Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Mo.C.1616 - Mo.C.1621

Monday, July 8, 1996

Mo.C.1616
A NATIONAL MULTICENTRIC STUDY IN INDIA TO DETERMINE STD INCIDENCE
AMONGST INTERCITY TRUCK DRIVERS
Rao Asha, Misra K,Verma K. Dey A, Is am A. Bhoruka Public Welfare Trust
Objective:-To find out S-1D r(inidernce aireongst Intercity ruck drivers in India.
Methods: A 0arnle size cf )(! tr,k divers, randomly selected from 5 centres -Uluberia in
W. Bengal. Na-,iK, [ )elh,Gus rtin d Ichapurirm was taken for the study. Data was collected from rearor petr or p rmps Chita s, iheckposts & clinic sites along the highways.Truckers
were intervie wed rndvidually (5), and focus group discussions were also held
Results: 1) STD occurrence r ng fr om 29.9% to 4 i.2% in Nasik & Uluberia centre to as
high as 58.8% 60.3% & 67 i e Ohir, Ichaparm & Guwahati centres respectively 2)
Multiple episodes of 5TDs,) e b reen found to be as high as 55.1% & 53% at Uiuberia &
Guwahati centres to as low as 30 I% at Delhi 3) Ulcers are the commonest STD problem
at all 5 centres. Discharges h we Inee: found to be high at Nasik (37.9%). 4) Condom usage
s higher in )Delhi % Ic. kapulr8 i 50.2%, Naslk 59.3%, lowest being in Guwahati 18% only.
5) Regular use of condores were protected from STD infection (55-86%)
Conclusion: Incienc of S F n, on, st tr uck d;vers in high (S5 1.2% avg. of 5 centres).
Profrrorti1 ripity ST[) tiruei ret:: r, ranagesent facilities have to be provided for truck dr
vers on the i. In pite of nigh condon iusage at Delhi centre, S D infect on is also
quite high. l,ire i's needt I c in- irondom usage, brand and qualty of condoms used.
Dr Asha Rao, 6, Raft AFmed Kidwa Road. Calcutta -16. West Bengal, India Ph:245 -2705/2706 1 r 32.12
Mo.C.1617
PREVALENCE OF CHLAMYDIA TRACHOMATIS INFECTION AND HIV INFECTION
AMONG PREGNANT WOMEN AND YOUNG FEMALES
ATakuseiUe_ Y Uai.._Yto, 1. z, i. I i..S. Kat mine., I.S. Narula.,,aind H Kkuc h,.
The Univer sit()fi Tokio
Objective: Pxrcrine the rela tonsfr between Cdl r::yd, TrForncotis infection as a marker
for sexual activity and HIV r nfection.
Methods: Subjects: Samples were colected from 7,234 pregnant women during 1993 to
1995 fronm 6 prcectures. Sanmples were also collected from 300 young females (age: 1 8 20)
durnn 1976 to 199. Tfrese were tested for Chiamya T. antibody with HITAZYME (Hitachi
Clero(o, Itd.. )25 Cr.a ny,'ri. positive isamples from pregnant women from one prefecture were,alo added. HIV test: Ch/ rnydir 1 positive sera were screened by HIlV I and
HIV 2 antibodies wcth SERO rA (FujiRebio). HIV testing was performed by anonymous
unlnked ranethod.
Results:,6P 2(22I2.6% out of the 7,234 pregnant women were positive for ChrIramydra T
antibody anrid tre ranrge for the nfrcton rate was between 13.6% and 29.3% in 6 prefectures. Total of.857 Cfhiryrr positive sera which included the sample of 225 were tested
for HIV- and HIV anrftiFbodes and found to be negative. 42 (1 4%) out of 300 young
females were pos tive for Chlr,:rydi T. antibody and the range for the infection rate was
between 1.7% and 1 83..
Discussion: Infect pn rate of ( ]rnyda T. may reflect sexual activity amrong the population
because it i s transrmitted prinmiar ly through sexual contact, In 5 prefectures positive antibody
rates ranged between 20.5% and 29.3% in pregnant women and between II.7% and 18.3%
irmong your, ferrales. It suggests that Ch lrrryi T:nfection is wide spread among sexually
active younc,dultst n Japan. r wever there was no H IV- and H IV-2 infection in the tested
sepa. Phws study shows a widep ead P frilydic infection which suggest higher sexual actvity Since sexdr,lactivity is alo rnked to H-IIV transmissior further exploration of Criomydic
as a marker for sexual c tvity and consequent HIV transmission needs to be carried out.

