the prevalence of gonorrhoea occurred (from 22% in 1984 to 6% in 1988, p < 0.01), whereas an increase in the number of patients with genital warts was observed (from 4% in 1984 to 10% in 1988, p < 0.05). The prevalence of chlamydia, genital herpes, and cervical dysplasia remained unchanged. No significant changes in the number of sexual partners, or the frequency of sexual intercourse or unplanned pregnancy could be detected from 1984 to 1988.

CONCLUSIONS

The safer sex campaigns have only been partly successful, as a general reduction in all sexually transmitted diseases should be expected as a result of the increased use of condoms. Future campaigns should focus on the correct use of condoms, and encourage a lifestyle with stable sexual relationship.

HIV infection among intravenous drug users in Copenhagen

From October 1985 until the end of December 1986, 439 intravenous drug users (IVDU) presented themselves at the outpatient venereal disease clinic of Copenhagen for an HIV-test. HIV-antibodies were found in 53 out of 272 men (19.5%) and in 25 of 167 women (15.0%), giving an overall prevalence of 17.8%. Risk factors for HIV were the length of drug abuse (p less than 0.05) and having injected drugs within the last six months before testing (p less than 0.005). HIV-antibodies were found in 18 of 90 women (20%) and in three of 20 men (15%), who had a history of a past or ongoing life as a prostitute. The IVDU in this study have been chosen as a cohort and recalled for an ongoing follow-up study focusing on drug and sexual behaviour in relation to the initial HIV-test result.

[Sexually transmitted infections in HIV-positive persons]

In 1989 and 1990, newly-acquired sexually transmitted bacterial disease was found in 41 HIV-antibody-positive men seen at a sexually transmitted disease (STD) clinic in Copenhagen. In 38 homo/bisexual men, the new STD was transmitted from a male contact in 36 cases and from a female contact in two cases. In three male intravenous drug users, the new STD was transmitted from a female contact. In two men, the HIV-infection was first diagnosed together with the new STD, the other men had been aware of their HIV-infection for a mean period of 38 months. Gonococcal infections were diagnosed in 33 men, Chlamydial infections in ten men and syphilis in three men. Anorectal gonococcal infections were found in 13 men, corresponding to 43% and 30% of the total number of anorectal gonococcal infections in 1989 and 1990 respectively. The data presented might indicate a relapse to unsafe sexual practices among homosexual men in Copenhagen. This could influence the HIV prevalence as at least 12% of the contacts were known to be HIV-antibody-negative.

HIV-2 infection in Denmark

A collection of 3019 selected serum samples (ss), comprising 329 ss from intravenous drug abusers, 558 ss from homosexual men, 682 samples from persons attending a STD clinic, 100 ss from individuals of African origin, 300 ss from sexual contacts to Africans, 650 ss from Danish blood donors who resided in Africa greater than 2 years prior to donating the ss, and 400 ss with equivocal antibody reactions in an HIV-1 Western blot was tested for antibodies against HIV-2 by in-house HIV-2 ELISA and Western blot. Four ss were positive for antibodies against HIV-2. Three of the ss originated from West African men, the fourth belonged to the spouse of one of these men. Three of the samples presented with an uncharacteristic reaction in a HIV-1 Western blot. The study indicates that HIV-2 infection is not yet widespread in Denmark and that it remains closely related to West Africa.

Human immunodeficiency virus surveillance at a sexually transmitted disease clinic in Copenhagen

During four study periods, each of 3-4 weeks' duration in 1987 and 1988, all patients attending the Copenhagen outpatient Venereal Disease Clinic were encouraged to have a test for human immunodeficiency virus (HIV) antibody. Anonymous testing or testing for research purposes only without any data was also offered. Patients known to be HIV antibody-positive were not re-tested. A total of 1753 patients (1118 men, 635 women) were counselled and testing recommended. Testing was refused by 255 patients, 57 of whom had been tested (all negative) within the previous 3 months. HIV serology was therefore unknown in 11.7% (198 of 1696 persons), including 120 of 922 heterosexual men (13%), 16 of 159 homo/bisexual men (10%) and 62 of 615 women (10%). There was no substantial difference between the four study periods in the numbers refusing the test. Sixteen of the 1498 patients tested were HIV antibody-positive, including one woman and 3 men with a history of intravenous drug abuse and 11 homo/bisexual men; one heterosexual man with HIV antibodies had no known risk behaviour. It is concluded that HIV testing with informed consent at a sexually transmitted disease clinic will not include all persons, and therefore will not exclude a self-selection bias. Surveillance studies using unlinked HIV testing are therefore necessary and it is recommended that they should be performed in Denmark. In this study, unlinked HIV testing of the serum specimens taken for syphilis serology would have decreased the percentage of 'non-attenders' from 12.4% to 0.8% during the final study period.

