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Manila, Philippines, WHO, Regional Office for the Western Pacific, STI, HIV and AIDS Focus, 2002 Jul.  p.Sexually transmitted infections (STIs) are infectious diseases that are transmitted from person to person during sexual contact, not necessarily vaginal intercourse. A large number of bacteria, viruses, fungi and other organisms may be sexually transmissible and may result in disease. Most bacterial, fungal and parasitic infections can be cured with antimicrobial agents. On the other hand, most viral infections cannot be cured. Antiviral drugs can sometimes contain the progression or effects of viral infections, although such treatments are often expensive, are inaccessible to many individuals, and may have substantial side effects. Persons with sexually transmitted infections are infectious to their sexual partners even though they may have no symptoms or signs of infection. In fact, many people - men and women - have STIs without symptoms or signs, although they can develop serious complications. STIs are a public health problem because of their potential to cause serious complications such as infertility, chronic disability and death in men, women and children. STIs can affect the foetus, neonate and infant, resulting in eye infection, blindness and pneumonia. The public health importance of STIs has taken on an even greater dimension with the advent of human immunodeficiency virus (HIV) infection. HIV infection is sexually transmissible, is not curable and leads to the acquired immunodeficiency syndrome (AIDS). (excerpt)
Indian Journal of Community Medicine. 2003 Apr-Jun; 28(2): p..Research question: What is the sensitivity and specificity of WHO s syndromic approach in diagnosing Reproductive Tract Infections (RTIs)? Objective: To test the validity of WHO diagnostic algorithm in diagnosing RTIs among married women. Study design: Cross-sectional study. Setting: Primary Health Centre, Palam, New Delhi. Participants: Married women attending antenatal and gynae clinics. Sample size: 300 married women. Statistical analysis: Proportions. Results: The prevalence of RTIs in married women was 37.0% by syndromic approach based on symptoms, 51.7% by clinical examination and 36.7% by microbiological laboratory investigations. The sensitivity and specificity of syndromic approach to diagnose any RTI was 53.6% and 72.6% respectively while clinical examination had 68.2% sensitivity and 60.5% specificity. Overall clinical examination had relatively high sensitivity but low specificity. For trichomoniasis and bacterial vaginosis the clinical examination had low sensitivity but a high specificity. Conclusions: WHO syndromic approach based on symptoms had a low sensitivity in diagnosing RTIs among women. Sensitivity increased when clinical examination was used for the diagnosis of these infections. In the absence of microbiological laboratory facilities, syndromic approach should be supplemented with clinical examination for diagnosing RTIs in women to avoid over-treatment of women. (author's)
INTEGRATION. 1991 Sep; (29):4-5.The work of the Soviet Family Health Association (SFHA) is described. Created in January, 1989, the organization boasts 25 state-paid workers, and as of June 1991, membership of 15,000 corporate and individual members. Individual annual membership fee is 5 rubles, and entitles members to counseling and family planning (FP) services. The SFHA works in cooperation with the Commission on Family Planning Problems of the USSR's Academy of Sciences, and has been a member of the International Planned Parenthood Federation (IPPF) since 1990. Association activities include lectures for students, newly-weds, adolescents, and working women on modern contraceptive methods; research on attitude regarding sex, sex behaviors, and the perceived need for effective contraception; clinical trials of contraceptive suitability for women; and the training of doctors in FP and contraceptives. Problems central to the SFHA's operations include insufficient service and examination equipment, a shortage of hard currency, and the small number of FP specialists in the country. Solutions to these obstacles are sought through collaboration with the government, non-governmental organizations in the Soviet Union, and international groups. The SFHA has a series of activities planned for 1991 designed to foster wider acceptance of FP. Increased FP services at industrial enterprises, establishing more FP centers throughout the Soviet Union, and studying FP programs in other countries are among Association targets for the year. Research on and promotion of contraceptives has been virtually stagnant since abortion was declared illegal in 1936. Catching up on these lost decades and remaining self-reliant are challenges to the SPHA.
International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations. Jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989.
[Unpublished] 1991. , 64 p.The International Conference on the Implications of AIDS for Mothers and Children was organized by the World Health Organization (WHO) in cooperation with the French Government. Co-sponsors included the United Nations organizations UNDP, UNICEF, and UNESCO, along with the International Labor Organization (ILO), the World Bank, and the Council of Europe. Following assorted introductory addresses, statements by chairmen of the conference's technical working groups are presented in the paper. Working group discussion topics include virology; immunology; epidemiology; clinical management; HIV and pregnancy; diagnoses; implications for health, education, community, and social welfare systems; and economic and demographic impact. Chairman statements include an introduction, discussion of the state of current knowledge, research priorities, implications for policies and programs, and recommendations. The Paris Declaration on Women, Children and Acquired Immunodeficiency Syndrome concluded the conference.
Report of the Meeting on Research Priorities Relating to Women and HIV / AIDS, Geneva, 19-20 November 1990.
[Unpublished] 1991. 13 p. (GPA/DIR/91.2)A meeting of international experts was held to identify gaps in knowledge essential to design and implement AIDS prevention and control programs as they relate to women. Fundamental to successful research efforts are the need for increased access of women to training and participation in research, new consideration of the neglect of gender specificity in existing research, and the need for such research to contribute to the empowerment of women. Specific research needs in epidemiology, behavioral research, and social and economic aspects of HIV/AIDS were identified, ranked according to their potential for contributing to the prevention and control of AIDS, relevance for developing countries, and feasibility. 12 specific research questions are posed in the report, and cover issues such as the determinants of HIV transmission, contraceptive method impact, diagnosis and treatment of STDs in women, social and economic support, women's empowerment, and the risks of female health care provider HIV infection. Additionally, HIV infection natural history differences between men and women are compared, followed by consideration of psychosocial stress, monitoring, HIV and pregnancy, and research protocol development. Background, key issues, reports of the working groups, and recommendations are included in the report.
