A total of 425 questionnaire-based interviews and 15 in-depth interviews with FSWs in Nepal including non-participant observation in the field were conducted in 2006. The age range of the FSWs participated was 15-46 years.  FSWs (30.8%) reported having had STI symptoms in presences 12 month.  The quantitative findings suggested that many reported having used condoms during their last sexual intercourse, but in-depth interviews suggested the opposite.  One fifth (21%) had never visited health facilities.  Of those who visited, 149 (50.3%) turned to a private clinic and pharmacy; 181 (61.1%) used Non-Governmental Organisation (NGO) clinics, 79 (26.6%) resorted to care in hospital and 30 (10.1%) treated themselves.  The remainder 85 (28.7%) were found to seek help from primary health care centre, health posts, family planning clinic or other health institutions for treatment.  The behaviour theories and models used in this study (i.e. health belief model, theory of reasoned action and planned behaviour) partly explain the decisions of FSW on use and non-use of available health services.  The study identified that lack of confidentiality and privacy created distrust among FSWs and stopped them from accessing health services.  Embarrassment, disregard by health care providers and poor communication with them, long waiting time and fear of exposure as a sex worker were major barriers to seeking health services. It is therefore necessary to provide specific training to service providers in all types of health care institutions in order to promote confidential and quality health services.

Background: The sexually transmitted infections (STIs), chlamydia and gonorrhea, disproportionately affect racial and ethnic minorities. Community attributes like poverty and prevalence of STIs, along with residential segregation and its impact on composition of sexual networks contribute to these disparate rates. The Southeast had the highest rates of chlamydial and gonorrheal infection among the four regions of the United States. Because relationships between race and place can confound national statistics, it is important to examine whether racial disparities within the region are associated with higher rates of infection. Purpose: The study aims to evaluate local geospatial clustering of gonorrhea and chlamydia rates in the Southeast, and their persistence during 2000-2005 and any associations with residential segregation, income inequality, unemployment and uninsured rates, and race. Methods: Using the Local Indicators of Spatial Association tests of spatial clustering, cluster maps were created for each STI outcome and year. Independent sample t-tests were then used to examine the difference in means of each community level variable across counties composing the high-rate clusters and all other counties in the region. Results: Over 60% of counties composing high-rate clusters persisted as high rate clusters over time, and were significantly associated with higher levels of community disadvantage than all other counties (p < 0.01). Overall gonorrhea rates decreased from 2000 to 2005 and chlamydia rates increased, while their associations with community disadvantage remained persistently strong over time. Conclusions: Counties with higher rates of chlamydia and gonorrhea persist over time and experience persistently higher levels of residential segregation and income inequality, as well as higher unemployment and uninsured rates, and higher proportions of blacks in the population. The social environment and segregated sexual networks may play important roles in the persistently high rates of chlamydia and gonorrhea observed for certain regions within the Southeast. Continued surveillance of reportable STIs and their probable predictors is needed in order to better understand the persistent disparities in STI rates across counties in the Southeast.

This diploma thesis is focused to the analysis of sexual education on high schools in Liberec region. The most part of the diploma thesis is composed by the questionnaire survey which was perfomed on two comprehensive schools, two secondary schools and two vocational schools. The research attended the students of the third school classes only (18-19 years old). The questionnaire survey was focused to the students knowledge and attitude towards the sexual education. I have defined 9 hypothesis based on the research which were statistically analyzed after that. It appears that the students of comprehensive schools have better knowledges than the students from other secondary/vocational schools and that the knowledges are different among the boys and girls. The congizance of sexual education generally appear as good. The teachers paying attention to this topic during the lessons because they consider the theme important as well as the students. On the other hand the survey revealed that the students did not learn any news during the school lessons in this respect which they know more likely from the Internet. It shows importance to integrate the sexual lessons to the primary schools rather that. Key words: sexual education, contraception, sexually transmitted infection, questionnaire survey.

