OBJECTIVES:To estimate the prevalence and incidence of hepatitis B virus (HBV) infection among patients attending three STD clinics in Pune, India, and to identify associated risk factors.METHODS:Of the 2098 patients screened at STD clinics in Pune during 1996, 497, who returned for at least one follow up visit, were screened for various markers of HBV infection (HBsAg, anti-HBs, anti-HBc), HIV antibody, and VDRL.RESULTS:Of the 497 participants 3.6%, 26.5%, and 43.2% were positive for HBsAg, anti-HBs, and anti-HBc respectively. Tattooing (AOR 1.64, 95% CI 1.03 to 2.64) was found to be independently associated with presence of core antibody. Additionally, history of being in commercial sex work and history of a genital ulcer were independently associated with a positive anti-HBc antibody test (AOR 12.45, 95% CI 5.58 to 27.82 and AOR 1.70, 95% CI 1.09 to 2.66, respectively). 72 out of 497 (14.5%) participants were HIV positive at baseline. HIV-1 antibody positive patients were more likely to have a positive anti-HBc test (69.4% v 39.0%, p<0.001). 30 out of 282 participants, negative for anti-HBc antibody at enrolment, seroconverted subsequently, resulting in an incidence of 10.86 per 100 person years (95% CI 7.2%, 14.5%) (mean and accumulated follow up of 11.7 months and 276.17 person years, respectively).CONCLUSIONS:A high prevalence and incidence of HBV infection, seen in STD clinic attendees underscore the need to provide HBV vaccine to commercial sex workers and their clients in India.

Objectives: To determine the etiology of genital ulcer disease (GUD) among patients attending sexually transmitted disease (STD) clinics in Pune, India, and to examine the relationship to HIV infection and compare the clinical diagnosis of GUD with the results of a multiplex polymerase chain reaction (M-PCR) assay for Treponema pallidum, herpes simplex virus (HSV), and Hemophilus ducreyi infection.Methods: Between June 20, 1994, and September 26, 1994, 302 patients with a genital ulcer were evaluated. Clinical etiology of GUD was based on physical appearance and microbiologic evaluations which included darkfield microscopy and serology for syphilis. Swabs of each genital ulcer were tested for HSV antigen by enzyme immunoassay (Herpchek; Dupont, Wilmington, DE) and processed in a multiplex PCR assay (M-PCR; Roche, Branchburg, NJ) for simultaneous detection of HSV, Treponema pallidum, and Hemophilus ducreyi.Results: Two hundred seventy-seven men and 25 women with a median age of 25 were evaluated. The seroprevalence of HIV was 22.2%. The etiology of GUD as determined by M-PCR was HSV (26%), H. ducreyi (23%), T. pallidum (10%), and multiple infections (7%); no etiology was identified in 34%. HIV seroprevalence was higher among those patients positive for HSV compared with other etiologies (OR = 2.1, CI: 1.2-3.7; p = 0.01), When compared with M-PCR, the Herpchek test was 68.5% sensitive and 99.5% specific. Darkfield detection for T. pallidum was 39% sensitive and 82% specific, in contrast to rapid plasma reagin and fluorescent treponemal antibody absorption test, which was 66% sensitive and 90% specific, Clinical diagnosis alone or in combination with basic laboratory tests showed poor agreement with M-PCR.Conclusions: The etiology of GUD among STD patients in India is multifactorial with a predominance of herpes and chancroid infections. Herpes was more common among HIV-positive individuals, possibly reflecting underlying immunosuppression. These data demonstrate that clinical diagnosis is not dependable for identification of GUD etiology especially in HIV seropositive cases. In areas where diagnostic tests are limited, a syndromic approach using antibiotics directed against both syphilis and chancroid, and where prevalent, lymphogranuloma venereum and donovanosis is recommended for patients with GUD.

Of the five ciprofloxacin resistant isolates two were penicillinase producers (PPNG) one was susceptible and two exhibited reduced susceptibility to penicillin. No plasmid mediated high level tetracycline resistance was observed in the isolates studied. Fifteen of the 16 penicillin resistant isolates were PPNG. All the isolates were susceptible to spectinomycin. (excerpt)

Objectives: Sexually transmitted diseases (STDs) are an important cause of pelvic inflammatory disease (PID) but have often not been detected in microbiological studies of Indian women admitted to hospital gynaecology wards or private clinics. In this cross sectional study, women living in the inner city of Mumbai (Bombay) were investigated for socioeconomic, clinical, and microbiological risk factors for PTD.Methods: Microbiological tests and laparoscopic examination were carried out on 2736 women aged less than or equal to 35 years who came to a health facility with suspected acute salpingitis or infertility or for laparoscopic sterilisation. 86 women with a clinical diagnosis of PTD were not referred for laparoscopy although their characteristics are described, Associations between various risk factors and PID status were investigated and logistic regression performed on all factors that remained significant.Results: Of women with a laparoscopically confirmed evaluation, 26 women had acute and 48 chronic pelvic infection. Independent risk factors for PID were later age at menarche (greater than or equal to 14 years), a history of stillbirth and no previous pregnancy, history of tuberculosis, STD, dilatation and curettage or previous laparoscopy, and presence of Gardnerella vaginalis.Conclusions: It is concluded that STD related risk factors applied to only a small proportion of PID cases and that other determinants of PID are important, including obstetric complications, invasive surgical procedures such as laparoscopy, and tuberculosis.

Aim of the present study was to assess prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients attending sexually transmitted disease (STD) clinics and prisoners from Pune. 346 sera from patients attending STD clinics 134 sera from prisoners and 462 sera from voluntary blood donors were tested for hepatitis B antigen (HBsAg) anti-HBs anti-HB core antigen and anti-HCV antibodies. The prevalence of HBV was 43.82% (5.78% HbsAg positive and 38.15% anti-HBs positive) in STD patients and 57.33% (7.46% HBsAg positive and 41.04% anti-HBs positive) in prisoners. In both groups exposure to HBV was significantly higher (P < 0.005 and P < 0.005 respectively) than that in voluntary blood donors showing 16.4% prevalence of HBV (0.64% HBsAg positive and 15.58% anti-HBs positive). Antibodies to HCV (anti-HCV) were present in 0.64% of STD patients and none of the sera from prisoners were reactive for anti-HCV. The absence of anti-HCV among voluntary blood donors indicate low circulation of hepatitis C virus in this population. Low prevalence of anti-HCV among STD patients and prisoners demonstrate low risk of sexual transmission of HCV in this region of India. (authors)