trimethoprim--sulfamethoxazole-drug-combination and Syphilis

In sub-Saharan Africa, HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes. In Kenya, policy states women should be tested for all four conditions (malaria only if febrile) at first antenatal care (ANC) visit. In practice, while HIV screening is conducted, coverage of screening for the others is suboptimal and early pregnancy management of illnesses is compromised. This is particularly evident at rural dispensaries that lack laboratories and have parallel programmes for HIV, reproductive health and malaria, resulting in fractured and inadequate care for women.. A longitudinal eight-month implementation study integrating point-of-care diagnostic tests for the four conditions into routine ANC was conducted in seven purposively selected dispensaries in western Kenya. Testing proficiency of healthcare workers was observed at initial training and at three monthly intervals thereafter. Adoption of testing was compared using ANC register data 8.5 months before and eight months during the intervention. Fidelity to clinical management guidelines was determined by client exit interviews with success defined as ≥90% adherence.. For first ANC visits at baseline (n = 529), testing rates were unavailable for malaria, low for syphilis (4.3%) and anaemia (27.8%), and near universal for HIV (99%). During intervention, over 95% of first attendees (n = 586) completed four tests and of those tested positive, 70.6% received penicillin or erythromycin for syphilis, 65.5% and 48.3% received cotrimoxazole and antiretrovirals respectively for HIV, and 76.4% received artemether/lumefantrine, quinine or dihydroartemisinin-piperaquine correctly for malaria. Iron and folic supplements were given to nearly 90% of women but often at incorrect doses.. Integrating point-of-care testing into ANC at dispensaries with established HIV testing programmes resulted in a significant increase in testing rates, without disturbing HIV testing rates. While more cases were detected and treated, treatment fidelity still requires strengthening and an integrated monitoring and evaluation system needs to be established.

Topics: Adult; Anemia; Anti-Bacterial Agents; Anti-HIV Agents; Antimalarials; Artemether, Lumefantrine Drug Combination; Artemisinins; Dietary Supplements; Erythromycin; Female; Folic Acid; Guideline Adherence; Health Personnel; HIV Infections; Humans; Iron, Dietary; Kenya; Laboratory Proficiency Testing; Longitudinal Studies; Malaria; Penicillins; Point-of-Care Testing; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Prenatal Care; Quinine; Quinolines; Syphilis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Injuries; Agricultural Workers' Diseases; Anti-Bacterial Agents; Argentina; Ciprofloxacin; Drug Therapy, Combination; Endemic Diseases; Humans; Male; Middle Aged; Mycetoma; Nocardia; Nocardia Infections; Penicillin G; Syphilis; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Topics: Antiretroviral Therapy, Highly Active; HIV Infections; Humans; Syphilis; Trimethoprim, Sulfamethoxazole Drug Combination

Absent for several decades, the chancroid reappeared in Algeria in 1988. In the unique department of Dermatology and Venereology of the University Hospital of the country of Tlemcen (more than 700,000 inhabitants), we wanted to know the state of this STD seven years after the report of the first cases. The file of the consulting patients were examined. We looked for the principal characteristics of this STD: age, sex, incubation period, place infection contact, type of relation, clinical presentation, evolution without and with treatment, other associated STD (syphilis, HIV). From August 1988 (1st case) to December 1995, 144 cases of chancroid were collected = 1988: 6, 1989: 5, 1990: 7, 1991: 18, 1992: 11, 1993: 33, 1994: 48, 1995: 16. The presentation is quite stereotyped; it concerns males only, singles in must cases, having had sexual relations with prostitutes. The incubation period is short (less than 10 days), the characteristic ulceration presents, very often, some adenopathies. The treatment by cotrimoxazole is efficient. They are no concomitant syphilis or HIV infection. The chancroid is the first cause of genital ulceration in the world. Since 1991, it is the principal STD in our department. It spreads within a male population, young singles associated with prostitutes. It is well installed in Algeria, and its role, although minor, in the transmission of the HIV infection, should not be neglected.

Topics: Adolescent; Adult; Age Factors; Algeria; Anti-Infective Agents; Chancroid; Genital Diseases, Male; HIV Infections; Humans; Lymph Nodes; Male; Marital Status; Middle Aged; Penile Diseases; Retrospective Studies; Scrotum; Sex Factors; Sex Work; Sexual Partners; Sexually Transmitted Diseases, Bacterial; Skin Ulcer; Syphilis; Trimethoprim, Sulfamethoxazole Drug Combination

A 39-year-old Norwegian seaman developed penile ulcerations after sexual contact overseas. The diagnosis of syphilitic chancre and of chancroid was confirmed. The ulcers healed after combined treatment with benzathine penicillin and trimethoprim-sulfamethoxazole.

Topics: Adult; Chancre; Chancroid; Drug Combinations; Haemophilus ducreyi; Humans; Male; Penicillin G Benzathine; Penile Diseases; Sulfamethoxazole; Syphilis; Syphilis Serodiagnosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination