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

Mo.C.1628 - Mo.C.1632

Monday, July 8, 1996

women, the only risk factor for STD was having the perception the male partner was
unfaithful (OR- 3.0; 95% Cl 1.4, 6.4; p-=0.003).The algorithm for vaginal discharge was 66.7%
sensitive and 66.5% specific for management of cervical infection; positive predictive value
(PPV) was only 10.8%. It was 18.6% sensitive and 90.5% specific for management of vaginal
infection with a PPV of 54.2%. The algorithm for lower abdominal pain was 16.7% sensitive
and 48.2% specific, with a PPV of 2% for management of cervical infection.
Conclusion: This is our first attempt to validate algorithms in an Arab-Muslim country
Determirning risk assessment scores for use in algorithms for women in Morroco was subject to cultural cornstraints. However questions concerning women's perception of partner's
faithfulness were acceptable and correlated positively with a woman's risk of STD. In men,
history of alcohol, a new partner or multiple partners correlated positively with risk of STD.
Lisa Manhart, c/o A. Nimocks, AIDSCAP 210 I Wilson Blvd., Arlington,VA, USA. 2220 I;
703 516.9779; Fax: [phone]
Mo.C.1628
VALIDATION OF ALGORITHMS FOR THE SYNDROMIC MANAGEMENT OF STD IN
THE DOMINICAN REPUBLIC
Volquez C*, S,inchez J**, Ryan, Carolyn*", Quironez M*, Hasbun J***, Butler M***,
Dallabetta G****, Holmes KK**. *DETS, Instituto Dermatoldgico, Santo Domingo,
Dominican Republic; "University of Washington, U.S.A.; ***AIDSCAP/Dominican Republic;
* **AIDSCAPArlingtonVA, U.S.A.
Objectives: To determine the prevalence and risk factors associated with STDs in STD clinic
patients in Santo Domingo and the validity of algonrithms for vaginal discharge (VD) in women.
Methods: 358 volunteers with urethral discharge (UD),VD, or genital ulcers (GU) were
interviewed and examined. Genital specimens were collected for wet mount, gram stains,
Hoemophilis ducreyi and Neisseriao gonorrfroeae (GC) cultures, Chlomydia trachormanotis (CT)
EIA, and urine for GC and CT ligase chain reaction. Serum was tested for HIV and syphilis
(VDRL/FTA ABS). Four algorithms for VD were evaluated for their sensitivity (SE), specificity
(SF), and positive predictive value (PPV) in determining cervical and vaginal infections: A
clinical findings alone; B WHO recommended; C Algorithm B with age risk changed to
<25: and D Algorithm C including cervical WBC.
Results: Of 10 1 men with UD, 6 I1.4% were diagnosed with either GC (30) and/or CT (35);
I% had HIV.The clinical correlation between clinical and laboratory diagnosis was 59.5% for
GC and 34.5% for CT. For women with VD, STD prevalence was: GC 0.8%, CT 9.8%, GC
and/or CT 10.5%, Trichomonas vaginalis 7.8%. bacterial vaginosis 24.1%, syphilis 2.3%. and
HIV I1.6% Cervical infection was associated with age <25 (OR 2. I; 95%CI 0.9,4.6), partner
with UD (OR 1.6; 95%CI 0.4,5.7), IUD use (OR 3.3; 95%CI 0.8,12), cervical ectopy (OR 2.3;
95%CI 0.7,7.5), cervical friability (OR I1.6; 95%CI 0.6,3.8), and > 10 WBC/field on gram stain
(OR 3.3; 95%CI I.4,7.8). Risk factors of not living with a steady partner, a new partner, or
> I partnrier in the previous 3 months, cervical mucopus during examination, and oral contraceptive use were not associated with cervical infection.The SE, SF and PPV for the diagnosis of cervicitis were, respectively 7.4%, 95.2%, and I 5.4% for algorithm A; 25.9%, 80.2%,
