acyclovir and Gonorrhea

Topics: Acyclovir; Anti-Bacterial Agents; Chlamydia Infections; Female; Gonorrhea; Herpes Genitalis; Humans; Male; Neisseria gonorrhoeae; Penicillinase; Recurrence; Sexually Transmitted Diseases

This study aimed to determine the prevalence of genital ulcer and urethral pathogens, as well as their association with clinical features, in men with genital ulcer disease (GUD) enrolled in a clinical trial.. Clinical data were collected by questionnaire. Ulcer swabs were tested for herpes simplex viruses (HSV-1/2), Treponema pallidum, Haemophilus ducreyi, and Chlamydia trachomatis L1-L3. First-pass urine was tested for urethral pathogens, namely Neisseria gonorrhoeae, C. trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Pathogens were detected by real-time molecular assays. Blood was tested for HIV, HSV-2, and syphilis-associated antibodies. Pathogens and clinical associations were investigated using the χ test.. A total of 615 men with GUD were recruited. Herpes simplex virus (HSV-1, 4.2%; HSV-2, 98.2%) and bacterial pathogens were detected in 451 (73.6%) and 48 (7.8%) of genital ulcers, respectively. Human immunodeficiency virus, HSV-2, and treponemal antibodies were detected in 387 (62.9%), 434 (70.6%), and 141 (23.0%) men, respectively, whereas 54 men (8.8%) were rapid plasmin reagin (RPR) seropositive. A total of 223 urethral infections were diagnosed in 188 men (30.6%), including 69 (11.2%) M. genitalium, 64 (10.4%) T. vaginalis, 60 (9.8%) C. trachomatis, and 30 (4.9%) N. gonorrhoeae infections. Dysuria was reported by 170 men (27.6%), and 69 men (11.5%) had urethral discharge on examination. Urethral pathogens were detected in 102/409 (24.9%) men without these clinical features.. Herpes accounted for most GUD cases and urethral pathogen coinfections were common. Erythromycin, dispensed to treat infrequent chancroid and lymphogranuloma venereum cases, provided additional treatment of some asymptomatic urethral pathogens. Additional antibiotics would be required to treat asymptomatic trichomoniasis and gonorrhea.

Topics: Acyclovir; Adult; Chancre; Chlamydia Infections; Chlamydia trachomatis; Gonorrhea; Haemophilus ducreyi; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV Seropositivity; HIV-1; Humans; Male; Neisseria gonorrhoeae; Prevalence; Primary Health Care; Real-Time Polymerase Chain Reaction; Sentinel Surveillance; South Africa; Surveys and Questionnaires; Syphilis; Treponema pallidum; Ulcer; Urethral Diseases; Urine

A randomized, double-blind, placebo-controlled trial (RCT) of herpes simplex virus type 2 suppressive therapy with acyclovir 400 mg twice daily conducted among women in northwestern Tanzania reported a similar rate of HIV acquisition in both trial arms (Current Controlled Trials number ISRCTN35385041). Risk factors for HIV incidence were examined in the context of 3-monthly follow-up visits offering both voluntary counselling and testing and care for sexually transmitted infections.. Prospective cohort analysis of trial participants enrolled and followed for up to 30 months.. Risk factors for HIV acquisition were analysed using Cox regression.. Overall, 821 herpes simplex virus type 2 seropositive, HIV seronegative women were randomized; 400 randomized to acyclovir and 421 to placebo; 659 (80.3%) completed follow-up. HIV incidence was 4.27 per 100 person-years. There was no overall impact of acyclovir on HIV incidence [hazard ratio = 1.01; 95% confidence interval (CI) 0.61-1.66]. HIV acquisition was independently associated with younger age at enrolment (age 16-19 vs. 30-35: hazard ratio = 4.02; 95% CI 1.67-9.68), alcohol consumption at enrolment (> or =30 drinks/week vs. none: hazard ratio = 4.39, 95% CI 1.70-11.33), having paid sex within the previous 3 months (hazard ratio = 1.82, 95% CI 1.09-3.05), recent infection with gonorrhoea (hazard ratio = 3.62, 95% CI 1.62-8.08) and injections in the previous 3 months (hazard ratio = 3.45, 95% CI 1.62-7.34). There was some evidence of an association between HIV incidence and living in the recruitment community for less than 2 years (hazard ratio = 1.75, 95% CI 0.98-3.10) and exposure to hormonal contraception (hazard ratio = 1.60, 95% CI 0.93-2.76).. A high incidence of HIV was observed in this trial cohort, especially in young women. Interventions are needed to address the risk associated with alcohol use and to sustain control of other sexually transmitted infections.

Topics: Acyclovir; Adolescent; Adult; Age Factors; Alcohol Drinking; Antiviral Agents; Contraception Behavior; Contraceptives, Oral, Hormonal; Epidemiologic Methods; Female; Gonorrhea; Herpes Genitalis; HIV Infections; Humans; Sex Work; Young Adult

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Anti-Bacterial Agents; Antitrichomonal Agents; Female; Genital Neoplasms, Female; Gonorrhea; Humans; Lice Infestations; Lymphogranuloma Venereum; Lymphoma; Pregnancy; Pregnancy Complications, Infectious; Sarcoma, Kaposi; Sexually Transmitted Diseases; Syphilis

Topics: Acute Disease; Acyclovir; Adult; Chlamydia Infections; Diagnosis, Differential; Female; Gonorrhea; Herpes Genitalis; Humans; Male; Meningitis; Sexually Transmitted Diseases; Simplexvirus; Syphilis