clove and Chlamydia-Infections

Female sex workers who had prevalent chlamydial, gonococcal, or trichomonal infection at enrollment into a randomized trial in Madagascar were 2 to 4 times as likely to become infected during follow-up, compared to women without STIs at baseline, despite provision of condoms, safer sex counseling, and repeat STI testing and treatment.

Topics: Adult; Chlamydia Infections; Condoms; Condoms, Female; Counseling; Female; Gonorrhea; Humans; Incidence; Interviews as Topic; Madagascar; Predictive Value of Tests; Prevalence; Recurrence; Sex Work; Sexual Behavior; Sexually Transmitted Diseases; Trichomonas Infections; Young Adult

To examine and compare young sex workers' risk of acquisition of sexually transmitted infections (STIs) with the risk among their older counterparts.. To evaluate the effect of young age--16-19 years vs. 20 years and older--on risk of incident infection with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT).. A randomized controlled trial of 1,000 sex workers in Madagascar was conducted. STI testing was conducted at baseline, 6, 12, and 18 months.. About 13% of the cohort (n = 134) was composed of young women aged 16-19 years. STI incidence rates in this group over the 18-month study period were high: 51.9/100 woman-years (WY) for GC and 47.4/100 WY for CT compared to 27.4/100 WY and 19.1/100 WY for sex workers over age 20, respectively. In multivariable models, young sex workers were at significantly higher STI risk compared with their older peers: The adjusted risk ratio (aRR) for GC comparing younger to older women was 1.50 (95% confidence interval (CI): 1.20, 1.88); for CT, the aRR was 1.72 (95% CI: 1.35, 2.19) and for GC or CT combined, the aRR was 1.42 (95% CI: 1.22, 1.66).. This exploratory analysis suggests that additional research is warranted to identify effective and acceptable prevention strategies that benefit young women, and interventions already proven effective among adolescents should be given high priority for scale-up.

Topics: Adolescent; Adult; Binomial Distribution; Chlamydia Infections; Cohort Studies; Female; Gonorrhea; Humans; Incidence; Madagascar; Prevalence; Regression Analysis; Risk Factors; Sex Work; Sexually Transmitted Diseases

To test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured in terms of STI prevalence and reported male condom use.. 1000 female sex workers in Madagascar were randomised to two study arms: peer education supplemented by individual risk reduction counselling by a clinician (peer + clinic) versus condom promotion by peer educators only (peer only). STI testing was conducted at baseline and 6 months. Behavioural interviews were administered at baseline, 2, 4, and 6 months.. At baseline, women in the peer only arm had prevalences of 16.0%, 23.6%, and 12.1% for chlamydia, gonorrhoea, and trichomoniasis respectively, with an aggregate prevalence of 38.2%. Baseline STI prevalences for the peer + clinic arm were slightly lower and 34.1% in aggregate. At 6 months, aggregate STI prevalence increased in the peer only arm to 41.4%, whereas the aggregate prevalence diminished slightly to 32.1% in the peer + clinic arm. In logistic regression analyses, the estimated odds ratios (ORs) for chlamydia, gonorrhoea, trichomoniasis, and aggregate STI were 0.7 (95% confidence interval 0.4 to 1.0), 0.7 (0.5 to 1.0), 0.8 (0.6 to 1.2), and 0.7 (0.5 to 0.9) respectively, comparing the peer + clinic arm with the peer only arm. The logistic regression OR for reported condom use with clients in the past 30 days increased from 1.1 at 2 months to 1.8 at 6 months, comparing the peer + clinic arm with the peer only arm, and was 1.4 overall (1.1 to 1.8). Adjustment for baseline factors changed the regression results little.. The impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction. Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multidimensional control programmes.

