Misdiagnosis of Sexually Transmitted Diseases in Hong Kong Outpatient Private Healthcare

Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impose adverse effects on patient treatment. Sexually transmitted disease (STD) is one of the most common infectious diseases, and more than one million of STD cases are acquired every day globally. Misdiagnosis of STD inevitably exists, therefore should not be overlooked. Being a medical diagnostic laboratory providing various STDs diagnosing service in Hong Kong, we aimed to determine the misdiagnosis rate of STDs and investigate the possible underlying cause. Methods: Specimens were collected for STD diagnosis from multiple clinics during 1 June 2021 to 20 October 2021 from different clinics and hospitals were included in the study. DNA extraction was performed using magnetic bead based method;then the extracted DNA was tested using the DiagCor GenoFlowTM STD Array kit to detect the existence of any targeted pathogens. Results: 1459 specimens were collected and included during the designated time period, with 643 specimens found to be positive with at least one targeted STD pathogen. 494 of these were found to be aligned with test ordered by physicians, and the remaining 149 positive cases had at least one pathogen detected but not requested to be tested by the physicians resulting in misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149/643), with high frequency of misdiagnosis occurred to tests ordered for one to three pathogens detection. Also, Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) was the commonest pathogen detected in this study. Conclusion: The findings suggested incorrect test selection made by physicians was one of the major reasons of STDs misdiagnosis in outpatient settings. To reduce diagnostic errors in STD diagnosis, physicians are encouraged to select and request test that allow detection of multiple pathogens, as co-infection of multiple pathogens in STD patients is commonly observed. The correct selection of test would not only benefit the patient, but also the public health.

Socio-Demographic, Clinical, and Hygiene Profile of Syndromically Managed Sexually Transmitted Diseases: A Cross Sectional Study in a Tertiary Care Center in India

Background: Sexually transmitted diseases are one of the several major public health concerns, the burden of which is borne by low- and middle-income countries like India. Purpose: The purpose is to evaluate the relationship between menstrual and sanitary hygiene and sexually transmitted diseases (STD) based on syndromic diagnosis Methods: An out-patient department (OPD) based cross sectional survey to determine these associations, if any exist, which would help critically analyze syndromic management. STD was reported by the presence of vaginal/cervical/urethral discharge with or without irritation and itching, lower abdominal pain and ulcer. Results: The prevalence of STD was 66.84% with the most commonly reported symptoms being discharged (31.18%), followed by abdominal pain (17.92%) and itching/irritation (12.90%), with ulcer (4.83%) being the least reported symptom. Perimenopausal age ((AOR: 0.420 [CI: 0.189 - 0.915];p = 0.030), higher grades of education ((AOR: 0.228 [CI: 0.119 - 0.424];p < 0.001) for secondary), urban residency (AOR: 0.435 [CI: 0.686 - 2.733];p < 0.001), and contraception use (AOR: 0.531 [CI: 0.308 - 0.887];p = 0.018) were associated with lesser odds of presenting with an STD symptom. Belonging to a minority religious community (AOR: 7.20 [CI: 1.866 - 48.251];p < 0.012) or backward castes (AOR: 3.753 [CI: 1.587 - 10.144];p < 0.001), having similar illness (AOR: 4.205 [CI: 2.795 - 6.439];p < 0.001) or having an invasive gynecological procedure done in the past one year (AOR: 1.953 [CI: 1.184 - 3.295];p = 0.010) and washing the reusable sanitary material only with water (AOR: 4.900 [CI: 2.701 - 9.116];p < 0.001) as compared to washing it with water and soap, had a higher association with presenting with STD symptoms. Stratified analysis also showed that women presenting discharge (AOR: 2.049 [CI: 1.343 - 3.146] for vaginal and cervical;AOR: 1.426 [CI: 0.826 - 2.482] for urethral) were more likely to not have a toilet facility in an accessible condition. Women with sanitary napkin use had lesser odds (AOR: 0.780 [CI: 0.516 - 1.180];p = 0.293) of presentation for STD in OPD than women who used other material. Conclusion: To better manage the group of diseases that may present with symptoms of STD under syndromic approach, we propose interventions such as menstrual hygiene education and promotion of the use of sanitary napkins among women especially those belonging to lower socio-economic sections of the society.

