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.

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.

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.

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.

SEXUALLY TRANSMITTED DISEASES:INCIDENCE AND DISTRIBUTION

The incidence of sexually transmitted diseases(STDs) increased from 26. 04 per 100 000 in 1987 to 104. 81 per 100 000 in 1993 in selected areas of the country. Gonorrhea is by far the most common STD but its constituent ratio declined because of a rapid increase of nongonococcal uretheritis and genital warts during most recent years. The incidence of syphilis is relatively low and cases of congenital infection are noted. The wide spread of resistant Neisseria gonorrhoeae infection gives a challenge to the therapeutical and control strategies of STDs. Sexually transmitted Chlamydia trachomatis infections, an important cause of urethritis. cervicitis and pelvic inflammatory disease. is becoming common in our country. Attention has been drawn on viral hepatitis in their means of transmission by sexually behaviors, and also, on the homosexuals, assumed to be the high risk group to catch STDs. Coordinated national efforts to control STDs in China have been taken.

A Case of Multiple Sexually Transmitted Diseases (STDs),with Stevens-Johnson Syndrome and Mediastinal Tumor

A 29-year-old man was admitted for erythema, papules and erosions. Erosions and purulent secretions were seen in the circumference of the mouth, eyes, oral mucosa,tongue, and preputium. Conjunctivas were swollen and the urethral orifice was red, both were accompanied by purulent secretions. Multiple vesicles were shown in the penis.The patient was diagnosed with:①Stevens-Johnsonsyndrome;②gonococcal ophthalmoblennorrhea;③nongonococcal urethritis, gonococcal urethritis;④genital herpes;⑤mediastinal tumor.

The Educational System Against Sexually Transmitted Diseases:Optics in the Brazilian School Context

The aim of this study was to contribute to the teaching of sexually transmitted diseases(STDs)in high schools.The study was done from the research knowledge about STDs of 61 students from two schools of Rio Claro-SP,Brazil:A state and a private school,through a questionnaire(pre-test)and an interview with two biology professors,and each one from each school.The results indicated that,in general,the students in the private school had more knowledge about the subject.The public school students showed more problems with knowledge about the symptoms of STDs.In those two schools,the knowledge on the subject proved to be generic and superficial.According to the biology teachers,both of them teach about the content,and the teaching material contains themes of sexuality and STDs.From these results,an intervention was developed with students,using methods such as group dynamics and lecture dialogued lessons.After the intervention,there was an increase in the percentage of correct answers for the students of both schools(post-test)which shows that it was effective.We conclude that this work has achieved the objective of clarifying the theme to the students,but lack the schools a better dialogue with them for the planning of this content,since,although it is foreseen the your teaching,you're not going on an apprenticeship.

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.

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.

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.

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.

Epidemiological Investigation of Human Papillomavirus Infection in Men Attending a Sexually Transmitted Disease Clinic in Hangzhou Area

Objective To investigate the epidemiological characteristics of human papillomavirus （HPV） infection in men attending a sexually transmitted diseases （STD） clinic in Hangzhou area. Methods Male subjects （n=375） aged 18-70 years, attending the STD clinic were recruited. Urethral swabs were assessed for HPV DNA using polymerase chain reaction （PCR） with the consensus primers MY09/11. HPV genotypes of positive PCR products were determined by restriction fragment length polymorphisms and direct sequence analysis. Results Of the 375 swabs collected, 305 （81.3%） yielded sufficient DNA for the subsequent HPV analysis. Among the 305 subjects, the prevalence of HPV was 13.8%. Nononcogenic HPV types were found in 8.5% （26/305） of subjects, oncogenic types in 4.3% （13/305）, and multiple types in 1.0% （3/305）. The prevalence of HPV infection was higher in subjects from urban area than in those from rural area （P〈0.05）. The prevalence was also higher in those who received fewer years of education （P〈0.05） and those who had more sex partners （P〈0.05）. Conclusions HPV infection among men at high risk is not uncommon. The detection rate of HPV DNA is significantly related to some sociodemographic factors, such as residence, educational level and the number of sex partners.

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.

Sexually Transmitted Infections (STIs) Knowledge Assessment of Adults in a US South Eastern Texas Region

The purpose of this cross-sectional descriptive study was to assess knowledge level regarding signs and symptoms, prevention, treatment of STIs among a sample of residents from Southeastern Texas. One hundred and fifty-seven participants age 18 and over responded to the 23 questionnaire items. Questionnaires were distributed to mostly public places such as hair salons, fitness centers, health centers, gas stations, apartments, and stores. Results indicated that 50.3% of participants reported syphilis was not curable;while over 61% reported gonorrhea was incurable. Over 64% of respondents reported they did know the symptoms for syphilis and over 70% believed that syphilis was vaccine preventable. The data collected from this study indicated that some residents from Southeast Texas lack basic information concerning Syphilis, Gonorrhea, and Chlamydia with regard to prevention, signs and symptoms, and treatment. The cost and effort to increase educational programs and educational messages appear to be justified. Implications for practice include increasing funding and efforts to provide more educational programs focusing on sexually transmitted disease prevention, health literary education to dispel the myths and stigma related to STIs and community wide collaboration efforts to increase awareness.

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.

The Social Determinants of Health in Relation to Sexually Transmitted Infections in Maricopa County Arizona

Based on the information that was collected on the County Health Rankings website [1], one of the top health concerns for Maricopa County was sexually transmitted infections or STIs. A big concern with STIs is this is not a common subject explored in educational settings or addressed socially. There are many organizations, including the CDC, that have access to materials, there is limited distribution of the educational content. Therefore, the public is not well informed and lacks the information to make educated decisions. The areas with insufficiencies are knowledge of the disease processes, prevention, and treatment.

Arboviruses and Sexually Transmitted Infections in the Bioceanic Route: Health Indicators in a Municipality

Background: the physical integration of South America through a Bioceanic Corridor has been idealized for a long time by the countries that make up Mercosur. This integration will have impacts on the population residing in the cities where the route will be built. Among them, Porto Murtinho, southern Mato Grosso on the border with Paraguay, stands out, where a bridge will be built over the Paraguay River that will link these two countries. Methods: a retrospective, quantitative and cross-sectional study of a descriptive type of documentary approach that sought to analyze the prevalence of arboviruses, Sexually Transmitted Infections (STIs) and Diseases Related to Inadequate Environmental Sanitation (DRIES) notified and stored in the National System of Notifiable Diseases (SINAN). The sample consisted of new cases of these pathologies in the municipality of Porto Murtinho registered between January 2017 and December 2020. Results: there was an increase of 10% in the total number of diseases within this period. The number of dengue cases increased 36 times;the incidence of Syphilis, HIV and HPV decreased;and, finally, maintenance of cases of Gonorrhea, Leptospirosis, Yellow Fever, Zika, Chikungunya, Hepatitis A and B. Conclusions: actions are needed to prevent the increase of these pathologies together with the construction of the Bioceanic Route, thus avoiding damage population health and increased consumption of government resources.

HIV/AIDs Risk Perception and Sexual Behavior among Commercial Female Sex Worker in Thailand