Mo.C.1619
MISSED OPPORTUNITIES FOR REDUCING THE SPREAD OF HIV IN PATIENTS WITH
OTHER STDS ATTENDING A CAPE TOWN CLINIC
C Mathews***, A van Rensburg***, G Schierhout*, D Carney***, E van Schalkwyk.",
C Lombard'*, N Coetzee**. *lMedical Research Council, Cape Town, South Africa; "Dept
of Community Health, Univ of Cape Town, South Africa; ***Health Dept, Cape Town City
Council; -***S.A.I.M.R., Cape Town, South Africa
The management of sexually transmitted diseases (STD),s recognised a: t -te,-r r-,a:irce
the sexual transmission of HIVThis study was undertaken c1995 irnn< ce-.n-rc
at a time when the management protocol included both aetioogical arid sydromc ostic
categories, and syndromic treatment protocols had not been formally instituted
Objectives: To assess the extent to which opportunities for health education of pitaents
were utilized, and the extent to which syndromic management protocols coule reduce
missed opportunities for the treatment of STDs.
Methods: The study population was all new patients over six weeks. SampringNas
by sex. Data were collected after the clinical consultation, by record review, Dat et cw
and by takin g specimens for microbiological irnvestigatiorns Cinc diagnosesvri w ri.dted
against microbiological findings, or (for genital ulcer d sese) a thorough re-ex ms'-,,i rn Vise
treatments prescribed were assessed against those recom ended i syndromc protocls.
Results: 170 men and 61 women were sampled (78~ %rm-,ale; 95- ick( -7 i!,'ictr
used a condom, and only 27.6% received ian explanation about condom use dunn t'e clinic visit.The sensitivity and specificity of clinicians' aetiological diagnoses were respectvely, for
Gonorrhoea, 82.8% and 66.2% in men, and 67.3% and 46.4% n women; for Trichomonis
vaginalis, 4% and 92% in women; and for Candida a!bicans. 0% and 98.5%. For syndror
diagnoses, sensitivity and specificity were, respective, for enital ulcerative disase, 82.5
aid 100% in men, and 36.4% and 967% i women;rd fo no u!erti',e,fctios. 89.9%0
aind 53.5% in men, and 80.3% and 23. I% A rwomen -2 / rer,iite e
inappropriately treated for at least one infection.
Conclusion:The rmajority of patients in this setting are not receiving edc
vention of HIVThe syndromric approach to the managernent of STDs aIreatn rore
sensitive diagnoses, particularly for women with non-ulcerative infections., and wi result n
more appropriate treatment.
Catherine Mathews, CERSA Medical Research Council, P O Box 19070 'rtc' r, /502,
ph: (02 1) 4066495, Fax. (02 I) 4066 I163, e-mail: [email protected]
Mo.C.1620
EFFECTIVENESS OF SYPHILIS SCREENING AND MANAGEMENT AMONG
ANTENATAL CLINIC ATTENDERS IN SWAZILAND
Dr: L.T Kanya *, Dr van derVeen**, * Ministry of Healt. Swzilan d: 'HIV,'AL)S
Programme of the E.C., Brussels.
Objectives: To assess the effectiveness of syphilis scrernir)g and nranagreriet practrces
among antenatal attenders, a key component of the nationa STDAIDS pre,a-s"':in
Swaziland.
Methods: A retrospective study of medical records covering a period of one year possessed
by 2 antenatal clinics in a central (Mbabane) and peripheral (Piggs Peak' health ii
Results:

eu-ou i. unkyolu,-iokyo, 13, Japan Tel./Faix. 8 I-3-5802-295 I1

Screening Mababan
% of RPR screened ANC clients 2503/250
% of RPR posrtive among screened ANC clients 297/250.
Treatment of RPR positive ANC clients
Full treatment 158/297
Incomplete treatment 33/297
No treatment no information 106/297

