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<JournalTitle>BMC Infectious Diseases</JournalTitle>
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<Year>2006</Year>
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<ArticleDOI>10.1186/1471-2334-6-22</ArticleDOI>
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<ArticleSequenceNumber>22</ArticleSequenceNumber>
<ArticleTitle Language="En" OutputMedium="All">Patterns of sexually transmitted
infections in adolescents and youth in Dar es Salaam, Tanzania
</ArticleTitle>
<ArticleCategory>Research article</ArticleCategory>
<ArticleFirstPage>1</ArticleFirstPage>
<ArticleLastPage>8</ArticleLastPage>
<ArticleHistory>
<RegistrationDate>
<Year>2005</Year>
<Month>5</Month>
<Day>26</Day>
</RegistrationDate>
<Received>
<Year>2005</Year>
<Month>5</Month>
<Day>26</Day>
</Received>
<Accepted>
<Year>2006</Year>
<Month>2</Month>
<Day>10</Day>
</Accepted>
<OnlineDate>
<Year>2006</Year>
<Month>2</Month>
<Day>10</Day>
</OnlineDate>
</ArticleHistory>
<ArticleCopyright>
<CopyrightHolderName>Chalamilla et al; licensee BioMed Central Ltd.</CopyrightHo
lderName>
<CopyrightYear>2006</CopyrightYear>
<CopyrightComment>
<SimplePara>This article is published under license to BioMed Central Ltd. This
is an Open Access article distributed under the terms of the Creative Commons At
tribution License (<ExternalRef>
<RefSource>http://creativecommons.org/licenses/by/2.0</RefSource>
<RefTarget TargetType="URL" Address="http://creativecommons.org/licenses/by/2.0"
/>
</ExternalRef>), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.</SimplePara>
</CopyrightComment>
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<ArticleHeader>
<AuthorGroup>
<Author AffiliationIDS="Aff1" EqualContribution="Yes">
<AuthorName>
<GivenName>Guerino</GivenName>
<FamilyName>Chalamilla</FamilyName>
</AuthorName>
<Contact>
<Email>gchalamilla@muchs-harvard.org</Email>
</Contact>
</Author>
<AuthorName>
<GivenName>Judica</GivenName>
<FamilyName>Mbwana</FamilyName>
</AuthorName>
<Contact>
<Email>jmbwana@muchs.ac.tz</Email>
</Contact>
</Author>
<AuthorName>
<GivenName>Fred</GivenName>
<FamilyName>Mhalu</FamilyName>
</AuthorName>
<Contact>
<Email>fmhalu@muchs.ac.tz</Email>
</Contact>
</Author>
<AuthorName>
<GivenName>Eunice</GivenName>
<FamilyName>Mmari</FamilyName>
</AuthorName>
<Contact>
<Email>emmari@muchs.ac.tz</Email>
</Contact>
</Author>
<AuthorName>
<GivenName>Mtebe</GivenName>
<FamilyName>Majigo</FamilyName>
</AuthorName>
<Contact>
<Email>mmajigo@muchs.ac.tz</Email>
</Contact>
</Author>
<AuthorName>
<GivenName>Andrew</GivenName>
<FamilyName>Swai</FamilyName>
</AuthorName>
<Contact>
<Email>aswai@muchs.ac.tz</Email>
</Contact>
</Author>
<Author AffiliationIDS="Aff2" CorrespondingAffiliationID="Aff2" EqualContributio
n="Yes">
<AuthorName>
<GivenName>Willy</GivenName>
<FamilyName>Urassa</FamilyName>
</AuthorName>
<Contact>
<Email>wurassa@muchs.ac.tz</Email>
</Contact>
</Author>
<AuthorName>
<GivenName>Eric</GivenName>
<FamilyName>Sandstrom</FamilyName>
</AuthorName>
<Contact>
<Email>eric.sandstrom@karolinska.se</Email>
</Contact>
</Author>
<Affiliation ID="Aff1">
<OrgName>Ilala Municipal Council</OrgName>
<OrgAddress><City>Dar es Salaam</City>
<Country>Tanzania</Country></OrgAddress>
</Affiliation>
<OrgName>Muhimbili University College of Health Sciences</OrgName>
<OrgAddress><City>Dar es Salaam</City>
<Country>Tanzania</Country></OrgAddress>
</Affiliation>
<OrgName>Karolinska Institute at Stockholm Soder Hospital</OrgName>
<OrgAddress><City>Stockholm</City>
<Country>Sweden</Country></OrgAddress>
</Affiliation>
</AuthorGroup>
<Abstract ID="Abs1" Language="En" OutputMedium="All">
<Heading>Abstract
</Heading>
<AbstractSection ID="ASec1">
<Heading>Background
</Heading>
<Para>Syndromic management of STIs has been advocated as simplified and cheap ap
proach. Youth have been reported to be at increased risk of acquiring STIs which
can facilitate HIV transmission. We have investigated the relationship between
the syndromic management and specific aetiology diagnosis and its relationship w
ith HIV infection and health seeking behaviour among youth attending a reproduct
ive health clinic in Dar es Salaam, Tanzania.</Para>
</AbstractSection>
<Heading>Methods
</Heading>
<Para>Between September 1998 and February 1999 among 1895 adolescents and youth
below 25 years seen in the clinic 199 (10.5%) were randomly selected and consent
ed to participate in the study. A standard questionnaire was administered. Blood
and vaginal or urethral specimens were taken and investigated for STI causative
agents.</Para>
</AbstractSection>
<Heading>Results
</Heading>
<Para>Among a total of 199 studied adolescents and youth 22.6 % were teenagers,
with fewer females 17.8% than males; 27.5% (p < 0.018). 20.8% of the fema
les compared to 11.5% in males were HIV infected. Genital discharge was the most
common complaint which was reported in 54.1% of male and 63.4 % of female patie
nts. All males with gonorrhoea and four out of five with Chlamydia were given ap
propriate treatment with syndromic management, while 28% women with gonorrhoea o
r Chlamydia received appropriate treatment by syndromic management. All patients
found with active syphilis by serology had not complained of genital ulcers and
would not have been assigned to syndromic treatment for syphilis at the initial
visit.</Para>
</AbstractSection>
<Heading>Conclusion
</Heading>
<Para>The burden of STIs in this youth population is large indicating that youth
are at increased risk of STIs and will certainly require youth friendly clinics
. There is a need to refine the current syndromic management guidelines.</Para>
</AbstractSection>
</Abstract>
<ArticleNote Type="Misc">
<SimplePara>Guerino Chalamilla, Judica Mbwana, Fred Mhalu, Eunice Mmari, Mtebe M
ajigo, Andrew Swai, Willy Urassa and Eric Sandstrom contributed equally to this
work.</SimplePara>
</ArticleNote>
</ArticleHeader>
<Body>
<Section1 ID="Sec1">
<Heading>Background
</Heading>
<Para>Sexually Transmitted Infections (STIs) especially genital ulcer diseases a
re an epidemiologic and biologic risk factor for the transmission of HIV-1 infec
tion [<CitationRef CitationID="CR1">1</CitationRef>, <CitationRef CitationID="CR
2">2</CitationRef>]. Young people aged 15 to 24 years are at the epicentre of th
e HIV epidemic especially those living in sub Saharan Africa which accounts for
about 64.5% of people living with HIV/AIDS globally [<CitationRef CitationID="CR
3">3</CitationRef>]. There are recent reports showing that adolescents in Africa
engage in unsafe sexual behaviour which predisposes them to adverse outcome inc
luding sexually transmitted infections [<CitationRef CitationID="CR4">4</Citatio
nRef><CitationRef CitationID="CR7">7</CitationRef>]. Consequently the youth in th
e continent have been reported to have high rates of various STIs [<CitationRef
CitationID="CR8">8</CitationRef><CitationRef CitationID="CR11">11</CitationRef>].
