Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

302 Abstracts 22197-22201

12th World AIDS Conference

S22197 Low prevalence of active syphilis in a population with
high prevalence and incidence of HIV: Experiences in an
urban factory cohort in Harare, Zimbabwe
Mary Bassett1, L. Gwanzura1, P.R. Mason1, R.M. Machekano1, A.S. Latif1,
M.T. Mbizvo1, D.A. Katzenstein2. 1Zimbabwe AIDS Prevention Project, Nelson
Mandella Ave., Harare, Zimbabwe; 2Stanford University, Stanford, CA, USA
Objectives: The HIV/AIDS epidemic has been associated with the resurgence
of active syphilis. As an important cause of genital ulcer, syphilis may help fuel,
as well as manifest, the spread of HIV/AIDS. We used data from a male factory
cohort with baseline HIV prevalence of 19% and annual HIV incidence of 3 per
100 PY to examine the prevalence and incidence of active syphilis.
Design: Prospective cohort study.
Methods: 3401 men were entered into a rolling cohort drawn from 40 factories
between 1993-96. Serological tests performed included HIV and VDRL at enrollment and after every six months. VDRL positive specimens were tested by TPHA
and FTA. Social and behavioral data were gathered by questionnaire.
Results: The average age was 27 years. A total of 78 cases of active syphilis
(VDRL+, TPHA+ and FTA+) were identified, a prevalence of 2.3%. Only 13 new
cases of syphilis were identified during follow-up. In a multi variate model, risk
factors for prevalent syphilis included HIV seropositivity (OR = 2.88, 95% Cl
1.80-4.62), age >30 (OR = 2.93, 95% Cl 1.79-4.78), and income per 10 USD
(OR = 0.88 95% CI 0.78-0.98). When we removed HIV status from the model,
cash payment for sex became an important predictor of syphilis (OR = 1.76, 95%
CI 1.07-2.90).
Conclusion: Acquisition of syphilis was rare, despite a high rate of HIV infection (3 per 100 PY). Men who tested positive for active syphilis were more
likely to be older, of low socioeconomic status and to have sex with prostitutes.
HIV seropositivity carried a three-fold risk for syphilis at enrollment. Widespread
access to syndromic antibiotic therapy of STDs appears to have suppressed
transmission of syphilis.
22198 Congenital syphilis: Epidemiological or laboratory
diagnosis?
Peter Gichangi, C. Kigondu, K. Fonck, J. Bwayo, J. Ndinya-Achola, E. Bwibo,
M. Temmerman. 1University of Nairobi, PO Box 19676, Nairobi, Kenya;
2University of Ghent, Ghent, Belgium
Objectives: To determine the correlation between laboratory (LD) and epidemiological diagnosis (ED) of congenital syphilis.
Materials and Methods: As part of an ongoing project, at Pumwani Maternity
Hospital in Nairobi, a retrospective cohort study was done on a sample of 100
women who were diagnosed as RPR+ at delivery. Information on past antenatal
care (AC) including screening and treatment for syphilis was obtained. Laboratory
methods included RPR titres and TPHA on mother and cord blood, FTA-lgM and
ELISA IgG on cord blood. Laboratory diagnosis of CS was defined as FTA-lgM
and ELISA IgG positive in cord blood. Epidemiological diagnosis of CS was defined according to Holmes et al 1990 as either infant born to mother (1) untreated
(RPR- or not screened at ANC), (2) inadequately treated (treatment in third
trimester) at ANC, or (3) infant cord blood titre was 4 times greater than maternal
blood.
Results: Of the 100 mothers enrolled, 75 were screened for syphilis while 25
were not screened. Reasons for not screening were non-attendance of intervention clinic (p = 0.015). Women who tested positive for both RPR and TPHA at
delivery were classified as syphilis infected. Seventy seven women were syphilis
infected at delivery and of these past AC showed 30 as RPR-, 22 as not screened
and 25 as RPR+. Of the 25 RPR+, 16 were treated adequately (treated before 28
weeks) and 9 were inadequately treated. Using epidemiological diagnosis of CS,
61/100 (61%) neonates were classified as having CS compared to 2/71 (2.8%)
neonates identified by laboratory test (FTA-IgM and ELISA-lgG).
Conclusions: By epidemiological diagnosis 61% of the babies are classified
as having congenital syphilis while only 2.8% were diagnosed using laboratory
testing. This shows widely contrasting results. Epidemiological criteria for CS
does not correlate well with the laboratory diagnosis. Diagnosis of CS therefore
remains an issue that needs to be resolved to allow easy diagnosis in setting with
limited diagnostics, comparison of results and allows cost effectiveness studies
to be done.
22199 Genital ulcer disease etiology by M-PCR in STD patients
in Pune, India: Implications for syndromic management
Raman Gangakhedkar1, A.R. Risbud1, D.A. Gadkari1, K. Chan-Tack2,
M.E. Shepherd2, R.C. Bollinger2, T.C. Quin2. iNational AIDS Research Institute,
Pune, MS, India; 2Johns Hopkins University, Baltimore, MD, USA
Background: Sexually transmitted diseases (STD) increase the risk of acquiring
HIV infection. Hence, syndromic approach for management of STD is adopted
for control of HIV infection. This study was undertaken to determine the aetiology
of genital ulcer diseases (GUD), its relationship with HIV infection and compare

clinical diagnosis of GUD with Multiplex PCR (M-PCF, Roche) for syphilis, herpes
simplex virus and chancroid infection.
Methods: Between June and September 1994, 302 (96%) of 313 consecutive
patients presenting to STD clinic with GUD were evaluated clinically, by darkfield
microscopy, serology for syphilis and for HIV. All genital ulcer scrapings were
subjected for HSV EIA (Herpchek, Dupont) and M-PCR.

