5 Records out of 22207 Records

Sexually transmitted infections and the associated risk factors among young women aged 18-24 years in Kisumu City Kenya

Author: Ombati, Everlyne Nyaboke

Awarding University: Jomo Kenyatta University of Agriculture and Technology, Kenya

Level : MSc

Year: 2011

Holding Libraries: Jomo Kenyatta University of Agriculture and Technology Library ;

Subject Terms: Women ; Sexually transmitted diseases ; HIV infection ; AIDS (Disease) ; Risk ; Kisumu, Kenya ; Health education ; Neisseria gonorrhoeae ; Chlamydia trachomatis ; Syphilis ; Condoms ;

Abstract:

Sexually transmitted infections including HIV/AIDS are common in developing countries. Young women continue to be one of the populations at greatest risk for HIV infection. The STIs and HIV epidemics are inter-dependent. Behaviours such as frequent unprotected intercourse with different partners, place people at high risk of both infections, and there is clear evidence that conventional STIs increase the likelihood of HIV transmission. The main objective of this study was to investigate the prevalence of and risk factors for STIs among young women (aged 18-24 years) in Kisumu city. This was a cross-sectional analysis of 312 women screened for participation in a phase 1 randomized placebo controlled microbicide trial. Prevalent cases of gonorrhea, chlamydia, trichomoniasis were identified through Nucleic acid amplification test (NAA T), HIV and herpes simplex virus (HSV)-2 were diagnosed using enzyme linked immunosorbent assay (ELISA), syphilis was tested using rapid plasma reagin (RPR) test, bacterial vaginosis was identified through Nugent scoring criteria and yeast infection was identified through wet mount. Demographic information and behavioral risk factors were assessed using structured questionnaires. Data analysis was carried out using Epi InfoTM version 3.3. Results showed that herpes simplex virus type 2 was the most prevalent STI at 30.4%, HIV was 6.7%, in addition, non-classical STIs such as bacterial vaginosis and yeast infection were diagnosed in 19.9% and 10.6% of the women, respectively. Neisseria gonorrhoeae and syphilis had a prevalence of 0.6% while Chlamydia trachomatis was 4.5%. In bivariate analysis results indicated that, sexual debut before 18 years of age, HSV-2 sero-positivity, and low levels of education were associated with HIV infection. Whereas in multivariate analysis, only HSV -2 sero-positivity (Adjusted (A) OR 7.295% CI 2.0-26.4) was associated with HIV infection. Being married was the only risk associated with HSV-2 sero-positivity (AOR 8.6, 95% CI 1.8-39.8) in multivariate analysis. In conclusion, from the data above HSV -2 is the most prevalent STI in young women aged 18-24, where as HSV -2 and HIV as the most prevalent co-infections. Factors such as early sexual debut and low levels of education are the high risk factors for HSV -2 and other STIs. Based on these findings, issues such as advocacy for delayed sexual debut, condom use and development of female-controlled methods need to be an integral part in interventional strategies such as educational campaigns which are aimed at minimizing the risk of sexually transmitted infections.

Analysis of serovar-specific immunity to Neisseria gonorrhoeae.

Author: Fudyk, Trevor Charles

Awarding University: University of Manitoba, Canada

Level : PhD

Year: 2002

Holding Libraries: University Microfilms International ;

Subject Terms: Immunology ; Neisseria gonorrhoeae ; Neisseria infections ; Gonorrhea ; Pumwani, Nairobi, Kenya ;

Abstract:

Infection with Neisseria gonorrhoeae constitutes an important cause of morbidity in human populations. The Porin protein (Por) is the major outer membrane protein of the gonococcus and displays considerable antigenic diversity among gonococcal strains. Two hypotheses to explain the diversity and dynamics of gonococcal populations is that protective, serovar- specific immunity, mediated by antibody to Por, develops following gonococcal infection, and that the development of protective immune responses within the core group act as a selective force for por antigenic heterogeneity in the gonococcal population. One core group in which gonococcal epidemiology has been studied extensively includes a collection of women working the commercial sex trade in the lower socioeconomic district of Pumwani in Nairobi, Kenya. Two experimental strategies were used to evaluate these hypotheses in a more recent longitudinal study of these female, sex workers in Nairobi, Kenya. The first line of experiments sought to examine the nature and distribution of genetic polymorphism in the Por genes of the gonococcal serovars infecting the Nairobi cohort. Nucleotide substitutions were observed predominantly in surface-exposed encoding segments of the 1a and 1b por genes. The majority of substitutions, particularly those occurring in surface- exposed encoding gene segments, resulted in amino acid change. The second line of experiments sought to determine the effect of the antibody response to por on serovar-specific gonococcal infection. Cohort women were assayed for baseline antibody responses to a recombinant 1b2 porin and a collection of polypeptides corresponding to 1b Por surface-exposed loops and followed longitudinally for gonococcal infection. Overall, antibody to the 1b2 porin appeared to provide limited protection from 1b infection, although this protective effect did not appear to extend to infection with 1a serovars. Women with antibody to 1b2 Por experienced significantly fewer homologous 1b2 and heterologous 1b3 serovar infections, compared to women without antibody. The data observed in this study support the hypothesis that the humoral immune response to Por is an important component in the ecologic interaction of human and gonococcal populations, while the generation of antigenically diverse pathogen populations act a mechanism to ensure endemic infection and pathogen survival in the face of this immune barrier. (Abstract shortened by UMI.)

Molecular epidemiology of Neisseria gonorrhoeae using newer methods.

Author: Xia, Minsheng

Awarding University: University of Washington, USA

Level : PhD

Year: 1997

Holding Libraries: University Microfilms International ;

Subject Terms: Microbiology/Neisseria infections/Gonorrhea/Neisseria gonorrhoeae/Neisseria meningitidis/Kingella denitrificans/Eikenella corrodens/Diagnostic tests/ ;

Abstract:

Gonorrhea is one of the most common human sexually transmitted diseases in the United States and the world. Discriminating and reproducible genotyping methods are needed for typing Neisseria gonorrhoeae for epidemiologic studies. In my dissertation, Pulsed-Field Gel Electrophoresis (PFGE) and Polymerase Chain Reaction (PCR) were used for typing N.Gonorrhoeae. PFGE patterns were stable with both in vitro and in vivo passaged N.Gonorrhoeae. Criteria for interpreting PFGE patterns were established based on examination of isolates from sex partners using three different enzymes. Fourteen pro/ia-6 isolates from Kenya produced 8 nhei and 7 xbai patterns. Using a combination of nhei, spei and xbai patterns, both genetic diversity and genetic relatedness were found among 16 isolates with decreased susceptibility to ciprofloxacin recovered over a two-year time period from various geographic locations. Genomic homogeneity of 68 arginine, hypoxanthine and uracil requiring ia-1,2 isolates from Seattle-King County over the past decade were examined by PFGE using nhei and xbai. Based on the criteria that isolates with $/le$1 band difference belonged to a single group, 5 nhei, 8 xbai and 11 nhei-xbai combination PFGE patterns were found. One nhei, one xbai and one nhei-xbai combination pattern accounted for 74%, 57% and 54% of the isolates respectively. A PCR assay was developed to amplify the downstream region of the incomplete tet m transposon in the 25.2 mda conjugative plasmid in 44 N.Gonorrhoeae, 12 N. Meningitidis, 4 Kingella denitrificans and 1 Eikenella corrodens isolates. One of two different PCR products of approximately 700 or 1600 base pairs was amplified. The difference between the two PCR fragments was a deletion of over 800 base pair in the smaller fragment. The two different sized pcr fragments had $>$90% DNA sequence identity with ureaplasma urealyticum tet m downstream sequences. The PCR assay was useful in differentiating the 25.2 mda plasmid. My dissertation demonstrated that PFGE had better discriminatory power than currently used typing methods for N.Gonorrhoeae. The PFGE method could be used to generate data for longitudinal molecular epidemiologic studies of gonococcal infections. Projects completed in my dissertation have laid the foundation for standardized PFGE.

