Thesis (MPH) -- University of Limpopo, 2011. / Introduction STIs, including easily treatable bacterial infections such as syphilis and gonorrhoea, continue to cause a huge burden of ill health in both developing and developed countries. Syndromic management is currently the best approach for the management of sexually transmitted infections in developing countries, but its successful implementation is often questionable Objectives The overall aim of this study was to assess and compare the quality of STI services in the primary health care clinics in Leribe district, Lesotho. The specific objective of the study was to assess the availability of STI drugs, clinicians’ knowledge of STI management, and the availability of STI examination equipment Methods A descriptive cross-sectional quantitative study was conducted with 23 nurse clinicians in PHC clinics in Leribe district of Lesotho. This study explored the gaps and issues around the provision of syndromic management of STIs using the DISCA tool. Results Most of the facilities have inadequate and non reliable equipment and supplies as well poor and inadequate infrastructure. There is lack of continuous training on STI management, low complete treatment to STI clients with only a few of the health centres giving complete treatment and there was also poor contact tracing of partners. Almost all clinicians cited the correct treatment for managing male urethral syndrome. Conclusion The lack of continuous training compromised STI management because nurse clinicians lacked skills to provide quality services. In general, although the principles of syndromic management are well understood by most clinicians, there are no systems in place to support the use of these guidelines

ABSTRACT Introduction: Sexually transmitted infections (STI) are a major public health concern because they are frequent, with high prevalence and incidence; they can result in serious complications and sequaelae; they have social and economic consequences; and a number of STIs have been identified as facilitating the spread of HIV. STI’s are a major public health concern in South Africa, accounting for about 11 million cases annually. It is estimated that approximately 5.3 million South Africans were infected with HIV at the end of 2002 and controlling STI by a steady supply of resources, among other interventions, could contribute to lowering of the incidence of HIV. Methods: The study was a cross-sectional descriptive survey of fixed primary health care clinics offering STI services in three sub-districts of the Johannesburg Metro. A convenient sample of 22 fixed clinics was surveyed. The 11 Johannesburg Metro sub-districts were stratified according to suburban, township and inner-city. Descriptive statistics were used to analyse the data. These were proportions(percentages) to summarise categorical data; and means were used to summarise numerical variables Results: All facilities had adequate equipment except for two clinics (10% of facilities), one in region 10 and the other in region 8. More than 70% of PHC facilities had clinical management guidelines in every consultation room. Over 60% of clinics reported having no IEC materials written in local language. All facilities had condoms strategically located in accessible places and only two reported condom stock-outs. Two clinics reported drugs stock-outs prior to assessment and only one reported drug stock-outs during the assessment. All the clinics offered services between 7am and 4pm daily and more than 80% of clinics offered counselling and HIV testing. Partner notification was a problem in facilities in all the regions.

En sexuellt överförbar infektion (STI) kan drabba alla människor vid oskyddat sex oberoende av ålder, kön och sexuell läggning. Unga vuxna mellan 20-29 år är en speciellt utsatt grupp när det gäller att smittas av en STI. De vanligaste STI bland unga vuxna är klamydia, kondylom och genital herpes och obehandlade kan dessa infektioner leda till komplikationer och infertilitet. Syftet med studien var att undersöka och belysa unga vuxnas kunskaper och attityder om STI. Som metod i studien har fokusgruppsintervjuer tillämpats. Deltagarna var unga vuxna kvinnor och män i åldersgruppen 20-26 år från folkhögskolor. Materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultatet presenteras utifrån de sex kategorier som framkom i analysen. Resultatet visar att unga vuxna vet hur STI smittar och de vet var de ska söka information men de önskar att de visste mer. De unga vuxna tror att orsaken till att fler drabbas av en STI beror på att kondom används mer sällan och att om de skulle drabbas så är infektionen lätt att bota. När de unga vuxna går och testar sig anpassas efter sexlivet. De är mer rädda för att drabbas av en STI vid en utlandssemester då de inte känner samma trygghet som när de är hemma. Konklusionen med studien är att unga vuxna inte är rädda för att drabbas av en STI. De vet att STI kan smitta vid sexuellt umgänge men är inte så noga med att använda kondom. En förändring av unga vuxnas attityder till STI och en mer positiv syn på kondomanvändning kan påverka smittspridningen av STI i samhället.

