Violence against women is a global problem, and rates in Southeast Asia is high enough.Patriarchy culture take a part for this condition. The culture is also contribute to the situation. Gender inequality is especially visible in developing countries. Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early, either through early ma...
Violence against women is a global problem, and rates in Southeast Asia is high enough.Patriarchy culture take a part for this condition. The culture is also contribute to the situation. Gender inequality is especially visible in developing countries. Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early, either through early marriage or sexual abuse. In most cases their partners are typically much older men. Physical and sexual violence within marriage are also common, and women have little
room to negotiate the use of condoms or to refuse sex to an unfaithful partner. Culture is not immutable, but change has to come from within a society,because people feel the need for it.Mobilization of local resources and indigenous knowledge, as well as the promotion of women's
creativity and productivity, can be vital tools in the prevention and control of HIV/AIDS amongst women. There is a strong need of media support, NGO, and government.
While sharing Adams and colleagues’ concerns about the use of major outcomes averted, I should like to point out a factual error in their description[1] of the results from the ClaSS model[2]. The definition of major outcome used in that report, which appears in the text on page 107
and in the caption to Figure 18 on page 108 of the report[2] excludes epididymitis. The “seemingly perverse” result that sc...
While sharing Adams and colleagues’ concerns about the use of major outcomes averted, I should like to point out a factual error in their description[1] of the results from the ClaSS model[2]. The definition of major outcome used in that report, which appears in the text on page 107
and in the caption to Figure 18 on page 108 of the report[2] excludes epididymitis. The “seemingly perverse” result that screening males in addition to females is more cost-effective than screening females alone is therefore based on an outcome measure that does not include epididymitis. While it is true that the cost of epididymitis is included in the calculations, the result cited still holds even if the cost of epididymitis is removed. In the interests of further clarity, I should also like to point out that we only considered screening males in addition to females: we never considered screening males alone.
References
[1] Adams E J, Edmunds W J, Turner K M. Commentary on “The cost-effectiveness of opportunistic chlamydia screening in England”. Sex Transm Infect 2007;83:275.
[2] Low N, McCarthy A, Macleod J, et al. Epidemiological, social, diagnostic and economic evaluation of population screening for genital
chlamydial infection. Health Technology Assessment, 2007. Report No. 11(8).
Recent reports on lymphogranuloma venereum (LGV) proctitis in men who have sex with men (MSM) have highlighted that affordable diagnostics for both symptomatic as well as asymptomatic LGV infections are urgently
needed. 1,2 LGV responds well to extensive antibiotic treatment but when untreated LGV can cause chronic or irreversible complications because of severe inflammation and invasive infection.3...
Recent reports on lymphogranuloma venereum (LGV) proctitis in men who have sex with men (MSM) have highlighted that affordable diagnostics for both symptomatic as well as asymptomatic LGV infections are urgently
needed. 1,2 LGV responds well to extensive antibiotic treatment but when untreated LGV can cause chronic or irreversible complications because of severe inflammation and invasive infection.3
In a recent interesting study, van der Snoek et al conclude that an elevated Chlamydia trachomatis (CT) IgA antibody response and the age of the infected individual are of possible diagnostic value for early detection of LGV proctitis. 4 Based on their study of 24 MSM with L2
proctitis and 15 MSM with rectal CT (non-LGV) infection, they suggest that the association between LGV L2 and significantly higher titers of IgA and IgG are caused by more invasive and more chronic inflammation of the
proctum due to the LGV biovar.
As published previously, and also mentioned in the article of van der Snoek, a considerable number of the patients with LGV proctitis in the present epidemic are asymptomatic.2,4,5 In a retrospective case controlled
study we found only 47% of the LGV cases had signs of proctitis (mucous membrane abnormalities) upon proctoscopic examination.2 Unfortunately the manuscript of van der Snoek fails to inform its readers on the patient complaints and/or clinical symptoms found among the included patients.
Their recommendation to test IgA levels in high risk populations to exclude LGV might therefore possibly miss a considerable number of asymptomatic cases of LGV proctitis with consequences for both the individual patient and the population at risk.
We previously studied MSM patients with any form of chlamydial proctitis and they were designated into 2 groups based upon mucous membrane abnormalities found during proctoscopic examination.5 In the group of 44 cases with mucous membrane abnormalities 32 had LGV proctitis and 12 had non-LGV chlamydial proctitis. In the group of 30 men without mucous membrane abnormalities, 13 had LGV proctitis and 17 had non-LGV proctitis. In the group with mucous membrane abnormalities IgG serology (C. trachomatis–IgG pELISA, Medac Diagnostika GmbH, Hamburg, Germany) had
a high positive predictive value for LGV proctitis (0,94) when a cut-off value of < 1:200 was used. However, in the group without mucous membrane abnormalities both the positive and negative predictive value were low (resp. 0,57 and 0,65). We concluded that IgG species-specific
serology could help support the LGV diagnosis when clinical symptoms are present but cannot be used for screenings purposes to detect LGV-infected persons without clinical symptoms.
In a second retrospective case controlled study performed by our group in Amsterdam, proctosopic examination and anal mucosal smears in MSM with receptive anal sex in the previous 6 months were found to be helpful to detect LGV proctitis.2 In that study 87 men with proctitis based on CT
serovar L2b men were compared with 2 separate control groups: MSM who had non-LGV Chlamydia proctitis (n = 377) and MSM who reported having receptive anorectal intercourse but who did not have anorectal chlamydia (n = 2677). Apart from HIV seropositivity, either proctitis detected by
proctoscopic examination or elevated >10 white blood cells/high-power field detected on an anorectal smear specimen were found to be the only clinically relevant predictors for LGV proctitis in MSM.
In the recently published IUSTI/WHO guideline on STI proctitis it is recommended to perform proctoscopy and anal mucosal smears in all MSM with receptive anal sex in the previous 6 months and to screen for anal chlamydia and gonorrhea.6 In case inflammatory signs and/or >10
leucocytes per high-power field upon microscopic examination of anal mucosal smears are detected presumptive treatment with doxycyclin is advised until the definite diagnosis become available. In case anal chlamydia is found, biovar determination of the chlamydia strain is indicated to confirm potential LGV proctitis.
In the ongoing LGV proctitis epidemic there is a great need for simple and affordable diagnostic procedures to screen the (asymptomatic) population at risk. Additional serological markers are required to evaluate as diagnostic tools for LGV proctitis in larger, well defined and
described cohorts. Until those studies are performed the gold standard for LGV diagnostics (both in symptomatic as well as in asymptomatic patients) remains molecular determination of chlamydia biovars.
References
1. Ward H, Martin I, Macdonald N, Alexander S, Simms I, Fenton K, French P, Dean G, Ison C. Lymphogranuloma venereum in the United kingdom.
Clin Infect Dis. 2007 Jan 1;44(1):26-32.
2. Van der Bij AK, Spaargaren J, Morré SA, Fennema HS, Mindel A, Coutinho RA, de Vries HJ. Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case-control study. Clin Infect Dis. 2006 Jan 15;42(2):186-
94. Epub 2005 Dec 5.
3. Weir E. Lymphogranuloma venereum in the differential diagnosis of proctitis. CMAJ 2005; 172:185.
4. van der Snoek E, Ossewaarde J, van der Meijden W, Mulder P, Thio B. The use of serologic titers of IgA and IgG in (early) discrimination between rectal infection with non-LGV and LGV serovars of Chlamydia trachomatis.
Sex Transm Infect. 2007 Aug;83(4):330-4.
5. Spaargaren J, Fennema HS, Morré SA, de Vries HJ, Coutinho RA. New lymphogranuloma venereum Chlamydia trachomatis variant, Amsterdam. Emerg Infect Dis. 2005 Jul;11(7):1090-2.
6. McMillan A, van Voorst Vader PC, de Vries HJ. The 2007 European Guideline (International Union against Sexually Transmitted Infections/World Health Organization) on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens.
Int J STD AIDS. 2007 Aug;18(8):514-20
Screening for syphilis during pregnancy in Nigeria: a practice that must continue We read with interest the report from Osogbo in Nigeria (1). In our opinion and experience, we agree that this practice should not only continue but be improved upon. In a similar study on pregnant women done in Lagos, Nigeria (2), the incidence of positive syphilis test was about 3%. Serology for other possible sexually trans...
Screening for syphilis during pregnancy in Nigeria: a practice that must continue We read with interest the report from Osogbo in Nigeria (1). In our opinion and experience, we agree that this practice should not only continue but be improved upon. In a similar study on pregnant women done in Lagos, Nigeria (2), the incidence of positive syphilis test was about 3%. Serology for other possible sexually transmitted infections was done and reported as shown in Table1. While the antenatal patients in Osogbo made a captive audience, the report did not mention tracing and screening the male partners of the women positive for syphilis. Contact tracing of sexual partners is an important part of controlling the spread of sexually transmitted infections. This is not an easy exercise but it is essential. The prevalence of hepatitis B and HIV infections is high in sub-Saharan Africa. We suggest that following counselling and with patient consent, it is prudent to screen antenatal patients for these infections. Early detection and appropriate treatment will decrease maternal-fetal transmission of these infections.
References
1. Taiwo S.S, Adesiji O.O, Adekanle D.A. Screening for syphilis during pregnancy in Nigeria: a practice that must continue. Sex. Transm. Infect. 2007; 83: 357-358.
2. Opaneye A, Fabanwo A, Ashton V, Dada O. A. Seroprevalence of HIV and hepatitis B virus markers in Ikeja, Nigeria. Sexual Health Matters 2006; (7): 65-67. www.sexualhealthmatters.com
Abayomi Opaneye
Consultant in GU/HIV Medicine
Department of Genitourinary Medicine,
James Cook University Hospital,
Middlesbrough, England. TS4 3BW.
Adetokunbo Fabamwo
Senior Lecturer
Honorary Consultant Obstetrician and Gynaecologist,
Lagos State University College of Medicine/ Teaching Hospital,
Ikeja,
Lagos, Nigeria.
Over several years we have been interested in urethritis and its possible causes. We are aware that a few subjects whose urethral smears are Gram stain negative are, nevertheless,
infected with pathogenic micro-organisms. In view of this, we were interested in the paper by Orellano et al. 1 in which they indicate that this may be a bigger problem than otherwise thought...
Over several years we have been interested in urethritis and its possible causes. We are aware that a few subjects whose urethral smears are Gram stain negative are, nevertheless,
infected with pathogenic micro-organisms. In view of this, we were interested in the paper by Orellano et al. 1 in which they indicate that this may be a bigger problem than otherwise thought. However, we feel that there are aspects of their findings that deserve comment or questioning, as follows: i) The
men examined were more than fifteen years of age, but the range of ages and mean age are not mentioned. The fact that only 70 (14%) of 491 symptomatic men had 5 or more PMNLs suggests an
unusual population 2-4 ; ii) Samples of urethral exudate were taken from all men with urethral symptoms, which are not described. Was no man asymptomatic and referred as a contact for
a "check-up" ? ; iii) The duration of symptoms and any antibiotic use before examination are not mentioned; iv) Of the four urethral swabs, was the first always used for making a smear for staining? ; v) The Gram stain results are recorded as the number of PMNLs per high-power field , but is this a single field or 5 fields, which is standard practice? 5,6 ; vi) Gram staining was performed for all men with or without a discharge, yet no mention is made of whether more PMNLs were found in men with a discharge than in those without 2-4,7; vii) In the first six months of the study the test for detecting Chlamydia trachomatis was less sensitive than the test used in the second six months. What impact did this have on the relationship between C. trachomatis and the Gram stain results ?viii) The sensitivity of the Gram stain as a means of determining the existence of urethritis was assessed (Table 2) ; this was done by comparing the Gram stain results with a reference method, the latter being detection of the various micro-organisms. The rationale of this approach needs explanation since urethritis is not defined by micro-organisms that might cause it but by the presence of urethral inflammation. It is well recognized that Chlamydia trachomatis and ureaplasmas do not always elicit urethral inflammation in men 2,3,5,6,8.
REFERENCES
(1) Orellana MA, Gomez-Lus, Lora D. Sensitivity of Gram stain in the diagnosis of urethritis in men. Sex Transm Infect 2012; 88: 284-7.
(2) Falk L, Fredlund H, Jensen JS. Symptomatic urethritis is more prevalent in men infected with Mycoplasma genitalium than with Chlamydia trachomatis. Sex
Transm Infect 2004; 80 :289-93.
(3) Horner PJ, Thomas B, Gilroy CB et al. Do all men attending departments of genitourinary medicine need to be screened for non-gonococcal urethritis? Int J STD AIDS 2002; 13: 667-73.
