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Bloodborne sexually transmitted infections in patients presenting for substance abuse treatment in Jamaica.

Background Substance use, including alcohol and illicit drugs, increases the risk for the acquisition and transmission of sexually transmitted infection (STI). Goal To determine the prevalence of bloodborne STI including HIV, human T-cell lymphotrophic virus type 1, hepatitis B virus, and syphilis in residents of a detoxification and rehabilitation unit in Jamaica. Study Design The demographic characteristics and the results of laboratory investigations for STI in 301 substance abusers presenting during a 5-year period were reviewed. The laboratory results were compared with those of 131 blood donors. Results The substances used by participants were alcohol, cannabis, and cocaine. None of the clients was an IV drug user. Female substance abusers were at higher risk for STI. The prevalence of STI in substance abusers did not differ significantly from that in blood donors (12% versus 10%); however, the prevalence of syphilis in substance abusers was significantly higher than that in blood donors (6% versus 3%, P < 0.05). The prevalence of syphilis was dramatically increased in female substance abusers and female blood donors (30%, P < 0.001 and 13%, P < 0.05, respectively). An excess of human T-cell lymphotrophic virus type 1 was also observed in female compared with male substance abusers. Unemployment was identified also as a risk factor for sexually transmitted disease in substance abusers. Conclusion The results endorsed the policy of screening detoxification clients for STI and indicate a need for gender-specific approaches to the control of substance abuse and STI in Jamaica.

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission:

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU (n = 339), and control groups including asymptomatic men who were STD contacts (n = 61), asymptomatic men who were not STD contacts (n = 32) and men with gonococcal urethritis (GU) (n = 61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P < 0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)= 1.76; P < 0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P < 0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.

Genital Chlamydia trachomatis (serotypes D-K) infection in Jamaican commercial street sex workers.

OBJECTIVES: To determine the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmunofluorescence (MIF) test. RESULTS: The DFA detected C trachomatis in 16% (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24% (31/129) and 25% (33/129) respectively. The overall prevalence of current chlamydial infection detected by the isolation techniques used was 25% (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95%, 61/64) was found in CSSW compared with blood donors (53%, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9%) and Candida albicans (7%) were found in comparatively low frequencies, while Trichomonas vaginalis (0%) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequelae of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.