</Para>
<Para>Enhancing and optimising the management of STIs remains one of the most fe
asible and cost effective interventions to control them including HIV. A study d
one in Tanzania has shown that treatment of STIs can reduce HIV transmission by
more than 4060% [<CitationRef CitationID="CR12">12</CitationRef>]. The adoption o
f syndromic management has provided simplified and cheap method although its per
formance can be influenced by various factors including health seeking behaviour
, cultural and economic factors, and the distribution of major aetiologies of ST
I syndromes [<CitationRef CitationID="CR13">13</CitationRef>].</Para>
<Para>We have investigated the relationship between the syndromic management and
specific aetiology diagnosis in this group and its relationship with HIV infect
ion and health seeking behaviour among youth attending a reproductive health cli
nic in Dar es Salaam.</Para>
</Section1>
<Heading>Patients and methods
</Heading>
<Para>The study was done between September 1998 and February 1999. The study pop
ulation consisted of adolescents and youth below 25 years of age attending the y
outh reproductive health clinic. Recruitment of subjects was done randomly irres
pective of having symptoms by blind selection of cards at the reception on arriv

al. Those who picked a yes card were invited and consented to participate in the
study. A standardised questionnaire was administered to the recruited subjects
and was used to collect details of socio-demographic information, sexual history
, and basic knowledge on STIs and its prevention and on possible sources of the
current sexually transmitted infection, history of present illness and its manag
ement. Answers were pre-coded with an exception of few which gave youth opportun
ity to answer open-ended questions.</Para>
<Para>All consenting youth were clinically examined including speculum examinati
on in females. Free treatment was given to all those found with STIs using syndr
omic approach according to Tanzania national STI treatment guidelines. Sexual pa
rtners were invited to attend the clinic. Condoms, health education and counsell
ing were offered to all. All were offered pre and post-test HIV counselling. Tho
se who were found to be HIV infected, were offered further follow up counselling
sessions, medical care and were referred to other institutions which provide di
fferent services for people living with HIV/AIDS.</Para>
<Heading>Laboratory methods
</Heading>
<Para>Syphilis antibodies were detected by the Venereal Disease Research Laborat
ory (VDRL Murex Biotech Ltd, U.K) test and by Treponema Pallidum Particle Agglut
ination assay (TPPA) (Fujirebio Inc, Tokyo, Japan). Urethral swabs were taken fr
om male patients while cervical and high vaginal swabs were taken from female pa
tients. The swabs were inserted into Stuart transport media for culture of <Emph
asis Type="Italic">Neisseria gonorrhoeae</Emphasis> and <Emphasis Type="Italic">
Candida albicans</Emphasis>. Swabs for detection of <Emphasis Type="Italic">Chla
mydia trachomatis</Emphasis> antigen were collected using appropriate collection
kits. Using wet preparation all swab specimens were examined for the presence o
f pus cells, budding yeast cells and motile <Emphasis Type="Italic">Trichomonas
vaginalis</Emphasis> in the referral laboratory. Smears from the urethral and ce
rvical specimens were Gram stained and examined for the presence of typical bean
shaped Gram-negative diplococci, budding yeast cells and clue cells. Clinically
significant Candida infection was suggested by budding yeast cells in wet smear
s. Clue cells found on Gram stained smears were taken as an indication of bacter
ial vaginosis.</Para>
<Para>The swabs were inoculated onto modified Thayer Martin agar plates (Oxoid,
Unipath Limited, Basingstoke, UK) supplemented with vancomycin, nystatin, colist
in, and trimethoprim. The plates were incubated in a candle jar at 37C for 48 hou
rs. Presumptive identification of <Emphasis Type="Italic">N. gonorrhoeae</Emphas
is> was done by Gram stain and oxidase test on suspected colonies. All isolates
were confirmed to be <Emphasis Type="Italic">N. gonorrhoeae</Emphasis> by the Ph
adebact co-agglutination test (Phadebact, Monoclonal GC test, Boule Diagnostics
AB, Huddinge, Sweden). Specimens were also inoculated onto Saboraud's Dextrose a
gar (Oxoid, Unipath Limited, Basingstoke, UK) and incubated at 37C for 48 hours.
Suspected colonies were identified as <Emphasis Type="Italic">C. albicans</Empha
sis> using typical colonial morphology and germ tube test.</Para>
<Heading>Antigen detection of <Emphasis Type="Italic">C. trachomatis</Emphasis>
</Heading>
<Para>Chlamydia infection was diagnosed using Chlamydia EIA MicroTrak II (Behrin
g Diagnostics Inc. Cupertino, CA 95014, USA) following package insert instructio
ns.</Para>
<Para>The presence of HIV antibodies was initially determined using Enzygnost an
ti-HIV-1 &2 Plus ELISA (Behring, Marburg, Germany) and sera found to be r
eactive were further tested using Wellcozyme HIV-1 recombinant ELISA (Murex, Dar
tford, UK) in an alternative confirmatory strategy for diagnosis of HIV infectio
n [<CitationRef CitationID="CR14">14</CitationRef>]. Blood samples giving discor
dant results in the two assays were tested using Western blot assay (Genelab, US
A), which was interpreted according to the World Health Organisation criteria fo
r interpretation of Western blots [<CitationRef CitationID="CR15">15</CitationRe
f>].</Para>
</Section3>
</Section2>
<Heading>Statistical methods
</Heading>
<Para>Data were compiled and analysed by the SPSS 10.0 soft ware. Proportions we
re compared using chi-square (<Supers ript>2</Supers ript>) test or Fisher's exa
t test. A two tailed p-value <0.05 was onsidered signifi ant.</Para>
</Se tion2>
</Se tion1>
<Se tion1 ID="Se 6">
<Heading>Results
</Heading>
<Para>Between September 1998 and February 1999, 1895 adoles ents and youth below
25 years attended the youth reprodu tive health lini at the Infe tious Diseas
e Centre (IDC). Among these, 199 parti ipants onsisting of 101 (50.8%) females
and 98 (49.2%) males onsented to parti ipate in the study. Forty five (22.6%) w
ere teenagers and 154 (77.4%) were youth aged 20 and 24 years. One third of fema
les were already married ompared to 9% of the males (Table <InternalRef RefID="
Tab1">1</InternalRef>).<Table ID="Tab1" Float="Yes">
<Caption Language="En">
<CaptionNumber>Table 1
</CaptionNumber>
<CaptionContent>
<SimplePara>General hara teristi s of young people attending youth reprodu tive
health lini </SimplePara>
</CaptionContent>
</Caption>
<tgroup ols="4">
< olspe olnum="1" olname=" 1"/>
<thead>
<row>
<entry olname=" 1" align=" enter">
<SimplePara>Chara teristi </SimplePara>
</entry>
<SimplePara>Category</SimplePara>
</entry>
<SimplePara>Males N (%)</SimplePara>
</entry>
<SimplePara>Females N (%)</SimplePara>
</entry>
</row>
</thead>
<tbody>
<row>
<entry olname=" 1"/>
<SimplePara>98(49.2)</SimplePara>
</entry>
</entry>
</row>
<row>
<SimplePara>Age group</SimplePara>
</entry>
<SimplePara>1519</SimplePara>
</entry>