(4) Janier M, Lassau F, Casin I et al. Male urethritis with and without discharge: a clinical and microbiological study. Sex Transm Dis 1995; 22: 244-52.
(5) Shahmanesh M. 2007 UK National Guideline on the Management of Nongonococcal Urethritis: updated December 2008. http://www bashh org/guidelines 2008 Available from: URL:http://www.bashh.org/guidelines
(6) Shahmanesh M, Moi H, Lassau F, Janier M. 2009 European Guideline on the Management of Male Non-gonococcal Urethritis. Int J STD AIDS 2009; 20 :458-64.
(7) Horner P. Asymptomatic men: should they be tested for urethritis? Sex Transm Infect 2007; 83 :81-4.
(8) Haddow LJ, Bunn A, Copas AJ et al. Polymorph count for predicting non-gonococcal urethral infection: a model using Chlamydia trachomatis diagnosed by ligase chain reaction. Sex Transm Infect 2004; 80 :198-200.
We read the article of P. Zhou and collaborators1 with great
interest. We agree that clinicians should be aware that appropriate
therapy in early syphilis may be not sufficient for avoiding late-stage
disease, neuro-syphilis in particular. To support such an important issue,
we would like to deliver the data we obtained by a retrospective study we
conducted some years ago.
We read the article of P. Zhou and collaborators1 with great
interest. We agree that clinicians should be aware that appropriate
therapy in early syphilis may be not sufficient for avoiding late-stage
disease, neuro-syphilis in particular. To support such an important issue,
we would like to deliver the data we obtained by a retrospective study we
conducted some years ago.
The data were collected in our Section of Dermatology by examining
the clinical records of 62 patients diagnosed as having syphilis. Thirty
of them had early syphilis (either primary/secondary or latent since no
more than 2 years) and 32 had latent syphilis for more than 2 years. All
had been treated for at least 2 consecutive years with a total of at least
60 million units of benzathine penicillin. All patients were clinically
examined at the end of the treatment for neurological lesions and
compared with 62 serologically-negative subjects. The control group was of
the same gender and age (+3 years). Data have been analysed by the x2
test.
Neurological changes were observed in 22 patients (35%) vs 10 (16%)
controls. The difference was statistically significant. (x2 = 5.096; p =
0.024). Patients with early syphilis (36%) did not differ from patients
with latent syphilis (35%) (x2= 0.029; p=0.865).
Our study, which was conducted at a time in which long penicillin
treatments were usual in Italy, shows that penicillin, though extremely
effective in clearing the early cutaneous lesions, is grossly inefficient
to prevent late complications, neurological in particular. Worst than
that, it seems that it may even favour them. In fact, the prevalence of
neurological signs in our series is even higher than that found in Oslo
study2. This fact may simply depend on the incapacity of penicillin to
pass effectively through the hemato-encephalic barrier and achieve
treponemicidal concentrations in the central nervous system3, but other
factors, either autoimmune or atherosclerotic, should be taken into
consideration in the pathogenesis of neuro-syphilis. We believe that a
change of the supposedly "adequate" treatment for early syphilis should be
endeavoured.
This is retrospective study in which subjects were regular patients
with syphilis who have been treated with penicillin many years ago.
References
1. Zhou P, Gu X, Lu H, Guan Z, Qian Y.Re-evaluation of serological
criteria for early syphilis treatment efficacy: progression to
neurosyphilis despite therapy. Sex Transm Infect. 2012 Feb 23.
2. Gjestland T. The Oslo study of untreated syphilis; an
epidemiologic investigation of the natural course of the syphilitic
infection based upon a re-study of the Boeck-Bruusgaard material. Acta
Derm Venereol Suppl (Stockh). 1955;35(Suppl 34):3-368
3. Tramont EC. Persistence of Treponema pallidum following penicillin
G therapy. JAMA 1976; 236:2206-2207.
In 1985, I first suggested that vulnerability to AIDS and homosexuality may result from low DHEA. The first reports of low DHEA in AIDS appeared in 1989.
On average, DHEA is lower in male homosexuals than heterosexual men. I suggest that the continual loss of DHEA of AIDS actually produces the symptoms of AIDS.