Topics: Chlamydia Infections; Coitus; Condoms; Female; Gonorrhea; Health Promotion; Humans; Madagascar; Male; Prevalence; Risk Reduction Behavior; Sex Work; Sexual Partners; Trichomonas Infections

We wanted to determine the age-specific prevalence of selected sexually transmitted infections while assessing the risk factors among hidden female sex workers (HFSW).. One hundred HFSW over 15 years of age were recruited in an impoverished area of Antananarivo, Madagascar. After oral informed consent, blood and endocervical swabs were tested for specific antigens, antibodies, and pathogens using molecular, serologic, and microscopic examinations. A risk factor analysis was conducted with odds ratios and 95% confidence intervals.. Thirty-two percent, 27, 12, and 7% of HFSW were infected respectively with Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis. Specific antibodies against, syphilis were detected in 11%. None were HIV-positive. The main factors associated with STI were: young age, being married, lower education level, early age for first intercourse, and a history of genital infection.

Topics: Adolescent; Adult; Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; HIV Seronegativity; Humans; Madagascar; Middle Aged; Poverty Areas; Prevalence; Reproductive History; Risk Factors; Sex Work; Sexually Transmitted Diseases; Socioeconomic Factors; Trichomonas Vaginitis; Urban Population; Young Adult

In settings in which adequate laboratory service is lacking, the coexistence of urogenital schistosomiasis and sexually transmitted infections (STIs) poses a diagnostic challenge for health care providers in the management of patients with urogenital complaints.. Symptoms were recorded with use of a semistructured questionnaire at baseline and in follow-up surveys after STI and Schistosoma haematobium infection had been assessed and systematically treated as part of a community-based study of 253 women and 236 men, aged 15-49 years, living in an area of Madagascar where S. haematobium is endemic.. Of those infected with S. haematobium, 35% of the women had concordant STI (e.g., infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and/or Trichomonas vaginalis), compared with 17% of the men. Both S. haematobium infection and STI were significantly more common among younger individuals, aged 15-24 years, than among older individuals. A broad spectrum of urogenital symptoms was reported. However, one-half of the women and men who had positive test results for an STI or for S. haematobium infection were asymptomatic. Gross hematuria and dysuria were, in multivariate analysis, associated with S. haematobium infection, as were genitopelvic discomfort in women and ejaculation pain in men. The association became stronger with higher intensity of infection. In bivariate analysis but not in the multiregression model, STI was associated with vaginal discharge and genitopelvic discomfort in women and was associated with urethral discharge in men.. The rationale for empirical antischistosoma treatment of adolescents and younger adults in areas where S. haematobium is endemic, with praziquantel alone or in combination with existing anti-STI regimens, is discussed.

Topics: Adolescent; Adult; Animals; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Madagascar; Male; Middle Aged; Mycoplasma genitalium; Mycoplasma Infections; Schistosoma haematobium; Schistosomiasis haematobia; Sexually Transmitted Diseases, Bacterial; Trichomonas vaginalis; Trichomonas Vaginitis; Young Adult

Decision analytic techniques use formal specifications of utility for the four fundamental decision events: true positives, false positives, true negatives, and false negatives. An optimal policy is the one with the lowest expected net cost. In this paper, decision analytic techniques for treatment selection based on patient characteristics are applied to a resource-poor setting.. A cohort of 986 female sex workers in Antananarivo and Tamatave, Madagascar were tested for cervical infection at baseline and again 2 months later after presumptive treatment for gonorrhea and chlamydia.. Three equivalent approaches to identify the optimal policy based on patient characteristic subgroups are demonstrated. Two of them require exhaustive searches of all possible alternatives. The third identifies the optimal policy as an analytic expression that compares a decision function with a threshold and leads to a closed-form solution. With this approach, the optimal policy can be expressed in four equivalent forms using basic epidemiological measures: likelihood ratio, predicted probability of disease, logistic regression parameters, and total risk score.. These methods illustrate the application of a decision analysis to clinical epidemiology. Management of cervical infection for sex workers in Madagascar occurs under severe resource constraints, and therefore requires an algorithm for identifying optimal treatment regimens.

Topics: Adult; Algorithms; Chlamydia Infections; Cohort Studies; Cost-Benefit Analysis; Decision Support Techniques; Female; Gonorrhea; Health Care Rationing; Humans; Madagascar; Patient Selection; Sensitivity and Specificity; Sex Work; Uterine Diseases