Treponema pallidum ssp. pallidum is the causative agent of syphilis, a sexually transmitted infection characterized by multi-stage disease and diverse clinical manifestations. Treponema pallidum undergoes rapid vascular dissemination to penetrate tissue, placental, and blood-brain barriers and gain access to distant tissue and organ sites. The rapidity and extent of T. pallidum dissemination is well documented, but the molecular mechanisms that underlie this process have yet to be fully elucidated. Tp0751 is a T. pallidum adhesin that interacts with vascular factors and mediates adherence to endothelial cells under shear flow. This dissertation explores the molecular interactions and functional outcomes of Tp0751-mediated vascular endothelium adhesion. The findings presented herein demonstrate that recombinant Tp0751 adheres to human macrovascular and microvascular endothelial cells, including cerebral brain endothelial cells. This interaction is confirmed using live T. pallidum, where spirochete- endothelial cells interactions are disrupted with Tp0751-specific antiserum. Further, the 67 kDa laminin receptor (LamR) is identified as an endothelial receptor using affinity chromatography coupled with mass spectrometry to isolate and identify Tp0751-interacting proteins from endothelial cells membrane extracts. Notably, LamR is a brain endothelial cell receptor for other neurotropic invasive pathogens. Evaluation of endothelial intercellular junctions reveals that recombinant Tp0751 and live T. pallidum disrupt junctional architecture. However, transwell solute flux assays reveal that Tp0751 and T. pallidum do not alter endothelial barrier integrity. The transendothelial migration of T. pallidum can be partially abrogated with an endocytosis inhibitor, implying a transcellular route for barrier traversal. However, a subpopulation of T. pallidum localizes to intercellular junctions, indicating paracellular traversal may also be employed. These findings enhance our understanding of the mechanics of T. pallidum attachment to endothelial cells and suggest that T. pallidum may use both paracellular and transcellular mechanisms to traverse the vascular endothelium without altering barrier permeability. A more complete understanding of this process will facilitate vaccine development for syphilis. / Graduate / 2020-06-18

Könssjukdomen klamydia är bland de vanligaste könssjukdomarna i världen. Könssjukdomen är anmälningspliktig och det ingår sjuksköterskans profession att arbeta preventivt med bland annat provtagning och smittspårning för att ständigt förebygga smittan. Syftet med denna litteraturstudie är att belysa unga vuxnas upplevelser av att testa sig för könssjukdomen. Författarna har analyserat nio vetenskapliga artiklar som resulterat i två huvudkategorier och fem underkategorier. Den första kategorin samt underkategorierna till denna var följande: Vårdrelaterade upplevelser av klamydiatestning; En känsla av okunskap; Känsla av tillit till vårdarna. Kategori nummer två löd: Psykosociala upplevelser av klamydiatestning med underkategorierna; ”Andra” människors problem; Risk för stigmatisering; Ett moraliskt ansvar. Resultatet visade att det hos unga vuxna fanns brist på kunskap kring könssjukdomen klamydia och testning kring denna. Vårdpersonalen hade i samband med testning stor inverkan och kunde påverka unga vuxnas val kring vart testet föredrogs att utföras samt av vilken befattning. Könssjukdomen visade sig också vara stigmatiserad och kunde skada relationer samt väcka känsla av skuld och skam. Litteraturstudien bidrar med att synliggöra unga vuxnas upplevelser kring testning vilket medför möjlighet för vårdpersonal att förbättra bemötandet så att en god vård kan erbjudas.

