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

12th World AIDS Conference

Abstracts 33242-33246 641

33242 High prevalence of urethral infection in men with
non-specific symptoms at an STD clinic in Kenya
Mark W. Tyndall12, S. Omari3, I. Malonza4, J. Ombeti4, J.O. Ndinya-Achola4,
K. Fonck4, M. Temmerman5. 'St. Josephs Hospital 50 Charlton Ave. E. Hamilton,
Ontario L8N 4A6; 2McMaster University, Canada; 3Nairobi City Council, Nairobi;
4University of Nairobi, Nairobi, Kenya; 5University of Ghent, Ghent, Belgium
Background: Urethral infections promote HIV transmission and are a major
cause of morbidity. In resource poor settings the management of urethritis is
based primarily on clinical algorithms and empiric treatments. This study was
conducted to determine the prevalence of urethral pathogens using urine based
PCR testing and to evaluate the efficacy of single dose azithromycin.
Methods: Men presenting to an urban STD clinic with urethral symptoms, but
without purulent discharge, were eligible. The protocol included a genital examination, a urethral swab for gonorrhea culture, a first void urine sample, and HIV
testing. The men were randomized to treatment and returned for day 7 follow-up.
Results: Three hundred men were enrolled during 1997. Mean age was 28.5
years, 241 (80%) are self referred, 70 (23%) had previous treatment, and 19 (6%)
were HIV-1 positive. Overall, the detection of a urethral pathogen using PCR was
71%, with 30% having dual infections. The prevalence of N. gonorrhea was 37%,
C. trachomatis 33%, U. urealyticum 23%, and Mycoplasma species 15%. The
PCR for N. gonorrhea detected 25 of 28 (89%) positive cultures and 79 culture
negatives. Treatment was given to 214 men, with 107 receiving 1000 mg. single
dose azithromcyin and 107 receiving 800 mg. single dose norfloxacin plus 100
mg. bid of doxycycline for 7 days. Clinical cures were similar (93% azithromycin
and 96% norfloxacin/doxycycline).
Conclusions: Seventy-one percent of this population had a urethral pathogen
identified by urine PCR which supports the use of empiric treatment for men
with non-specific urethral symptoms. Single dose azithromycin appears to be
equivalent to standard urethritis treatment, even for men with documented N.
gonorrhea infection.
33243 Qualitative evaluation of perception and practises of
allopathic general practitioners in the provision of STD
services
Krishnamurthy Palaniappan1 2, Vijaya Srinivasan2. 142/5 Raj Flats, Harrington
Road Chennai 600030; 2APAC-VHS, Adayar, Chennai-600113, India
Objectives: To assess the perception skill and attitude in managing, STDs of a
sample of private practitioners. Also to assess their training needs in managing
STD conditions.
Methods: A random sample of hundred private practitioners of Madras city
were studied to assess their knowledge and attitude in STD case management.
Data was collected by a team of trained junior doctors and 10% of the data was
verified by the authors. The sample doctors were also interviewed about their
willingness to undergo training in improved methods of case management.
Results: The study indicates significant gaps in the knowledge of private practitioners on standardised treatment practises and in the preventive aspects of
STD case management. Most doctors resorted to treating the symptom complex
and prescribed varying range of antibiotics. Less than 5% practised the standardised treatment regiment. A symptomatic STD in women was known to only
8% of the physicians. Follow up was reported to be done by 60% and only 10%
were actually treating the partners. Condom use was advised by 62% while 36%
recommended reducing sex partners. 93% of the practitioners desired to be up
dated on the latest advances in the STD case management.
Conclusion: The study clearly brings out the gap in knowledge, of the private
practitioners in a high risk area of Madras city, India with regard to standardised
treatment practises and the preventive aspects of STD case management and
their willingness to up date the knowledge in STD case management.
33244 STD treatment and prevention among Nigerian
adolescents
Friday E. Okonofua1, P.M. Coplan2, M. Temin3. 1Women's Health & Action
Research Centre 4 Alofoje Street Benin City Edo State, Nigeria; 2Merck & CO.
INC. West Point, USA; 3 WHO Geneva, Switzerland
In order to establish a framework for designing interventions to improve the treatment and prevention of sexually transmitted diseases (STDs/HIV), we surveyed
the health seeking behaviour for STD prevention and treatment among in-school
adolescents in Edo State, Southwest Nigeria. A structured survey instrument was
developed based on the findings of in depth interviews and focus group discussions with youth and treatment providers in the city. The survey questionnaire was
self-administered on a randomly selected sample of male (n = 255) and female
(n = 255) adolescents in 8 secondary schools. Among the surveyed adolescents,
66% men and 63% women reported that they were sexually active. The mean
ages of reported first sexual debut was 14.6 years for men and 16.1 years for
women (P. 0.0002). Eighteen per cent of male and 25% of female adolescents
reported having had a sexually transmitted infection. Among the adolescents who

reported a sexually transmitted infection, the majority (22%) reported that they
sought treatment from patent medicine dealers. The next most frequent source
of treatment was the group who said they received no treatment followed by
those who received treatment from private practitioners. Only few adolescents
received treatment for STDs from public health institutions and traditional healers
and virtually none from formal STD clinics. Utilisation of private physicians was
similar for men and women, but female adolescents were more likely to attend