Results: The aetiology of GUD as determined by M-PCR was HSV (26%),
chancroid (23%), syphilis (10%), multiple infections 7% and no aetiology was
identified in 34%. Overall HIV prevalence was 22.2% which was associated with
HSV (OR = 2.1, p < 0.01). When compared with M-PCR, the Herpchek test
was 68.5% sensitive and 99.5% specific. Darkfield detection was 39% sensitive
and 82% specific, in contrast to RPR and FTA ABS serology (66% and 90%, respectively). Clinical diagnosis alone or in combination with basic laboratory tests
showed poor agreement with M-PCR (kappa range 0.13-0.4). Genital herpes
was often underdiagnosed, especially in HIV infected patients, whereas syphilis
and chancroid were overdiagnosed. Higher kappa scores were seen for duration
of symptoms of <8 days but not in prior antibiotic use and gender.
Conclusions: Herpes and chancroid infections predominate amongst GUDs in
India. Herpes predominance in HIV-positive individuals may be due to immunosuppression and reactivation of genital herpes. Data show that clinical diagnosis of
GUD aetiology is not dependable especially in HIV+ individuals. Use of syndromic
approach may result in overuse of antibiotics for GUDs due to underdiagnosis
of HSV, especially among HIV+ individuals and when duration of symptoms is
longer.
S22200 Attitude of physicians towards the seropositivity at the
HIV infection in a discordent couple: A study conducted
in Littoral, Cameroon
Christiane Nyassa Messina, Affana Ngaska Ada. B.P 2338 Yaounde, Cameroon
Issue: The attitude of Physicians towards seropositivity at HIV infection rises he
problem of the limits of medical secret, and the importance of partner's notification.
Project: The objectives of this retrospective study was to describe the attitude
of Physicians towards the healthy partner's notification in a discordant couple,
and to propose solutions linked to ethics in our socio-cultural context.
During 3 months, 60 Physicians from 15 health centers were interviewed about
the partner's notification in a discordent couple, towards the seropositivity on HIV
infection.
30 Physicians (50%) declared that they have never faced to that situation,
while 24 (40%) revealed to have registered such cases, concerning women and
6 others (10%) recorded that situation, for men.
Results: Talking about woman seropositivity, two alternatives were observed:
- Partner's notification by the physician, and counselling
- Partner's notification by the patient, and counselling.
In case of seropositivity of the man, the partner's notification by the patient, and
counselling were the predominant attitudes. That survey highlights the awkward
on which the Physicians are faced, towards the of healthy partner's notification.
On one hand, he is bound by the professional secret, on the other hand, he is
unable to verify the respect of the prevention's measures, proposed to his patient.
Lessons Learned: The professional secret is inequally applied at the detriment of the woman because of her socio-cultural subordination to man. It is then
essential to relaunch the debate on the systematic information of the woman, in
case of seropositivity of her partner.
22201 A study on sexual behaviour and HIV prevalence in
patients with sexually transmitted diseases attending a
STD clinic in north eastern state of India
Prasanna Kumar Kar. Lt Col PK KAR, AMC, MD, Classified Specialist
(Dermatology & STD), 151 Base Hospital, c/o 99 Apo, India
Objectives: To determine the sexual risk behaviour and to monitor HIV seroprevalence among STD patients attending a STD clinic as a part of sentinel
surveillance programme during period August 1994 to July 1997 in North Eastern
State of India.
Designs: Prospective, controlled study.
Methods: Clinical examinations and investigations were carried out in all new
patients attending the STD clinic using a standard procedure. The frequency
of condom use, and the number of sexual partners preceding 6 months were
recorded. Pre HIV test counselling were given to all cases before the HIV test
was performed.
Results: Out of 680 males 66.4% were aged 20-29 years. 78.6% were not
married. 89.2% men reported to have had sexual contacts with prostitutes. Being
younger, single and staying away from home were independent risk factos for
having sexual contact. 34.7% men used condom at all times, 27.25% reported
inconsistent use and 38.1% did not use condoms. Risk factors for inconsistent
and non use of condom were due to complaint of lack of sexual pleasure during
intercourse, and a higher number of contacts. Eleven (1.6%) of the 680 STD
patients tested were found to be HIV positive. All HIV seropositive cases were
non-IVDU men, had multiple heterosexual contact with prostitutes, not used
condom and had genitoul-cerative disease.
Conclusion: Compared with the findings among the same group in metropolitan cities of India, the HIV seroprevalence is still low; this may be due to recent
introduction of virus in the areas. HIV infection trends should continue to be
monitored among risk groups such as STD patients.