Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts ThPeC7586-ThPeC7589 481

of them. However, the majority of the sexual behavior- related deaths occurred
among men (66%) and HIV was the single leading cause of unsafe-sex-related
deaths (18,221 of 19634 deaths, 557,021 of 936,464 DALYs). The leading causes
of unsafe-sex-related deaths among women are cervical cancer (4,921 deaths)
and HIV (4,234 deaths).
Conclusions: HIV is the leading cause of sexual behavior related deaths and
DALYs in the U.S. Sexual behavior attributed DALYs in the U.S. are 3- fold higher
than that in overall established market economies. Primary interventions to promore safer sex behaviors, screening, counseling, and treatment for preventable
and curable diseases, hepatitis B vaccines, and contraceptives can reduce sexual
behavior-related public health burden.
Presenting author: Shahul Ebrahim, Mail Stop E-46, CDC, 1600 Clifton Road,
Atlanta, GA 30345, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeC7586 Periodic presumptive treatment of sexually
transmitted infections (STIs) among female sex
workers in Cotonou and Porto Novo (Benin):
Baseline results
A.C. Labbe1, N. Geraldo2, H. Meda3, C.A.B. Gnintoungb3, S. Anagonou 4,
M. Alary1. Unit de recherche en sant des populations, Centre hospitalier
affilie universitaire de Qu6bec, 34 Nancy, Lorraine, Quebec, J6Z 1T1.; Canada;
2 Dispensaire /ST Cotonou, Benin; 3Projet Sida3-Bdnin, Cotonou, Benin;
4Programme national de lutte contre le sida, Cotonou, Benin
Background: The role of STIs in increasing HIV susceptibility is well established.
Their treatment can reduce genital HIV excretion. The prevalences of N. gonorrhoeae (NG) and C. trachomatis (CT) infections among female sex workers
(FSW) in Cotonou have decreased significantly since 1993 but are still high. In
the search for alternative strategies to the syndromic approach, a trial of periodic
presumptive treatment of STIs among FSW started in 2001.
Methods: Recruitment took place in two clinics dedicated to FSW in Cotonou
and Porto Novo. After informed consent, a questionnaire was administered and
a gynecological exam performed. The syndromic approach was used to manage
STI and a cervical swab taken for analysis in Montreal by PCR for NG and CT
All participants were offered voluntary HIV testing by fingerprick on filter paper
(tested in Cotonou).
Results: As of October 24, 293 FSW had been enrolled in Cotonou and 124 in
Porto Novo. Median age of the 417 women was 32 years, median duration of
sex work 1 year and median number of clients in the previous week 20. Country
of origin was Nigeria (42.0%), Ghana (36.5%), Togo (15.6%) or Benin (5.3%).
During the previous week, 53.9% of FSW used condoms with all their clients,
35.9% with 50-99% and 10.2% with less than half. Only 12/155 (7.7%) women
who had sex with a regular partner during the previous week always used condoms with him. Overall, NG and CT infections were diagnosed by PCR in 20.9%
and 3.6% women respectively; 207/404 women (51.2%) were HIV-1 infected. The
prevalence of both HIV (60.5% vs 47.4%, p<0.05) and NG (29.0% vs 17.4%) was
higher in Porto Novo than in Cotonou.
Conclusions: Recruitment of FSW to participate in a trial of presumptive treatment of STI was successful. Should this approach prove to be effective in reducing the prevalence of STI, it would represent an important complementary
strategy for the prevention of HIV infections in this high-risk group.
Presenting author: Annie-Claude Labbe, 34 Nancy, Lorraine, Quebec, J6Z 1T1,
Canada, Tel.: [phone], Fax: [phone], E-mail: labbeac@yahoo.
fr
ThPeC7587 Prevalence and prediction of sexually transmitted
diseases among rural clinic attendees in Uganda
E. Nakku-jolobal, F. Kambugu2, D. Neuhauser3, E. Borawski3, C. Whalen4.
1Department of Epidemiology and Biostatistics Case Western Reserve
University School of Medicine, Mulago Hospital STD Clinic, 11328 Euclid
Avenue Apt 305, Cleveland, Ohio, 44106, United States; 2Mu/ago Hospital STD
Clinc, Kampala, Uganda; 3Department of Epidemiology and Biostatistics Case
Western Reserve University School of Medicine, Cleveland,OH, United States;
4Department of Epidemiology and Biostatistics Case Western Reserve
University School of Medicine, Cleveland,OH, United States
Background: Management of sexually transmitted diseases (STD) in resource
poor countries is based on syndromic approach. However, the positive predictive value of syndromic diagnosis depends on local prevalence. In Uganda, data
on rural STD prevalence is limited. The objective of this study was to determine
prevalence of STDs in rural STD clinic attendees using molecular diagnostics.
Methods: A cross-sectional study was conducted at 2 rural clinics in Uganda,
from June to August 2001. A questionnaire seeking demographic and risk factors
for STDs was administered. A syndromic diagnosis, based on national guidelines,
was made. Samples (vaginal swabs, urine) were analyzed by PCR for gonococ
cal, chlamydia, chancroid, herpes, syphilis and trichomonas infection. HIV diagnosis was by ELISA, and syphilis by RPR.
