ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The definitive identification of sexually transmitted pathogens has become increasingly important as their incidence has increased and their presence has been linked to transmission of human immunodeficiency virus. In the detection of pathogen-specific DNA, DNA probes and the polymerase chain reaction have tremendous theoretical advantages over traditional diagnostic methods in terms of sensitivity and automation. These new methods have been applied to the detection of human papillomavirus,Neisseria gonorrhoeae, syphilis, chancroid,Chlamydia trachomatis, andTrichomonas vaginalisamong others. However, despite these advantages, the problems with specificity and positive predictive values, as well as increased costs, have limited the broad application of molecular methods in most situations. Continued development of newer detection systems and comparison with existing methods will be needed to determine the proper utilization of molecular diagnostic methods in sexually transmitted diseases.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In many societies, approximately 5% to 15% of the sexually active population is infected byChlamydia trachomatis, although a tendency towards a decrease in the prevalence and incidence of genital infections by this agent has been registered in a number of countries. The use of noninvasive methods for screening,ie, testing of voided urine, has confirmed that men are a neglected reservoir for infections byC. trachomatis. Novel means of diagnosing chlamydial infection,eg, by amplified (polymerase chain reaction techniques) detection of chlamydial antigen in body fluids and biopsy material, as well as in histologic sections, has opened up new possibilities of studying the natural history of chlamydial infections. Studies of the mechanism behind the killing of chlamydial organisms in the host,eg, the role of cytokines and other nonimmunologic principles, as well as the study of the humoral and cell-mediated immune response, have also increased knowledge on the natural history ofC. trachomatisinfection. Several recent studies have confirmed the important role ofC. trachomatisin infertility, ectopic pregnancy, and neonatal infections.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

New clinical aspects of genital human papillomavirus (HPV) infection are still emerging. The most interest surrounds subclinical infection, as revealed by magnification after the application of acetic acid. This may be the real cause of some genital dermatoses, such as balanoposthitis. However, the course and epidemiology of these acetowhite lesions are by no means clear and will need further study. Micropapillomatosis labialis affecting the vulvar introitus was formerly regarded as a type of genital wart, but in a recent study it has been shown to be largely unrelated to HPV. Anogenital warts in children may be a sign of sexual abuse, but much is yet to be learned about their pathogenesis and clinical features. Accurate diagnosis of the condition is essential because of its medicolegal importance. The treatment of genital HPV-associated disease remains problematic, and no new treatment modalities have emerged recently. A stable remission of condylomata acuminata and papular warts can be achieved with existing forms of therapy, but remission of subclinical HPV infections is much more difficult to effect; in fact, the need to treat it at all has been questioned. The value of interferons in the treatment of genital HPV disease remains doubtful, except possibly as an adjunct to other forms of therapy.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Worldwide, sexual contact continues to be the major mode of transmission of human immunodeficiency virus (HIV) among adults. There is a striking association between HIV infection and several sexually transmitted diseases. Diseases causing genital ulceration including chancroid, syphilis, and anogenital herpes simplex infection may facilitate HIV transmission. HIV infection appears to alter the clinical presentation, natural history, and therapeutic response of some sexually transmitted diseases. Recent epidemiologic and virologic studies have noted an increase in anogenital human papillomavirus among HIV-seropositive persons and an association with anogenital intraepithelial neoplasia. Control of sexually transmitted diseases is important in limiting the spread of HIV.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The identification of a sexually transmitted disease in a child beyond the neonatal period has both medical and legal implications. Gonorrhea and syphilis are almost exclusively transmitted sexually and are useful markers of sexual abuse in children. However, exceptions do occur;eg, rectal and genital infection withChlamydia trachomatisin young children may be due to persistent perinatally acquired infection, which may persist for up to 3 years. Infection due to human papillomavirus (condylomata acuminata) presents a similar problem, because the period of latency after perinatal acquisition may be 2 years or longer. Other sexually transmitted diseases, such as bacterial vaginosis, may be acquired nonsexually and have been identified in both abused and nonabused children. When the only evidence of sexual abuse is the isolation of an organism or the detection of antibodies, the findings should be carefully confirmed. Any laboratory report may be required in pending legal action. The identification of gonorrhea andC. trachomatisshould be by culture only, with confirmation by standard recognized techniques.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Sexually transmitted diseases (STDs) are a major public health problem, affecting predominantly adolescents. The past decade has witnessed major developments in the epidemiology of STDs. “Traditional” STDs, such as syphilis and gonorrhea, are increasingly concentrated in high prevalence or “core” areas, which are typically in the inner city communities with high rates of drug use and other public health problems. Sexual behavior associated with crack cocaine has had a substantial impact on the epidemiology of STDs, especially syphilis. Because drug use and STDs are both independent risk factors for human immunodeficiency virus infection, human immunodeficiency virus counseling and testing has become an integral part of STD control programs. The high prevalence of antibiotic-resistant gonococcal infections has resulted in new public health needs for surveillance and has made penicillin obsolete for therapy. Chlamydial control programs are hampered by a relative lack of funds and by the high proportion of disease that occurs without signs or symptoms. Defining the epidemiology of chronic viral STDs, such as herpes simplex and human papillomavirus infection, is difficult. These diseases are widely prevalent and overwhelmingly symptomatic, and diagnostic tests for chronic herpes simplex virus and human papillomavirus suffer from both sensitivity and specificity problems.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Primary prevention of sexually transmitted diseases through immunization has been advocated as the most effective control strategy. We review present efforts and future paths for development of gonococcal, chlamydial, treponemal, and genital herpes vaccines. Central themes such as the role of core groups, herd immunity, and mucosal surface immunity are examined. Hepatitis B vaccine is the possible success story of sexually transmitted disease vaccine development. A rational, well-researched implementation strategy that could serve as a model for other sexually transmitted diseases is advocated.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Urinary tract infections are common clinical problems and result in substantial morbidity. The management of certain syndromes remains controversial. Chronic bacterial prostatitis that relapses after treatment with older antibiotics often responds to therapy with norfloxacin; however, this fluoroquinolone is not reliably effective for chronic prostatitis caused byPseudomonas aeruginosa. The indications for treating asymptomatic bacteriuria are still debated. Single-dose antibiotic treatment may reduce the incidence of symptomatic urinary tract infections in patients who have asymptomatic bacteriuria 48 hours after removal of their urinary catheters. However, the alternative approach of initiating therapy only if symptoms develop may be more cost effective. No clear benefits of antibiotic treatment have been demonstrated for asymptomatic bacteriuria in elderly or diabetic patients. Although candiduria can be at least transiently eliminated with only 2 days of amphotericin bladder irrigation, the majority of asymptomatic patients with candiduria require no treatment. Trimethoprim-sulfamethoxazole may be the preferred therapy for acute uncomplicated pyelonephritis caused by most gram-negative bacteria; the need for intravenous antibiotics (including the concurrent use of gentamicin) as initial therapy in hospitalized patients can be challenged. Recent insights into the natural history of recurrent urinary tract infection in adult women have confirmed the efficacy of long-term antibiotic prophylaxis.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID