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

304 Abstracts 22207-22211

12th World AIDS Conference

S22207 Management of different STD and systemic or topical
antibiotics, antimicrobial, antifungal and anti-protozoal
medicines in Bangladesh
M. Anwarul Huq Mian1, E. Karim2, H. Mahmud3, M.N. Islam4, M.A. Kabir5. 1Flat
3, Building 13, Govt. Officer's Quartre, Uttara Model Town Dhaka-1212; 2St.
Scientific Officer, IEDCR, Mohakhali Dhaka; 3Team Leader, STD Project, IEDCR,
Mohakhali, Dhaka; 4 Project Director, Bangladesh AIDS Prevention & Control
Programme; 5 Medical Officer, STD Project, IEDCR, Mohakhali, Bangladesh
Objective: To assess the rational use of antibiotics, antimicrobial, antifungal or
anti-protozoal medicines by the health care providers for the management of
STD.
Design: Cross-sectional interview survey.
Methodology: The study was conducted in purposively selected 15 districts
of Bangladesh based on the proportionately higher number of STD cases reported. A semi-structured interview schedule was used to conduct the survey in
three different stages of each district; one was the District town, one randomly
selected Thana (Police Station, medium level administrative unit) Head Quarter
and other was randomly selected Union bazar (smallest administrative unit). In
each interview site, 5 Health Care Providers (HCPs) were interviewed on an
average including STD specialists, Gynecologists, Graduate Medical Practitioner
and Allied Medical Practitioners (AMPs) e.g. Rural Medical Practitioners (RMP)
and Health Assistant (HA) etc. A total of 215 HCPs were enrolled from 45 sites in
15 districts of Bangladesh. Data were analyzed using SPSS/PC+ software. The
study was conducted between February and April'96.
Results: 8 interviewee out of 215 HCPs (Health Care Providers) refused to
give interview and were excluded from the analysis. Of those interviewed, 12.5%
(26) were Venereologist/Gynecologists, 49.2% (102) were Medical Graduate (GP)
and 38.3% (79) were AMPs. The specialist were found to be quite rational in
choosing antibiotics for STD, used 2 groups of antibiotics for treating syphilis, 5
groups for gonorrhoea and chlamydia, 2 for trichomonal infection, 6 groups for
chancroid, 8 groups for endogenous infection (BV) and 4 for candida. The GPs
used to use 5 groups for syphilis, 8 groups for gonorrhoea and chlamydia, 5
groups for trichomonas, 7 groups for chancroid, 10 for BV and 7 for candida. For
the AHCPs, it was 7 groups for syphilis and gonorrhoea, 5 for trichomonas and
candida, 7 for chancroid and 8 for BV.
Conclusion: It appeared from the study that there is irrational use of antibiotics
for the management of STD especially by the Medical Graduates and Allied
Medical Practitioners.
22208 Prevalence of sexually transmitted pathogens and
Candida albicans amongst women in Old Golimar,
Karachi, Pakistan
Kamyla Marvi Tapal1, Sikander S.S.S. Saddrudin Sohani2, T.A.C. Tahira Anwer
Chaudhry2, M.K. Mike Bailey2, S.K. Safia Khairuddin2. 1F27-1 Block-8 Clifton
Karachi, Pakistan; 2Karachi Reproductive Health Project, Karachi, PK, Pakistan
Objective: To determine the extent of sexually transmitted pathogens, associated risk factor and Candida Albicans amongst women in an urban, low-income
community in Pakistan.
Area of Study: Old Golimar- a multi-ethnic urban squatter settlement of Karachi,
Pakistan.
Methodology: A cross-sectional study of 601 married women aged between
17-45 years were recruited through households sampling, each participants participated in a socio demographic questionnaire, clinical examination, laboratory
identification of pathogens, syndromic diagnosis and treatment.
Results: Pathogens identified were Treponema pallidium in 1 participant
(0.2%), Niesseria Gonorrhea in 5 participants (0.9%), Chlamydia Trachomatis
in 1 participant (0.2%), Trichomonas Vaginalis in 28 participants (4.7%). In addition Candida Albicans although not sexually transmitted was identified in 35
participants (5.9%). There was no genital ulcer, warts, active herpes simplex,
inguinal buboo, scabies or pubic lice at the time of clinical examination. 376
(62.6%) participants expressed concerns about their current vaginal discharge.
Clinical examinations led to syndromic diagnosis and treatment of sexually transmitted diseases or candida albicans infection in 362 (60.3%) participants but
only 35 participants (6%) were laboratory diagnosed as an STD cause of vaginal
discharge. 133 participants (22.2%) were neither syndromicaly diagnosed nor
complained of vaginal discharge.
The prevalence of sexually transmitted pathogens and of candida albicans is
low amongst these women. However the outcome of syndromic diagnosis suggested the need of substantial treatment. This highlights the need for syndromic
protocol for vaginal discharge to be reviewed and help the women to recognized
their own normal genital physiology. No associated risk factors were identified
because of the low prevalence of sexually transmitted diseases in the study
population.
22209 Effects of practice of Ramadan's fast on the treatment of
genital discharge with Erythromycin tablets, on

Yaounde's sexually transmitted diseases's (STDs) clinic's
attenders
Gislaine Marie B. Affana Ada Ngaska. B.P 2338 Yaounde, Cameroun
Issue: The practice of Ramadan's fast may disrupt the treatment of genital discharge with Erythromycin. The main objective of this study was to precise the
effects of fasting on this treatment.