ANNALS OF TROPICAL PAEDIATRICS. 1989 Mar; 9(1):1-5.A total of 177 children seen at 2 hospitals in Kampala are described who were strongly suspected of having acquired immunodeficiency syndrome (AIDS), either on clinical grounds or because they fulfilled WHO case- definition criteria for diagnosis of pediatric AIDS. Blood was taken from the 177 children and 154 of their mothers and tested for antibody to human immunodeficiency virus (HIV) by an enzyme-linked immunoassay (ELISA). Altogether, 119 (67%) children were seropositive, but only 85 (71%) fulfilled the WHO case-definition criteria, and they were significantly older than the 34 who did not fulfill the criteria. A further 58 children were seronegative but fulfilled the WHO criteria. Of the 119 seropositive children, only 3 had a history of previous blood transfusion, but 103 (98%) of 105 mothers were HIV seropositive: consequently, their children were considered to have been infected in utero or perinatally. 13 (26%) of 49 mothers of seronegative children were seropositive. 80% of HIV-infected children were under 2 years of age at diagnosis and 23% died within 3 months of diagnosis. None of the parents was known to be an intravenous drug user, a prostitute, or bisexual. The difficulty of accurate diagnosis of AIDS presents a major problem in Africa, as the WHO clinical case-definition criteria alone are clearly not adequate. (author's)
London, International Planned Parenthood Federation, 1979. 58 p.This International Planned Parenthood report states the agency's policy position on management of infertility, and then briefly goes on to cover the following topics, in handbook form: 1) epidemiology of infertility; 2) etiology of infertility; 3) proper infertility counseling; 4) prevention (trauma avoidance and early treatment of diseases); 5) diagnostic techniques for the couple, man, and woman; 6) treatment of infertility in women and men; 7) use of artificial insemination, both with donor's semen and partner's semen; and 8) the place of adoption within the community of infertile couples. Prevalence of infertility is placed at an international average of 10%, though places such as Cameroon have rates as high as 40%. The factors influencing infertility are divided into 3 groups: 1) socio-cultural, 2) sexually transmitted diseases, and 3) other diseases and disorders. Causes of female infertility include: ovulation dysfunction; tubal obstruction or dysfunction; uterine actors such as fibroids, polyps, or developmental abnormalities; cervical abnormalities; vaginal factors, such as severe vaginitis or imperforate hymen; endocrine and metabolic factors, particularly thyroid disturbances, diabetes, adrenal disorder, severe nutritional disorders (anemia), or other systemic conditions; and repeated pregnancy wastage. Male causes include poor semen quality; ductal obstruction; ejaculatory disturbances (i.e., failure to deliver sperm to vagina); emotional stress (may lead to hypogonadism); and genetic factors (Klinefelter syndrome). Causes specific to the couple include lack of understanding of reproductive physiology, immunoloigcal incompatibility, nutritional deficiencies, and psychogenic factors.
Design of studies for the assessment of drugs and hormones used in the treatment of endocrine forms of female infertility.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 135-154The lack of uniformity in diagnostic selection of women for treatment of infertility, in choice of therapy, in monitoring of therapy, and in follow-up, frequently does not allow a meaningful comparison of results reported from different centers. To design studies assessing effectiveness of therapy of endocrine forms of female infertility, it is essential to consider: 1) mechanism controlling reproductive functions (e.g., process of ovulation); 2) cause(s) responsible for infertility (mechanical factors, ovarian failure, and pituitary failure); and 3) the mechanism of action of agents used for therapy (e.g., gonadotropins stimulate gonadal function, clomiphene stimulates gonadotropin secretion, and ergoline derivatives inhibit prolactin secretion). Patients selected for therapy should be grouped according to etiology: 1) hypothalamic-pituitary failure; 2) hypothalamic-pituitary dysfunction; 3) ovarian failure; 4) congenital or acquired genital tract disorder; 5) hyperprolactinemic patients with a space-occupying lesion in the hypothalamic-pituitary region; 6) hyperprolactinemic patients with no space-occupying lesion; and 7) amenorrheic women with space-occupying lesion. Ideally, an infertile couple should be diagnosed and treated as a unit.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 111-134A 6-month regimen for managing infertile men and/or women ideally forms 4 stages: 1) history and examination of the couple; 2) confirmation of ovulation, compatibility of sperm and mucus, and seminology; 3) tests for tubal patency; and 4) detailed endocrine tests for abnormalities found in Stages 1-3. Medical history should include emotional stress and work pressures, if any. Ovulation confirmation requires 2 tests combined from these 4: 1) basal body temperature; 2) endometrial biopsy; 3) blood progesterone levels; and 4) urinary pregnanediol. These procedures are outlined in detail, and figures chart body temperature variations and expected progesterone and pregnanediol levels. Assessment of cervical mucus and measurement of sperm penetration combine in vitro and in vivo tests. The Sims-Huhner test (postcoital test), though not standardized, is used to analyze sperm-mucus interaction by quantitative scoring of sperm count and motility. Other in vitro tests are the sperm-mucus match test and the fractional postcoital test (both described). Tubal patency is investigated by tubal insufflation with CO2, hysterosalpingography, endoscopy, and laparoscopy. Additional Stage 4 tests include vaginal cytology and assessment of estrogen and progesterone effects.