https://www.jstor.org/stable/info/3776411

Sexually transmitted infections among adolescents: the need for adequate health services

ContextSexually transmitted diseases are increasing rapidly in China. Surveillance
data imperfectly indicate current prevalence and risk factors.ObjectivesTo estimate the prevalence of genital chlamydial and gonococcal infections
and to describe patterns of infection by subgroup and behavioral patterns.Design, Setting, and ParticipantsA national stratified probability sample of 3426 Chinese individuals
(1738 women and 1688 men) aged 20 to 64 years, who were interviewed between
August 1999 and August 2000, completed a computer-administered survey, and
provided a urine specimen (69% total participation rate).Main Outcome MeasurePositive test result for chlamydial or gonococcal infections.ResultsThe overall prevalence per 100 population of chlamydial infection was
2.6 (95% confidence interval [CI], 1.6-4.1) for women and 2.1 (95% CI, 1.3-3.3)
for men. For gonococcal infection, the overall prevalence per 100 population
was 0.08 (95% CI, 0.02-0.4) for women and 0.02 (95% CI, 0.005-0.1) for men.
Risk factors for chlamydial infection among men aged 20 to 44 years were unprotected
sex with a commercial sex worker (odds ratio [OR], 8.24; 95% CI, 3.51-19.35),
less education (OR, 7.20; 95% CI, 2.31-22.37), and recent sex with their spouse
or other steady partner (OR, 7.73; 95% CI, 2.70-22.10). Among women aged 20
to 44 years, risk factors for chlamydial infection were having less education
(OR, 2.82; 95% CI, 1.01-7.91) and living in a city (OR, 3.46; 95% CI, 1.67-7.18)
or along the southern coast (OR, 2.16; 95% CI, 1.29-3.63) and having a spouse
or other steady sexual partner who earned a high income (OR, 2.85; 95% CI,
1.11-7.29), who socialized often (OR, 2.79; 95% CI, 1.08-7.19), or who traveled
less than 1 week per year (OR, 5.40; 95% CI, 1.44-20.3).ConclusionsThe prevalence of chlamydial infection in China is substantial. The
patterns of infection suggest potential avenues for intervention.

https://jamanetwork.com/journals/jama/articlepdf/196147/JOC30372.pdf

Population-based study of chlamydial infection in China: a hidden epidemic.

The objective was to use observed data to develop a mathematical model that estimates the impact of migration on the spread of HIV in South Africa. A deterministic mathematical model was designed to evaluate the dynamic interactions between mobility sexual behaviour HIV and sexually transmitted infections. The model was based on a population study of 488 adults which included male migrants male non-migrants and their rural partners in KwaZulu/Natal South Africa. The model predicted that the impact of migration depends upon the epidemics stage and the pattern of migration. Early in the epidemic frequent migration between populations with different HIV prevalence rates accelerated HIV spread; however local sexual risk behaviour determined the eventual scale of the epidemic. If migration is coupled with increased sexual risk behaviour by migrant men as has been reported in the South African communities studied HIV prevalence would increase 10 times among migrants female partners (1.8 to 19%). In contrast if migration were to occur infrequently with migration-associated risk behaviour assumed to be at current levels the predicted epidemic would be one fifth that currently observed (2.8 versus 15.1%). Migration primarily influences HIV spread by increasing high-risk sexual behaviour rather than by connecting areas of low and high risk. Frequent return of migrants is an important risk factor when coupled with increased sexual risk behaviour. Accordingly intervention programmes in South Africa need to target the sexual behaviour of short-term migrants specifically even though these individuals may be more difficult to identify. (authors)

Modelling the impact of migration on the HIV epidemic in South Africa.

The effectiveness of syndromic treatment as an STD control strategy depends on the proportion of episodes which become symptomatic; few studies have measured this directly. We estimated these proportions for gonorrhoea (NG) and chlamydia (CT), synthesizing data on the point prevalence of self-reported discharge and dysuria among infected cases in rural Uganda, the durations of symptoms, incubation period and asymptomatic episodes, and the effect of treatment on symptom duration. Estimated proportions of episodes that become symptomatic were 45% for males with NG, 11% for males with CT, 14% for females with NG and 6% for females with CT. This was on average 1.5-fold higher than symptom prevalence at cross-section among infected cases in this population. Estimates were sensitive to assumptions on the relative durations of asymptomatic and symptomatic episodes, but were invariably inconsistent with previous direct estimates based on a US cohort study. These results show that the probability of recognizing symptoms in NG and CT episodes varies between settings. In populations with low treatment rates like Uganda, these probabilities can be very low. Here, health education should have priority in STD management programmes.