<SimplePara>27 (27.5)</SimplePara>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Marital status</SimplePara>
</entry>
<SimplePara>Single</SimplePara>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Married</SimplePara>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Others</SimplePara>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Sexual partners now</SimplePara>
</entry>
<SimplePara>none</SimplePara>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Sexual partners last 6 months</SimplePara>
</entry>
<SimplePara>one</SimplePara>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Sexual partners lifetime</SimplePara>
</entry>
<SimplePara>one</SimplePara>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</row>
<row>

<SimplePara>10 or more</SimplePara>
</entry>
</entry>
</entry>
</row>
</tbody>
</tgroup>
</Table>
</Para>
<Heading>Sexual behaviour
</Heading>
<Para>The median age at oitar he was 17 years for both sexes. Among the females
, 24% reported only one lifetime sexual partner, while 16% had five or more part
ners. Over the last 6 months the majority (73.7%) of females reported having onl
y one sexual partner, and none had 5 or more sexual partners; 10.5% of females r
eported on urrent partners at the time of interview (Table <InternalRef RefID="
Tab1">1</InternalRef>). The mean duration of sexual a tivity among women was 3.4
years. Forty-six women reported 66 pregnan ies while 22 had undergone 41 aborti
ons (data not shown)</Para>
<Para>Among males, 6.4% reported one lifetime sexual partner while 58.1%, had fi
ve or more lifetime sexual partners. Over the last 6 months 60% reported having
multiple partners and 31.6% a knowledged on urrent sexual partners at the time
of interview (Table <InternalRef RefID="Tab1">1</InternalRef>). The mean duratio
n of sexual a tivity was 4.5 years. Among the parti ipants all ex ept 5 a knowle
dged having pra tised vaginal-penile sex while 11% and 7% of the males; 7% and 1
6% of the females had pra ti ed oral and anal sex, respe tively.</Para>
</Se tion2>
<Heading>Comparison of the syndromi and aetiologi al diagnosis of patients
</Heading>
<Para>Genital dis harge was the most ommon omplaint that was reported by 54.1%
of male patients and 63.4 % of female patients. Out of 199 patients re ruited i
nto the study, ulture was done on 110 (55.2%) patients who did not respond afte
r seven days of treatment using syndromi management. These in luded 28/98 (28.6
%) male and 82/101(81.2%) female patients. There was no signifi ant differen es
on the sexual hara teristi s in luding the mean age at oita he, the mean numbe
r of lifetime sex partners or mean years of sexual a tivity among those who had
ulture done ompared to those who had no ulture done. <Emphasis Type="Itali ">
N. gonorrhoea</Emphasis> was isolated in 13 (54.1%) of 24 male samples, but in o
nly 2 (3.6%) of 55 female samples. <Emphasis Type="Itali ">C. tra homatis</Empha
sis> antigen was dete ted in 9.7% in the males and 3% in women. Six out of seven
patients who were found to have a tive syphilis using serology were found to ha
ve other infe tions in luding <Emphasis Type="Itali ">N. gonorrhoea</Emphasis>,
andidiasis, tri homoniasis and ba terial vaginosis. Among women omplaining of
genital dis harge andidiasis was found in 26.6%; ba terial vaginosis in 16.9% w
hile tri homoniasis was found in 10.9% (Table <InternalRef RefID="Tab2">2</Inter
nalRef>).<Table ID="Tab2" Float="Yes">
</CaptionNumber>
<CaptionContent>
<SimplePara>Aetiologi al diagnosis versus presenting symptoms of sexually transm
itted diseases among patients.</SimplePara>
</CaptionContent>
</Caption>
<tgroup ols="13">
<thead>
<row>
<entry namest=" 1" nameend=" 3" align=" enter">
<SimplePara>Aetiologi al diagnosis</SimplePara>
</entry>
<SimplePara>Presenting symptoms</SimplePara>
</entry>
</row>
<row>
<SimplePara>Total</SimplePara>
</entry>
<SimplePara>Genital dis harge</SimplePara>
</entry>
<SimplePara>Genital ul ers</SimplePara>
</entry>
<SimplePara>Dysuria</SimplePara>
</entry>
<SimplePara>Genital it h</SimplePara>
</entry>
<SimplePara>Rash</SimplePara>
</entry>
</row>
<row>
<SimplePara>M No (%)</SimplePara>
</entry>
<SimplePara>F No (%)</SimplePara>
</entry>
</entry>
</entry>

</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
</thead>
<tbody><row>
<SimplePara>53/98 (54.1)</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Gonorrhoea</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
<SimplePara>0/1</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Chlamydia</SimplePara>
</entry>
</entry>
</entry>
</entry>
<SimplePara>1/37 (3)</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Syphilis</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>

</entry>
</row>
<row>
<SimplePara>Clue ells</SimplePara>
</entry>
<SimplePara>-</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Tri hom onas</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Candida</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>

</entry>
</entry>
</row>
<row>
<SimplePara>HIV</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
</tbody>
</tgroup>
</Table>
<Table ID="Tab3" Float="Yes">
</CaptionNumber>
<CaptionContent>
<SimplePara>HIV serostatus in relation to syndromi
various STIs</SimplePara>
</CaptionContent>
</Caption>
or aetiologi al diagnosis of
<tgroup ols="5">
<thead>
<row>
<SimplePara>HIV- seropositive</SimplePara>
</entry>
<SimplePara>HIV- seronegative</SimplePara>
</entry>
</row>
<row>
<SimplePara>STI agent/syndrome</SimplePara>
</entry>
<SimplePara>Males (n = 11) No (%)</SimplePara>
</entry>
<SimplePara>Female(n = 21) No (%)</SimplePara>
</entry>
<SimplePara>Males (n = 85) NO (%)</SimplePara>
</entry>
<SimplePara>Females (n = 80) No (%)</SimplePara>
</entry>
</row>
</thead>
<tbody>
<row>
<SimplePara>Genital dis harge</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Genital ul er</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>N. gonorrhoeae</SimplePara>
</entry>
<SimplePara>3/4(75.0)</SimplePara>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>C. tra homatis</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Ba terial vaginosis</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>T. vaginalis</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>C. albi ans</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
</tbody>
</tgroup>
</Table>
</Para>
<Para>All males who were found to have gonorrhoea and four out of five with Chla
mydia re eived appropriate treatment based on syndromi management approa h. Thi
s is in ontrast to only two out of seven women who were found to have either go
no o al or hlamydial infe tions who were appropriately treated syndromi ally.<
/Para>
<Para>A genital ul er was the reason for attendan e for 14.3% of the males and 1
1.8% of the females and was the lini al diagnosis in all with ex eption of one
in ea h sex. Genital ul er as a guide to initiate treatment for syphilis was le
arly inadequate sin e none of the seven patients with a tive syphilis using sero
logy were among the 26 who omplained of genital ul er. Among these seven patien
ts one was found to have gonorrhoea, two had andidiasis, one had tri homoniasis
and two had lue ells suggestive of ba terial vaginosis. Among the seven patie
nts there were no lini ally suspe ted ases of han hroid or Lymphogranuloma ve
nerium. A spe ifi diagnosis for Herpes genitalis infe tion was not available du
ring the study.</Para>
<Para>Two males presented with both genital dis harge and genital ul er ompared
to 12 females (Table <InternalRef RefID="Tab2">2</InternalRef>). Only three of
the women with signs suggestive of ba terial vaginosis, tri homoniasis or yeast
infe tion had multiple agents. Three of the 6 females with a provisional diagnos
is of pelvi inflammatory disease (PID) had an Enzyme Immunoassay for Chlamydia
done and all were negative. One of the 3 women with gonorrhoea was diagnosed wit
h PID. Among 16 women who used intra uterine devi es one had PID.</Para>
</Se tion2>
<Heading>HIV in relation to behavioural fa tors
</Heading>
<Para>Among all the parti ipants, 20.8% of the females were HIV infe ted, ompar
ed to 11.5% in males. Among the 45 teenagers; 3/27 (11.1%) males and 3/18 (16.6%
) females were found to be HIV-1 infe ted. In males the risk of being HIV infe t
ed was relatively onstant with regard to number of partners up to 10 lifetime p
artners. However when the number of lifetime sexual partners was more than 10, t
he risk of HIV infe tion rose to 26.3%. In females an in reased risk to be HIV i
nfe ted was already seen in those with more than 4 lifetime sexual partners and
the risk by then rose to 43.8%. The urrent number of partners or partners over
the last 6 months was not asso iated with risk of being HIV infe ted, although i
t may have influen e the risk of transmitting the virus.</Para>
<Para>Out of 22 women with history of abortions 6 (27.3%) were found to be HIV i
nfe ted and of the 26 women who had given birth to live hildren 5 (19.2%) were
HIV infe ted. Of the 9 married males 2 (22%) were HIV infe ted ompared to 7/32
(21.9%) married females. The rate of HIV infe tion among those who were not marr
ied was 10.5% and 18.8% for males and females respe tively. Among women who a kn
owledged having only one lifetime partner, 4/24 (17%) were HIV infe ted, three o
f whom were married.</Para>
<Para>Most of the sexual partners, at the inter ourse when the urrent STI was t
hought to have o urred, were single. The most ommon meeting pla e was at home
94/120 (78%) and majority of these sexual partners were onsidered as friends 96
/127(76%). However, it was also ommon that the sexual partners were married and
most of these en ounters were also at home 40/45 (89%). Though the questionnair
e did not define whether some of them were their spouses, 28/36 (78%) defined th
em as a 'friend'. Females 38, more often had married partners than males, 8, p &
#x003C; 0.001. Seven (18%) of the females whose last partner was married, were H
IV infe ted.</Para>
</Se tion2>
<Heading>HIV in relation to syndromi and spe ifi diagnosis
</Heading>
<Para>There was a non-signifi ant trend to less GDS in HIV infe ted ompared to
non-infe ted in males (64 vs. 79%) and females (71 vs. 90%) respe tively, whi h
was signifi ant if the genders were ombined, p = 0.045. Regarding GUD there was
a non-signifi ant trend to more GUD in HIV infe ted ompared to non-infe ted in
males (27 vs. 19%) and females (49 vs. 23%) respe tively, whi h remained non-si
gnifi ant even if the genders were ombined. The small numbers pre lude a ompar
ison between HIV serostatus and spe ifi diagnosis, however it was noted that 3
of 4 males with gonorrhoea were HIV infe ted.</Para>
</Se tion2>

<Heading>Condoms use
</Heading>
<Para>81 males (82.6%) and 94 females (93.1%) reported to have ever used a ondo
m. There was no asso iation between ondom use and HIV status, urrent sexual a
tivity, number of lifetime sexual partners or duration of sexual a tivity. About
10% of males and 6% of females had used a ondom the day the urrent STI was th
ought to have o urred. Eighty per ent of males and females knew that ondoms o
uld prote t against STIs. There was no relationship between this knowledge and H
IV serostatus.</Para>
</Se tion2>
<Heading>Health seeking behaviour
</Heading>
<Para>The median number of days with STI symptoms was 14 days with a wide range
(1720) for men and 19 days with a range (3720) for females (Table <InternalRef Ref
ID="Tab4">4</InternalRef>). Thus it seems that the lini is readily available f
or a subpopulation, while others are greatly underserved. Gonorrhoea, hlamydia,
syphilis, genital dis harge or rash, were asso iated with the shortest delays i
n men, while tri homoniasis, dysuria and genital dis harge aused the shortest d
elays in women. However, genital ul ers were not asso iated with short delays. H
IV serostatus did not seem to affe t the health seeking behaviour, at least in m
en.<Table ID="Tab4" Float="Yes">
</CaptionNumber>
<CaptionContent>
<SimplePara>Median days of symptoms before visit to the lini a ording to symp
toms or aetiologi al diagnosis</SimplePara>
</CaptionContent>
</Caption>
<tgroup ols="5">
<thead>
<row>
<SimplePara>Males</SimplePara>
</entry>
<SimplePara>Females</SimplePara>
</entry>
</row>
<row>
<SimplePara>Median (range)</SimplePara>
</entry>
<SimplePara>N</SimplePara>
</entry>
<SimplePara>Median (range)</SimplePara>
</entry>
<SimplePara>N</SimplePara>
</entry>
</row>
</thead>
<tbody>
<row>
<SimplePara>Genital Dis harge</SimplePara>
</entry>
<SimplePara>8.5 (1720)</SimplePara>
</entry>
</entry>
<SimplePara>14 (3720)</SimplePara>
</entry>
</entry>
</row>
<row>
<SimplePara>Genital ul er</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Dysuria</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Genital it hing</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Genital rash</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Genital swelling</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Gonorrhoea</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Chlamydia</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Tri homonas</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Candida</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>BV</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>HIV</SimplePara>
</entry>
</entry>
</entry>
</entry>
</entry>
</row>
<row>
<SimplePara>Any</SimplePara>
</entry>
</entry>
</entry>
</row>
</tbody>
</tgroup>
</Table>
</Para>
<Para>Fa tors asso iated with disempowerment were asso iated with staying for lo
nger periods with symptoms before seeking medi al attention. Four males and nine
females, who had not onsented to the last inter ourse, waited a median of 90 a
nd 60 days respe tively. Fourteen women ould not advi e their sexual partner to
ome while eight agreed to be tested but did not wish to know their HIV serosta
tus. These two groups of women were asso iated with median delays of 45 and 45 d
ays respe tively. These observations form a pattern but are not individually sta
tisti ally signifi ant due to the great varian e. Those 33 females who ould per
suade their male partners to ome to the lini had a shorter median delay of 14
days, p = 0.018. None of the other so iologi al, sexologi al or lini al fa tor