Within the span of a single human lifetime, we have discovered that DNA is the basis of genetic inheritance, deciphered the genetic code, and determined the entire sequence of multiple human genomes. However, we still have only a basic understanding of many of the processes that regulate DNA structure, function, and dynamics. The work presented in this dissertation describes the roles of two sets of genes that regulate the expression of genetic information and its transmission from one generation to the next.The condensin II complex has been implicated in the maintenance of genomic integrity during cell division and in transcriptional regulation during interphase. These roles stem from its ability to regulate chromosome structure though the mechanisms of this regulation are unclear. Evidence suggests that it is important for chromosome condensation and segregation during mitosis and meiosis. We have shown that this complex regulates the condensation of chromosomes during interphase. Its ability to reduce chromosome axial length provides a mechanism for the establishment of chromosome territories. We have also shown that condensin II differentially regulates interactions between homologous and heterologous DNA sequences. These findings contribute to our understanding of the overall structure of the nucleus, the regulation of chromosome structure, and the regulation of gene expression.The function of the Drosophila gene, sticky, is poorly understood. It contributes to cytokinesis by phosphorylating myosin II, but it also has a role in the regulation of chromatin structure. Mutations in sticky are associated with a wide range of developmental abnormalities. We provide evidence that this gene regulates the expression of numerous other genes which contribute to the phenotypes observed when sticky is mutated. We also show that sticky function overlaps with that of dfmr1, an ortholog of the gene associated with the most common form of human mental retardation. These findings contribute to our understanding of transcriptional regulation in chromatin and its implications in development and disease.

The health risks associated with sexual behaviour may be prevented by strengthening the individual's identity, self-esteem and the ability to handle relationships. Increase of the use of condoms among youth and young adults, 15 to 29 year olds, may reduce the spread of the most common sexually transmitted infection (STI); chlamydia. The project “love ambassadors” are situated at Mälardalen University and works according to “the peer-to-peer education”, which means that students educate other students. The theoretical perspective of this study is the “diffusion theory”, which involves the dissemination of knowledge and “Self-efficacy” which includes a self-belief of the individuals own ability to influence events that has effects on the individual's life. The purpose of this study was to investigate in which extent college students are testing for STI and HIV and furthermore, if there were gender differences. Moreover, the students were asked about if they considered any specific need for more knowledge about sexual health issues. The study was performed through a quantitative method, with a cross-sectional studydesign. Secondary data was used from a web-based survey, provided by the County council of Sörmland. Results revealed that the most sought knowledge among students regarding sexual health issues is about STI is infectious, and advises regarding relationships.   Keywords; college students, cross-sectional study, Love Ambassadors, self-efficacy, sexuality, STI. / De hälsorisker som kan förknippas med sexuellt beteende kan förebyggas genom att stärka individens identitet och självkänsla samt förmågan att hantera relationer till andra människor. Att öka kondomanvändningen bland unga och unga vuxna, 15 till 29 år, är ett sätt att minska smittspridningen av klamydia som är den vanligaste förekommande sexuellt överförbara infektionen (STI). Projektet Kärleksambassadörerna verkar på Mälardalens högskola och arbetar enligt metoden peer-to-peer education som innebär att studenter utbildar studenter. I denna studie beskrivs diffusionsteorin som handlar om spridningen av kunskap och self-efficacy som innebär tron på den egna förmågan att kunna påverka händelser som influerar individens liv. Syftet med denna studie var att undersöka utsträckning av testningen av STI och hiv bland högskolestudenter och om det fanns könsskillnader samt vilken kunskap om sexuell hälsa som efterfrågas. Som metod valdes en kvantitativ ansats med en tvärsnittsdesign. Sekundär data användes från en webbaserad enkätstudie som tillhandahölls från Landstinget Sörmland. Resultatet visar att den mest efterfrågade kunskapen gällande sexuell hälsa bland studenterna gäller smittvägar för STI och hur man får en relation att fungera bra.      Nyckelord: högskolestudenter, Kärleksambassadörerna, self-efficacy, sexualitet, STI, tvärsnittsstudie.

Thesis (MPH)--University of Limpopo, 2010. / The primary purpose of Youth Centers is to provide adolescent reproductive health services, which includes equipping the youth with life-skills and knowledge that has potential to prevent the spread of HIV infections. The Adolescent Reproductive Health program of the Y centers includes information on sexual health, teenage pregnancy (including CTOP) and STI’s. These Youth Centers are located in various locations in South Africa, Mabopane being one. Y centers operates from the premise that, because information alone is not enough to make young people change behavior, young people also need the attitudes, motivation and negotiating capacity to put what they know into practice. Life Skills, a program that focuses on enabling young individuals to deal effectively with the demands and challenges of everyday life, is a key aspect of the program in youth centers. The program deals with building skills such as self-esteem, problem solving, assertiveness, and negotiation skills that are useful to young people in their everyday lives. This study evaluated the implementation of the youth program at the Odi Youth Center, which is in Mabopane, as well as the impact of the center on the lives of young people who utilize these services. The positive findings of the study were that young people in the area value the services offered at the centre and are grateful to this facility, crediting it with having provided them with knowledge and skills that enable them to deal with sexual and other social matters. However, they stated that the impact would be greater if the centre could open for longer periods during the week and also on Saturdays. HIV and AIDS education, which is a significant component of Youth Center programs, is provided by professional nurses who are employed by the Department of Health (North West Province). The centre also offers HIV counseling and testing, access to contraceptives including provision of condoms, diagnosis and treatment of STI’s. Young people reported that their knowledge of HIV is good because of the lessons they get from the centre. The study found the following areas of concerns, a. that the program implementation and activities do not follow a specific structure and occur haphazardly b. record keeping is poor c. the clinic staff who have been mandated to run the program have not been trained on the loveLife principles and youth friendly clinics d. the hours of operation for the Y center limits participation by the youth

