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

12th World AIDS Conference

Abstracts 22202-22206 303

122202 Syphilis in HIV infection compared to HIV-negative
controls
Helmut Schoefer1, M. Imhof2, E. Thoma-Greber3, N. Brockmeyer4,
A.K. Sakrauski3, A. Plettenberg5. 1ZDV; Theodor-Stern-Kai 7, D-60590
Frankfurt; 2Dept. Dermatology, Univ. Frankfurt; 3Dept. Dermatology, LMU
Muenchen, Muenchen: 4Dept. Dermatology, Univ. Essen, Essen; 5Dept.
Dermatology, AK St. Georg, Hamburg, Germany
Objectives: To study the clinical course, serology and therapy of syphilis in
HIV-infected patients compared to HIV-negative controls with syphilis.
Design: Controlled prospective multicenter study in 4 dermatological clinics in
Germany (German AIDS Study Group, grant No RKI/415-4476-09/06 Ministry of
Health)
Methods: Standardized evaluation of history, clinical findings and syphilis serology (VDRL, TPHA, IgG/IgM-FTA-ABS, 19s-lgM-FTA-ABS tests controlled by a
reference laboratory). Regular clinical and serological follow-ups for 12 months
in 30 patients (16 HIV+, 14 HIV ), further patients still in follow-up period. Standardized treatment (Guidelines of the German STD Society, DSTDG 1992) with
clemizol penicillin im (syphilis I-Ill), penicillin G iv (neurosyphilis) and doxycycline
iv in case of penicillin allergy.
Results: In group 1 (14 HIV-negative patients, medium age 35 y., 12 male,
2 female) 7 had primary, 5 secondary, 1 latent syphilis and 1 neurosyphilis. In
group 2 (16 HIV-infected patients, medium age 39 y., 14 male, 2 female) 3 had
primary, 3 secondary syphilis with syphilids, 2 secondary syphilis with ulcerating
lesions and general symptoms (syphilis maligna), and 8 latent syphilis. One year
after treatment no clinical or serological treatment failures were observed in both
groups, but a minimum twofold decline of VDRL titres was obviously later among
HIV-infected patients and an early disappearance of IgM antibodies was more
frequent in group 1.
Conclusions: Clinical features: HIV-infected patients showed typical symptoms
of primary, secondary or neurosyphilis. Syphilis maligna however, was diagnosed
in HIV+ patients exclusively. Serology: the response to treatment was delayed in
group 2. Therapy: The standardised treatment regimen by the DSTDG resulted
in complete clinical and serological cure in all HIV+ (n = 16) and HIV- (n = 14)
patients, which had been followed up for at least one year.
22203 Unusual characteristics of adolescents and youths
attending a new special STD clinic for them in Dar es
Salaam: A preliminary report
Davis Mwakagile1, E. Mmari2, C. Makwaya1, F. Mhalu1, G. Biberfeld3,
E. Sandstrom4. 1 Muhimbili Medical Center, P.O. Box 65001, Dar Es Salaam;
2City Commission of Dar Es Salaam, Dar Es Salaam, Tanzania; 3Karolinska
Institute, Stockholm; 4South Hospital, Stockholm, Sweden
Objectives: To determine the main socio-demographic characteristics of adolescents and youths attending an STD clinic specifically set up for them in Dar es
Salaam.
Methods: A standard questionnaire on socio-demographic characteristics was
administered to a sample of adolescents and youths aged between 10 and 24
years who attended the special STD clinic between September 8, 1997 and
December 6, 1997 in Dar es Salaam.
Results: A total of 204 youths were entered to the study out of whom 18/203
(58.1%) and 85/203 (41.9%) were males and females respectively. Single males
and females accounted for 110/118 (93.2%) and 55/85 (64.7%) respectively. Of
those aged 10-19 years, 27/118 (22.9%) and 26/84 (31.0%) were males and females, respectively while the rest for both sexes were aged between 20-24 years.
The most popular hobby for both sexes was seeing movies (50.0% and 45.0%
for males and females respectively). Eighty-three out of 94 (88.3%) males and
38/54 (70.4%) females reported to have heard about the clinic from their friends.
Two out of 109 (1.8%) males and 9/82 (11.0%) females said their coitarche was
forced. The median age for coitarche for both sexes was 17 years. All reported
to have had penile vaginal sex, in addition 3.6% and 9.8% males and females
respectively had had penile/anal sex while penile-oral sex was reported by 8.9%
and 13.4% males and females respectively. Masturbation was self reported by
10.7% o the males and none of the females. Radio was the commonest source of
STD knowledge for both sexes. HIV-1 seropositivity was 6/118 (5.1%) and 21/86
(24.4%) for males and females, respectively. HIV-1 prevalence among condom
users was 12.3% compared to 17.5% in non-condom users. Two (16.7%) of the
12 who admitted to penile anal sex were HIV infected compared to 23 of 153
(15%) who admitted to exclusive penile vaginal sex.
Conclusion: More females than males are coerced into sex debut. Practice
of penile-oral sex is commoner in both sexes that that of penile-anal. The HIV-1
seropositivity among young females with STDs is twice higher than the average of
13 0% among pregnant women in Dar es Salaam. Youths in Dar es Salaam with
STDs especially females are a high risk group for HIV-1 acquisition and therefore
should be targeted for aggressive preventive health promotion against STDs and
HIV infection.

22204 Syndromic management of STDs in Ghana - A new
dimension
Joyce Addo-Atuah, K. Nzambi Dr.. West Afica Project To Combat AIDS, PO Box
710 Achimota ACCRA, Ghana
Issue: The Syndromic Management of STDs especially in developing countries
has been seen as a key strategy in the global fight against the spread of HIV/AIDS.