and I 3.5% for algorithm B; 29.6%, 74.4%, and I 2.1% for algorithm C; and 70.4%, 49.3%. and
14.2% for algorithm D.
Conclusions: Syndromrnic management of STD was successfully applied to men with urethral
discharge or genital ulcers. For women, the addition of a modified WHO risk assessment
and cervical WBC to the clinical evaluation, resulted in an increase in SE, SF, and PPV of the
algorithm for vaginal discharge.
Carolyn Ryan, c/o Alfred Nimocks, AIDSCAP 210 I Wilson Blvd., #]700 Arlington,VA, USA,
2220 I;Tel [phone]; Fax. [phone]
Mo.C.1629
SELF-REPORTED STD SYMPTOMS BY NUMBER OF SEXUAL PARTNERS: GENDER
DIFFERENCES AT A VOLUNTARY TESTING SITE
Stallings, R*, Schumann, Debra A"*, Rwabukwali C'***, Marks, J****, Nathanson, C*,
Salmond,W*****, Barugahare, L****. *Johns Hopkins U.. "**U. of Illinois at Chicago,
***Makerere U., ***"Case Western Reserve U., ****"World Learning, ******AIDS
Information Centre (deceased)
Objective:To assess change in self reported symptoms of sexually transmitted diseases
(STDs) in a sample of 344 individuals recruited at a voluntary HIV testing and counseling
center in Kampala, Uganda, and followed 8- 15 months later.
Methodology: Rapid ethnographic assessment procedures were used to identify specific
symptomatology of STDs in Uganda. At both baseline and follow-up, study subjects were
asked about their experiences with specific STD symptoms andithe number of different
sexual partners in the prior six months.
Results: Eighty-nine males and 97 females reported abstinence in the six months prior to
follow up, while 77 males anrid 81 females reported F+ partners. Overall, there was a
decrease in reported STD symptomatology between baseline and follow-up for females for
both abstinent and non-abstinent females, while for males, only rash/sores on penis"
(p<0.025) decreased for both abstinents and non-abstinents and "yellow pus from penis"
(p<0.01) actually increased for non-abstinent males. Despite their overall decreases, abstinent females reported STD symptois more frequently than their non-abstinent counter -
parts during the follow-up interview. Neither HIV serostatus nor condom use were found
to be confounders. Rather, the negative association between number of partners and STD
symptoms at follow up remained significant only among females reporting I+ partners at
baseline, with relative risks ranging frorn 2.0 to 6.4.
Conclusion: Females reporting abstinence at follow-up were more likely to report various
STD symptoms; this association was confounded by the number of partners at baseline.
These findings suggest that "high risk" women may be more likely to choose abstinence
after testing and less likely to receive appropriate STD treatment.
Debra A. Schumann office phone: [phone] Dearlove Rd. home phone:
847 299-5480 Glenview, Ilinois 60025 fax: [phone] email: [email protected]
Mo.C.1630
Mahbooba Akhter Kabita, Project Officer HASAB NGO Support Programme
Issue: Proper need assessment for STD/AIDS prevention of the garment workers, slum
dwellers, rickshaw pullers, truck drivers living in Dhaka, the capital city of Bangladesh
through local CBOs/NGOs for development of right STD/AIDS prevention programme.

