Characteristics of patients with syphilis attending Baltimore STD clinics: multiple high-risk subgroups and interactions with human immunodeficiency virus infection

Article Abstract:

The number of cases of syphilis has escalated in recent years, leading public health officials to investigate the possible causes and consequences of this increase. Syphilis is a sexually transmitted disease, and those who have the disease may be at risk for human immunodeficiency virus (HIV) infection, which causes AIDS. Syphilis has also been linked to drug use, which is also a risk factor for acquiring HIV. The medical records of 341 patients with syphilis, who were being treated at a sexually transmitted disease clinic, were assessed to determine what high-risk behaviors might have predisposed them to acquire syphilis, and possibly HIV infection. Most of the participants were black, and lived in Baltimore, Maryland. The syphilis patients were more likely to be IV drug users and to have had a prior case of syphilis; among male patients, they were more likely to be homosexual. Compared with other patients at the clinic, those with syphilis were also more likely to have a positive HIV test, which indicates that they had been exposed to the virus. Interestingly, patients with syphilis were more likely to refuse to be tested for HIV; this was especially true among those with a history of syphilis infection. A history of syphilis could be significant in relation to the transmission of HIV, because the presence of genital ulcers, which might occur in patients with syphilis, has been shown to increase the risk of becoming infected with HIV. This medical record survey revealed that half of the male and one-third of the female patients with syphilis engaged in one or more high-risk behaviors that placed them at risk for acquiring HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ambulatory care facilities, Risk factors, Surveys, Maryland, Clinics, Baltimore, Maryland, Syphilis patients

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The association of syphilis with risk of human immunodeficiency virus infection in patients attending sexually transmitted disease clinics

Article Abstract:

The spread of infection with HIV, the agent that causes AIDS, remains a major concern of health officials in the United States. Although the incidence of AIDS appears to be declining among homosexual men, presumably due to safer sexual practices, education has been less successful in altering the behavior of intravenous drug users. IV drug users and their heterosexual contacts continue to be at high risk for acquiring the AIDS virus. Since it is difficult to obtain accurate information about high-risk behavior from this population by direct means, the association between syphilis and HIV infection was examined among the patients at two inner-city sexually transmitted disease clinics. Infection with syphilis may be considered to be a valid indicator of high-risk sexual behavior. The survey of patients revealed that 24.3 percent of the patients with syphilis were positive for the AIDS virus, in contrast with 3.5 percent of the patients who did not have syphilis. The percentage of HIV-infected women rose from 3.0 percent in 1987 to 3.6 percent in 1988, which is suggestive of increased heterosexual transmission. While the strong correlation between syphilis and HIV infections may be largely due to their mutual association with high-risk behavior, there is also the possibility that a syphilitic chancre may provide a superior opportunity for the spread of HIV. The association between syphilis and HIV infection in this patient population suggests that further public health efforts are necessary if the heterosexual spread of AIDS among IV drug users and their sexual contacts is to be controlled. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sexual behavior, Demographic aspects, Disease transmission, Drug addicts, Drug abusers, AIDS (Disease)

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Genital human papillomavirus infections in patients attending an inner-city STD clinic

Article Abstract:

Although infections of the genital tract by human papillomavirus (HPV) may be associated with genital warts, they are not clinically obvious in many cases and must be diagnosed by sophisticated laboratory assays. To learn more concerning the prevalence of HPV infection in an inner-city group of women who visited a clinic that treated sexually transmitted diseases (STDs), a study of 116 patients was carried out. The patients were interviewed and underwent gynecological examinations during which specimens were collected. Tests were carried out for several STDs in addition to HPV infection. A comparison of the results of different tests for diagnosing HPV was made. STDs were common among this clinic population: 14 percent of the patients tested positive for gonorrhea; 15 percent were infected with Chlamydia trachomatis (which causes chlamydia); 21 percent had signs of Trichomonas vaginalis (which causes trichomoniasis); and 23 percent had bacterial vaginosis. Between 12 percent and 41 percent of the women were infected with HPV; the results varied according to the diagnostic test used. Evaluation of Pap smears for pathologic changes associated with HPV led to the highest estimation of the prevalence of HPV, while diagnoses based on the presence of warts led to a much lower estimate. Each diagnostic approach has strengths and weaknesses, and almost one-fifth of the specimens could not be evaluated for HPV by all methods. The difficulty in obtaining appropriate specimens hinders the accurate diagnosis of the disease. Diagnosing HPV infection presents an important problem for STD clinics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Testing, Papillomaviruses, Papillomavirus, Papillomavirus infections

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