Degree of Masters in Public Health by coursework and research report Maternal and Child Johannesburg, March 2012 / Adolescent sexual behaviour related to low condom-use and early sexual debut has been a concern in the transmission of sexually transmitted infections (STIs) and HIV. Treatment-seeking behaviour is a problem in adolescents due to embarrassment and unfriendly health care services. The Birth to Twenty study group (Bt20) is a cohort of singletons born in 1990 with approximately 10% having tested positive for STIs at an early age. Their sexually activity and unprotected sex practices have increased their risk for HIV infection. The objectives of this study were to explore the perceptions, sexual behaviour and treatment-seeking behaviour of a sample of girls who had a previous STI, through their narratives. One-on-one narrative interviews were done on 19 girls with the aid of an interview schedule. A life history of their sexual encounters was documented. The interviews were taped and transcribed. Thematic analysis was performed. The majority of the girls had no knowledge of STIs before they were counselled by the Bt20 nurses yet 50% of the girls used condoms in their first sexual experiences. Once counselled, almost all the girls went on to seek treatment for their STI. A third of the girls reported poor service at the clinic and would prefer to be treated either privately or at Bt20 if possible. Information regarding the role of STIs in the transmission of HIV seems to be unclear. Improving the life orientation programme at schools with a focus on STIs and pregnancy would positively impact on HIV transmission. One-on-one counselling is effective but may not be feasible in under-resourced communities and the continued education of nurses in clinics, whilst increasing the number of adolescent friendly clinics, must be prioritised.

This dissertation discusses anti-HIV-1 microbicide research. In particular, it concentrates on microbicide formulation and delivery. Microbicides are anti-HIV-1 agents that when applied in the human vagina or rectum may prevent sexual HIV-1 transmission. Although most of the anti-HIV-1 agents being developed as microbicides are active in vitro, they have proved to be ineffective in vivo. A review of microbicide development over the last decade expounds the view that unsatisfactory microbicide failures may be a result of inefficient delivery systems employed. Thus, necessitating a thorough scientific qualitative and quantitative investigation of important aspects involved in HIV-1 transmission as a prerequisite for microbicide development. In this dissertation it is postulated that intravaginal targeting of HIV-1 increases the chances of microbicide success, wherein vaginal micro-environmental factors including pH would be maintained at HIV-1 prohibitive acidic levels to ward off other sexually transmitted diseases which compromise vaginal epithelial barrier properties. Furthermore, targeting early stages of the HIV-1 infection accompanied by computation and delivery of appropriate microbicide quantities could result in an effective microbicide formulation. In an effort to address microbicide formulation challenges, an intravaginal delivery system able to deliver anti-HIV-1 agents (zidovudine and BP36) over 28 days was formulated. This delivery system is a caplet-shaped composite system comprising zidovudine (AZT) and BP36-loaded pectin-mucin-polyethylene glycol submicrospheres embedded within a poly(D,L-lactide), magnesium stearate, polyvinyl acetate/polyvinylpyrolidone (Kollidon® SR) and poly(acrylic acid) based polymeric caplet matrix. The delivery system was tested in vitro and in vivo in the pig model. X-ray imaging illustrated the delivery system swelling and its matrix contrast fading over time as vaginal fluid permeated the matrix’s core. Plasma, vaginal fluid and tissue drug was detected and quantified using ultra performance liquid chromatography-tandem photodiode array detector. AZT plasma and vaginal fluid concentrations measured on days; 3, 7, 14, 21 and 28 decreased gradually with time. Vaginal tissue AZT concentrations (after 28 days) were higher than plasma AZT concentrations and were in the same range as vaginal fluid AZT concentrations. The herbal extract, BP36, was detected in plasma, vaginal fluid and tissue but was only qualitatively analysed due to its lack of standardization. Histopathological analysis of excised vaginal tissue revealed different scores of abnormalities comprising mild to moderate epithelial proliferation and exocytosis, subepithelial leukocyte influx, perivascular cell cuffing and isolated epithelial erosion, stromal fibrosis and isolated tissue necrosis.