e (n=2

2503) Piggs Peak (n=651)
0)% 6/65i-f-.
I 2's o0/'3 i-%

Tikusei Um

Mo.C.1618
IMPACT OF HIV ON ACUTE PELVIC INFLAMMATORY DISEASE IN A NAIROBI
OUTPATIENT CLINIC
Bukusi Elizabeth '2 iStevens Coen 1,3 Reily M3. Sinei SI, Holmes K3, NdinyaAehola JO, Moses S, Kris; J3. University of Nairobi, Kenya Medical Research
Institute2, Un iversity of W -I'shint n3, University of Manitoba4
Objective: This study wa s designed to chracterize the dernographic, clinical, and microbiological factoryrsoc ted with linica ly diagnosed PID at an outpatient clinic in Nairobi,
Kenya. and to determie the' effect of HIV serostatus on clinical presentation, severity, and
etiology of acute PID
Methods: Women aged I 8 40 years presenting to two city courncil clinics with complaints
of lower abdo )nal pain for -les than one month duration were recruited. Participants
underwent a standardized questionnare, physical examination, and assignment of a clinical
severity score (cervical rmotion tenderness (0-3) uterine tenderness (0-3), adnexal tenderness (0 6), d rect abdominal tenderne ss (0 I2). rebound ter',derness (0-12)). HIV serolorgy;
STD screenng, as well 4as,roi tral bipse to asses for the presence of endomretritis
were perforredt.
Results: 235 women were reuited durng 1994T and 1995. HIV seroprevalence was 32%.
HIV seropositive and lerone tive women had a similar mean age (25.7 vs. 25.4, p=.6), but
the former were signficantly more Ikely to have a history of prostitution (35% vs. 14 %, OR
1.6, 95% (- 1I.).3), and a,rc- te rmedun number of Itetime sexual partners (6 vs. 3,
p-.00 I). Clinical manife --or n,;tory of fever: nausea, chils, low back pain, abnormal vaginai dischainr, nd urethr,i ymprtons) were similar in the two groups, as was the mean clincal seventy s-r e (8.0 vs. 7., p.) )n pelvic examination HIV seropositive women were
more likely o have a pelvic rmass (7% vs. I%, OR I I.2, 95% CI I.3 98.0). N. gonorrhoeae
was detected in 62 (27/%) and. trachomaitis in 26 (I 4%).The prevalence of gonorrhea
and chamydi did not differ by HIV serostatus. Bacterial vaginosis by clinical criteria was
more con nion in the HIV seropositive patients (40% vs. 23%, OR 1.3, CI I.1 I-.7). Clinical
and mnicrobiologic response to therapy did not differ by HIV serostatus, and no patient
required hospita ization
Conclusion: In- arn rutpatrerrt ir,- in Nairobi 12 % of patients with a clinical diagnosis of
icute PID h d conrcor-ta rt H- 2rPfectiorn. Pcevi rnasses occurred with increased frequency
among HIV ser opot,' s c.:'ject.

Treatment of partners
Full treatment
Incomplete treatment
No treatment no information

33/297
33/297
231 /297

O"96 0?4
0/96 0.
96/ I007?

Conclusions: Coverage for syphilis screening is high in the 2 antenatal svcesuid.
However, 29% women with positive results did not receive any treatmer.tocra he
effectiveness of syphilis control the following measures are foreseen: i) c:,crease tiireiment
compliance by starting treatment at the day of testing, 2) establishment uof- asmple reporting system to monitor effectiveness of syphilis control, 3) increase of nuber of heltse,
vices with appropriate screening facilities, 4) educational actions to promote ANC redance early in pregnancy, screening, treatment cormpliaii ce, partner nolifcaton and safer
sexual behaviou:
De. L.T Kanya. Ministry of Health-PO. Box 8 - MbbaneS,.',
FAX: [phone]
Mo.C.1621
IMPACT OF IMPROVED STD TREATMENT AT PHC LEVEL ON SYPHILIS IN
MWANZA REGION,TANZANIA.
Mayaud Philippe*, Mugeye K*, Grosskurth H**,Todd J*, Gabone R, Corrnelissen J'),,I-le
A*, Hayes R**, Mabey D**. *AMREF Mwanza,Tanzania; London Sc c/hol ofHygiene &
Tropical Medicine, London, UK
Objective:To measure the impact of improved STD m nagement, using the rend -r-c
approach. on syphilis in Mwanza Region,Tanzania.
Methods: Community randomised trial, in which the prevalence of actwe s philis rwas corn
pared in 4244 adults aged 15-54 from 6 communities which had had improved STD m anagement for 2 years, and 4529 adults from 6 comparison comnmunities, i ter lo
age, sex, community pair, travel outside the districl, tory o T prcn
tion, male circumc-sison and baseline comrunurlty p'revlncC. ord to' <' x c,o,,
false positives and subjects whose sypilis hdad berer. uateyI t t e,.ed '
syphilis as a positive RPR at a titre of at lea-t I nin iepet,

[D: Flizroihi i Buk, us. Mes(.1 M,
2- -1Dm,,-.2-Iir72 -
'y Arww - cc, ).t Box 19676, Nairobi, Kenyi tel: 2- -