Joel Escamilla

Sexually transmitted infections in female sex workers: reduced by condom use but not by a limited periodic examination program.

Background and Objectives: The sexually transmitted diseases (STD) control program for female sex workers (FSW) in Lima, Peru, provided periodic serological tests for syphilis and cervical smears for gonococci, but not medication for STD or condoms. Goal of this Study: To assess program effectiveness. Study Design: We assessed prevalence of current STD and serum antibody to STD pathogens in FSW in relation to program participation and to condom use. Results: Program participation was not associated with significantly reduced rates of current gonococcal or chlamydial infections or Venereal Disease Research Laboratory (VDRL) titers ≥4 with reactive fluorescent treponemal antibody absorption (FTA‐ABS). However, regardless of control program participation, consistent condom use was associated with reduced prevalence of gonorrhea, and with significantly reduced seroreactivity for FTA‐ABS, C. trachomatis, anti‐hepatitis B core (HBc), and anti‐human T‐lymphotropic virus type I. Anti‐HBc was associated with years of receiving penicillin injections for syphilis prophylaxis. Conclusion: The scope, quality, and efficacy of STD control programs must be technically appropriate, well managed, and adequately financed. The safety of marginal programs warrants scrutiny.

Hepatitis B Infection in a Non-drug Abusing Prostitute Population in Mexico

The prevalence and risk factors of hepatitis B infection were studied in 354 non-drug abusing female prostitutes and 360 female controls in Tijuana, Mexico. Hepatitis B surface antigen (HBsAg) was found in the same percentage (0.8%) of prostitutes and controls. In contrast, antibody markers (anti-HBs or anti-HBc) were found in a significantly higher percentage of prostitutes than controls (8.2% vs. 2.2%, p = 0.0006). Prostitutes also had a higher prevalence of a positive RPR/FTA-ABS test for syphilis (p less than 0.0001). There was a significant association between the presence of hepatitis B markers and positive syphilis serology and a history of having had a STD. In this non-drug abusing population, prostitution was found to be a risk factor for total hepatitis B infection but not for surface antigenemia. Further studies are indicated to determine the incidence of chronic infection in adult women following sexual transmission of hepatitis B.

Antimicrobial susceptibility of Neisseria gonorrhoeae isolates from a military population in San Diego.

Neisseria gonorrhoeae isolates were studied to determine their patterns of antimicrobial susceptibility and possible chemotherapeutic implications. Of 370 consecutive isolates, 32 (8.7%) were penicillinase-producing N. gonorrhoeae (PPNG). The remaining 338 were subjected to disk-diffusion tests, and those apparently resistant to penicillin, tetracycline, or spectinomycin were tested by an agar-dilution method. The dilution test showed that 5.4% (20/370) were penicillin-resistant, non-PPNG strains, of which 100%, 90%, and 45% were also resistant to tetracycline, cefoxitin, and erythromycin, respectively. No resistance to spectinomycin or ceftriaxone was demonstrated, although there was an association between minimum inhibitor concentrations (MICs) of penicillin of greater than or equal to 1.0 microgram/ml and increased MICs of ceftriaxone. The overall incidence of penicillin resistant isolates, including PPNG, was 14.1% (52/370). Of the 20 penicillin-resistant, non-PPNG strains, all were also resistant to tetracycline, and another 21 exhibited tetracycline resistance but were sensitive to penicillin. The in-vitro data suggested that: (1) neither penicillin, tetracycline, nor cefoxitin were acceptable drugs for routine treatment of gonorrhea in our population during the study period; (2) spectinomycin and ceftriaxone continue to demonstrate adequate in-vitro activity against N. gonorrhoeae despite increasing in-vitro resistance to penicillin; and (3) non-plasmid-mediated resistance to penicillin may predict future resistance to ceftriaxone.

Penicillinase-producing neisseria gonorrhoeae in various seaport cities of latin america

One hundred fifteen acute cases of gonorrhea were documented in U.S. military personnel during a five-month cruise in which 22 port cities of Latin America were visited in 1985. Penicillinase-producing Neisseria gonorrhoeae (PPNG) was isolated from 23 (20%) of the 115 cases. No penicillin-resistant, beta-lactamase-negative gonococci were encountered. None of the ten cases of gonorrhea acquired in the Caribbean region was due to PPNG. In South America, the PPNG infection rate was 35% (19/54) in ports along the Pacific Ocean and 8% (4/51) in those along the Atlantic. Infections incurred in four cities of three countries on the Pacific coast of the South American continent accounted for 78% of all PPNG isolates. Although the study did not deal directly with infections in the local populations, the data suggest that PPNG are common in coastal South America and that hyperendemic foci exist in some cities of the continents western coast.