public hospitals than male adolescents. By contrast, male adolescents were more
likely to report the use of traditional healers for STD treatment and prevention.
Factors associated with use of the various health providers by the adolescents
included cost considerations, confidentiality and perceptions relating to treatment
effectiveness.
These findings have implications for public health measures designed to improve the treatment of STDs among adolescents. Improved STD treatment could
in turn reduce the risk of acquisition of HIV/AIDS in the adolescents.
33245 Where do female sex workers go for sexual health care?
A study from Abidjan, Cote d'lvoire
Bea Vuylsteke1, P.D. Ghys2, G. Mah-Bi3, K. Yao3, M. Traore3, S.Z. Wiktor4,
M. Laga2. Institute of Tropical Medicine, Nationalestraat 155, B-2000, Antwerp;
2Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium;
31nstitut National de Sante Publique, Abidjan; 4Project RETRO-CI, Abidjan, Cdte
d'lvoire
Objective: To obtain baseline data on the type of services female sex workers
(FSW) prefer for the treatment of sexually transmitted diseases (STD) and contraceptive supplies, and the reasons for their preferences. These data will be used
for improving health services for FSW.
Methods: A structured questionnaire on health needs and care seeking behaviour was prepared, based on information obtained from focus group discussions with FSW. This questionnaire was administered to a representative sample
of 500 FSW, randlomly selected from the estimated 5000 FSW in Abidjan.
Results: Thirty percent of the women acknowledged that they ever had a
STD. Of these, 30% first attended a public health service for the last episode of
STD, 30% sought care in the private sector (clinic or pharmacy), 12% went to a
specialized clinic for FSW and 21% bought drugs on the market. The majority of
women were satisfied with the services they obtained. The main reason for this
satisfaction was the perceived efficacy of the treatment. The specialized clinic
was also appreciated because it is free of charge and the reception is friendly,
but was still unknown by 46% of the population. Health care seeking behaviour
for malaria showed a similar pattern.
Sixty-seven percent of women used a contraceptive method, among whom
90% used a modern contraceptive. Hormonal contraception or IUD were used
by 19% of women, condoms by 71%. Hormonal contraceptives were mostly obtained from the pharmacy (47%) and family planning centre (24%). The majority of
women (73%) bought condoms from shops. Forty-six percent of women reported
a history of unwanted pregnancy, of whom 80% had an abortion.
Conclusion: Most FSW go to the public or private sector both for STD and other
diseases. Despite relatively high satisfaction rates, there is a need to strengthen
the quality of these structures. As expected, contraceptives were obtained through
other channels. High rates of unwanted pregnancies indicate that contraceptive
services should be improved. Integration of contraceptive services into curative
services seems a logical step towards the provision of comprehensive health
services for FSW in Abidjan.
33246 Immunohistochemistry as a diagnostic modality and its
role in studying the pathogenesis of syphilis
Jeannette Guarner, P.W. Greer, J. Bartlett, W.J. Shieh, V. Pope, S.R. Zaki.
Center for Disease Control and Preven 1600 Clifton RD MS G32 Atlanta GA
30333, USA
Issues: Syphilis can affect almost any organ, producing a variety of cutaneous
and systemic manifestations. In many instances, the only specimens available for
diagnosis are formalin-fixed, paraffin-embedded tissues, for which silver stains
are used but lack sensitivity and specificity. A more sensitive and specific test that
preserves morphology is desirable to help unravel different pathogenesis issues.
Objective: Develop and evaluate with clinical specimens immunohistochemical
(IHC) test for Treponema pallidum.
Methods: We developed a two step IHC test using formalin-fixed, paraffinembedded tissues from a syphilis-infected rabbit testis and a polyclonal rabbit
antibody against T. pallidum. The test was applied to 3 human cases for which
syphilis was in the differential diagnosis.
Results: The IHC test demonstrated numerous intact spirochetes in the small
intestine of a new born with congenital syphilis. Spirochetes were present in the
liver, lung, spleen, and meninges. In the liver granular staining was also observed.
A consistent pathologic feature in this case was a concentric macrophage infiltrate
around blood vessels in various tissues, suggesting that macrophages play an
important role in the immune response in congenital syphilis. Also tested were
macerated tissues from a stillborn of a woman with syphilis, in which abundant
spirochetes were seen in all tissues. Interestingly, the placenta revealed occasional villi with few treponemes, suggesting that the placenta is an important
barrier to infection; however once the fetus is infected, bacteria multiply rapidly
since few immune protective mechanisms are present. IHC test of the third case,
a tongue biopsy specimen, from a patient with secondary syphilis, showed typical
epidermo-tropism of T. pallidum, since numerous spirochetes were present in the

mucosal surface and fewer in the submucosa.
Conclusions: IHC is a sensitive method for detection of T pallidum in formalinfixed, paraffin-embedded tissues. This diagnostic technique has the advantage
of preserving tissue morphology and thus permits a detailed evaluation of the
localization of spirochetes and their relationship with the surrounding tissues,
which will increase our understanding of the pathogenesis of syphilis.