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We determined the prevalence of Neisseria gonorrhoeae and describe sociodemographic factors, knowledge and sexually transmitted disease (STD) history associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI). The prevalence of gonorrhoea was 25%. Predictors for gonorrhoea were: male gender (odds ratios [OR] 3.5), age 15-19 (OR 2.5) and 20-29 years (OR 2.1), unawareness of the term STD (OR 1.5), self-perceived risk for STDs (OR 1.7) and no history of syphilis (OR 2.0). When the data were analysed by gender, significant associations were identified between gonococcal infection and age <30 years, single status, and self-perceived risk for STDs for males. Among females, significant associations existed between gonorrhoea and age <30 years, and unawareness of the term STD. This study is novel in describing sociodemographic characteristics of STD clinic attenders, and risk markers associated with gonococcal infection in Trinidad.

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Sexual behavioural factors associated with gonococcal infection among 991 STD clinic attenders in Trinidad, West Indies (WI) were determined by univariate and stepwise multiple logistic regression analysis. Casual sex (odds ratios [OR] 1.6) was the only predictor of gonorrhoea. Among males, significant associations were identified by univariate analysis between concurrent partnerships, > or =one sexual partner(s) in the past 6 months, and drug use prior to engaging in casual and/or oral sex. No significant associations were identified between gonorrhoea and sexual behaviour factors among females. This study is the first to describe sexual behaviours associated with gonococcal infection in Trinidad and to evaluate risk behaviours by gender.

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The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4) had N gonorrhoeae and 100 (13.6) had C trachomatis. Only 151 (36) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100) patients who had single infection with N gonorrhoeae and in 23 patients (96) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.

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The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7 to 10 days for follow up. Of the 735 patients who were enrolled in the study, 319 (43.4 percent) had N gonorrhoeae and 100 (13.6 percent) had C trachomatis. Only 151 (36 percent) of the 419 patients with a pathogeneic isolate returned for clinical and microbiological assessment. The remaining 268 (64 percent) of the 419 patients were lost to follow up. One hundred and forty three patients (94.7 percent) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65 percent), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100 percent) patients who had single infection with N gonorrhoeae and in 23 patients (96 percent) with C trachomatis infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad. (AU)

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The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct observed therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago. All patients with genital discharge and their contacts were given one gram oral dose of azithromycin under direct supervision after collection of urethral and cervical swabs for N gonorrhoeae culture and smear and for C trachomatis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patients who were enrolled in the study, 319 (43.4%) had N gonorrhoeae and 100 (13.6%) had C trachomatis. Only 151 (36%) of the 419 patients with a pathogenic isolate returned for clinical and microbiological assessment. The remaining 268 (64%) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7%) had total abatement of signs and symptoms after taking azithromycin. One patient (0.65%), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis) failed to respond clinically to azithromycin. Microbiological eradication was achieved in 115 (100%) patients who had single infection with N gonorrhoeae and in 23 patients (96%) with C trachomatis infection. Of 12 patients with combined infections, N gonorrhoeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorrhoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervision is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trachomatis in STD clinic attenders in Trinidad.

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We tested the susceptibility patterns of 128 N. gonorrhoeae isolates to six antimicrobials; penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin and azithromycin, and examined whether certain demographic or behavioral factors related to antibiotic use increased the likelihood of infection by a resistant strain. There was a low rate of resistance to penicillin; penicillinase-producing and chromosomal-mediated penicillin resistant gonorrhea were estimated to be 0.8%. A much higher proportion of isolates were resistant to tetracycline (up to 15%). All isolates were sensitive to spectinomycin, ciprofloxacin and ceftriaxone. However, less than 2% of isolates displayed intermediate resistance to both ciprofloxacin and ceftriaxone, and 9% exhibited intermediate resistance to spectinomycin. Patients who had obtained medication before attending the clinic and had taken all of the medication were more likely (p = 0.03) to be infected with a resistant strain of gonococcus. Also, patients who were asked by a clinic doctor to return for a test of cure during an earlier clinic visit, but who did not return were more likely to be infected with a resistant organism (p = 0.006) compared to those who returned at the doctor's request. These findings have important implications for antibiotic use and educational programs in Trinidad and Tobago.

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BACKGROUND: Access to HIV-1 voluntary counselling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings. METHODS: The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters. FINDINGS: HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and $346, respectively, and the cost per DALY saved was $12.77 and $17.78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5.16-27.36 in Kenya, and $6.58-45.03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10.71 in Kenya and $13.39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8.36 in Kenya and $11.74 in Tanzania. INTERPRETATION: HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly.