Since there is overlap in DHEA levels, there should be some vulnerability...
In 1985, I first suggested that vulnerability to AIDS and homosexuality may result from low DHEA. The first reports of low DHEA in AIDS appeared in 1989.
On average, DHEA is lower in male homosexuals than heterosexual men. I suggest that the continual loss of DHEA of AIDS actually produces the symptoms of AIDS.
Since there is overlap in DHEA levels, there should be some vulnerability to HIV in heterosexuals as well as some protection in homosexual men exposed to the HIV. These vulnerabilities have been established. That is, some with low DHEA may be easily infected, some with medium DHEA may be infected but not develop AIDS, and some homosexual
men have been proven to have been exposed to the HIV but will mount an immune response that occurs even prior to antibody formation. This has been established.
I suggest testosterone reduces availability of DHEA. Therefore, black men, especially, and women should exhibit increased HIV infection rates as black men and women produce more testosterone than white men and women respectively. This also accounts for the large vulnerability to HIV
found in male homosexuals.
The paper by Hopkins et al suggests that repeat testing for C
trachomatis (CT) and N gonorrhoeae (NG) is unnecessary.1 This issue has
long been debated 2,3,4 and currently, with many laboratories having to
reduce costs, the view put forward in this paper seems attractive. We
would, however, like to make the following points. Repeat testing for CT
using the same platform is not recommended for the purpose of
confirmation...
The paper by Hopkins et al suggests that repeat testing for C
trachomatis (CT) and N gonorrhoeae (NG) is unnecessary.1 This issue has
long been debated 2,3,4 and currently, with many laboratories having to
reduce costs, the view put forward in this paper seems attractive. We
would, however, like to make the following points. Repeat testing for CT
using the same platform is not recommended for the purpose of
confirmation. Confirmation must be by a second assay with similar
performance power to the initial assay. Repeat testing was initially
introduced to help identify any mismatch errors due to the significant
manual intervention required in the early testing platforms. Although
advances in technology have reduced this, repeat testing does also serve
to identify issues with contamination which, because of the high volume of
samples being tested, can be significant. This remains a consideration and
so, if repeat testing is stopped, robust IQA measures must be put in place
together with a strict cleaning and decontamination regimen.
In addition, many young people may be happy to receive unnecessary
antibiotic treatment, as stated in the paper, but we are constantly being
warned about the overuse of antibiotics and this must be taken into
account.
For NG testing, BASHH guidelines (http://www.bashh.org/guidelines ) state
that reactive results should be confirmed to ensure that PPV is >90%
and it is essential that the confirmatory test is robust with respect to
target selection as well as the usual statistical performance
characteristics as per CT. The best strategy to use for an STI is to
employ a sensitive test which ensures that no cases are missed followed by
confirmation to verify the true result. This paper looked at Genitourinary
Medicine patients and established the PPV for this group although there
were only 2 patients with equivocal results to investigate. In
laboratories using dual testing on samples from the NCSP programme where
the prevalence of infection may be much lower, it would be prudent to use
the suggested confirmatory algorithm unless extensive validation work has
shown that it is not required. We agree that a PPV of >95% for
screening should be the standard for both infections as the authors
suggest.
1. Hopkins MJ, Smith G, Hart I et al. Screening tests for Chlamydia
trachomatis or Neisseria gonorrhoeae using the cobas 4800 PCR system do
not require a second test to confirm: an audit of patients issued with
equivocal results at a sexual health clinic in the Northwest of England,
UK. Sex Transm Infect 2012
2. Schachter J, Chernesky MA. Routine Confirmation of Positive
Nucleic Acid Amplification Test Results for Neisseria gonorrhoeae is Not
Necessary. J Clin Microbiol 2012; 50:208
3. Tabrizi SN, Hjelmevoll SO, Garland SM et al. Reply to above. J
Clin Microbiol 2012; 50:209-10
4. Schachter J, Chow JM, Howard H et al. Detection of Chlamydia
trachomatis by nucleic acid amplification testing: our evaluation suggests
that CDC-recommended approaches for confirmatory testing are ill-advised.
J Clin Microbiol 2006; 44: 2512-7
Recently we concluded that an elevated IgA antibody response and the age of the infected individual (a total sum score of seven times IgA titre plus individual's age greater than or equal to 50.0) appeared to be of diagnostic value for (early) detection of LGV proctitis.1 Statistical
analyses showed that the use of this total sum score had high diagnostic accuracy. As published previously, over 85% of th...