s seemed to influen e the delay to seek medi al are. Most had heard about syphi
lis and gonorrhoea, however only two thirds regarded HIV as an STI.</Para>
</Se tion2>
<Heading>Referral
</Heading>
<Para>Ninety four per ent of young people stated that they attended the lini d
ue to symptoms; however 16 women were notified by their partners to attend, of w
hom 12 were asymptomati . Four of the 16 females who were referred by their sexu
al partners were HIV positive. However, at the end of the study, 16 female partn
ers to study males and 33 male partners to study females had been investigated a
t the IDC outside the study and a further 8 patients were treated elsewhere, in
addition 5 patients were identified as index ases outside the study. Thus the
ounselling initiated by the study dramati ally hanged the referral pattern from
a minority of females who had heard of the disease from their partners to a ref
erral of male partners of almost one third of the affe ted females.</Para>
</Se tion2>
</Se tion1>
<Heading>Dis ussion
</Heading>
<Para>We have previously shown the high rate of STIs among youth in Dar es Salaa
m,[<CitationRef CitationID="CR9">9</CitationRef>] and have now pro eeded to furt
her study possible avenues of intervention. In order to treat STIs it is not onl
y important that health are an be sought when symptoms appear, but also that t
he subsequent treatment ures the disease and prevents re-infe tions. This requi
res knowledge on the part of youth and availability of health are fa ilities as
well as appropriate diagnosis, treatment and referral pro edures. The lini ha
s ontinued to attra t a large number of youth primarily through the word of mou
th and the awareness of STIs is generally widespread in this population, althoug
h only two thirds had heard that HIV was spread as a STI. Although studies like
this one relies on self-reported data it is worth noti ing that an illegal pro e
dure su h as abortion was a knowledged by 21.8% of women, whi h an be taken as
a sign of the atmosphere in the lini . However in onsisten ies do o ur su h as
7 men and 3 women reporting a younger urrent age than when they ommen ed sexu
al a tivity.</Para>
<Para>All but 12 patients reported STI symptoms as the reason for attendan e. It
remains to be seen if the in rease in asymptomati patients sin e the last inve
stigation is a sign of a trend towards greater a eptability of the lini . The
most ommon omplaint in both men and women was genital dis harge. In men, gonor
rhoea dominated with 50%, followed by hlamydia (10%) and tri homoniasis (4%). I
n women vaginal andidiasis (27%), ba terial vaginosis (17%) and tri homoniasis
(11%) dominated while gonorrhoea (3.6%) and hlamydia (3%) were relatively rare
auses of genital dis harge.</Para>
<Para>These figures should be viewed with some aution and probably underestimat
es the importan e of the various agents. Culture for gono o i followed standard
te hniques and the transport was adequate, but gono o i are notoriously sensit
ive. The relatively low proportion of males with genital dis harge and gonorrhoe
a in this series ould refle t the relative lower sensitivity of ulture in diag
nosis of <Emphasis Type="Itali ">N. gonorrhoeae</Emphasis> infe tion as reported
elsewhere[<CitationRef CitationID="CR16">16</CitationRef>, <CitationRef Citatio
nID="CR17">17</CitationRef>]. Chlamydia was dete ted by ELISA whi h is not an op
timal te hnique [<CitationRef CitationID="CR17">17</CitationRef>], but the rate
among men is approximately that expe ted from studies in industrialized ountrie
s, while the low frequen y in women has been found in previous studies from Dar
es Salaam [<CitationRef CitationID="CR9">9</CitationRef>] and ould be due to la
k of sensitivity in the test or a predominan e of other auses of dis harge. Cl
ue ells on Gram stains taken from swabs transported to the laboratory were take
n as an indi ation of ba terial vaginosis and are a reasonable approximation of
bedside performed pH, sniff test and wet mounts [<CitationRef CitationID="CR18">
18</CitationRef>]. Viable tri homonads was sought on saline diluted swabs in the
referral laboratory and probably underestimates its importan e, while the notor
iously diffi ult laboratory diagnosis of relevant Candida infe tion was estimate
d from the presen e of budding yeast ells in wet smears. Of the three men who h
ad positive smears, ulture yielded one isolate of <Emphasis Type="Itali ">C. al
bi ans</Emphasis> while the remaining two isolates were other Candida spe ies. O
f the 22 women patients with positive smears only one had a positive ulture due
to <Emphasis Type="Itali ">C. albi ans</Emphasis> while 6 were other Candida sp
e ies. Patients with sera giving positive VDRL and TPPA tests were onsidered to
have a tive syphilis. An additional 7 males and 3 females had only a positive T
PPA indi ating past syphilis.</Para>
<Para>Syndromi treatment was appropriate in men with GDS sin e gonorrhoea and
hlamydia dominated. However GDS in females an be aused by many agents that in
lude gono o i, Chlamydia, anaerobi ba teria, <Emphasis Type="Itali ">T. vagina
lis</Emphasis> and Candida. As a results most of diagnosti assays perform bette
r in males ompared to females as reported elsewhere [<CitationRef CitationID="C
R16">16</CitationRef>, <CitationRef CitationID="CR17">17</CitationRef>]. In that
regard syndromi management in women with GDS may be a better approa h than usi
ng laboratory results.</Para>
<Para>In this lini , herpes simplex as in other studies has been found to be th
e major ause of genital ul ers (>60%) and han roid to be rare (<
10%). The use of syndromi algorithm for GUD to diagnose and treat syphilis was
found to be very inappropriate sin e none of those with ul er had a tive syphili
s, rather it was asso iated with agents ausing genital dis harge. The study jus
tifies suggestion of the in lusion of RPR test in syndromi proto ols that ould
provide appropriate therapeuti over for syphilis as syphilis ontrol is a pri
ority within STI ontrol programs. There were fewer tenden ies to be HIV infe te
d in those with genital dis harge but a trend to be more likely to be HIV infe t
ed in those with genital ul ers.</Para>
<Para>HIV infe tion was found in 21% of females and 12% of males whi h is slight
ly lower for females and higher for males than in the previous study [<CitationR
ef CitationID="CR9">9</CitationRef>]. These high figures are found without a par
ti ularly high-risk behaviour among the females, although their vulnerability is
illustrated by the high number of unwanted pregnan ies. One quarter had so far
adhered to the publi health advi e of having only one partner, this did not pro
te t against HIV infe tion nor did marriage. Very few had however used a ondom
with the partner at the inter ourse they thought was the ause of the urrent ST
I even though it was often with a friend and o urred in the relatively safe set
ting of the home.</Para>
<Para>Teenagers seem to be exposed to a similar risk for STIs as older youth and
servi es should be targeted even more to their needs. Teenagers did not differ
