This study evaluates the effect of an Acquired Immune Deficiency Syndrome (AIDS) prevention program on the incidence of gonorrhea among the enlisted men in the 105th Battalion of the Honduran Army. The education program was initiated as a result of the high incidence of AIDS in Honduras (more than half of all of the known cases of AIDS in Central America are in Honduras). The AIDS prevention program for this battalion was initiated in July, 1989 and consists of lectures, videos, and printed materials concerning the nature of HIV/AIDS. The program emphasized the use of condoms as a means of avoiding infection: thus the incidence of gonorrhea would also be expected to decrease as a result of the program. The program is presented to new recruits as a portion of their three month basic training in first aid and personal health. Although the AIDS education program provided to the recruits entering the 105th Battalion is similar to that given to recruits entering other battalions, in only the 105th is the program continued after graduation from basic training, where quarterly refresher courses are given throughout the enlisted men's service career. This retrospective observational study compares the prevalence of gonorrhea among the 105th and three other military units that did not receive ongoing AIDS educational program. The prevalence of gonorrhea was used as an indicator of the effectiveness of the program because its prime route of infection (intimate sexual contact) is the same as HIV, and because gonorrhea is easily detected. The study covered the period between January 1990 and December 1993. The data in the study were provided by the Honduran Army and consists of summaries of the results of periodic inspections conducted by military physicians on all enlisted men at approximately 6 week intervals. In these inspections, the enlisted men are medically examined for the presence of signs of gonorrhea. The data include the date of the inspection, the number of soldiers examined, and the number cases of gonorrhea detected. In the Honduran Army, the incidence of gonorrhea has declined significantly in the last four years. It is speculated that at least three contributing factors are responsible: the free distribution of condoms; the increasing awareness and fear of AIDS; and, the specific AIDS education campaigns presented to the enlisted men. The results of this study indicate that significant reductions in the prevalence of gonorrhea occurred in all military units studied and that the rate of reduction in the unit that received the ongoing educational campaign was greater than in the units that did not receive the educational campaign. The study indicates that the provision of ongoing AIDS education to the Honduran enlisted soldiers results in a decrease in the prevalence of gonorrhea. The study also demonstrated the feasibility of conducting research on sexually transmitted diseases in military units. / Graduation date: 1994

Thesis (M. Med. Sc.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 35-42).

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Thesis (M.Med.Sc.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 35-42). Also available in print.

No description available.

Untreatable gonorrhea, caused by fully antimicrobial resistant Neisseria gonorrhoeae (GC), is a major global health threat. While a vaccine would greatly help address this crisis, development of a GC vaccine is complicated by the lack of lab models of symptomatic gonorrhea. We hypothesized that overt disease in animal models of gonorrhea is limited by the human-restriction of gonococcal virulence factors, and the impact of the reproductive hormone cycle (estrus and diestrus phases). We tested these hypotheses by examining the host response to infection in transgenic mice expressing targets of bacterial adhesion, human carcinoembryonic antigen-related cell adhesion molecules (hCEACAMs), in uterine versus vaginal infections, and in different phases of the reproductive cycle (estrus and diestrus phases). hCEACAM expression most impacted estrus phase infections, prolonging colonization in vaginal infection and inducing greater inflammation in uterine. Reproductive phase greatly influenced host response to uterine infection as diestrus infection was more inflammatory than estrus. Phase differences in uterine infection were driven by greater activation of a chemokine-centric common anti gonococcal response and unique induction of type 1 interferons in diestrus. These findings suggest that symptomatic uterine and vaginal GC infection can be modeled by transcervically infected wild-type diestrus mice and transgenic, vaginally-infected estrus mice, respectively. A novel approach to GC vaccine development is also needed. Mono-antigenic vaccines have failed to produce immunity suggesting a poly-antigenic antigen, like natural outer membrane vesicles (nOMVs) may be necessary. It has been shown that any GC vaccine must lack the bacterioprotective antigen, reduction modifiable protein (RMP), and no such nOMV has been previously described. Here we report successful isolation of RMP-deficient nOMVs through sequential size and weight restrictive filtration. Vesicle morphology, proteomics, and bioactivity was characterized via various methods. nOMVs were found to be consistent in size, shape and antigenic load. As antigens, nOMVs induced high serum titers and measurable vaginal levels of antigen and GC specific IgG that recognized several nOMV immunogens supporting the vaccine potential of GC nOMVs. These findings lay the groundwork for protective studies of nOMV vaccines in novel models of active gonorrhea moving the field closer to discovering the mechanism of protective anti-gonococcal immunity.

