Durante un año fueron estudiados 61 pacientes consecutivos VIH positivos, con el fin de establecer la prevalencia de las manifestaciones oftalmológicas. Veintinueve pacientesestaban en estadío de SIDA (IV de la Clasificación CDC) y 32 eran portadores asintomáticos. En la primera evaluación, se encontró compromiso oftalmológico en 15/29 pacientes con SIDA (51.72%); siendo los hallazgos: microangiopatía retinal no infecciosa 27.6%, infecciones oportunísticas 20.68%; Sarcoma de Kaposi, 3.44% y atrofia óptica en 3.44%. De las infecciones oportunísticas encontradas en la primera visita, la más importante fue la retinitis por citomegalovirus (CMV) en 10.34%. En portadores asintomáticos, uno presentó microangiopatía retinal no infecciosa con presencia de manchas algodonosas retinales (3.1%). En el seguimiento, de los pacientes con SIDA cuyo examen inicial era normal, 2 desarrollaron microangiopatía y 3 retinitis por CMV; mientras que de los pacientes que al inicio tenían microangiopatía retinal, 5 desarrollaron retinitis por CMV en la evolución. También se observó un nuevo caso de Sarcoma de Kaposi conjuntival y uno de parálisis del VI par craneal y papilitis. Al término de este estudio habíamos acumulado 9 casos de retinitis por CMV (31%) y compromiso oftalmológico en 19/29 pacientes con SIDA (65.51%). De los 32 portadores asintomáticos, uno desarrolló retinitis por CMV, debutando como SIDA con una manifestación ocular. Se concluye que el compromiso oftalmológico en el SIDA es importante, por lo que es necesario un adecuado seguimiento oftalmológico en esta población.

Objectives: To assess low abdominal pain, yellow vaginal discharge, other symptoms and signs, and demographic and behavioural variables as predictors for cervical or vaginal infection.Methods: A cross sectional study of women attending gynaecology and family planning clinics in Lima, Peru was undertaken. 630 consecutive eligible female patients with chief or elicited complaints of yellow vaginal discharge, low abdominal pain, or both were interviewed and examined, together with a comparable reference group without these complaints. Vaginal specimens were tested for trichomoniasis and bacterial vaginosis. Endocervical specimens were tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the ligase chain reaction.Results: Infections found included chlamydial infection in 69 women (10.9%), gonorrhoea in 10 (1.6%), and either infection in 77 (12.2%); trichomoniasis in 46 (7.3%), bacterial vaginosis in 189 (30%), and either infection in 209 (33.2%). Cervical infection with C trachomatis and/or N gonorrhoeae was independently associated with history of a new sex partner within the last 3 months, more than one sex partner within the last year, use of condoms never or in less than 50% of sex acts, history of sex partner with STD within the last year; with symptoms of persistent low abdominal pain and of yellow vaginal discharge; and with signs of profuse and yellow vaginal discharge, cervical ectopy, easily induced endocervical bleeding, or brown cervical secretion. Using these findings, an algorithm was created that had a positive predictive value (PPV) of 36% for cervical infection among women reporting chief or elicited complaint of this abnormal vaginal discharge and a PPV of 25% among those without a complaint. A chief complaint of yellow vaginal discharge had a PPV of 50% for trichomoniasis or bacterial vaginosis. Among women without a chief complaint of yellow vaginal discharge, clinical findings of yellow vaginal discharge had a PPV of 55%.Conclusions: Where economic and technical constraints preclude testing, clinical findings and risk assessment are helpful in detecting vaginal and cervical infections. Several demographic, behavioural, clinical, and laboratory variables were predictive of infection in this population.

Four hundred female sex workers attending a sexually transmitted disease clinic in Lima, Peru, were interviewed for demographic information and medical, contraceptive, and sexual practice histories. Cervical cultures were done for Neisseria gonorrhoeae and Chlamydia trachomatis, and serum was tested for antibodies to human immunodeficiency virus, human T cell lymphotropic virus type I (HTLV-I), Treponema pallidum, C. trachomatis, herpes simplex virus type 2 (HSV-2), and Haemophilus ducreyi. The prevalence of HTLV-I increased with duration of prostitution from 3.6% (< 3 years) to 9.3% (3-6 years) to 15.9% (> 6 years; P < .01). After adjustment for duration of prostitution, reduced risk of HTLV-I was significantly correlated with condom use for more than half of all sexual exposures for > 3 years (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.13-0.89). Further adjusting for condom use, HTLV-I seropositivity was associated with C. trachomatis (OR, 3.7; 95% CI, 1.4-13.2) and with antibody to HSV-2 (OR, 3.7; 95% CI, 0.5-29.6). Thus, duration of prostitution, lack of consistent condom use, and past infection with C. trachomatis were significantly associated with HTLV-I seropositivity.