Epidemiological Analysis of Sexually Transmitted Disease Control and Prevention from 1998 to 2003 in Chongqing

Objectives： To understand trends and epidemiology of STDs in Chongqing from 1998 to 2003 and to provide scientific evidence for developing preventive strategies and distributing government health resources effectively. Methods： STD case-reporting data collected from 43 counties and districts in Chongqing from 1998 to 2003 were analyzed with STD Data Management Software and Excel Software. Results： A total of 133,323 cases of eight different STDs were reported from 1998-2003. The annual incidence of all eight STDs combined was 71.89/10^5.Generally, reported cases and incidence have decreased since 2001. Although gonorrhoea diagnoses made up a significant proportion of the STD burden, this proportion decreased annually. The proportion of the STD burden attributed to Condyloma accuminatum （CA） was always above 30 percent. The proportions of non-gonoccocal urethritis, genital herpes and syphilis within the combinedSTD burden increased gradually from 1998 to 2003.Reported cases of HIV increased rapidly over this time. A total of 214 HIV cases were reported from 1998 to 2003,the majority of which were among men. For HIV, the maleto-female ratio was 1.17, but CA was found among more women than men. Incidence for all STDs was highest among 20-39 year olds, who accounted for 72.2% of reported infections. The majority of STDs were transmitted through extra-marital intercourse,accounting for 55.3%. Conclusion： The STD epidemic in Chongqing changed from 1998-2003. STD incidence declined, as a result of various factors. The epidemiology of STDs has changed.HIV incidence has increased rapidly. This indicates that the AIDS epidemic has reached a critical period. The results of this study suggest a need for readjusting control measures and redistributing health resources.

Digital core based transmitted ultrasonic wave simulation and velocity accuracy analysis

Transmitted ultrasonic wave simulation （TUWS） in a digital core is one of the important elements of digital rock physics and is used to study wave propagation in porous cores and calculate equivalent velocity. When simulating wave propagates in a 3D digital core, two additional layers are attached to its two surfaces vertical to the wave-direction and one planar wave source and two receiver-arrays are properly installed. After source excitation, the two receivers then record incident and transmitted waves of the digital rock. Wave propagating velocity, which is the velocity of the digital core, is computed by the picked peak-time difference between the two recorded waves. To evaluate the accuracy of TUWS, a digital core is fully saturated with gas, oil, and water to calculate the corresponding velocities. The velocities increase with decreasing wave frequencies in the simulation frequency band, and this is considered to be the result of scattering. When the pore fluids are varied from gas to oil and finally to water, the velocity-variation characteristics between the different frequencies are similar, thereby approximately following the variation law of velocities obtained from linear elastic statics simulation （LESS）, although their absolute values are different. However, LESS has been widely used. The results of this paper show that the transmission ultrasonic simulation has high relative precision.

Global epidemiology of sexually transmitted diseases

Sexually transmitted diseases （STDs） are among the first ten causes of unpleasant diseases in young adult males in developing countries and the second major cause of unpleasant diseases in young adult women. Adolescents and young adults （15-24 years old） make up only 25% of the sexually active population, but represent almost 50% of all new acquired STDs. In general, STDs are epidemics and present an enormous health and economic consequences. An adequate screening for STDs should be done on a routine basis in every part of the world. Many STDs are asymptomatic and therefore can difficult to control. The purpose of reporting of STDs is to ensure that persons who are infected will be quickly diagnosed and appropriately treated to control the spread of infection and also so that partners are notified, tested and appropriately treated. It is estimated that reported cases of STDs represent only 50%-80% of reportable STD infections in the United States, reflecting limited screening and low disease reporting. High-risk sexual behavior is a highly contributive factor of this process as it often leads to teenage pregnancies and HIV/AIDS. One possible explanation for this behavior is that people do not have enough information about the transmission of STDs or ignore the precautions required for safe sex. Approximately 60% of new HIV infections worldwide occur in young people. The frequency of high-risk behaviors among youths may also be influenced by opportunity to engage in them, particularly the amount of time that they are unsupervised by adults. However, in diagnosing and treating these patients, we can effectively prevent the spread of HIV/AIDS. Individuals infected with STDs are 5-10 times more likely than uninfected individuals to acquire or transmit HIV through sexual contact. The breaking of the genital tract lining or skin creates a portal of entry for HIV and, hence, HIV-infected individuals with other STDs are more likely to shed HIV in their genital secretions. To date, the condom is the most effective method available for males for protection against STDs. It is important to control STDs, and prevention can be the key of this process. Prevention can be achieved through education of the population, identification of symptomatic and asymptomatic people, and effective diagnosis and treatment of these patients and their partners.