Bakgrund: Varje år inträffar det cirka 330 miljoner fall av sexuellt överförbara infektioner i världen. I Sverige har klamydiafallen tredubblats de senaste tio åren. Sveriges befolkning har blivit sämre på att använda kondom vid sexuella samlag. Syftet: Syftet med litteraturstudien var att beskriva riskbeteenden kring sexuellt överförbara infektioner bland ungdomar och unga vuxna i Sverige. Metod: Artiklar samlades in genom en systematisk litteratursökning i databasen Pubmed. Materialet bearbetades och analyserades utifrån syftet och frågeställningar. Resultat: Det framkom fyra teman som bildade resultatet, flera tillfälliga sexuella partners, negativa attityder mot kondomanvändning, ignorans mot negativa effekter på den sexuella hälsan samt okunskaper om riskerna. Resultatet visade att ungdomar och unga vuxna hade fler tillfälliga sexuella partners nu än tidigare. En negativ syn på kondomanvändning fanns hos ungdomarna. Anledningar till att inte använda kondom vid sexuellt samlag var att kvinnan använde hormonella preventivmedel, pinsamhet i att köpa kondomer, priset och att det minskade nöjet i sexet. Ungdomar och unga vuxna har blivit mer nonchalanta mot riskerna i den reproduktiva hälsan. Under det senaste året hade 76 procent av unga män i Sverige haft sexuellt samlag med en ny partner utan att använda kondom. Det fanns okunskaper om riskerna kring sexuellt överförbara infektioner. Konklusion: Sammanfattningsvis har sexuella samlag utan att kondom används fördubblats de senaste 20 åren i Sverige och det med takt att individer också har fler tillfälliga sexuella partners. Implikationer: Ett förslag till fortsatt forskning är att utveckla skolans sexualundervisning kring riskbeteenden i den sexuella hälsan, eftersom att skolan anses vara den största arenan där ungdomar inhämtar information om den reproduktiva hälsan.

N. Gonorrhoeae is a major public health concern due to its capacity to develop antibiotic resistance and its potential complications including pelvic inflammatory disease, epididymitis, infertility, and disseminated infection. In order to keep up with resistance trends, the treatment recommendations for gonorrhea have changed frequently. In other areas of medicine, guideline adherence has been shown to be limited, even without frequent guideline changes. In the case of gonorrhea, inappropriate treatment can have serious individual and public health implications, making the quality of and compliance with clinical guidelines critical. This thesis is a three-part mixed methods research project assessing the development and uptake of gonorrhea treatment guidelines. We conducted a systematic review of current gonorrhea treatment guidelines and used the AGREE II tool to assess the quality of guideline development (Chapter 2). We observed that guideline quality varied greatly with many guidelines having weaknesses in their use of existing evidence to develop recommendations, their reporting of potential conflicts of interest and how they were addressed, and their consideration of barriers to the implementation of their recommendations. We then assessed physician adherence to first-line treatment recommendations in Ontario by conducting a segmented time series analysis of Ontario gonorrhea treatment data from iPHIS, the province’s reportable disease database (Chapter 3). Following the introduction of new guidelines that recommended substantial changes from current practice, we found very dramatic drops in guidelines adherence that then improved slowly over time. We then explored the use of process mapping as a tool to look at the local management of cases in the City of Ottawa by following them across the various possible treatment pathways (Chapter 4). Here, we noted differences in practice between the management of cases at Ottawa Public Health’s Sexual Health Clinic and the management of cases elsewhere in the community.