Project: HASAB NGO ",iupport Programme started its activities in Bangladesh with the
financial and tech iica support of International HIV/AIDS Alliance, U.K. to sustain and
expand the work on I-IV/AIDS at local level through NGOs/CBOs by providing technical
and financial assistn.ce. HASAB NGO support programme designed its programme based
on the nees of the community with attention to the involvement and participation of
women, minority cornmunit, and people living with HIV Considering all these, HASAB
completed the reed assessment of the core groups at high risk - rickshaw pullers, truck drivers, garment workers nmigrant workers (local and abroad), CSWs, slum dwellers and Bihari
community (minority) through local potential NGOs, following qualitative methods like
focus group discussion, indepth interview etc.
Results: Findings were very big including many general findings, i.e. lack of sanitation, safe
water education and unhealthy working environment.The mentionable risk behaviors are
unsafe sex practise, multiple sexual partners, many wives, congested living arrangement, sex
with CSWs. Based on the study report different intervention programmes have been devel
oped for different communities specifically addressing the following sexual health needs: a)
knowledge about safe sex, b) knowledge about condomr use, c) availability of condoms, d)
education and services for STDs/RTI and e) knowledge about HIV/AIDS. A total number of
9 (nine) organizations have started their prevention programme for HIV/AIDS STDs which
are the first initiatives in Bangladesh, with technical and financial support from HASAB
NGO support programme.
Lesson learned: Effective programmes can be designed according to the needs of the comemunity rather than designing hypothetically
Mahbooba Akhter Kabita, Project Officer HASAB NGO Support Programme, 38/F, Block F,
Ring Road, Shyamoli, Dhaka, Bangladesh.Telephone: [phone], Fax: [phone]
Mo.C.1631
"TRUCKERS & STDS/HIV" A ONE YEAR STUDY AT ULUBERIA A CHECKPOST IN
WEST BENGAL, INDIA.
Misra Kingsuk, Rao A, Dey A,Verma K, Islam A. (Bhoruka Public Welfare Trust)
Objective-To determine syndrome based STD prevalence among truckers.To determine
period prevalence of HIV, Syphylis and Hepatitis B.
Methodology- The patient log book of the clinic was used to collect syndrome based STD
prevalence data. A total of I 622 truckers received treatment at the clinic out of which 50 I
were STD related. Diagnosis of STDs were based solely on sign, symptoms & clinical examination.Two ml. of blood was collected from 2406 truckers over the course of a year from
January Ist to December 31 st 1994.The sample were randomly selected. Blood was tested
by Elisa for Hepatitis B and HIV I and 2. HIV reactive samples were confirmed by Western
Blot. Syphilis was tested by VDRL test.
Results-STD positivity rate was found to be 30.9%. About 4 I1.5% suffered from Purulent
Urethral Discharge, 25.4% from Penile Ulcers, I9.7% from Penile Papules, I1.6% from
Buboes, 0.4% from Genital Warts and oral candidiasis and 0.2% from Moluscum
Contagiosum.
HIV seropositivity rate was found to be 5.36%, Hepatitis B, 3.53% and VDRL 2.49%.
Conclusion-STD prevalence rate is high and so is HIV seropositivity. Known high risk sexual
behaviour of truckers increases the risk of transmission of STD/HIV infection to the general
population. So there is need for strengthening STD treatment facilities along highways.
Dr Kingsukh Misra, 63, Rafi Ahmed Kidwai Road, Calcutta - 16.Telephone: [phone]
Fax: [phone].
Mo.C. 1632
PREVALENCE OF SEXUALLY TRANSMITTED INFECTIONS AMONG PATIENTS WITH
GENITAL DISCHARGE AND PREGNANT WOMEN IN MAURITANIA
Abbas. M.H.*, Dr Phillipon', DrTandia*, Dr van derVeen***, Dr Fransen*"*. * Ministry of
Health, Mauritania: "French Cooperation; ***-HIV/AIDS Programme of the E.C., Brussels.
Objectives: To assess the prevalence of reproductive tract infections among male and
female patients with genital discharge, in order to facilitate the establishment of national
management guidelines for STD related syndromes.
Methods: Among 579 consecutive patients with genital discharge attending the dermatology service of the hospital in Nouackchott, data on history and clinical examination were
collected, blood was taken for serology and genital samples were examined for the pres
ence of reproductive tract infections. Among I 106 consecutive anternal clinic attenders of
an urban health centre in Nouackchott, prevalence of active syphilis and HIV was assessed
Results:

N. Gonorrhoeae
C.Trachomatis
TVaginalis
Candida
Syphilis
HIV
Bacterial Vaginosis
No pathogens observed

Male patients (n=- 110)
50/97 52 %
8/92 9 %
1/108 I %
23/103 27%
I/I 0 0,9%
36/I I10 33%

Female patients (n=469)
17/442 4%
27/419 6 %
64/467 14%
89/443 20%
62/451 I 14%
4/430 0,9%
104/441 24 %
166/466 39%

Syphilis prevalence among pregnant women (RPR + TPHA positive) was 204/1075 (19%).
HIV prevalence: HIVI: 3/1 106, HIV2: 0, HIVI + 2: 2/1I 106 (overall = HIV: 0.5%).
Conclusions: It has been possible to collect relevant data on reproductive tract infections
within 2 strengthened public health services in Nouackchott. On the basis of these results,
treatment guidelines for STD related syndromes have been established using essential drugs
available at peripheral units and improved STD management is gradually introduced in all
health facilities as a major component of the national AIDS/STD programme.
Dr Abbas, Programme National de Lutte contre les MST et le SIDA-NouackchottMauritanie.Tel: [phone] FAX: [phone] BP 320, Novackchett, Mauritania

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