The prevalence of transfusion transmitted virus infection in blood donors

INIRODUCIIONA newly discovered DNA virus,transfusiontransmitted virus (TTV),was reported as a cause ofpost-transfusion hepatitis of unknown etiology inJapan.In order to investigate TTV prevalence insouthern China,a study was carried out amongblood donors,patients with liver diseases andhemodialysis to determine the epidemiologicalcharateristics.

Transmitted and Reflected Coefficients for Horizontal or Vertical Plate Type Breakwater

Surface or submerged horizontal or vertical plate can be considered as a new concept breakwater. This paper investigates the wave-plate interaction of this type of breakwater by use of the boundary element method. The relationships of wave transmitted and reflected among plate thickness, submergence and length are carefully studied by numerical simulation. It is shown that： （1） The transmitted coefficients of submerged horizontal plate or vertical plate will become larger with the increase of plate thickness and reduce rapidly with the decrease of plate submergence. （2） Both surface horizontal and vertical plate are efficient for intermediate and short wave elimination, but vertical plate is more effective. （3） Submerged horizontal plate can act more effectively than submerged vertical plate does. With all wave frequencies, the vertical plate almost has no wave elimination effect.

Dynamic analysis of a sexually transmitted disease model on complex networks

In this paper,a sexually transmitted disease model is proposed on complex networks,where contacts between humans are treated as a scale-free social network.There are three groups in our model,which are dangerous male,non-dangerous male,and female.By mathematical analysis,we obtain the basic reproduction number for the existence of endemic equilibrium and study the effects of various immunization schemes about different groups.Furthermore,numerical simulations are undertaken to verify more conclusions.

Transfusion transmitted virus: A review on its molecular characteristics and role in medicine

The present review gives an updated overview of transfusion transmitted virus （TTV）, a novel agent, in relation to its molecular characteristics, epidemiological features, modes of transmission, tissue tropism, pathogenesis, role in various diseases and its eradication from the body. TTV, a DNA virus, is a single stranded, non-enveloped, 3.8 kb long DNA virus with a small and covalently closed circular genome comprising 3852 bases. It was tentatively designated Cirdnoviridae virus.TTV genome sequence is heterogeneous and reveals the existence of six different genotypes and several subtypes. TTV has been reported to transmit not only via parenteral routes, but also via alternate routes. This virus has been detected in different non-human primates as well. At present, TTV is detected by polymerase chain reaction （PCR） with no other available diagnostic assays. It shows its presence globally and was detected in high percent populations of healthy persons as well as in various disease groups. Initially it was supposed to have strong association with liver disease; however, there is little evidence to show its liver tropism and contribution in causing liver diseases. It shows high prevalence in hemodialysis patients, pointing towards its significance in renal diseases. In addition,TTV is associated with several infectious and non-infectious diseases. Though, its exact pathogenesis is not yet clear, TTV virus possibly resides and multiplies in bone marrow cells and peripheral blood mononuclear cells （PBMCs）. Recently, attempts have been made to eradicate this virus with interferon treatment. More information is still needed to extricate various mysteries related to TTV.

Donor transmitted and de novo cancer after liver transplantation

Cancers in solid organ recipients may be classified as donor transmitted,donor derived,de novo or recurrent.The risk of donor-transmitted cancer is very low and can be reduced by careful screening of the donor but cannot be abolished and,in the United Kingdom series is less than 0.03%.For donors with a known history of cancer,the risks will depend on the nature of the cancer,the interventions given and the interval between diagnosis and organ donation.The risks of cancer transmission must be balanced against the risks of death awaiting a new graft and strict adherence to current guidelines may result increased patient death.Organs from selected patients,even with high-grade central nervous system(CNS)malignancy and after a shunt,can,in some circumstances,be considered.Of potential donors with non-CNS cancers,whether organs may be safely used again depends on the nature of the cancer,the treatment and interval.Data are scarce about the most appropriate treatment when donor transmitted cancer is diagnosed:sometimes substitution of agents and reduction of the immunosuppressive load may be adequate and the impact of graft removal should be considered but not always indicated.Liver al-lograft recipients are at increased risk of some de novo cancers,especially those grafted for alcohol-related liver disease and hepatitis C virus infection.The risk of lymphoproliferative disease and cancers of the skin,upper airway and bowel are increased but not breast.Recipients should be advised to avoid risk behavior and monitored appropriately.