[Sexual behavior in HIV antibody positive homosexual and bisexual men]

With the object of describing how their own health is experienced, the social circumstances and sexual behaviour in anti-HIV-positive homosexual and bisexual men, an anonymous questionnaire to be completed by the recipient was distributed in 1987 in connection with a placebo controlled investigation to assess the value of isoprinosin (Imunovir) in preventing the development of AIDS. 87% participated. Among the total of 85 participants, 78% considered that their health was good, 29% met family members and 75% friends at least once weekly. Fifty patients (65%) felt stressed in their daily lives which was definitely higher than in the normal population. All of the participants had altered their sexual behaviour in a manner which reduced the risk of HIV-transmission but 18 (21%) had had sexual behaviour known to transmit HIV within the past year. This behaviour occurred more frequently in young persons (p = 0.09) and in smokers (p = 0.03). In addition, no connection could be demonstrated between a series of possible determinants for this, which may, however, be due to the limited extent of the material. It is demonstrated that awareness that one is infected with HIV does not eliminate dangerous sexual behaviour in all cases.

[Androgens in women with hirsutism who are referred for electroepilation]

The androgen status was determined in 105 women with hirsutism. Raised values of at least one androgenic hormone was found in 58 women, most frequently free testosterone, dehydroepiandrosterone sulphate and delta-4-androstendion. No significant correlation was found between the androgen level and the degree of hirsutism or the frequency of disturbances of menstruation apart from amenorrhoea. Fifty-three women were examined at least six months after the electroepilation therapy. Significant decrease in the degree of hirsutism and the frequency of self-treatment were found together with great satisfaction with the result of treatment.

Roxithromycin compared with erythromycin against genitourinary chlamydial infections

The efficacy and safety of roxithromycin 300 mg once a day was compared with that of erythromycin 500 mg twice a day, both for seven days, in a double blind study of 281 patients (188 men, 93 women) with genitourinary chlamydial infections. At the end of the treatment 251 (89%) patients were evaluable, and at follow up two weeks later 227 (81%) were evaluable. The bacteriological cure rate was close to 100% at the end of both treatment regimens. At follow up 55/75 (73%) evaluable men and 38/39 (97%) evaluable women treated with roxithromycin were chlamydia negative compared with 50/71 (70%) evaluable men and 37/42 (88%) evaluable women treated with erythromycin. Of the 47 who were still chlamydia positive, reinfection could not be excluded in half the men and all the women. Side effects were mainly gastrointestinal and were found in about 15% of patients receiving each treatment, but did not necessitate discontinuing treatment in any case. Roxithromycin seems to be as safe and efficacious as erythromycin in treating chlamydial infections in men and women, and it has the advantage that treatment is by a single daily dose.

Condoms and sexual behaviour of young tourists in Copenhagen

Sleep-in is a summer youth hostel in the center of Copenhagen with 459 beds, which was used for 19,296 overnight stays in July and August 1987. In the summer of 1987, each of the guests, 95% of whom were young tourists, received an envelope with a condom and a written reminder about the use of condoms during sexual relationships. During a period of the summer, 1,229 guests (498 women and 731 men) completed a questionnaire. The results showed that 21% of the men always, and 43% never had condoms in their luggage when travelling and 6% of the women always, and 79% never had condoms in their luggage. Of the 40 men who had sexual contact with Danish girls, 19 had always used a condom. Of the nine men with Danish homosexual contacts, three had always used condoms. Of the four women who had sexual contact with Danish men, none had used condoms.

Hepatitis B in symptomless Danish homosexual men

Forty eight symptomless homosexual men attending a sexually transmitted disease (STD) clinic and found by screening to have hepatitis B surface antigen (HBsAg) were followed up for a median of 10 (range six to 26) months to characterise their liver disease. Initially 33/50 (66%) of the men had increased serum liver enzyme activity and 19/47 (40%) had increased serum immunoglobulin G concentrations. Liver biopsy specimens showed acute hepatitis B in 12 (39%) and chronic hepatitis B in 19 (61%) of the 31 patients who underwent liver biopsy. The course of the infection was: acute hepatitis B in 14/48 (29%), chronic persistent hepatitis B in 23/48 (48%), chronic aggressive hepatitis B in 8/48 (17%), and cirrhosis in 3/48 (6%) of the patients. Antibodies against human immunodeficiency virus (HIV) were present in 16/45 (36%) of the patients, but the presence of antibodies to HIV did not influence the course of hepatitis B in the observation period.