Project: In a retrospective study conducted in 1997, during the period of Ramadan's fast, 75 muslim patients, among 350 attenders at the Yaounde STD
Clinic were followed for genital discharge, based on syndromic approach.
53 patients (70%), among whom 38 men and 15 women consulted for genital
discharge while 22 patients (30%), among whom 18 women and 4 men were
notified partners.
All patients were treated with Erythromycin tablets, at a dose of I g twice daily
before meals, in accordance with the National Policy for Management of STDs.
Results: 66 patients (88%) (44 women and 22 men) returned to hospital one
week later with drug intolerance. Reasons evocated were: digestive disturbances
and dizziness. The daily dose was then reduced to 500 mg twice daily and the
duration of the treatment prolonged from 15 to 30 days in 40 patients (60%), while
25 others (38%) who refused to continue, were put on cotrimoxazole tablets, on
the dose of 480 mg twice daily, and doxycycline tablets on the dose of 100 mg
twice daily.
Of the 40 patients (60%) put on Erythromycin tablets, 36 (90%) showed clinical
improvment, while the 18 (72%) of those put on bitherapy improved after 15
days. The 7 others (28%) had continued their treatment during 21 days, to notice
improvment.
Lessons Learned: The prescription of antibiotics with side effects to muslim
patients during the fasting period should be readjusted, if they cannot abstain from
fasting, since fasting modify biological parameters. For an efficient senzitation of
the patient, religious authorities should be associated on the counselling process.
22210 1_ Sexual transmitted diseases (STDs) incidence in women
in Mexico City
Xochitl Teran1, Griselda Hernandez2, Laura Beltran2, Carmen Varela2
Patricia Uribe2.1 Tlalpan 4585 Torriello Guerra, CP 14050; 2Conasida, Mexico,
Mexico
Objective: To know STD's incidence and risk factors in women who attend an
HIV detection center in Mexico City.
Design: Descriptive, longitudinal prospective study from January to December
1997. All women requesting HIV test were asked to have a genital exam with
secretion samples to detect other STDs.
Results: 2815 women attended to be HIV tested, 32.6% accepted the vaginal
exam, 97.5% (2110) were symptomatic.20% (431) knew about other STDs, but
ignored about the association risk. 16.4% had precedents of a STD.
Medium age was 25 years, 69% were single, mean number of sexual partners
was 3 and 63% reported not using condom. Vaginal discharge was present in
97.95%. HIV positive 6.12% (42), B Hepatitis 2% (14), Syphilis 3.1% (7), VHS-2
1% (7), Gonorrhea 2% (14), Gardnerella 35.7% (246), Other bacteria 27.5%
(190), Trichomonas 3.1% (211), Condilomas 2% (14). Major association was
Gardnerella with HIV 11.42%.
Conclusion: Risk perception for other STDs and the association with HIV
infection is very low among women that are aware of HIV/AIDS. There is an
urgent need of educational strategies specially oriented to women.
222111 Prevalence of Chlamydia and Trichomonas and the
potential association with lower levels of education:
A preliminary report
Aldo Vivar1, R.H. Gilman2, G. Soto3. 1Carlos Gonzales 2S1 URB Maranga
Lima; 3A.B. Prisma Lima, Peru; 2Johns Hopkins University Baltimore MD, USA
Background: Current prevalence studies are disclosing the STD epidemic in
Peru. Biological, social, and cultural determinants place women in a significant
disadvantage to acquire STDs. The goal of this study is to explore the relation of
these determinants and the carriage of Chlamydia and Trichomonas in women.
Methods: A cross-sectional survey is being conducted in two family planning
and prenatal clinics that provide care principally for the low income population of
Lima: Loayza Hospital (HAL) and 2 de Mayo Hospital (H2M). Women attending
these clinics willing to participate in the survey were interviewed by the physician
by means of a questionnaire. Demographic and Socioeconomic data, medical
history and sexual behavior data were obtained on a confidential basis. During the
complete gynecological exam, samples were obtained through swabbing vaginal
walls and brushing the endocervix. Vaginal samples were stored in a transport
media and few hours later cultured for Trichomonas detection. Cervical samples
were tested by the PCR technique for the detection of Chlamydia.
Results: By the end of 1997, a total of 141 women were surveyed from both
centers. Higher prevalence rates were found in H2M center, Chlamydial carriage
was found in 11% (6/53) and Trichomonads in 9% (5/53), whereas in the HAL
center, the rates were: 6% (5/88) for Chlamydia and 2% (2/88) for Thrichomonas.
No striking differences were found in sexual behavior among women from both
centers. However, lower educational levels were found in women from H2M center
when compared to HAL center.
Conclusion: Differences in the carriage of sexually transmitted pathogens like
Chlamydia and Trichomonas in women of low income population from Lima, Peru
can be explained in part for differences in education levels. Lower literacy can

be a marker to poor access for information in good reproductive health and puts
women at greater risk to become infected with a STD.