Indiana University-Purdue University Indianapolis (IUPUI) / Idiopathic urethritis (IU) comprises up to 50% of symptomatic cases of male urethritis in clinical settings. The syndrome is of an unknown etiology but may be due to an as yet unidentified bacterial pathogen(s). We were interested in identifying pathogens that could cause IU using multiple methods. Shotgun metagenomic sequencing or 16S rRNA sequencing methods can provide rich datasets but are limited by the completeness of the corresponding sequence reference databases. We generated metagenomic and 16S datasets from DNA extracted from urethral swabs of men with IU to determine the composition of their urethral microbiome. In order to enrich the corresponding reference databases used to identify the reads in the sequence datasets, I cultivated bacteria from the first void urine (FVU) of men with IU. My goal was to grow and whole genome sequence bacterial isolates that are not currently represented in the reference databases. Of the 216 men we enrolled at the Bell Flower STD clinic in Indianapolis, IN, 59 men had IU. I grew a total of 802 isolates from the FVU of the IU patients and identified those isolates using colony-based 16S rRNA PCR. Based on % sequence similarity to the nearest type strain, I sorted the 16S alleles into four categories: Species (≥98 % identity) (N=264), Genus (≥95 % identity) (N=407), Closest Match (<95 % identity) (N=95), and No Hit (0 % identity) (N=22). There were 24 genera represented in the isolate collection. Of these, the six most abundant genera were Streptococcus, Staphylococcus, Corynebacterium, Haemophilus, Gardnerella, and Prevotella. These six genera composed nearly 80% of all IU-associated isolates. All sequences below 98% sequence similarity represent potentially novel strains of bacteria. We will proceed with whole genome sequencing of bacterial isolates with the goal of improving genome database coverage of bacterial diversity in the male urethra.

SAMMANFATTNING  Det förekommer en ökning med sexuellt överförbara infektioner (STI), främst gonorré bland ungdomar i Sverige. För att minska förekomsten av STI bland ungdomar krävs effektiva preventiva åtgärder, kontroll och ett effektivt samarbete. Sexuell och reproduktiv hälsa är lika viktigt som den psykiska, fysiska och sociala hälsan, samt utgör en grundläggande del av människors allmänna hälsa och välbefinnande.   Syftet med studien är att undersöka aktörers uppfattningar om ungdomarnas kunskap om STI-prevention och hur aktörerna arbetar förebyggande med STI. För ett systematiskt tillvägagångssätt i studien används en kvalitativ metod baserad på målstyrt urval för att besvara syftet. Därmed genomfördes en semistrukturerad intervju vid datainsamlingen med totalt sex deltagare från professioner inom ungdomsmottagning och elevhälsan i två olika regioner. Därefter analyserades den insamlade data med en manifest innehållsanalys där två huvudkategorier; Aktörerna vill arbeta med STI-prevention och Ungdomars kunskap om STI och STI-prevention räcker inte framkom.    Resultaten visar att ungdomars kunskap om STI varierar enligt aktörernas uppfattning, trots kunskaper underskattar ungdomar ofta risken att drabbas av STI. Det framkom också att ungdomarnas kunskap om STI-prevention påverkas av olika riskfaktorer såsom alkoholkonsumtion, vänskapskretsen och tidig sexuell aktivitet, vilket hindrar effektiviteten av skyddsfaktorer. Aktörerna vill arbeta med STI-prevention på olika arenor och har specifika insatser för olika grupper. Dock framkom brist på samverkan som ett hinder för att nå ut till fler. För ett effektivt förebyggande arbete krävs det en gemensam riktlinje och strategier i aktörers arbete som skapar bättre förutsättningar för ungdomar kring STI. / ABSTRACT  There is an increase in sexually transmitted infections (STI), mainly gonorrhea among young people in Sweden. To reduce the incidence of STIs among adolescents, effective preventive measures, control and effective cooperation are required. Sexual and reproductive health is as important as mental, physical and social health, and makes a fundamental part of people's well-being and overall health.   The aim of the study is to investigate actors' perception of adolescents' knowledge of STI-prevention and how they work preventively with STIs. For a systematic approach in the study, a qualitative method based on purposive sampling is used. Thus, a semi structured interview was carried out during the data collection with a total of six participants from professions in youth health clinics and school health services in two different regions. Then the collected data was analyzed with a manifest content analysis where two main categories; The actors aim to work with STI-prevention and Adolescents' knowledge of STIs and STI-prevention is not enough emerged.   The results show that adolescents' knowledge of STIs varies according to the actors' perception, despite knowledge adolescents often underestimate the risk of contracting STIs. It also emerged that adolescents' knowledge of STI-prevention is affected by various risk factors, which hinders the effectiveness of protective factors. The actors aim to work with STI prevention in different arenas and have specific initiatives for different groups. However, a challenge in reaching out to more people has risen due to a lack of cooperation. Effective preventive efforts require a common guideline and strategies in the work of actors that create better conditions for young people around STIs.