Recently we concluded that an elevated IgA antibody response and the age of the infected individual (a total sum score of seven times IgA titre plus individual's age greater than or equal to 50.0) appeared to be of diagnostic value for (early) detection of LGV proctitis.1 Statistical
analyses showed that the use of this total sum score had high diagnostic accuracy. As published previously, over 85% of the Rotterdam population of patients with L2 proctitis reported symptoms (rectal discharge and bleeding) and more than 70% had clinical manifestations (discharge and
perianal erythema).2
We agree with Henry J. de Vries and co-workers and acknowledge the need for 'simple and affordable diagnostic procedures to screen the (asymptomatic) population at risk'.3 Our data show that Chlamydia-specific IgA antibody titers can be adequately used for the early discrimination
between LGV and non-LGV proctitis, a clear reflection of the more invasive character of the LGV serovars.1 Therefore, one might postulate that our sum score can not serologically discriminate between LGV and non-LGV serovars in persons without mucosal abnormalities. After all, there must
be at least some degree of tissue invasion (together with visible mucosal abnormalities, such as erythema or ulceration), before a significant antibody response can be mounted.
De Vries et al. did not use the same test as we did in our study. Although both tests use synthetic peptides and a similar format, the test we used, the Savyon test, incorporates more LGV-specific epitopes. In theory, the Sayvon test should be more specific for LGV diagnosis. The
conclusion of De Vries et al. that serology in general is of no diagnostic value is premature. The correct conclusion is that the Medac test might not be suitable for LGV diagnostic purposes.
We reanalyzed the data of the 24 Rotterdam patients with LGV proctitis. Only one patient reported no symptoms and had no clinical manifestations of proctitis on examination (patient A). Three patients had symptoms although no clinical manifestations were seen in proctoscopic examination (patient B, C and D). One patient had no symptoms while a mucosal ulcer was seen at proctoscopy (patient E). The total sum score in
all rectal LGV patients ranged from 47.7 to 96.2 with a median score of 61.7. Two of the LGV patients did not fulfill the criterion of a score greater than or equal to 50.0 as was reported in our paper.1 Patient A had a sum score of 63.5, just above the median score. Patient B,
C and D had a sum score of 55.8, 71.6 and 87.7 respectively. Patient E had a sum score of 68.2. The age of patient A to E did not differ from the other rectal LGV patients (p = 0.19). Though numbers are small, there seems to be no relation between self-reported symptoms, clinical
manifestations on proctoscopy and our sum score in the Rotterdam LGV patients. Other researchers also recommend the use of serology.4,5,6,7
The conclusion of our paper was that an increased IgA antibody response and the age of the infected individual are of possible diagnostic value for (early) detection of LGV proctitis.1 Simply put: if you find a high titer you have a high chance for LGV. We do not, however, recommend testing for IgA in order 'to exclude LGV' as suggested by De Vries et al.
In conclusion: a total sum score of seven times IgA titer plus individual's age greater than or equal to 50.0 appeared to be a simple,accurate and affordable diagnostic procedure to discriminate between chlamydial proctitis with serovar L2 and non-LGV serovars in a high-risk
population of MSM and is of possible diagnostic value for (early) detection of LGV proctitis, even in the absence of symptoms.
References
1. Van der Snoek EM, Ossewaarde JM, Van der Meijden WI, Mulder PGH, Thio HB. The use of serologic titers of IgA and IgG in (early) discrimination between rectal infection with non-LGV and LGV serovars of Chlamydia trachomatis. Sex Transm Infect 2007;83:330-4.
2. Waalboer R, Van der Snoek EM, Van der Meijden WI, Mulder PGH, Ossewaarde JM. Analysis of rectal Chlamydia trachomatis serovar distribution including L2 (lymphogranuloma venereum) at the Erasmus MC STI
clinic, Rotterdam. Sex Transm Infect 2006;82:207-11.
3. De Vries HJ, Smelov V, Morré SA. Electronic letter, Sex Transm Infect 28 augustus 2007.
4. Forrester B, Pawade J, Horner P. The potential role of serology in diagnosing chronic lymphogranuloma venereum (LGV): a case of LGV mimicking Crohn's disease. Sex Transm Infect 2006;82:139-40.