Globally, the incidence of infection caused by Neisseria gonorrhoeae is the second highest among the bacterial sexually transmitted infections. In Canada, declining rates during the 1990s suggested progress toward curbing gonorrhea; however, those have been increasing since 1999, with rates in Saskatchewan among the highest in the country. Infection can cause serious complications in men and women, and reported resistance to third-generation cephalosporins could lead to potentially untreatable infections. Increased understanding of gonorrhea transmission dynamics, sexual networks, and predictors of antimicrobial resistance development is needed to inform the development of improved approaches to prevention and treatment. The research presented herein draws upon data from Shanghai, China, and Saskatchewan, Canada, to compare and contrast varying epidemiologic approaches to enhancing understanding of gonorrhea in the two settings. Using traditional statistical approaches, multi-level statistical modeling, social network analysis, and dynamic simulation modeling, questions related to sexual behavior, partner presentation, and antimicrobial resistance development are explored. Each technique is evaluated for its potential contribution to overall understanding of the issues related to the ongoing gonorrhea epidemic, globally, and in Saskatchewan. The relative strengths and limitations of the application of the analytical approaches in the different settings are described. Socio-demographic characteristics provided useful indicators of antimicrobial resistant infection among patients with gonorrhea from Shanghai. Further, socio-demographic characteristics were also useful for predicting presentation of a partner for testing and treatment and the use of condoms during intercourse, among this study population. In Saskatchewan, socio-demographic characteristics were useful in predicting coinfection with gonorrhea and chlamydia at the time of diagnosis as well as repeat infection with gonorrhea. Social network analysis of the Saskatchewan dataset provided little additional understanding of the gonorrhea epidemic in the province. This result was largely related to how STI data are collected and stored in the province. The utility of dynamic simulation modeling to investigate the potential impact of antimicrobial resistance in Saskatchewan was also limited due to the same data constraints. However, the insight gained from the model building process and findings from the working model did offer a starting point for conversations around the best ways to postpone the development of antimicrobial resistance in N. gonorrhoeae in Saskatchewan, as well as contribute additional information about how the ways in which STI data are collected and stored in the province considerably restrict the applicability of otherwise powerful epidemiologic tools. With persistently high rates of disease transmission, and the threat of untreatable infections due to antimicrobial resistance, N. gonorrhoeae remains a substantial public health threat locally and globally. The research presented herein describes various approaches to understanding and controlling this disease, applied in contrasting settings. There are a wide variety of elements that should be considered when choosing the appropriate tool(s) to address gonorrhea in a given population; there is no “one size fits all” solution. The local epidemiology of disease, cultural and behavioural norms, the characteristics of the notifiable disease reporting and information systems, and the availability of suitable data all affect the relative strengths and weaknesses of the available analytic methods and disease control approaches.

Millions of dollars are spent each year on preventing sexually transmitted diseases (STDs), yet the rates of chlamydia trachomatis (chlamydia) and neisseria gonorrhoeae (gonorrhea) infection continue to be high. Health literacy and its impact have been recognized in diabetes maintenance, control of hypertension, medical adherence, and reproductive health outcomes, yet no research has been conducted regarding the relationship between health literacy and chlamydia and gonorrhea prevalence. This study examined the relationship between health literacy scores and chlamydia and gonorrhea prevalence health literacy scores and reproductive health/STD knowledge, and reproductive health/STD knowledge and chlamydia and gonorrhea prevalence. Participants included 114 women over 18 years of age, who attended community health clinics in the northeastern United States. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine instrument, and reproductive health/STD knowledge was assessed using a self-administered questionnaire. Data analysis revealed an inverse correlation between lower health literacy scores and an increase in gonorrhea and combined chlamydia/gonorrhea prevalence. Findings also revealed a positive correlation between health literacy scores and reproductive health/STD knowledge scores. The results of this study suggest that service providers should consider the use of health literacy level with targeted reproductive health and STD messages as a tool to empower clients, decrease the prevalence of chlamydia and gonorrhea, and increase positive reproductive health outcomes.

La gonococcie est une infection sexuellement transmissible due au gonocoque. Elle est devenue un problème majeur de santé publique du fait de la multirésistance aux antibiotiques, mais surtout de la résistance au traitement de dernière intention actuellement en vigueur. Lactobacillus crispatus, une bactérie naturelle, commensale du vagin de la femme, s’est montré efficace pour inhiber le gonocoque. Les gels, une forme galénique bien acceptée, sont déjà utilisés pour le traitement des infections genitales de la femme. Disposer d’un gel contenant Lactobacillus crispatus, efficace, facile à administrer par la femme elle-même parait donc attractif pour la prévention de la gonococcie. Ainsi, nous avons conçu un gel à base d’un polymère thermogélifiant, le poloxamer 407 et d’un polymère biocompatible, l’alginate de sodium. Dans un premier temps, une étude physico-chimique du mélange de polymères a permis de retenir les concentrations optimisées. Dans un second temps, la souche de Lactobacillus choisie a été caractérisée et introduite dans le mélange de polymères. Les propriétés physicochimiques dont les caractéristiques rhéologiques, l’expulsion d’un dispositif d’administration, la stabilité, la microstructure ainsi que l’efficacité in vitro du gel obtenu ont été étudiés. Une répartition homogène de Lactobacillus crispatus a été observée dans le gel. Ce système est facilement administrable et possède des propriétés rhéologiques favorables à son étalement et son maintien dans la lumière vaginale. Ce gel a permis d’inhiber la croissance du gonocoque in vitro. / Gonorrhea is a sexually transmitted infection caused by Neisseria gonorrhoeae. It has become a major public health issue due to multidrug resistance, especially resistance to the current last-intention treatment.Lactobacillus crispatus, a natural bacterium, commensal to the woman's vagina, has been shown to inhibit Neisseria gonorrhoeae. Gels, a well-accepted dosage form, are already used for the treatment of woman's genital infections. Having a gel containing Lactobacillus crispatus, that is effective, easy to administer by the woman herself, would be ideal for the prevention of gonorrhea. Thus, we designed a gel based on a thermogelling polymer, poloxamer 407, and a biocompatible polymer, sodium alginate. First, a physicochemical study of the polymers mixtures allowed to select the optimized concentrations. Second, the selected Lactobacillus strain was characterized and introduced into the optimized polymer mixture. Physicochemical properties including rheological characteristics, expulsion from a device, stability, microstructure as well as in vitro gel efficacy were studied. A homogeneous distribution of Lactobacillus crispatus was observed in the gel. It was easily administered and its rheological properties were suitable for its spreading and its long reidence time in the vaginal lumen. This gel showed an inhibition of gonococcal growth in vitro.