International Journal of STD & AIDS

Genital ulcer disease as a risk factor for HIV transmission has become apparent in the fight against AIDS. In poor communities in developing countries with people living under low hygienic conditions chancroid is often reported to be the most common form of genital ulcer. It is caused by Haemophilus ducreyi; a fastidious bacterium, notoriously difficult to grow in the laboratory. Apart from a few small micro-epidemics from time to time the disease, which has interesting immunological aspects, is now rare and almost forgotten in most industrialized countries. This may be part of the reason why there is no simple and inexpensive diagnostic test available yet that would be useful in the low-resource settings where chancroid is prevalent. The present review focuses on the diagnosis and pathogenesis of chancroid.

Cytomegalovirus (CMV) is a non-pathogenic organism in the immunocompetent, but is a major cause of morbidity and mortality amongst patients with AIDS, and the retina is the commonest site of infection¹. If left untreated, patients with CMVR will develop disease in their second eye and ultimately become blind². However, with correct diagnosis and treatment useful vision can be maintained in the majority of cases. Fifteen to 20% of patients with AIDS will contract cytomegalovirus retinitis (CMVR)³⁻⁷ and this may be the AIDS-defining diagnosis though more commonly it occurs months after the diagnosis of AIDS. Given the increasing number of HIV positive patients and their longer survival, it is likely that CMVR will become an increasingly prevalent condition. In these patients loss of sight from CMVR has devastating consequences in terms of loss of independence and quality of life and therefore ophthalmologists and physicians should be aware of the presenting characteristics of CMVR, be familiar with therapy and its complications, and be able to recognize relapsing infection.

One sample of young gay men (n = 219) and 3 samples of older gay men (n = 219, n = 207, and n = 88) recalled a sexual encounter in which they had engaged in unprotected anal intercourse. Throughout the evening of the encounter, desire specifically for unprotected intercourse had generally been less common the more distant the relationship with the partner. Young men having sex with an anonymous partner were an exception to this pattern, however: they had desired unprotected intercourse almost as commonly as had young men having sex with a lover. The extent to which unprotected intercourse is premeditated in young men with an anonymous partner may make it particularly hard to modify their behaviour. This group had also been in an especially negative mood state at the start of the evening, suggesting the importance of trying to inculcate non-destructive ways of dealing with negative mood states.

Between 1986 and 1992, 15% of all cases of penicillinase-producing Neisseria gonorrhoeae (PPNG) notified in the UK were seen at our central London clinic. During this time the geographical provenance of PPNG has changed. Africa and SE Asia have been supplanted by the Caribbean as the predominant source, with 21.4% of all cases being directly imported from there in 1992. If all gonococcal infections acquired outside the UK had been assumed to be PPNG, together with those occurring in patients with family origins in Africa or SE Asia, some 60% of cases of PPNG could have been predicted before laboratory confirmation of resistance. There is little evidence that PPNG has become endemic in the United Kingdom.

The aim of the study was to determine the reliability and validity of a self-report symptom checklist designed for use in HIV infection. One hundred and seventy-one gay men completed a 28-item symptom checklist which produces 3 dimensions: physical, cognitive and psychological. The validity of each dimension was examined by comparing scores on the checklist with indices of disease progression and previously validated psychological scales. People with more advanced HIV disease had higher scores on the physical and cognitive checklists, though the psychological scale was not related to disease stage. All the scales showed moderate correlations with measures of psychological health. Examination of individual item responses suggested that patients over-reported the presence of some symptoms. Although individual items should be interpreted with caution, the overall scores of the RSC are reliable and valid as measures of subjective health status in HIV infection. The importance of psychological factors in the reporting of symptoms suggests that symptom checklists should be interpreted in the light of adequate measures of psychological state.

The medical records, retinal drawings and fundus photographs of all patients with cytomegalovirus retinitis (CMVR) and AIDS in Edinburgh between 1986–1992 were reviewed to determine the efficacy of treatment in preserving vision. Ophthalmoscopic features of CMVR were observed in 32 eyes of 24 patients with AIDS, 19 males and 5 females. HIV transmission in this group was by homo/bisexual contact (16), injection drug use (7) and blood transfusion (1). Unilateral blurring was the commonest visual symptom although 9 (38%) patients had no visual symptoms. All patients presented with a corrected visual acuity of 6/12 or better in at least one eye. Following treatment with systemic ganciclovir or foscarnet 16 patients (66%) developed toxic side-effects of therapy and 13 (54%) experienced a recurrence of CMVR. Four (17%) patients developed a retinal detachment in one eye. The mean survival was 8.3 months after the diagnosis of CMVR. At final follow-up, between 2–26 months after the diagnosis of CMVR, 21 (87.5%) patients retained useful vision (6/18 or better) although 3 (12.5%) were effectively blind (less than 6/60). We conclude that with prompt diagnosis and treatment of CMVR vision can be preserved in the majority of cases.

Women are infected with HIV in increasing numbers; the predominant mode of spread is through heterosexual transmission. Little is known regarding the mechanism of HIV transit through the female genital tract. We investigated whether early passaage cervical epithelial cells could be directly infected with HIV-1_LAI*.

Virus production was measured using the reverse transcriptase (RT) assay and direct assay for syncytia-forming units. In-situ hybridization was performed on infected cervical cell cultures. Immunostaining was carried out using a monoclonal antibody to leukocyte common antigen (LCA).

Virus was recovered in the supernatants of all infected cervical cultures. Localization of HIV infection using in-situ hybridization identified rare cells in the population which gave a strong signal. These infected cells had a lymphoid morphology and were also detected using immunostaining for LAC.

Cervical epithelial cells were uninfected in this in vitro model; cells in this population which supported viral replication were most likely of the macrophage/monocyte lineage.