Given that community pharmacies in these areas are frequently the first port of
call for healthcare seekers in the community, providing training in this area might
prove beneficial to the community.
Project: The West Africa Project to Combat AIDS is currently training community pharmacists in Syndromic STDs Management. The pharmacists' training has
been in response to previous survey findings. The one-day training sessions cover
among other things syndromic diagnosis and management, partner notification
management, condom promotion and specific skills including patient counselling.
Results: Between March and December 1997, a total of 210 community pharmacists have been trained. They have enthusiastically embraced the training
as it has increased thier confidence and skills in offering management which
is standardised by the protocols provided by the National STDs/HIV control
programme
Lessons Learned: Community pharmacists have demonstrated the ability
to contribute to the management of public health problems following capacity
building.
22205 Urethritis in 606 men presenting to a sexually transmitted
disease (STD) clinic in Los Angeles
Peter Katsufrakis', C.L. Pearce2, G. Gati2, L.A. Borenstein3
S.M. Harvey3, Richwald4. 11975 Zonal Ave 100 Los Angeles CA 90033 Los
Angeles CA 90033; 2L.A. Gay and Lesbian Center Los Angeles CA; 3L.A.
County Public Health Laboratory Los Angeles CA; 4L.A. County Health Services
S.T.D. Program LosAngeles CA, USA
Background: Sexually transmitted diseases are associated with HIV transmission. The Sept.26, 1997 MMWR documented a rise in gonorrhea (GC) cases
in men who have sex with men (MSM) in several large US cities. This study
describes urethritis in men attending a STD clinic in Los Angeles.
Methods: All men presenting to the Los Angeles Gay & Lesbian Center STD
clinic from June 1996 to June 1997 were invited to participate in this urethritis
study. Data collected include demographics, sexual orientation & behaviors, self-reported HIV status, and symptoms. Specimens were tested for Ureaplasma.
Mycoplasma, C. trachomatis, GC, and syphilis. Data were analyzed for associations between diagnosis and behaviors or HIV status.
Results: 606 men enrolled with mean age 32.4 yrs (range 16-70). Sexual orientation: 63.2% gay; 16.2% bisexual; 18.0% heterosexual; 2.6% no response (NR).
Ethnicity: 48.1% Caucasian, 30.7% Hispanic, 12.1% African-American, 3.5%
Asian, and 5.6% other. Education: 7.8% had not graduated from high school,
while 43% were college graduates. Self-reported HIV status: 81.7% negative.
9.0% positive, and 9.2% unknown/NR. 61.1% were asymptomatic; remainder
had urethritis symptoms. 15.2% reported anal sex without a condom, 50.9%
reported oral sex without a condom, and 10.8% reported vaginal sex without a
condom. Incidence of lab-proven cause of urethritis was 21.3%; 4.3% syphilis
blood tests were RPR+. GC diagnosis was associated w/HIV+ status (p < 0.01)
and being gay or bisexual (p -- 0.0001). Associations between U. urealyticum
infection and being gay or bisexual (p = 0.1), and between RPR+ and HIV+ (p =
0.09) were not significant.
Conclusions: In this diverse group of predominantly MSM, a bacteriologically-proven diagnosis of GC was associated with HIV+ status and being gay
or bisexual, though causation is unclear. Substantial numbers of participants
reported high-risk sex. There was a non-significant trend toward association between being gay or bisexual and having U. urealyticum, and between being HIV+
and RPR+.
22206 HIV subtyping and prevalence of STD in HIV-positive
individuals in Honduras, Central America, 1996
Ivette Lorenzanal, R. Mesa2, J. Soto3, E. Zelaya3, W. Klaskala4, M. Essex5.
Colonialara, 5 Avenida" Calle, Tegucilagalpa, Ministry of Health, Tegucigalpa,
Honduras; University of Miami, Miami, FL, Harvard University, MA, USA
Objectives: To characterize the local HIV-1 subtypes by genotyping and to determine the prevalence of STD (Syphilis, N. gonorroheae, Chlamydia, Hepatitis B
and HTLV-1) in HIV-seropositive individuals from the five main cities of Honduras.
Methods: A total of 208 blood samples were collected. Serum and PBMCs
were obtained from each participant. Individuals with history of blood transfusion
and use of I.V. drugs were excluded. All of them wereasymptomatic. To investigate
the prevalence of Syphilis, we used non- treponemic assays and then the positive
reactions were confirmed by treponemic assays. Immunoenzimatic assays were
used for Hepatitis B markers and for HTLV-1 antibodies. Genital, urethras and
anal samples were cultured in a selective media to isolate N. gonorroheae. We
investigated the presence of Chlamydia trachomatis antigen in genital secretions
or urine by immunoenzimatic methods. After the separation of the PBMCs, DNA
was extracted, followed by heminested PCR of the entire gp120. The amplified
products were udes for DNA sequencing (V3 loop). Nucleotide and amino acid
sequences were compared with consensus sequences of the known HIV clades.
Results: From the study group 72.4% were females. The medien of age (29
years old) was similar for both males and females, 89.8% were mestizo and 8.7%

garifuna:21.4% were commercial sex workers. The global prevalence of STDs
was 40.2%. Prevalence of Syphilis was 5.5%, Hepatitis B 17.6% and the carrier
rate 3.6%, HTLV-1 3.5%, Chlamydia 6.2% and gonoccoci 1.7%. The genotyping
of a subgroup of 67 samples were all of the subtype B.
Conclusion: There is strong relationship between HIV infection and STD. The
predominat subtype circulating in honduras is the B subtype.