Background: Commercial female sex workers (CFSWs) are considered a high-risk group for HIV/AIDs. The prevalence of HIV/AIDs trends to increase among those groups also in Thailand. An adequate perception of the degree to which one is at risk of having HIV is necessary for behavioral change and of safe behaviors. HIV/AIDs risk perception among CFSWs was needed to reduce HIV/AIDs infection. Methods: A cross-sectional study was conducted among 141 CFSWs in Bangkok, Thailand. Participants were selected using convenient and purposive sampling methods for January to October 2019. Self-access questionnaire was used for collecting data with the reliability testing of 0.82. Logistic regression employed to identify adjusted odd ratio between demographic data, sexual behaviors and HIV/AIDs risk perception, p-value less than 0.05 was considered statistically significant. Results: 51.77% of CFSWs perceived themselves at high risk for HIV/AIDs infection. Most CFSWs reported that they did not consistently use condom (57.45%), factors associated with perception risk of HIV/AIDs including education level (adjusted OR = 2.23, 95% CI = 1.07 - 4.54), knowledge of HIV and STDs (adjusted OR = 3.65 and 3.22. 95% CI = 1.89 - 3.91), Condom use (adjusted OR = 2.56, 95% CI = 1.05 - 2.90) years engaged in sex work, age of initiating in sex work, frequency of sex work in the last month and unplanned sex work were significant with risk perception of HIV/AIDs (adjusted OR = 3.33, 2.71, 2.67, 2.56 and 95% CI = 1.99 - 3.84, 1.72 - 3.32, 1.29 - 3.12, 1.05 - 2.78 respectively), and had HIV/STDs test (adjusted OR = 3.22, 95% CI = 2.11 - 3.95). Other used illicit drugs by injection, smoking and alcohol consumption had a strong association with the high perception of HIV/AIDs among CFSWs. Conclusion: Majority of CFSWs with risky sexual behaviors had a high HIV/AIDs risk perception. Effective educational programmes are necessary to enable CFSWs to correctly assess their own HIV/AIDs risk and change risk behaviors based on self-assessment of actual risk.

杭州市272名暗娼STD/AIDS检测及安全套使用情况调查

[目的]了解杭州市暗娼性传播疾病/艾滋病(STD/AIDS)感染及安全套使用情况,为针对暗娼开展高危行为干预和遏制杭州市STD/AIDS流行提供依据。[方法]对2006年1～12月杭州市某妇教所在发廊、按摩院、酒吧、旅馆等营业性娱乐场所抓获从事卖淫活动的272名暗娼进行STD/AIDS检测、社会人口学特征、安全套使用情况调查。[结果]91.18%暗娼年龄在20～39岁之间;已婚48.53%,未婚40.44%;文化程度以初中及以下为主,占91.54%;外省户籍占83.46%;职业以待业为主90.81%。11.39%从没有未过安全套。STD检出率为94.05%,未检出HIV抗体阳性;检出病种以非淋菌性尿道炎(NGU)居首位,检出率91.08%;患两种及两种以上STD占49.44%。[结论]暗娼STD检出率高,安全套使用率低,应在暗娼人群中更深入地开展STD/AIDS健康教育、高危行为干预和推广100%使用安全套。

云南省某矿区嫖客人群中STD/AIDS知识行为及感染状况调查

目的了解云南省某地矿区嫖客人群性病／艾滋病（STD／AIDS）相关知识、行为及感染状况，分析可能的危险因素。方法采用标准化问卷匿名收集研究对象的人口统计学、STD／AIDS知识、性行为等信息，并对4种STD和艾滋病病毒（HIV）感染状况进行检测。结果该矿区嫖客STD／AIDS知识不足，安全套使用率低，AIDS相关知识全部回答正确率为4．3％。HIV阳性率为1、5％（95％CI：0．2％～2．8％），梅毒阳性率为2．4％（95％CI：0．8％～4．0％），2型单纯疱疹病毒（HSV-2）抗体阳性率为14．9％（95％CI：11．1％～18．7％），淋球菌阳性率2．1％（95％CI：0．6％～3．6％），沙眼衣原体阳性率为6．9％（95％CI：4．2％～9．6％），STD总感染率为23．2％（95％CI：18．7％～27．7％）。STD感染与吸毒（调整OR=6．4，95％CI：1．4～28.8）、镇上居住时间（调整OR=2．7，95％CI：1．5～4．9）及首次性行为年龄（调整OR=2．2，95％CI：1．0～5．0）的联系有统计学意义。结论该矿区嫖客性病艾滋病感染率较高，STD／AIDS知识缺乏，安全套使用率低，自我保护意识差，应作为今后干预的重要目标人群。