Article

Problems, solutions, and challenges in syndromic management of sexually transmitted diseases.

HIV/AIDS Department, Family Health International, Arlington, Virginia 22201, USA.
Sexually Transmitted Infections (Impact Factor: 3.08). 07/1998; 74 Suppl 1:S1-11.
Source: PubMed
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    • "The burden of disease for STIs is extremely difficult to quantify for a number of reasons [22] [23]. First, surveillance is inadequate, particularly in many of the resource poor settings where STI incidence is possibly highest; second there are sensitivities over the reporting of stigmatized conditions; third many infections are asymptomatic and many symptoms are not unique to particular infections; fourth the causal association between the STIs and disease is often difficult to quantify, as is the case for infertility caused by chlamydia [24] and preterm labor caused by trichomonas [25] and HIV transmission associated with all the different STDs [20]. "
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    ABSTRACT: Sexually transmitted diseases, a source of widespread morbidity and sometimes mortality, are caused by a diverse group of infections with a common route of transmission. Existing vaccines against hepatitis B virus (HBV) and human papilloma virus 16, 18, 6 and 11 are highly efficacious and cost effective. In reviewing the potential role for other vaccines against sexually transmitted infections (STIs) a series of questions needs to be addressed about the burden of disease, the potential characteristics of a new vaccine, and the impact of other interventions. These questions can be viewed in the light of the population dynamics of sexually transmitted infections as a group and how a vaccine can impact these dynamics. Mathematical models show the potential for substantial impact, especially if vaccines are widely used. To better make the case for sexually transmitted infection vaccines we need better data and analyses of the burden of disease, especially severe disease. However, cost effectiveness analyses using a wide range of assumptions show that STI vaccines would be cost effective and their development a worthwhile investment.
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    • "infection with symptoms or none has commonly been detected along side Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, and Trichomonas vaginalis (CDC, 1998; Kirsch et al., 1998; Beltrami et al., 1997). Hence such organisms should be looked up for in detection of both symptomatic and asymptomatic vaginal candidiasis (Dallabetta et al., 1998). More sensitive diagnostic methods should be deployed to the nation's laboratories, such as: Amplified polymorphic DNA methods, and Oricult-N Dipslide. "
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    ABSTRACT: Vulvovaginal candidiasis is a common clinical finding among women especially the sexually active group, even though there has been a sustained increase in both the variety and potency of antifungal drugs over the past three decades. The disease apparently appears not to have sufficiently yielded to these breakthroughs nevertheless. The study was therefore set up to ascertain the prevalence of vaginal candidiasis among women in Jos. The study was retrospective in nature: Data generated from analysis of endocervical and high vaginal swab (ECS/HVS) specimens by the Microbiology laboratory of Jos University Teaching Hospital (JUTH) for a period of five years (July 1999 - June 2004) was compiled. Samples were collected, transported, stored and processed using standard laboratory procedures. Additional information was obtained from patients’ case notes in the records department. Results were analyzed using Epi Info 6 statistical software. The prevalence of Candida infection was found to be 29.1% (n = 2458); no isolate was recovered from those less than 10 years of age, while the peak agegroup of infection was 30 - 39 years 11.8% (n = 997); the age-group 20 - 49 years accounted for over 25% of the entire infections. Common clinical manifestations were: Nil symptoms, 24.7% (n = 607); itching and rashes, 29.4% (n = 723). Due to the importance of the results, sex education workshops should be conducted for adolescents and young adults in order to educate them on the clinical importance of candidal infections.
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    • "This style of integration is characterized in this paper as 'active', in distinction to a responsive style in which clients have to take the initiative. The importance of this question stems from evidence that reliance on MCH or FP clients to report spontaneously concerns about, or symptoms of, STI/HIV infections (or MCH and STI clients to report FP needs) is clearly inadequate and makes little use of the opportunities presented by an integrated service (Dallabetta et al. 1998; Maggwa and Askew 1999). The published evidence on this topic is almost totally restricted to the proportion of FP clients who are exposed to STI/HIV information or advice (Miller et al. 1998). "
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    ABSTRACT: An integrated sexual and reproductive health package is widely regarded as essential for meeting the needs of both men and women. The practical realities of integration in KwaZulu-Natal, South Africa, were examined from the perspective of both providers and clients. Only minorities of clients received any assessment of reproductive and sexual health needs over and above their main presenting need or problem. The majority would have welcomed such assessments and many were classified as being in need, particularly for advice and services with regard to sexually transmitted infections, including HIV. Most providers were positive about integration, but their ability to practice an active form of integration was limited by inadequate training and time constraints. While training defects can be remedied, the time constraints posed by heavy patient loads are less tractable. More skillful use of booking clerks or the introduction of lay counsellors are also possible solutions.
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