Background This report examined the association and relationship between Migration, Gender and STIs among young adults in Lesotho. To achieve this, the first objective was to understand the historical trans-boundary relationship between Lesotho and South Africa and how it contributed to STIs among young adults in Lesotho. The report then described the relationship between migration and having had any STIs among young adults in Lesotho. After multivariate analysis the association, between gender and having had any STIs among young adults in Lesotho was explored for understanding. Methodology For data analysis, secondary data from the 2009 Lesotho Demographic Health Survey (LDHS) were used. The LDHS is a cross-sectional study, designed to provide estimates of health and demographic indicators at the national level, for urban-rural areas and for each of the ten districts in Lesotho. The sample size used for this report was N=6,270. The statistical methods employed for data analysis were descriptive analysis, to establish the distribution of young adult migrant groups, according to STIs, demographic, socioeconomic and sexual practices. A Chi-square test was done to test for association. And a multivariate analysis was done using the forward selection process, to examine the relationships between STIs, migration, gender and significant variables. Results Migration status was found to have an insignificant (p=0.237) association with STIs. On the other hand, after considering migration status and gender at multivariate level, migration status, specifically urban-non migrants, were found to have a significant (p<0.05) relationship with having had any STIs. Gender was found to have an insignificant (p=0.587) association with having had any STIs and an insignificant (p=0.365) relationship with having had any STIs. However at multivariate level being female was found to be 16% protective against having had any STIs. Conclusion The report found that the relationships between migration status and having had any STIs were closely linked to factors related to gender and social and cultural norms pertaining to sexual behaviour. These influences were reflected in the literature and empirical evidence of this research report.

Orientador: Lenice do Rosário de Souza / Coorientador: Hélio Amante Miot / Banca: Marli Terezinha Cassamassimo Duarte / Banca: Walter Belda Junior / Resumo: A infecção pelo HPV é a DST mais comum no mundo. Dos 630 milhões de casos novos anuais, trinta milhões são relacionados a verrugas anogenitais. Embora a forma subclínica seja mais comum, o aparecimento de condilomas também está associado à diminuição da imunidade causada pelo HIV. Tendo em vista as altas taxas de prevalência da coinfecção HPV/HIV, principalmente entre homens que fazem sexo com homens, os objetivos deste trabalho foram analisar a prevalência de verrugas anogenitais em homens portadores de HIV/aids e identificar fatores associados. Estudo transversal, descritivo e analítico com 159 homens atendidos em serviço de referência de Botucatu (SP). Dados sociodemográficos, comportamentais e clínicos foram relacionados ou não à presença de verrugas anogenitais. Após análise hierárquica dos dados, as variáveis com valor de p menor do que 0,2 foram incluídas no modelo logístico multivariado não condicional. Foram diagnosticados 49 (31,0%) pacientes HIV+ com verrugas anogenitais, cuja média de idade foi de 44,6 ± 9,6 anos. Os principais fatores associados às verrugas foram: escolaridade menor que ou igual a oito anos; maior tempo de diagnóstico do HIV; tratamento antirretroviral irregular; baixas contagens de linfócitos T CD4+. Verrugas anogenitais são prevalentes e relacionadas à imunossupressão da infecção pelo HIV. Ações como o cuidado integral do paciente e educação e prevenção em saúde colaboram para diagnóstico precoce e diminuição da vulnerabilidade a DSTs / Abstract: HPV infection is the most usual STD in the world responsible for 630 million new cases annually, of which 30 million are related with anogenital warts. Although subclinical form is the most common, warts are also associated with reduction of HV-related immunity. There are high rates involving prevalence of the association HIV/HPV around the world. Following this point of view the aim of this study was analyze the prevalence of wart in HIV-infected men and describe the associated factors. cared by a reference service in the Botucatu city - São Paulo/Brazil. Sociodemographic, behavioral and clinical data were collected by an individual interview and medical records. There were 49 (31,0%) HIV-infected men with anogenital warts with mean age of 44,6 ± 9,6 years. The main associated factors were: have up to 8 years of study; longer duration of HIV-infection; irregular treatment to HIV-infection; lower counts of lymphocytes T CD4+. Genital warts are prevalent and are associated with HIV- infection magnitude. Actions such as the complete care over the patients, increasing the education and prevention in health system could help to do a previously, diagnosis and decreasing the vulnerability to STD / Mestre

