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.

This study explored Childline Zimbabwe’s provision of psychosocial support to sexually abused children. This was done by reviewing counsellors’ practices regarding face-to-face counselling, counselling approaches, referrals, follow-ups, case recording and through measuring client satisfaction levels. A qualitative case study approach was adopted with mixed methods to collect data from counsellors and clients. Data analysis was informed by grounded theory and followed an inductive process of coding and categorising the data into relevant themes. The outcomes of this study showed that referral of clients represents a major strategy of addressing child sexual abuse cases. The engagement of clients in face-to-face counselling stages however remained limited due to difficult work environments and challenges related to individual counsellors’ capacities. This posed questions about Childline’s role as a counselling or referral organisation. This study contributes to counselling of sexually abused children with information over the counselling interventions necessary in addressing survivors of sexual abuse. / Psychology / M. A. (Psychology)

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

Vivenciando no dia-dia que o número de casos das infecções sexualmente transmitidas (IST) e da aids vem aumentando em todo mundo e na África, principalmente na população jovem, é imprescindível a tomada de medidas preventivas para seu controle. Assim, desenvolvemos este estudo do tipo descritivo transversal com o objetivo de identificar os conhecimentos e risco para IST e aids entre estudantes de nível médio. O referencial teórico foi o “o Modelo de Crenças em Saúde" que compõe as dimensões de susceptibilidade percebida, severidade percebida, benefícios percebidos e barreiras percebidas. A população estudada constituiu-se de 385 estudantes, pertencente a três escolas de ensino médio. A coleta dos dados ocorreu no período de maio a junho de 2004 e os dados analisados quali-quantitativamente. Para análise quantitativa, os dados foram codificados e registrados numa base de dados e tratados em estatística descritiva. Quanto aos dados qualitativos foram tratados com base no Método de BARDIN (1977), sendo analisados e interpretados utilizando o referencial teórico do Modelo de Crenças em saúde de Rosenstock (1974a). Quanto às características demográficas, 59,9% dos estudantes eram do sexo feminino, 49,1% do sexo masculino, a idade variou entre 13 e 45 anos, 83,9% referiram ser solteiros. Com relação às práticas sexuais, 77,4% dos alunos investigados eram sexualmente ativos, sendo que 51,6% mencionaram nunca terem usado ou usado algumas vezes o preservativo; 66,7% referiram nunca terem usado e ou usado algumas vezes o preservativo com o parceiro fixo; 55,3% perceberam o risco de adquirir as IST/ aids. Quanto as informações acerca das IST /aids 95,8% dos respondentes já ouviram falar da aids, 95,3% de sífilis, 92,9% de gonorréia, 58,1% de hepatite B, sendo que 90,1% dos informantes tiveram como fonte de informação a televisão, 85,4% o radio, 78,4% os amigos, 74,5% os livros, 65,9% o jornal. Quanto à susceptibilidade, através dos enunciados dos participantes referiram perceber a sua vulnerabilidade e risco em adquirir IST/ aids. No tocante à severidade percebida, os estudantes associaram a aids a doença sem cura e à morte. Os informantes demonstram terem tido conhecimentos sobre os modos de transmissão e medidas preventivas das principais IST, porém bastante limitados. Sobre benefícios percebidos, foram mencionados pelos investigados alguns fatores facilitadores do uso do preservativo, como meio de prevenção e método contraceptivo, para além da citação de algumas barreiras percebidas como, a dificuldade no uso do preservativo. Diante destas situações, é imprescindível a implementação de programas educativos de prevenção com vistas à promoção da saúde. / Experiencing in everyday life that the number of cases with sexually transmissible infections (STI) and aids is increasing all over the world and in Africa, mainly in the juvenile population, preventive measures are essential for their control. Thus, this escriptive and cross-sectional study aimed to identify knowledge and risk of STI and aids among secondary students. The theoretical reference framework was the “Health Belief Model", which covers the dimensions of perceived susceptibility, perceived severity, perceived benefits and perceived barriers. The study population consisted of 385 students from three secondary schools. Data were collected in May and June and subject to qualitative and quantitative analysis. With a view to quantitative analysis, data were coded, registered in a database and treated by means of descriptive statistics. In qualitative analysis, data were treated on the basis of BARDIN’s method (1977) and analyzed and interpreted through the theoretical reference framework of ROSENSTOCK’s (1974 a) Health Belief Model. With respect to demographic characteristics, 59.9% of the students were women and 49.1% men, ages ranged from 13 to 45 years and 83.9% mentioned they were single. What sexual practices is concerned, 77.4% of the investigated students were sexually active; 51.6% indicated they had used the condom never or a few times; 66.7% mentioned they had used the condom never or a few times with their fixed partner; 55.3% perceived the risk of acquiring STI/aids. As to information about STI/aids, 95.8% of the respondents had already heard about aids, 95.3% about syphilis, 92.9% about gonorrhea and 58.1% about hepatitis B. 90.1% of the informants obtained their information from television, 85.4% from radio, 78.4% from friends, 74.5% from books and 65.9% from newspapers. With respect to susceptibility, the participants’ discourse indicated they perceived their vulnerability and risk of acquiring STI/aids. What perceived severity is concerned, students associated aids to an incurable disease and to death. The informants demonstrated their knowledge about transmission modes and measures to prevent the main STI, although quite limited. As to perceived benefits, the participants mentioned some facilitating factors of condom use as a means of prevention and contraceptive method. Furthermore, they indicated some perceived barriers as difficulties for condom use. In light of these situations, educational prevention programs have to be implemented with a view to health promotion.

