       Document 0515
 DOCN  M9640515
 TI    HIV, sexually transmitted diseases and gynaecologic disorders in women:
       increased risk for genital herpes and warts among HIV-infected
       prostitutes in Amsterdam.
 DT    9604
 AU    Fennema JS; van Ameijden EJ; Coutinho RA; van den Hoek AA; Department of
       Public Health and Environment, Municipal Health; Service, Amsterdam, The
       Netherlands.
 SO    AIDS. 1995 Sep;9(9):1071-8. Unique Identifier : AIDSLINE MED/96085724
 AB    OBJECTIVES: To determine the incidence of sexually transmitted diseases
       (STD; gonorrhoea, early syphilis, Chlamydia trachomatis infection,
       trichomoniasis and primary genital herpes) and gynaecologic disorders
       (vaginal candidiasis, anaerobic vaginosis, genital ulcerations of
       unknown cause, pelvic inflammatory disease, recurrent genital herpes,
       recurrent genital warts) in a cohort of HIV-infected and non-infected
       drug-using prostitutes in Amsterdam between 1986 and 1992. DESIGN: A
       subgroup of 212 female drug users with a history of prostitution, who
       made at least one visit to a special STD clinic for drug-using
       prostitutes was selected from an ongoing cohort study of drug users in
       Amsterdam. METHODS: Using Poisson regression, the relative risk (RR) for
       each outcome was calculated for HIV-positive women compared with
       HIV-negative women. To determine potential causal relations with immune
       suppression, associations between disease incidence and immunologic
       markers (CD4 cell count and anti-CD3 response) were assessed in
       HIV-positive women. RESULTS: Adjusted for number of clients and
       frequency of condom use, HIV-positive women were at strong and
       significantly increased risk for primary genital herpes (RR, 7.64),
       recurrent herpes (RR, 8.33) and recurrent genital warts (RR, 15.93);
       moderately (significantly) increased risks were found for gonorrhoea
       (RR, 1.43), trichomoniasis (RR, 1.39), vaginal candidiasis (RR, 2.11)
       and genital ulcers of unknown aetiology (RR, 2.60). Of these HIV-related
       outcomes, the risk for recurrent genital herpes and genital warts were
       strongly associated with decreased CD4 cell counts. CONCLUSIONS:
       HIV-infected women experience an excess morbidity of STD and
       gynaecologic disorders. The strongly increased risk for genital herpes
       and warts in HIV-seropositive women indicates a causal relation with
       HIV. This study emphasizes the need for accessible medical care for
       drug-using prostitutes.
 DE    Adult  Cohort Studies  Condylomata Acuminata/*EPIDEMIOLOGY
       Cross-Sectional Studies  Female  Herpes
       Genitalis/*EPIDEMIOLOGY/TRANSMISSION  Human  HIV
       Infections/*EPIDEMIOLOGY/TRANSMISSION  Incidence
       Netherlands/EPIDEMIOLOGY  Poisson Distribution  Prostitution/*STATISTICS
       & NUMER DATA  Recurrence  Risk  Support, Non-U.S. Gov't  Urban
       Population/*STATISTICS & NUMER DATA  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