Introdução: A infecção pelo vírus da hepatite C é atualmente um dos maiores problemas de saúde pública em todo o mundo. Sua principal via de transmissão é a parenteral, por meio da transfusão de sangue e hemoderivados e pelo uso de drogas injetáveis. A transmissão por via sexual é controversa e vem sendo objeto de estudos nos últimos anos. Objetivo: Avaliar a frequência do vírus da hepatite C em portadores de doenças sexualmente transmissíveis, correlacionar os achados sorológicos da população estudada com os fatores de risco para transmissão do vírus da hepatite C e analisar o papel da via sexual como meio de transmissão da doença. Casuística e Métodos: O estudo foi realizado em 1.000 pacientes portadores de doenças sexualmente transmissíveis atendidos no Centro de Saúde Escola Geraldo Paula Souza da Faculdade de Saúde Pública da Universidade de São Paulo e no Ambulatório de Doenças Sexualmente Transmissíveis da Divisão de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, no período de janeiro de 2004 a dezembro de 2006. Os pacientes foram entrevistados para identificação de fatores de risco para transmissão do vírus da hepatite C e foram colhidas amostras para realização de sorologia para hepatite C e HIV. Os dados coletados incluiram idade, orientação sexual, antecedente pessoal de transfusão de sangue ou hemoderivados antes de 1993, antecedente pessoal de uso de drogas injetáveis e a presença de tatuagem ou piercing. Resultados: Do total de 1.000 pacientes estudados, 44 (4,4%) apresentaram sorologia positiva para hepatite C. A avaliação do subgrupo de pacientes que não apresentava fatores de risco para transmissão do vírus da hepatite C apresentou taxa de soropositividade de 3,68% Os fatores de risco estatisticamente significantes (p<0,05) na população estudada foram o uso de droga injetável, infecção pelo HIV e idade igual ou superior a 29 anos. Conclusão: Em nosso trabalho, com a aplicação de modelo logístico multivariado, os fatores de risco estatisticamente significantes para transmissão do vírus da hepatite C foram o uso de droga injetável, infecção pelo HIV e idade igual superior a 29 anos, resultados semelhantes aos dados de literatura. Não foram estatisticamente significantes as associações entre presença de tatuagem, presença de piercing, orientação sexual e positividade ao anti-VHC. As taxas de prevalência observadas na população total estudada, bem como no subgrupo dos pacientes sem fatores de risco para hepatite C são maiores que as taxas observadas em estudos populacionais, o que nos permite inferir que a via sexual, embora secundária, deva ser considerada como possível via de transmissão do vírus da hepatite C / Introduction: The infection caused by the Hepatitis C virus (HCV) is currently one of the major issues in public health all over the world. The viruss main route of transmission is parenteral, either by transfusion of blood and blood products or by intravenous drug use. The transmission of HCV by sexual contact is questionable, and has become the focus of recent studies. Objective: To evaluate the rate of hepatitis C virus detection in patients with sexually transmitted diseases, and to correlate the serologic findings with risk factors for acquiring the HCV, in order to study the role of the sexual contact as a mode of transmission of the virus. Methods: One thousand patients with sexually transmitted diseases who regularly attended the outpatient clinic of the University of São Paulo School of Public Health and the Division of Dermatologys outpatient clinic for Sexually Transmitted Diseases at the University of São Paulo Clinics Hospital were admitted to the study, from January 2004 to December 2006. Patients were enquired about risk factors for hepatitis C virus acquisition. Analyzed data included age, sexual orientation, blood or blood product transfusion before 1993, intravenous drug use and presence of tattoos or body piercing. Blood samples were then collected for both hepatitis C and HIV serologic testing. Results: Forty-four of the 1,000 patients studied (4.4%) had positive hepatitis C virus serology. Among those patients with no risk factors for hepatitis C infection, the rate of positive serology was 3.68%. Risk factors significantly associated (p<0.05) with hepatitis C virus acquisition were: intravenous drug use, concomitant HIV infection and age 29 years or greater. Conclusions: Through a multivariate analysis, our study showed that the risk factors with a statistically significant correlation with hepatitis C virus positivity were intravenous drug use, HIV infection and age 29 years or greater, which were similar to those described in other studies. There was no significant association between HCV positivity and tattoos, body piercing or sexual orientation. However, the prevalence of hepatitis C virus in our study population and in the subgroup of patients with no risk factors was higher than the prevalence in other populational studies. These results suggest that sexual contact should be considered as a possible mode of hepatitis C virus transmission, even though it may have a secondary role