in their duration with symptoms prior to the visit to the lini . It seemed that
fa tors that ould be taken as disempowerment su h as involuntary inter ourse,
inability to advi e sexual partner to ome, not wanting to know their HIV serost
atus were asso iated with delays, while women who thought they ould persuade th
eir partners to attend had a shorter delay. The great span in delays was strikin
g. Some obviously had a very low barrier to seek are while others had the sympt
oms for long periods of time, with the risk of further transmission and risk for
ompli ations.</Para>
<Para>Partner referral has generally been onsidered to be very diffi ult in dev
eloping ountries, espe ially when only syndromi treatment is available. The la
rge number of auses of female GDS are not ne essarily a rationale for the male
partners to go for treatment of gonorrhoea or hlamydia, while females partners
to men with GDS have good reason to attend even if asymptomati . It is therefore
interesting to note that 16 women attended this study due to notifi ation from
their partner and that the ounselling during the study aused a further 16 fema
les to attend outside the study and may be more remarkably 33 males to female st
udy partners attended the lini outside the study. Thus there seems to be a gre
at potential for ounselling in the spe ifi setting of a youth lini .</Para>
<Para>However although males and females attended the same lini it is an overs
implifi ation to assume that in general they have sexual relationship. We have f
ound in this study, as previously reported that males reported more urrent, re
ent and lifetime partners than females. In addition men had 0.14 (SD3.0) and 2.1
5(SD 3.18) years younger partners at the first and last inter ourse respe tively
, the orresponding figures for females were 4.66(SD2.31) and 6.77 (SD 2.54) yea
rs older partners (data not shown). Thus these females in general seem to have m
ost of their partners outside the age span in whi h we are re ruiting men and a
different sexual behaviour. It is thus a hallenge to identify the sexual partne
rs to the young men we re ruit in these studies.</Para>
</Se tion1>
<Heading>Con lusion
</Heading>
<Para>The burden of STIs in this youth population is large indi ating that youth
are at in reased risk of STIs and will ertainly require youth friendly lini s
. There is a need to refine the urrent syndromi management.</Para>
</Se tion1>
</Body>
<BodyRef FileRef="BodyRef/PDF/12879_2005_Arti le_286.pdf" TargetType="OnlinePDF"
/>
<Arti leBa kmatter>
<Arti leNote Type="Mis ">
<Heading>Competing interests
</Heading>
<SimplePara>Authors have no ompeting interest regarding this work whi h we are
submitting for publi ation.</SimplePara>
</Arti leNote>
<Arti leNote Type="Mis ">
<Heading>Authors' ontributions
</Heading>
<SimplePara>GC parti ipated in the supervision of the study and writing of the m
anus ript. JM supervised testing of the samples in the referen e laboratory and
manus ript writing. WU parti ipated in statisti al analysis and manus ript writi
ng. FM parti ipated in the design, supervision of the study and manus ript writi
ng. EM parti ipated in ondu t of the study. MM parti ipated in manus ript wring
. AS parti ipated in the supervision of data entry and statisti al analysis, ES
parti ipated in the design, statisti al analysis and manus ript writing. All aut
hors read and approved the final manus ript.</SimplePara>
</Arti leNote>
<A knowledgments>
<Heading>A knowledgements
</Heading>
<SimplePara>The study re eived finan ial support from the Department for Resear
h Cooperation with developing Countries, SAREC of Swedish International Developm
ent Agen y, Sida. We would like to thank all those who made the work possible in
luding Mr. C. Kagoma, Ms M. Mashurano, Ms E. Malakasuka, Mrs M. Mtanda, Mrs M.
Lyaruu, Mr. S. Massam, Mr. C. M humaishoke and Mrs J. Masanje. The study had eth
i al learan e from the National AIDS Control program of the Ministry of Health
and Muhimbili University College of Health S ien e ethi al ommittee.</SimplePar

a>
</A knowledgments>
<Bibliography ID="Bib1">
<Heading>Referen es</Heading>
<Citation ID="CR1">
<CitationNumber>1.</CitationNumber>
<BibArti le>
<BibAuthorName>
<Initials>J</Initials>
<FamilyName>Wassererheit</FamilyName>
</BibAuthorName>
<Year>1992</Year>
<Arti leTitle Language="En">Epidemiologi al synergy. Interrelationships between
human immunodefi ien y virus infe tion and other sexually transmitted diseases
</Arti leTitle>
<JournalTitle>Sex Transm Dis</JournalTitle>
<VolumeID>19</VolumeID>
<FirstPage>61</FirstPage>
<LastPage>77</LastPage>
</BibArti le>
<BibUnstru tured>Wassererheit J: Epidemiologi al synergy. Interrelationships bet
ween human immunodefi ien y virus infe tion and other sexually transmitted disea
ses. Sex Transm Dis. 1992, 19: 61-77.</BibUnstru tured>
</Citation>
<Citation ID="CR2">
<BibArti le>
<BibAuthorName>
<Initials>P</Initials>
<FamilyName>Moodley</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>PD</Initials>
<FamilyName>Sturm</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>T</Initials>
<FamilyName>Vanmali</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>D</Initials>
<FamilyName>Wilkinson</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>C</Initials>
<FamilyName>Connolly</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>AW</Initials>
<FamilyName>Sturm</FamilyName>
</BibAuthorName>
<Year>2003</Year>
<Arti leTitle Language="En">Asso iation between HIV-1 infe tion, the aetiology o
f genital ul er disease and response to syndromi management
</Arti leTitle>
</BibArti le>
<BibUnstru tured>Moodley P, Sturm PD, Vanmali T, Wilkinson D, Connolly C, Sturm
AW: Asso iation between HIV-1 infe tion, the aetiology of genital ul er disease
and response to syndromi management. Sex Transm Dis. 2003, 30: 241-245.</BibUns
tru tured>
</Citation>
<Citation ID="CR3">
<BibChapter>
<InstitutionalAuthorName>UNAIDS/WHO</InstitutionalAuthorName>
<Year>2005</Year>
<NoChapterTitle/>
<BookTitle>AIDS epidemi update De ember 2004: Joint United Nations Programme on
HIV/AIDS (UNAIDS) World Health Organisation
</BookTitle>
</BibChapter>
<BibUnstru tured>UNAIDS/WHO: AIDS epidemi update De ember 2004: Joint United Na
tions Programme on HIV/AIDS (UNAIDS) World Health Organisation. 2005</BibUnstru
tured>
</Citation>
<Citation ID="CR4">
<BibArti le>
<BibAuthorName>
<Initials>SF</Initials>
<FamilyName>Kaaya</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>AJ</Initials>
<FamilyName>Flisher</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>JK</Initials>
<FamilyName>Mbwambo</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>H</Initials>
<FamilyName>S haalma</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>LE</Initials>
<FamilyName>Aaro</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>KI</Initials>
<FamilyName>Klepp</FamilyName>
</BibAuthorName>
<Year>2002</Year>
<Arti leTitle Language="En">A review of studies of sexual behaviour of s hool st
udents in sub Saharan Afri a
</Arti leTitle>
<JournalTitle>S and J Publi Health</JournalTitle>
