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

Track C: Epidemiology & Public Health
Mo.C.1633
COMPARISON OF SEXUALLY TRANSMITTED INFECTIONS (STI), SYMPTOMS AND
CLIENTELE AMONG THREE TYPES OF CLINICS OFFERING STI CARE TO WOMEN
IN MOROCCO
Selka, Rhizlaine*, Naouri B.*, Zidouh A.*, Manhart L.**, Ryan C.*, hIirour I.*, Daillabetta
G.+, Holmes K.**.*Ministry of Public Health, Morocco, **University cif VvW shingtorn, Seattle,
WA, +AIDSCAP/Washington
Objective: To determine to where and with what symptoms women it Mloroco seek care
for sexually transmitted infections (STI).A better understanding of vwomen as health seeking
behavior for STI, given the restricted mobility of women and the duitn;,.atrched to STIs in
this Muslim country, is needed to allocate limited resources for trainin ru -;;t arid treatment for STIls.
Methods: A primary health care center (PHC), a family planning clinic t i'),,id an STI specialty clinic (STD) were each selected in Agadir, Tangiers and Marr rt Ir. VMVcnrime were voluntarily enrolled after presentirng to one of the clinic sites complainngi ol drcharge, lower
abdominal pain, or genital ulcer. Patients underwent interviews and phys ical examinations
including specimen collection for: wet mount, Neisseria gonorrhoea, (GC) rultures, cervical
swabs for Chlamydia trachomatis (CT) EIA, and urine for GC and C 1lia:se chain reaction.
Serum was collected for HIV and syphilis testing.
Results: Over a three month period, 362 women were enrolled. Of these 72.7% presented
to a PHC clinic, 23% to a FP clinic, and 4.1% to a STD clinic. Overall, 44.3% of women complained of vaginal discharge, of whom 5.4% had a cervical infection (GC arnd/or CT) and
37.4% had a vaginal infection (trichomonas (TV), candida, and/or bacterial vaginosis); 36.8%
complained of lower abdominal pain with discharge, of whom 3.9% had a cervical infection
and 51.7% had a vaginal infection.The symptomatology for women attending the PHC or FP
clinics were similar; however; significantly more women with genital ulcers and venereal warts
were seen in STD clinics. Cervical infections were found in 5.6% of PHC 7.3% of fP and
1.2% of STD clinic clients.TV infections were found in 8. 1% PHC, 7.4% FP 0.8% STD clinic
clients. A positive syphilis serology was found in 8.0% PHC, 3.6% FP, and 18.2% STD clinic
clients.Venereal warts were seen on examination in 3.6% PHC, 1.2 FP and 80% STD clinic
clients. Any STD (GC, CT,TV and/or syphilis) was found in 25.4% P1 IC and 20.4% FP clinic
clients.Women attending the PHC were younger than those attending the other clinics
(p=0.003).Women attending the FP clinic were more likely to be married (p<0.000), and to
have had any schooling (p<0.000) than those attending PHC or STD clinics.
Conclusion: The majority of women with complaints of vaginal discharge and lower
abdominal pain are seen in PHC and FR and not in STD clinics. STD clinics in Morocco see
few women and those they do see are referred for positive syphilis serology or genital
warts.The frequency of laboratory confirmed STD is similar in PHC and FP clinics, and
resources for syndromic management of vaginal discharge should be allocated to these clinics and not STD clinics.
Ms. Rhizlane Selka, Biologiste, National Inst Of Hygiene, MOPH, 27 Ave Ibn Batouta, BP 769,
Agdal-Rabat, Morocco
Mo.C. 1634
HERPES,THE MOST COMMON STD IN A COHORT OF HIGH-RISK HIV-NEGATIVE
MEN WHO HAVE SEX WITH MEN
Stephen Tabet, MD, MPH, Melissa Krone, MS, Mary Paradise, ARNP'Valter Stamm, MD,
Larry Corey MD, Connie Celum, MD, MPH. - All affiliated with University of Washington
School of Medicine, Seattle, Washington, USA
Objective: The most prevalent STD associated with inflammation or ulceration in the U.S. is
genital herpes. Retrospective studies have implicated both syphilis and HSV-2 as a risk factor
for HIV seroconversion among men who have sex with men (MSM).The purpose of this
study was to determine the prevalence of symptomatic and asymptornatic bacterial and
viral STD among a cohort of high-risk HIV-negative MSM.