Results: A total of 394 patients mean age 28yrs (SD 9.3), females 306 (77%)
were seen. Prevalence of Lower abdominal pain was 97 (25%), Abnormal vaginal dischargel73 (44%), Urethral discharge syndrome 23 (6%), Genital ulcers 44
(11%). Prevalence of gonorrhea was 30 (8%), trichomonas 35 (9.0%), chlamydia
5 (1%). Fifty-eight patients (15%) tested HIV positive and 10 (3%) RPR positive.

Of 25 people tested for herpes, 8 were positive (30%). The sensitivity, specificity
and Positive Predictive value (PPV) of vaginal discharge or lower abdominal pain
diagnosis, compared to PCR diagnosis for gonorrhea, trichomonas or chlamydia
was 80%, 24% and 21% respectively. In men sensitivity, specificity and PPV for
urethral discharge syndrome compared to PCR for gonorrhea or chlamydia was
91%, 83% and 43% respectively
Conclusions: The sensitivity and predictive value of syndromic diagnosis is limited. Molecular diagnostics technology should be transferred to developing countries.
Presenting author: Edith Nakku-joloba, 11328 Euclid Avenue Apt 305, Cleveland, Ohio, 44106, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeC7588 Comparison of the serological response to
treatment of early syphilis in HIV positive versus
HIV negative individuals
M.A. Kingston, S.P. Higgins. North Manchester General Hospital, 7 Maple
Avenue, Chorlton, Manchester, M21 8BD, United Kingdom
Background: The effectiveness of treatment for syphilis is routinely evaluated by
demonstrating declining titres of the non-treponemal antibody tests, such as the
rapid plasma reagin (RPR) and the veneral disease reference laboratory (VDRL)
tests. The serological response in those treated for syphilis who are HIV coinfected has been the subject of considerable debate. Whilst some studies report
a similar serological response in HIV positive and negative individuals, others report a delayed response in those who are co-infected. In the past four years there
has been a dramatic increase in the number of cases of infectious syphilis in
Manchester, United Kingdom. The aim of this study is to evaluate the serological
response to treatment for syphilis in HIV positive and negative individuals treated
at North Manchester General Hospital.
Methods: From January 1999 to December 2001, 71 men (68 homosexual) and
4 women were diagnosed with early syphilis. Approximately half (38) were HIV
positive, with 4 declining an HIV test. In those who consented to HIV testing,
completed treatment and attended for follow-up, the reduction in RPR titres in
HIV positive and negative individuals were compared at 3, 6, and 12 months following treatment.
Results: Three months following treatment the mean reduction in RPR titres was
1.18 in the HIV positive group (n=19) and 1.00 in the HIV negative group (n=19)
p=0.69. At 6 months the mean reduction in titres was 1.25 in the HIV positive
group (n=1 1) and 1.75 in the HIV negative group (n=10) p=0.43 and at 12 months
from treatment was 1.15 in the HIV positive group (n=7) and 2.14 in the HIV negative group (n=8), p=0.22.
Conclusions: We found no significant difference in serological response at 3, 6 or
12 months following treatment for early syphilis in those who are HIV co-infected
compared to those who are not. These results indicate that the RPR remains a
valid test of response to treatment for syphilis in those co-infected with HIV.
Presenting author: Margaret Kingston, 7 Maple Avenue, Chorlton, Manchester,
M21 8BD, United Kingdom, Tel.: [phone], Fax: [phone],
E-mail: davemags @ dialstart.net
ThPeC7589I HIV detection among patients with sexually
transmitted diseases
M.V Tancredil, E.M.S. Brito2, N.J.S. Santos2, E.A.C. Ruiz2,
C.S.B. Domingues2. 1Referral Centers STD/Aids, Rua Rebeca, 140, Santo
Andrd, Sdo Paulo, CEP: 09061-400, Brazil; 2Referral Center STD/Aids, Sao
Paulo, Brazil
Background: - Epidemiological study performed in the State of Sao Paulo -
Brazil, including data from all Referral Centers for Sexually Transmitted Diseases,
with the objective of analyzing the profile of these conditions and the association
among STD and HIV/Aids.
Methods: - Data were obtained from a STD reporting computerized system
(SINDST) and analysed with EPIINFO 6.04B and STATA and include all the STD
cases from August 1998 to May 2001. Analysis was performed according to gender, age, sexual option, use of condoms, etiological and syndromic diagnoses
and the detection of co-infection with HIV.
Results: - We analysing 5,456 cases of STD, 48.1% men and 51.9% women.
We observed 70.7% of cases between ages 20 to 39 years, and 10.4% between
ages 10 to 19. The use of condoms revealed compliance of 46.3%, of wich 20.5%
of patients referred consistent use in all sexual relations. From the total cases
of STD 77.0% refered heterosexual option and 16.3% homosexual. There were
2,258 (41.4%) syndromic diagnoses of genital warts and white lesions with acetic
acid. The etiological diagnoses was defined in 1,426 cases as indications of presence of Human Papillomavirus (HPV). There were 180 (8.0%) patients identified
as seropositive to HIV and with HPV.
Conclusions: - Due to the magnitude and transcending question of the HIV in
fection we must adopt structural changes in Health Care in order to allow the early
identification of the HIV among patients with STD, along with the improvement of
Health Education and effectiveness of Epidemiological Surveillance.
Presenting author: Mariza Vono Tancredi, Rua Rebeca, 140, Santo Andrb, Sao
Paulo, CEP: 09061-400, Brazil, Tel.: [phone], Fax: [phone],
E-mail: [email protected]