<BibArti leDOI>10.1080/14034940210133807</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Kaaya SF, Flisher AJ, Mbwambo JK, S haalma H, Aaro LE, Klepp KI
: A review of studies of sexual behaviour of s hool students in sub Saharan Afri
a. S and J Publi Health. 2002, 30: 148-160. 10.1080/14034940210133807.</BibUns
tru tured>
</Citation>
<Citation ID="CR5">
<BibArti le>
<BibAuthorName>
<FamilyName>Meekers</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>M</Initials>
<FamilyName>Klein</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>L</Initials>
<FamilyName>Foyet</FamilyName>
</BibAuthorName>
<Year>2003</Year>
<Arti leTitle Language="En">Patterns of HIV risk behaviour and ondom use among
youth in Yaound and Douala, Cameroon
</Arti leTitle>
<JournalTitle>AIDS and Behaviour</JournalTitle>
<BibArti leDOI>10.1023/B:AIBE.0000004733.26053. 8</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Meekers D, Klein M, Foyet L: Patterns of HIV risk behaviour and
ondom use among youth in Yaound and Douala, Cameroon. AIDS and Behaviour. 2003,
7: 413-420. 10.1023/B:AIBE.0000004733.26053. 8.</BibUnstru tured>
</Citation>
<Citation ID="CR6">
<BibArti le>
<BibAuthorName>
<FamilyName>Eaton</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>A</Initials>
<FamilyName>Flisher</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Aaro</FamilyName>
</BibAuthorName>
<Year>2003</Year>
<Arti leTitle Language="En">Unsafe sexual behaviour in South Afri an youth
</Arti leTitle>
<JournalTitle>So S i & Med</JournalTitle>
<BibArti leDOI>10.1016/S0277-9536(02)00017-5</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Eaton L, Flisher A, Aaro L: Unsafe sexual behaviour in South Af
ri an youth. So S i & Med. 2003, 56: 149-165. 10.1016/S0277-9536(02)0001
7-5.</BibUnstru tured>
</Citation>
<Citation ID="CR7">
<BibArti le>
<BibAuthorName>
<FamilyName>Todd</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Changalu ha</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>DA</Initials>
<FamilyName>Ross</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>F</Initials>
<FamilyName>Mosha</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>AI</Initials>
<FamilyName>Obasi</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Plummer</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>R</Initials>
<FamilyName>Balira</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Grosskurth</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>DC</Initials>
<FamilyName>Mabey</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Hayes</FamilyName>
</BibAuthorName>
<Year>2004</Year>
<Arti leTitle Language="En">The sexual health of pupils in years 4 to 6 of prima
ry s hools in rural Tanzania
</Arti leTitle>
<JournalTitle>Sex Transm Infe t</JournalTitle>
<BibArti leDOI>10.1136/sti.2003.005413</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Todd J, Changalu ha J, Ross DA, Mosha F, Obasi AI, Plummer M, B
alira R, Grosskurth H, Mabey DC, Hayes R: The sexual health of pupils in years 4
to 6 of primary s hools in rural Tanzania. Sex Transm Infe t. 2004, 80: 35-42.
10.1136/sti.2003.005413.</BibUnstru tured>
</Citation>
<Citation ID="CR8">
<BibArti le>
<BibAuthorName>
<FamilyName>Brabin</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Kemp</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>OK</Initials>
<FamilyName>Obunge</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Ikimalo</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>N</Initials>
<FamilyName>Dollimore</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>NN</Initials>
<FamilyName>Odu</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>CA</Initials>
<FamilyName>Hart</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>ND</Initials>
<FamilyName>Briggs</FamilyName>
</BibAuthorName>
<Year>1995</Year>
<Arti leTitle Language="En">Reprodu tive tra t infe tions and abortion among ado
les ents in Nigeria
</Arti leTitle>
<JournalTitle>Lan et</JournalTitle>
</BibArti le>
<BibUnstru tured>Brabin L, Kemp J, Obunge OK, Ikimalo J, Dollimore N, Odu NN, Ha
rt CA, Briggs ND: Reprodu tive tra t infe tions and abortion among adoles ents i
n Nigeria. Lan et. 1995, 345: 300-3004. 10.1016/S0140-6736(95)90281-3.</BibUnstr
u tured>
</Citation>
<Citation ID="CR9">
<BibArti le>
<BibAuthorName>
<FamilyName>Mwakagile</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>E</Initials>
<FamilyName>Mmari</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Makwaya</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Mbwana</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>G</Initials>
<FamilyName>Biberfeld</FamilyName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Sandstrom</FamilyName>
</BibAuthorName>
<Year>2001</Year>
<Arti leTitle Language="En">Sexual behaviour among youths at high risk for HIV-1
infe tion in Dar es Salaam, Tanzania
</Arti leTitle>
<JournalTitle>Sex Transm Infe t</JournalTitle>
<IssueID>4</IssueID>
<BibArti leDOI>10.1136/sti.77.4.255</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Mwakagile D, Mmari E, Makwaya C, Mbwana J, Biberfeld G, Mhalu F
, Sandstrom E: Sexual behaviour among youths at high risk for HIV-1 infe tion in
Dar es Salaam, Tanzania. Sex Transm Infe t. 2001, 77 (4): 255-259. 10.1136/sti.
77.4.255.</BibUnstru tured>
</Citation>
<Citation ID="CR10">
<BibArti le>
<BibAuthorName>
<Initials>B</Initials>
<FamilyName>Auvert</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Ballard</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Campbell</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Carael</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Carton</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Fehler</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Gouws</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Ma Phail</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Taljaard</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Van Dam</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>B</Initials>
<FamilyName>Williams</FamilyName>
</BibAuthorName>
<Year>2001</Year>
<Arti leTitle Language="En">HIV infe tion among youth in South Afri an mining to
wn is asso iated with herpes simplex virus-2 seropositivity and sexual behaviour
</Arti leTitle>
<JournalTitle>AIDS</JournalTitle>
<BibArti leDOI>10.1097/00002030-200105040-00009</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Auvert B, Ballard R, Campbell C, Carael M, Carton M, Fehler G,
Gouws E, Ma Phail C, Taljaard D, Van Dam J, Williams B: HIV infe tion among yout
h in South Afri an mining town is asso iated with herpes simplex virus-2 seropos
itivity and sexual behaviour. AIDS. 2001, 15: 885-898. 10.1097/00002030-20010504
0-00009.</BibUnstru tured>
</Citation>
<BibArti le>
<BibAuthorName>
<Initials>AI</Initials>
<FamilyName>Obasi</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Balira</FamilyName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
<Initials>DA</Initials>
<FamilyName>Ross</FamilyName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Peeling</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>DC</Initials>
<FamilyName>Mabey</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>RJ</Initials>