Methods: 574 high-risk HIV-negative MSM from the Seattle area were recruited as part of
the HIVNETVaccine Preparedness Study a multi-site study funded by NIAID to conduct
AIDS prevention research. All men participated in a standardized interview and underwent
physical examination. Serologies were obtained for Herpes Simplex virus types I and 2 antibodies using Western Blot analysis, syphilis (rapid plasma reagent with confirmation by
raicrohemagglutination antibody- Treponemo pollidum), hepatitis B core and surface antibody
and surface antigen. Pharyngeal and rectal cultures for Neisserio gornorreoere (GC) and urine
samples for Chlorrydia trochonmotis (CT) ligase chain reaction (LCR) were also obtained.
Results: The median age of the 576 participants was 32 years, and 85.9% were caucasian.
Of 499 results available, 136 (27.3%) tested positive for HSV-2 antibodies. I-tSV-2 seropositivity increased with age and was correlated with past risk behaviors. Only 24.7% of HSV-2
seropositive men reported a history of genital or rectal herpes. Exposure to hepatitis was
detected in 72 of 444 (I6.2%) unvaccinated participants of whom 9 were chronic carriers.
Four participants were seropositive to syphilis, of whom three had been previously treated.
GC was cultured f6-om the pharynx in four participants and from the rectum in one. None
of 260 participaists tested for CT using urine LCR were positive.
Conclusions: Tis study clearly shows that the viral STDs, herpes and hepatitis B, are the
most comon ST~s identified among HIV-negative high-risk MSM. O aly one-fourth of
HSV-2 seropositive men reported any history of genital herpes wich is corrsisterit with
other studies of hseterosexuals. Further studies arn underway to chsaiacterize the frequency
of clinical versus subclinical herpes reactivation in MSM and the possible role of herpes as a
cofactor in HIV transmission.
Stephen Tabet, MD, MPH, CFAR, 1001 Broadway Suite 215, Seattle, WA 98122
Tel: [phone]: Fax: [phone]; email: [email protected]
Mo.C. 1635
COMPARATIVE ANALYSIS OF LABORATORY AND CLINICAL DIAGNOSIS IN WOMEN
WITH VAGINAL FLOW COMPLAINTS ASSISTED IN STD REFERENCE CENTERS.
* Bueno, Helvdcio, *Moherdaui F, **Siqueira LFG, *Rodrigues LGM, 5Poitrvin N, rSantos
MO, **Jardir ML, *Souza MCM, "* Sardinha JCG. ** STD Refierrcr c nters, r Ministry of
Health, Brasilia, Brazil

Objective:To determine the rate of concordance between the specific clini_,l diagnosis and
laboratory diagnosis realized in women with vaginal flow complain.
Method: A study involving 408 patients from 3 STD reference centers was initiated after

Mo.C.1633 - Mo.C.1640
having the medical personnel and laboratory technicians trained in order to standardize all
necessary procedures for picking up the information, diagnosis, treatment and processing of
samples in laboratory Doctors were oriented to assist the patients realizing one or two
presumptive clinical diagnoses based on their professional experience, but indicating standardized treatments according to the syndrome presented; the samples for laboratories
examination were collected from all patients, according to procedures previously standardized, and were processed according to gold standards pre-defined, in local laboratories, and
repeated in one reference laboratory for the study, which realized all the quality control
procedures.
Results: From the 408 cases assisted the laboratories' diagnosis was coincident in 183,
which gives us a rate of concordance of 45%. In the cases presumptively diagnosed as candidiasis, the laboratory confirmed in 39%; in the cases of trichomoniasis the concordance
rate was 67% and in the cases bacterial vaginosis of 58%. For endocervical gonococcal
infection the con cordance rate was 46% and in the non-pathological vaginal flow was 42%.
Conclusions: In general the concordance rates are considered extremely low, which without the utilization of syndromic approach for diagnosis and treatment of the cases, it would
lead to a seriesn of therapeutic mistakes, with disastrous consequences, like: the maintenance
of transmission chain, the maintenance of the activity of these pathologies, which some of
them could lead to pelvic inflammatory disease, which would cause infertility and increase
the financial costs of the treatment and the permanence of the infection is a factor of facilitation of HIV transrmissiorn.