What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic

In 2000 the first national probability survey of adult sexual behavior in China was completed. We use these data to address three questions. First has there been a revolution in sexual behavior in China? We examine eight trends covering two markers of change: a) the onset of sexual behavior (puberty masturbation age at first sex and marriage premarital sex) and b) commodification of sex (use of pornographic materials and commercial sex) and concurrent sex. We present a historical overview of previous studies and analyze findings from the national survey. Second is China unique in these transformations? We seek to situate findings pointing to a sexual revolution in China within a regional and global context considering whether China is different or follows patterns similar to those in other parts of the world. Third what are the implications of these findings for Chinas risk of a generalized HIV epidemic? As suggestive of possible future disease patterns we examine results from urine samples for the sexually transmitted infection chlamydia trachomatis - a potential co-factor of HIV. Although sexual behavior retains some distinctly Chinese characteristics our survey data demonstrate that a sexual revolution is occurring in China reflected by the fact that the sexual behavior of the countrys post open-door generation differs markedly from that of earlier generations. (excerpt)

Sexual Behavior in China: Trends and Comparisons

The study population consisted of all adults aged 15–59 residing in 56 rural commu-nities of Rakai District, southwest Uganda, enrolled in the Rakai STD Control for AIDS Preven-tion Study. Participants were interviewed about the occurrence of vaginal or urethral dischargeand frequent or painful urination in the previous 6 months. Respondents were asked to provideblood and a ﬁrst catch urine sample. Serum was tested for HIV-1. Urine was tested with ligasechain reaction (LCR) for

Original article Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population

OBJECTIVE: To document the prevalence of asymptomatic non-ulcerative genital tract infections (GTI) in a rural African cohort. METHODS: The study population consisted of all adults aged 15-59 residing in 56 rural communities of Rakai District, southwest Uganda, enrolled in the Rakai STD Control for AIDS Prevention Study. Participants were interviewed about the occurrence of vaginal or urethral discharge and frequent or painful urination in the previous 6 months. Respondents were asked to provide blood and a first catch urine sample. Serum was tested for HIV-1. Urine was tested with ligase chain reaction (LCR) for N gonorrhoeae and C trachomatis. Women provided two self administered vaginal swabs; one for T vaginalis culture and the other for a Gram stained slide for bacterial vaginosis (BV) diagnosis. RESULTS: A total of 12,827 men and women were enrolled. Among 5140 men providing specimens, 0.9% had gonorrhoea and 2.1% had chlamydia. Among 6356 women, 1.5% had gonorrhoea, 2.4% had chlamydia, 23.8% were infected with trichomonas and 50.9% had BV.53% of men and 66% of women with gonorrhoea did not report genital discharge or dysuria at anytime within the previous 6 months. 92% of men and 76% of women with chlamydia and over 80% of women with trichomonas or BV were asymptomatic. The sensitivities of dysuria or urethral discharge for detection of infection with either gonorrhoea or chlamydia among men were only 21.4% and 9.8% respectively; similarly, among women the sensitivity of dysuria was 21.0% while that of vaginal discharge was 11.6%. For trichomonas or BV the sensitivity of dysuria was 11.7% and that of vaginal discharge was 10.5%. CONCLUSION: The prevalence of non-ulcerative GTIs is very high in this rural African population and the majority are asymptomatic. Reliance on reported symptoms alone would have missed 80% of men and 72% of women with either gonorrhoea or chlamydia, and over 80% of women with trichomonas or BV. To achieve STD control in this and similar populations public health programmes must target asymptomatic infections.

https://sti.bmj.com/content/sextrans/74/6/421.full.pdf

Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population.

Background: Combination HIV interventions (CHIs) have led to significant declines in HIV incidence in sub-Saharan Africa; however, population-level data on non-HIV sexually transmitted infection (STI) burden in the context of CHIs are rare. We aimed to assess STI burden in Uganda following mass scale-up of CHIs, including universal HIV treatment. Methods: The Sexually Transmitted Infection Prevalence Study (STIPS) was a cross-sectional study nested within the Rakai Community Cohort Study (RCCS), a population-based cohort among inland agrarian and Lake Victoria fishing populations in southern Uganda. STIPS enrolled consenting participants, 18-49 years, between May and October 2019 and measured prevalence of Chlamydia trachomatis (chlamydia), Neisseria gonorrhoeae (gonorrhea), Trichomonas vaginalis (trichomonas), syphilis, and herpes simplex virus type 2 (HSV-2). Findings: STIPS enrolled 1,825 participants, including 965 women (53%), of whom 9% (n=107) were pregnant. Overall, there was 9.8% prevalence of chlamydia (95%CI:8.5-11%), 6.7% gonorrhea (95%CI:5.7-8.0%), and 11% trichomonas (95%CI:9.5-12%). In the fishing population, syphilis reactivity was 24% (95%CI:22-27%), with 9.4% (95%CI:7.7-11%) having high titer (RPR [≥]1:8) infection, including 17% (95%CI:12-24%) of HIV-positive men. Prevalence of [≥]1 curable STI (chlamydia, gonorrhea, trichomonas, or high titer syphilis) was 44% higher among HIV-positive persons (adjusted prevalence risk ratio [adjPRR]=1.44,95%CI:1.22-1.71), with no differences by HIV treatment status. HIV-positive pregnant women were more likely than HIV-negative pregnant women to have a curable STI (adjPRR=1.87, 95%CI: 1.08-3.23). Interpretation: STI burden remains extremely high in Uganda, particularly among HIV-positive persons. There is an urgent need to integrate STI diagnostic testing and treatment with HIV services in African settings.

The HIV and STI syndemic following mass scale-up of combination HIV interventions in Uganda: a population-based cross-sectional study

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Original article Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population

Asymptomatic non-ulcerative genital tract infections in a rural Ugandan population.

The HIV and STI syndemic following mass scale-up of combination HIV interventions in Uganda: a population-based cross-sectional study