Time-Domain Full Waveform Inversion Using the Gradient Preconditioning Based on Transmitted Wave Energy

The gradient preconditioning approach based on seismic wave energy can effectively avoid the huge memory consumption of the gradient preconditioning algorithms based on the Hessian matrix. However, the accuracy of this approach is prone to be influ- enced by the energy of reflected waves. To tackle this problem, the paper proposes a new gradient preconditioning method based on the energy of transmitted waves. The approach scales the gradient through a precondition factor, which is calculated by the ‘ap- proximate transmission wavefield’ simulation based on the nonreflecting acoustic wave equation. The method requires no computing nor storing of the Hessian matrix and its inverse matrix. Furthermore, the proposed method can effectively eliminate the effects of geometric spreading and disproportionality in the gradient illumination. The results of model experiments show that the time-domain full waveform inversion (FWI) using the gradient preconditioning based on transmitted wave energy can achieve higher inversion accuracy for deep high-velocity bodies and their underlying strata in comparison with the one using the gradient preconditioning based on seismic wave energy. The field marine seismic data test shows that our proposed method is also highly applicable to the FWI of field marine seismic data.

SEXUALLY TRANSMITTED DISEASE CONTROL IN CHINA(1949—1994)

This paper surnmarizes the historical experiences in venereal disease control in China during the 1950s.Venereal diseases had been all but eliminated in the whole country till 1964. However, along with the implementation of open-door policy and economic reform in the 1980s, the social environment was changed to a great extent in this country. Sexually transmitted diseases (STDs) were reintreduced in the Chinese mainland and new foci of infection established themselves in some cities. During the recent 8 years the national STD case-reporting and sentinel surveillance systems have been set up. The results of surveillance show that the annual incidence of STD has been on the increase. The existing factors associated with the increasing incidence of STD mainly are ; population movement , increasing affiuence in a part of population,the availability of multiple sexual partners (including the prostitution)and asymptomatic STD increased.Finally, the strategies for STD control are discussed in detail.

Prevalence and risks of soil transmitted helminths among Ethiopian school children:A cross-sectional study

Objective:To assess the prevalence and associated factors of soil transmitted helminths(STHs)among Endemata primary school in North West Ethiopia,2021.Methods:A cross-sectional study with 195 school children was conducted from May to July 2021 at Endemata primary school.The study participants were selected by using systematic random sampling technique.Stool samples were processed via direct wet mount and formol-ether concentration techniques.Data was entered by Epi-Dara version 3.1 and data analysis was done using SPSS version 20.0.Variables were considered to be statistically significant if P<0.05 at 95%confidence level.Results:The overall prevalence of STHs was 10.8%(95%CI 7.1-16.0).The prevalence of Ascaris lumbricoides,hookworm and Trichuris trichiura were 5.6%(95%CI 3.1-9.9),3.1%(95%CI 1.3-6.7)and 2.1%(95%CI 0.6-5.3),respectively.Grade 1-4 students were more likely to get infected with STHs as compared to grade 5-8 students(adjusted OR 4.7,95%CI 1.3-16.6).Students who did not have latrines at their home were at higher risk to develop STHs infection comparing with those who had latrine at their home(adjusted OR 5.0,95%CI 1.7-15.2).Similarly,the school children who did not wear shoes were more likely to be infected by STH parasite than those who did it(adjusted OR 6.3,95%CI 1.9-20.7).The odds of being infected by STH parasites in children who did not trim their fingernails were 4.9 as compared to those who did it(adjusted OR 4.9,95%CI 1.5-15.7).Conclusions:The prevalence of STHs among Endemata primary school children was low.Student grade level,latrine availability,shoes wear and nail status were significantly associated with STHs infection.Therefore,we recommend policy makers and stakeholders to follow the integration of deworming with water,hygiene and sanitation as well as the consistent health education of school children to control and prevent STH infections.

Case of Fitz-Hugh-Curtis syndrome in male without presentation of sexually transmitted disease

Fitz-Hugh-Curtis syndrome is a type of perihepatitis that causes liver capsular infection without infecting the hepatic parenchyma or pelvis. Fitz-Hugh-Curtis syndrome is known to occur commonly in women of childbearing age who do not use oral contraceptives and have sexual partners older than 25 years of age. However, the syndrome has been reported to occur rarely in males. The clinical symptoms are right upper quadrant pain and tenderness, and pleuritic right sided chest pain. The clinical presentation is similar in male and female. We experienced a case of Fitz-HughCurtis syndrome in a 60-year-old man with the chief complaint of right upper quadrant abdominal pain. Despite a previous history of gonorrhea, we have also described our experiences of improved symptoms and recovery with allopathic medicines and have thereby reported the present case with a literature review.