<FamilyName>Hayes</FamilyName>
</BibAuthorName>
<Year>2001</Year>
<Arti leTitle Language="En">Prevalen e of HIV and <Emphasis Type="Itali ">Chlamy
dia tra homatis</Emphasis>infe tion in 1519 years old in rural Tanzania
</Arti leTitle>
<JournalTitle>Trop Med International Health</JournalTitle>
<BibArti leDOI>10.1046/j.1365-3156.2001.00738.x</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Obasi AI, Balira R, Todd J, Ross DA, Changalu ha J, Mosha F, Gr
osskurth H, Peeling R, Mabey DC, Hayes RJ: Prevalen e of HIV and <Emphasis Type=
"Itali ">Chlamydia tra homatis</Emphasis> infe tion in 1519 years old in rural Ta
nzania. Trop Med International Health. 2001, 6: 517-525. 10.1046/j.1365-3156.200
1.00738.x.</BibUnstru tured>
</Citation>
<BibArti le>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Mwijarubi</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Klokke</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>K</Initials>
<FamilyName>Senkoro</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Mayaud</FamilyName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Ni oll</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>ka-Gina</FamilyName>
</BibAuthorName>
<Year>1995</Year>
<Arti leTitle Language="En">Impa t of improved treatment of sexually transmitted
diseases on HIV infe tion in rural Tanzania: randomised ontrol trail
</Arti leTitle>
<JournalTitle>Lan et</JournalTitle>
</BibArti le>
<BibUnstru tured>Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K
, Mayaud P, Changalu ha J, Ni oll A, ka-Gina G: Impa t of improved treatment of
sexually transmitted diseases on HIV infe tion in rural Tanzania: randomised on
trol trail. Lan et. 1995, 346: 530-536. 10.1016/S0140-6736(95)91380-7.</BibUnstr
u tured>
</Citation>
<BibArti le>
<BibAuthorName>
<FamilyName>Pettifor</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Walsh</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>V</Initials>
<FamilyName>Wilkins</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Raghunathan</FamilyName>
</BibAuthorName>
<Year>2000</Year>
<Arti leTitle Language="En">How effe tive is syndromi management of STIs?: a re
view of urrent studies
</Arti leTitle>
</BibArti le>
<BibUnstru tured>Pettifor A, Walsh J, Wilkins V, Raghunathan P: How effe tive is
syndromi management of STIs?: a review of urrent studies. Sex Transm Dis. 200
0, 27: 371-385.</BibUnstru tured>
</Citation>
<BibArti le>
<BibAuthorName>
<Initials>W</Initials>
<FamilyName>Urassa</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>S</Initials>
<FamilyName>Matunda</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>U</Initials>
<FamilyName>Bredberg Raden</FamilyName>
</BibAuthorName>
<BibAuthorName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Biberfeld</FamilyName>
</BibAuthorName>
<Year>1994</Year>
<Arti leTitle Language="En">Evaluation of the WHO human immunodefi ien y virus (
HIV) antibody testing strategy for the diagnosis of HIV infe tion
</Arti leTitle>
<JournalTitle>Clin Diagn Virol</JournalTitle>
<BibArti leDOI>10.1016/0928-0197(94)90030-2</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Urassa W, Matunda S, Bredberg Raden U, Mhalu F, Biberfeld G: Ev
aluation of the WHO human immunodefi ien y virus (HIV) antibody testing strategy
for the diagnosis of HIV infe tion. Clin Diagn Virol. 1994, 2: 1-6. 10.1016/092
8-0197(94)90030-2.</BibUnstru tured>
</Citation>
<BibArti le>
<InstitutionalAuthorName>WHO</InstitutionalAuthorName>
<Year>1990</Year>
<Arti leTitle Language="En">Proposed riteria for interpretation of results from
Western Blot for HIV-1, HIV-2, HTLV-1, and HTLV-II
</Arti leTitle>
<JournalTitle>Wkly Epidemiol Re </JournalTitle>
</BibArti le>
<BibUnstru tured>WHO: Proposed riteria for interpretation of results from Weste
rn Blot for HIV-1, HIV-2, HTLV-1, and HTLV-II. Wkly Epidemiol Re . 1990, 39: 281
-283.</BibUnstru tured>
</Citation>
<BibArti le>
<BibAuthorName>
<FamilyName>Consentino</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Landers</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>S</Initials>
<FamilyName>Hillier</FamilyName>
</BibAuthorName>
<Year>2003</Year>
<Arti leTitle Language="En">Dete tion of <Emphasis Type="Itali ">Chlamydia tra h
omatis</Emphasis>and Neisseria gonorrhoeae by strand displa ement amplifi ation
and relevan e of the amplifi ation ontrol for use with vaginal swab spe imens
</Arti leTitle>
<JournalTitle>J Clin Mi robiol</JournalTitle>
<BibArti leDOI>10.1128/JCM.41.8.3592-3596.2003</BibArti leDOI>
</BibArti le>
<BibUnstru tured>Consentino L, Landers D, Hillier S: Dete tion of <Emphasis Type
="Itali ">Chlamydia tra homatis</Emphasis> and Neisseria gonorrhoeae by strand d
ispla ement amplifi ation and relevan e of the amplifi ation ontrol for use wit
h vaginal swab spe imens. J Clin Mi robiol. 2003, 41: 3592-3596. 10.1128/JCM.41.
8.3592-3596.2003.</BibUnstru tured>
</Citation>
<BibArti le>
<BibAuthorName>
<Initials>EW</Initials>
<FamilyName>Hook</FamilyName>
<Suffix>3rd</Suffix>
</BibAuthorName>
<BibAuthorName>
<Initials>SF</Initials>
<FamilyName>Ching</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Stephens</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>KF</Initials>
<FamilyName>Hardy</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>KR</Initials>
<FamilyName>Smith</FamilyName>
</BibAuthorName>
<BibAuthorName>
<Initials>HH</Initials>
<FamilyName>Lee</FamilyName>
</BibAuthorName>
<Year>1997</Year>
<Arti leTitle Language="En">Diagnosis of <Emphasis Type="Itali ">Neisseria gonor
rhoeae</Emphasis>infe tion in women by using the ligase hain rea tion on patien
t-obtained vaginal swabs
</Arti leTitle>
<JournalTitle>J Clin Mi robiol</JournalTitle>
</BibArti le>
<BibUnstru tured>Hook EW, Ching SF, Stephens J, Hardy KF, Smith KR, Lee HH: Diag
nosis of <Emphasis Type="Itali ">Neisseria gonorrhoeae</Emphasis> infe tion in w
omen by using the ligase hain rea tion on patient-obtained vaginal swabs. J Cli
n Mi robiol. 1997, 35: 2129-2132.</BibUnstru tured>
</Citation>
<BibArti le>
<BibAuthorName>
<FamilyName>Conzalez</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Inzunza-Montiel</FamilyName>
</BibAuthorName>
<BibAuthorName>
<FamilyName>Ortiz-Zaragoza</FamilyName>
</BibAuthorName>
<Year>1997</Year>
<Arti leTitle Language="En">A omparison of 2 lini al laboratory methods in dia
gnosis of ba terial vaginosis
</Arti leTitle>
<JournalTitle>Aten Primaria</JournalTitle>
</BibArti le>
<BibUnstru tured>Conzalez A, Inzunza-Montiel A, Ortiz-Zaragoza C: A omparison o
f 2 lini al laboratory methods in diagnosis of ba terial vaginosis. Aten Primar
ia. 1997, 19: 357-360.</BibUnstru tured>
</Citation>
<BibSe tion ID="BSe 1">
<Heading>Pre-publi ation history
</Heading>
<BibUnstru tured>The pre-publi ation history for this paper an be a essed here
:
<ExternalRef>
<RefSour e>http://www.biomed entral. om/1471-2334/6/22/prepub</RefSour e>
<RefTarget TargetType="URL" Address="http://www.biomed entral. om/1471-2334/6/22
/prepub"/>
</ExternalRef>
</BibUnstru tured>
</Citation>
</BibSe tion>
</Bibliography>
</Arti leBa kmatter>

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