Flelv6cio Pueno // Ministerio da Saude, Bloco G, Sobreloja, sala I I I - 70.058-900 Brasilia,
Brazil. Phone [phone] // Fax [phone]
Mo.C.1637
VAGINAL FLORA OF HIV INFECTED WOMEN
Giraldo PC, Daniel-Ribeiro, AF, SimOes, JA, Amaral, E. State University of Campinas, SP
Objective: To compare the prevalence of Vaginal CandidiasisVaginalTrichomoniasis and
Bacterial Vaginosis among HIV+ women, women with AIDS and HIV- women under risk of
HIV infection.
Methods: A hundred and fifty two women (75 HIV - (group A), 46 HIV + (group B) and
31 with AIDS (group C) who attended a STD outpatient clinic at State University of
Campinas (SP- Brazil) in 1995 were included in this study All patients went under a gynecological exam when a vaginal smear was obtained for a gram study Data from gynecological
exam and laboratory results were stored and analyzed by Chi-square or Fisher exact tests.
Results:iichomoniasis was found in 4,0% in group, A, 8,7% in group B and 19,3% in group
C. Statistic analysis showed significant difference between groups A and C (p= 0,017) but
no difference between groups A and B (p= 0,247) or B and C (p= 0,154). Candidiasis was
registered in 17,3% of patients in group A, 21,7% in group B and 29,0% in group C, but
there was no statistical differences between them (p> 0,1). Bacterial vaginosis was found in
32% of group A, 36,9% in group B and 29,0% in group C and there was no difference
among them (p> 0, I).
Conclusions: The initial hypothesis of greater prevalence of Candidiasis among AIDS
women was not statistically confirmed in this study despite the observed tendency to that.
On the other hand a higher prevalence ofTrichomoniasis among patients with AIDS may
confirm the idea of a greatness in vaginal flora of patients with advanced disease.This may
be due not only to the clinical stage of the disease but also to the high drug therapy these
patients are usually taking.
Paulo Cdsar Gialdo, Rua Prof Luverci Pereira de Souza, I1827 Cidade Universitairia,
Campinas, SP, Brazil - CER: 13084-031 Tel.[phone] Fax. [phone]
Mo.C. 1640
CHANGE IN TUBERCULOSIS MORTALITY IN BRAZIL DUE TO THE AIDS EPIDEMIC
Fonseca, Maria-Goretti P, von-Borries GF, Castilho E. National STD/AIDS Program, Ministry
of Health, Brasila, Brazil.
Introduction: Recent studies have demonstrated a shift in the downward trend of tuberculosis mortality in younger USA adults after 1986, specially in the same age groups where
AIDS was more incident. In Brazil, tuberculosis is still a serious problem with its higher incidence in the sane age group as HIV/AIDS, being one of the most frequent diseases associated with AIDS.
Objective: To examine the trends in the tuberculosis mortality through 1980-1990 in Brazil,
according to the magnitude of the AIDS problem in defined group of counties (municipalities).
Methods: All counties with at least 50,000 population which had AIDS cases notified to the
National Program on STD/AIDS were categorized into 3 groups: high, medium and low
AIDS incidence according to their AIDS incidence in 1990, using a statistical cluster technique
based on Euclidean distances.Trends in death with tuberculosis in the three groups were
coResults: te group of countis with a high AIDS incidence had its mortality changed from a.
downward tas an upward ti-end after 1984, specially for males agnd 20-49.The medium
AIDS incidence group suggests to present a downward trend, but the adjustment did not fit
well diuc to tine senall number of counties on it and due to the fact that they presented
sense vanrnations in the naumber of tuberculosis deaths, specially in 84 and 85.Thn low AIDS
inciderice group did net chsange its downward tmortality trend in the period studied after
litting troth linear and quadratic nmodela.
Conclusion: A difference in the mortality tuberculosis trend was observed in the group of
countie thnat int a high AIDS incidence in 1990, clearly evident in males aged 20-49.The
increase of tuberculosis mortality in the same age group where AIDS was highly incident in
Brazil conernrs other studies of the relationship between AIDS and tuberculosis.
Maria-Goretti P Fonseca Medeiros. Ministerio da Saude, Bloco G, Sala I I I, 70.058-900
Brasilia, Brazil Tel: (55) (6 I) 31 524 17 Fax (55) (6 I) 31 525 19 email [email protected]

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