Risky Meetings Despite Knowledge of the Risk: A Qualitative Study of Young Adults Treated for Chlamydia Infection at a Sexual Transmitted Infection Clinic

The aim of the study was to describe the attitudes to risk behavior among patients diagnosed with a Chlamydia infection at a Sexual Transmitted Infection (STI) clinic. Qualitative interviews face-to-face were conducted with twenty patients, aged 18 - 30 years, with confirmed Chlamydia infections were included. An interview guide was used and the participants described the behavior that had led to the infection. The material was analyzed using qualitative content analysis. Eighteen informants were included and the theme was risk. Recurrent among the informants was risk behavior in sexual relations when using alcohol, while risk behavior in life in general was almost non-existent. Of the 18 informants, sixteen had previously been tested for STIs, and ten had had an STI before. Alcohol consumption emerged as a common denominator among the informants and as a contributor to risk. In contrast, almost none of the informants exposed themselves to any unnecessary risks in life in general.

Advances on Syndromic Management of Sexually Transmitted Diseases

Research data showed that syndromic approach could successfully manage gonococcal and chlamydial infections in males and syphilis and chancroid in males and females. However, low sensitivity, specificity and positive predictive value were found in the syndromic management of vaginal discharge. It is recommended that the syndromic algorithm for management of vaginal discharge used when serving high-risk and symptomatic women.

Transverse shift of the transmitted beam of a non-uniformly polarized paraxial light beam at dielectric interfaces

This paper reports that the central position of the reflected and transmitted beams of a nonlinear polarized light beam at the interface between two media undergoes transverse shifts. It presents a solution to the problem of transverse shift of a non-uniformly polarized paraxial light beam transmitting through interfaces between two homogeneous media by using a two-form amplitude and an extension matrix to represent the vector angular spectrum of a three-dimensional （3D） light beam. It derives general formula for the transverse shift of the transmitted beam, and discusses the shift of a well-collimated beam transmitting through an interface between two homogeneous media and a thin dielectric slab.

Sexually transmitted infections of the anus and rectum

Sexually transmitted infections(STIs) represent a significant public health concern.Several STIs,once thought to be on the verge of extinction,have recently reemerged.This change is thought to be partially related to an increase in STIs of the anus and rectum.Importantly,the global human immunodeficiency virus and acquired immunodeficiency syndrome(HIV/AIDS) epidemic has contributed to the emergence of particular anorectal lesions that require specialized approaches.In this report,we review common anorectal STIs that are frequently referred to colorectal surgeons in the United States.Epidemiology,clinical presentation,and management are summarized,including the latest treatment recommendations.The particularity of anorectal diseases in HIV/AIDS is addressed,along with recent trends in anal cytology and human papillomavirus vaccination.

The Sexually Transmitted Insect Virus, Hz-2V

Hz-2V is one of only a very few sexually transmitted viruses currently known in insects. Replication of this insect pathogenic virus results in sterility of infected moths rather than mortality. The sterility of the infected host is a consequence of virus directed malformation of adult reproductive tissues, which in females results in cellular proliferation and hypertrophy of these tissues. Virus replication has additional ramifications in infected females. Infected females produce more mating pheromones and attract more mates than healthy females, ultimately facilitating virus transmission and enhancing viral fitness. The molecular mechanisms used by the virus to manipulate the host to enhance its fitness are yet to be determined. Unraveling the underlying principles of these mechanisms promises to enhance our understanding of insect reproductive physiology, as well as provide molecular tools for use in novel approaches in sterile insect control programs.

Clinical Characteristics of Transmitted Transfusion Virus Infection in Children

Clinical characteristics of transmitted transfusion virus (TTV) infection and its pathogenicity in children were evaluated. Serum TTV DNA from 118 children (mean age : 7.8±2 8 years) was detected by nested PCR. The product of PCR was cloned and sequenced. The positive rate for serum TTV DNA in 20 healthy children, 9 cases of acute hepatitis, 51 cases of chronic hepatitis, 24 cases of nephritis or nephrotic syndrome and 14 cases of hypoplastic anemia or acute leukemia was 20 %, 11 %, 29 %, 42 % and 21 % respectively, but there was no significant difference in TTV DNA frequency among them ( P >0.05). Of the 16 patients receiving immunosuppressive agent for a long time, 7 (44 %) were positive for TTV DNA, and of the 17 cases not receiving immunosuppressive agent, 5 (29 %) were positive with the difference being not significant ( P >0.05). Essential characteristics were pathogen carrier or asymtomatic infection in children with TTV infection. Long term employment of immunosuppressive agent did not increase the incidence in TTV infection. There was still high prevalence in TTV infection in healthy children not receiving blood product, suggesting the possibility of non hematogenous transmitted transfusion in TTV transmission.