Este trabalho teve como objetivo principal avaliar o sêmen da jararaca ilhoa, Bothrops insularis, quanto ao volume, motilidade, vigor e concentração, além de verificar se estes paramentos estão relacionados ao comprimento ou massa dos animais ou se variam ao longo das estações, uma vez que esta espécie possui ciclo reprodutivo sazonal. Para tanto, foram avaliadas amostras de sêmen de 18 machos, com comprimento rostro-cloacal (CRC) variando de 43,5 a 73,70 cm, pertencentes ao plantel do Laboratório de Ecologia e Evolução do Instituto Butantan, entre os meses de agosto de 2012 e maio de 2013. O sêmen de Bothrops insularis apresentou coloração variando de esbranquiçada a amarelada e consistência cremosa e espessa. Foi possível observar amostras de sêmen viáveis em todos os 18 animais avaliados, indicando que animais com CRC igual ou acima de 43,5 cm já são sexualmente maduros. O espermatozoide de Bothrops insularis é filiforme, possui cabeça alongada, fina e com formato pontiagudo, seguindo o padrão morfológico descrito para outros Squamata. Não foi observada nenhuma relação entre o comprimento, massa e cada um dos parâmetros seminais avaliados. Foi observada variação significativa da motilidade e da concentração do sêmen de Bothrops insularis entre as estações, porém o volume e o vigor do sêmen não variaram. Foi no outono, época de cópula da espécie, que o sêmen apresentou as maiores médias para os parâmetros avaliados. / This study aimed to evaluate sperm parameters of the golden lancehead, Bothrops insularis, including appearance, sperm motility, vigor, volume and concentration, determine if these parameters varied with body size or weight and to verify whether these vestments vary throughout seasons, since this species has a seasonal reproductive cycle. Samples of semen of 18 males with snout-vent length (SVL) ranging from 43.5 to 73.70 cm, belonging to the squad of the Ecology and Evolution Laboratory at Instituto Butantan, were collected between August 2012 and May 2013. Sperm color from Bothrops insularis ranged from whitish to yellowish, and a creamy and thick consistency. Viable sperm was observed in samples from all 18 males evaluated, indicating that animals with SVL equal to or above 43.5 cm are sexually mature. Sperm of Bothrops insularis is thready, has elongated, thin and pointed shaped head, following the morphological pattern described for other Squamata. No relationship between length, mass and each of seminal parameters evaluated was observed. Significant variation of concentration and motility of semen from Bothrops insularis between seasons was observed, but volume and vigor did not change. It was during Fall, mating season of the species, that sperm had the highest means for all parameters evaluated.

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

Foram obtidos dados clínico-demográficos, swab vaginal e sangue de 302 mulheres. Detectou-se Mollicutes, Mycoplasma hominis e M. genitalium em 76,2%, 15,9% e 1,7% das amostras respectivamente. Frequência de 31,8% e 28,1% na qPCR foi encontrada para M. genitalium e M. hominis respectivamente. A infecção por micoplasmas foi associada a sinais e sintomas clínicos. A frequência de Trichomonas vaginalis Neisseria gonorrhoeae Gardnerella vaginalis e Chlamydia trachomatis foi de 3,0%, 21,5%, 42,4%, 1,7% respectivamente. Co-infecção destas espécies com micoplasmas foi encontrada. No polimorfismo da IL-1b, houve maior prevalência do genótipo CC, no entanto, o alelo T foi relacionado ao pequeno aumento dos níveis da interleucina no grupo caso. Para o polimorfismo de IL-6, o genótipo GG apresentou maior frequência, e o genótipo GC foi associado ao aumento dos níveis plasmáticos da citocina no grupo caso. O aumento dos níveis de IL-1b foi associado à presença M. hominis e ao fato das mulheres apresentarem sinais ou sintomas de infecção. / Clinical and demographic data, samples of vaginal swab and peripheral blood were obtained from 302 women. Mollicutes, Mycoplasma hominis and M. genitalium were detected in 76.2%, 15.9% and 1.7%, respectively. Frequency of 31.8% and 28.1% in qPCR was found for M. genitalium and M. hominis respectively. Infection by genital mycoplasmas, especially when analyzed by qPCR, was significantly associated with clinical signs and symptoms of sexually transmitted infections. The frequency of Trichomonas vaginalis, Gardnerella vaginalis, Neisseria gonorrhoeae and Chlamydia trachomatis was 3.0%, 21.5%, 42.4% and 1.7% respectively. Co-infection among these species and mycoplasmas was founded. In polymorphism of IL-1b, the genotype CC was more prevalent; however, the T allele was related to small increase of the interleukin levels in the group case. In the polymorphism of IL-6, higher frequency was of the genotype GG, and the GC genotype was associated with increased plasma levels of the cytokine in the group case. Increased levels of IL-1b were associated with presence of M. hominis and signs and/or symptoms of infection.