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OBJECTIVES: To determine if signed consent for a research project constitutes informed consent in sexually transmitted diseases (STD) clinic attendees who understood the voluntary nature of confidentiality outlined in the consent form. DESIGN AND METHODS: A sexual behaviour research project was conducted by researchers from local institutions in association with investigators from a university in Alabama. This present study was a cross-sectional survey using a 34-item questionnaire administered to a consecutive sample of STD clinic attendees in Port-of-Spain, Trinidad, who had been invited to participate in the sexual behaviour research project. RESULTS: Of the 102 participants, 48 (47.1 percent) persons had read the entire consent form in the sexual behaviour survey. Thirty-eight (37.3 percent) persons reported that they thought the health care they received would be worse if they declined to participate in that study. Subjects with less education were significantly more likely to believe their health care would be negatively affected if they refused to participate (p<0.001). Thirty-nine (38.2 percent) persons believed that they had to complete the sexual behaviour questionnaire in order to be treated at the clinic. Almost two-thirds of respondents thought that their answers to the sexual behaviour questionnaire could be traced back to them by persons other than the interviewers and researchers. CONCLUSIONS: The findings clearly indicate that amongst this population a signed consent form does not constitute informed consent. The process of obtaining truly informed consent for research conducted in this setting requires review.(Au)

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An open, non-randomized and non-comparative clinical study was undertaken to assess the efficacy of a single gram dose of azithromycin under supervision in patients with uncomplicated genital discharge and contacts of known STD cases. 151/435 patients (36 percent) with +ve culture for N. gonorrhoeae and antigen +ve for C. trachomatis by ELISA were available for evaluation of azithromycin. There were 119 males (median age 28 years) and 32 females (median age 23 years). Clinical cure was achieved in 95 percent of patients. Bacteriological eradication of N. gonorrhoeae was achieved in all patients with a single infection (115) and in 5/12 with dual infection with C. trachomatis 7 patients had persistence N. gonorrhoeae (5 smear positive and two culture positive) and were subsequently treated with spectinomycin C. trachomatis was eradicated in 23/24 (96 percent) patients with single, and 100 percent patients with mixed, infection during a follow-up assessment with repeat ELISA tests. No patients receiving oral azithromycin reported side effects. This study showed that a single one gram oral dose of azithromycin under supervision is effective in the syndromic management of genital discharge due to N. gonorrhoeae and C. trachomatsis. (AU)

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This study is an ongoing cross sectional survey aimed at determining factors associated with HIV infection in HIV-infected heterosexuals and bisexuals and their heterosexual partners. HIV-positive patients (index cases) were recruited when they attended the Queen's Park Counselling Centre and Clinic, the main clinic for sexually transmitted diseases in Trinidad. All subjects were required to give signed consent to participate in the study and respond to a questionnaire administered by an interviewer. Both partner notification (index cases refer partners) and provider notification (contact tracers locate partners) were used. A partner was defined as one who had had sexual intercourse with the index case up to 5 years preceding the interview. On enrolment, partners were counselled and offered an HIV test and a medical examination. Samples were screened by ELISA for HIV antibody and repeatedly reactive samples were confirmed, using immunofluorescence assay or Western Blot. Between September 14, 1992 and October 8, 1993, 192 index cases and 50 partners had been enrolled. Recruitment of partners was a challenge as the prospect of notification caused anxiety for many patients. Overall, HIV seroprevalence of sexual partners was 54 percent (27/50) and HIV seropositivity was significantly (p<0.05) associated with history of STDs and prostitution within the last 2 years. Genital ulcer diseases may be another risk factor (p<0.10). Cocaine use, though not itself associated with HIV seropositivity, was significantly associated with 2 of the 3 proposed risk factors, and may play an indirect role in HIV transmission (AU)

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Twenty four patients with the vulvar vestibulitis syndrome formed the basis of this clinicopathological study. Entry dyspareunia was the constant presenting complaint and vestibular erythema with acute superficial tenderness the invariable clinical finding. In our series there was a marked predominance of Caucasians, patients were most often of social classes I and II and most frequently in the third decade. The results of laboratory investigation revealed that this syndrome has a diverse range of potential aetiologies including vulval infections, dysplasia and in one instance acute vasculitis.

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