Study on the etiology of acute pelvic inflammatory disease in women the ages 16-40 years as seen at the special treatment clinic STC, Nairobi City Commission

Author: Oduor, Margaret Osolo

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 1991

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Pelvic inflammatory disease ; Women ; Sexually transmitted diseases ; Chlamydia trachomatis ; Neisseria gonorrhoeae ;

Abstract:

Acute Pelvic Inflammatory disease is a common gynecological problem in many parts of Africa. It is one of the major problems seen at the Sexually Transmitted Disease Clinic at Nairobi City Commission. In this study, 100 women within the ages 16-40 years with clinical signs and symptoms of acute pelvic inflammatory disease and another 100 women within the same age group but without clinical signs and symptoms of acute PID were enrolled for the study. The main objective of the study was to study the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis and Group B Streptococcus (Streptococcus agalactiae) in women with clinical signs and symptoms of acute pelvic inflammatory disease. Also to study the relation of acute PID in terms of age, parity, marital status and contraception method used by the patient. These findings were then to be compared to those seen in the control women. These women were screened for N. gonorr1weae, C. trachomatis, Group B. Streptococcus using endocervical cultures on Thayer Martin, blood agar and irradiated McCoy cell lines, and also by Gramstain of endocervical smears. They were also screened for Treponema pallidum antibodies using rapid plasma reagin card test. Acute pelvic inflammatory disease was found to be more prevalent in the younger age group below 25 years of age with a peak at 16-20 years. Oral contraceptive use was correlated with a significantly decreased risk of acute PID (odds ratio 0.78, p-value<O.05) and IUCD use correlated with a significantly increased risk of acute PID (odds ratio 1.27, p-value<O.05). Gonococcal acute PID was found to be commoner in a younger age group than non-gonococcal acute PID. Risk of gonococcal acute PID was also found to be significantly increased in the single, separated (odds ratio 3.12; pvalue<O.05) and the divorced women (odds ratio 1.67; p-value<O.05). Chlamydial acute PID was found to be commoner in a younger age group as compared to non-chlamydial acute PID. Group B streptococcus was isolated from only 1 % of acute PID cases.

A study of gonococcal infection among a selected prostitute population in a slum area in Nairobi Kenya with particular reference to socio-economic legal aspects and intervention strategy

Author: Gakinya, Michael Njoroge

Awarding University: University of Nairobi, Kenya

Level : MPH

Year: 1985

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Gonorrhea ; Prostitution ; Pumwani ; Nairobi ; Kenya ; Neisseria gonorrhoeae ; Spermicides ; Preventive medicine ;

Abstract:

NEISSERIA GONORRHOEA infection is a major Public Health Problem in Kenya. It is a major cause of morbidity in males and females in 'the population. Control programmes have been mainly concentrated on Seconday Prevention which concentrates on early diagnosis and treatment of Neisseria gonorrhoea infection. Primary prevention has been mainly in the form of Health Education. The target population in primary prevention has been mothers in 'Antenatal Clinics ,and the maternal Child, Health Clinics. , The major reservoir of N. Gonorrhoea infection are the: prostitutes. This study explored an alternative intervention strategy using Health Education and intravaginal spermicides as a form of Primary Prevention. A randomized control trial study using 31 ,prostitutes as control and 28 prostitutes as the study group was conducted in Pumwani Estate in Nairobi. After Health Education to both groups, the study population was instructed to insert menfegol spermicides during every sexual intercourse. Both groups were followed up every two weeks , An endocervical swab was taken from each prostitute and cultured in Modified Thayer Martin t1edium of Neisseria gonorrhoea. THs.process was repeated for every visit for a period of 12 weeks. Those infected received 2 grams of intramuscular spectinomycim. On data analysis it was found that Menfegol spermicides did not significant reduce the rate of infection in the study group. This was thought to be due to the short duration of follow up and , motivation period, the inconvenience and side effects of the in this group of prostitutes. It is recommended that the same kind of study be repeated ., using a: larger population sample. The follow up period should be longer than in this study and the spermicides should , be convenient. Spermicides to be inserted twice a day will be more appropriate. The side effect of the selected spermicides should be minimal.