5. Halioua B, Bohbot JM, Monfort L, Nassar N, de Barbeyrac B, Monsonego J, Sednaoui P. Ano-rectal lymphogranuloma venereum: 22 cases reported in a sexually transmitted infections center in Paris. Eur J Dermatol 2006;16:177-80.
6. Spornraft-Ragaller P, Luck C, Straube E, Meurer M. Lymphogranuloma venereum. Two cases from Dresden. Hautarzt 2006;57:1095-100.
7. Den Hollander JG, Ossewaarde JM, de Marie S. Anorectal ulcer in HIV patients, don't forget lymphogranuloma venereum! AIDS 2004;18:1484-5.
E.M. van der Snoek,
J.M. Ossewaarde,
W.I. van der Meijden,
P.G.H. Mulder and H.B. Thio
Eric M. van der Snoek,
Dermatologist-Venereologist,
Department of Dermatology and Venereology,
Erasmus MC, Rotterdam, the Netherlands.
Dear Editor,
Violence against women is a global problem, and rates in Southeast Asia is high enough.Patriarchy culture take a part for this condition. The culture is also contribute to the situation. Gender inequality is especially visible in developing countries. Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early, either through early ma...
Dear Editor,
While sharing Adams and colleagues’ concerns about the use of major outcomes averted, I should like to point out a factual error in their description[1] of the results from the ClaSS model[2]. The definition of major outcome used in that report, which appears in the text on page 107 and in the caption to Figure 18 on page 108 of the report[2] excludes epididymitis. The “seemingly perverse” result that sc...
This article contains invaluable information to learn more about Syphilis and it's control strategy. Thanks to the author.
Conflict of Interest:
None declared
Dear Editor,
Recent reports on lymphogranuloma venereum (LGV) proctitis in men who have sex with men (MSM) have highlighted that affordable diagnostics for both symptomatic as well as asymptomatic LGV infections are urgently needed. 1,2 LGV responds well to extensive antibiotic treatment but when untreated LGV can cause chronic or irreversible complications because of severe inflammation and invasive infection.3...
Dear Editor,
Screening for syphilis during pregnancy in Nigeria: a practice that must continue We read with interest the report from Osogbo in Nigeria (1). In our opinion and experience, we agree that this practice should not only continue but be improved upon. In a similar study on pregnant women done in Lagos, Nigeria (2), the incidence of positive syphilis test was about 3%. Serology for other possible sexually trans...
Over several years we have been interested in urethritis and its possible causes. We are aware that a few subjects whose urethral smears are Gram stain negative are, nevertheless, infected with pathogenic micro-organisms. In view of this, we were interested in the paper by Orellano et al. 1 in which they indicate that this may be a bigger problem than otherwise thought...
We read the article of P. Zhou and collaborators1 with great interest. We agree that clinicians should be aware that appropriate therapy in early syphilis may be not sufficient for avoiding late-stage disease, neuro-syphilis in particular. To support such an important issue, we would like to deliver the data we obtained by a retrospective study we conducted some years ago.
The data were collected in our Sectio...
Dear Editor,
In 1985, I first suggested that vulnerability to AIDS and homosexuality may result from low DHEA. The first reports of low DHEA in AIDS appeared in 1989.
On average, DHEA is lower in male homosexuals than heterosexual men. I suggest that the continual loss of DHEA of AIDS actually produces the symptoms of AIDS.
Since there is overlap in DHEA levels, there should be some vulnerability...
The paper by Hopkins et al suggests that repeat testing for C trachomatis (CT) and N gonorrhoeae (NG) is unnecessary.1 This issue has long been debated 2,3,4 and currently, with many laboratories having to reduce costs, the view put forward in this paper seems attractive. We would, however, like to make the following points. Repeat testing for CT using the same platform is not recommended for the purpose of confirmation...
Dear Editor,
Recently we concluded that an elevated IgA antibody response and the age of the infected individual (a total sum score of seven times IgA titre plus individual's age greater than or equal to 50.0) appeared to be of diagnostic value for (early) detection of LGV proctitis.1 Statistical analyses showed that the use of this total sum score had high diagnostic accuracy. As published previously, over 85% of th...
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