STD HIV CONTROL IN MALAWI AND THE SEARCH FOR AFFORDABLE AND EFFECTIVEURETHRITIS THERAPY - A FIRST FIELD-EVALUATION/

Objectives-To evaluate gonococcal (GU) and nongonococcal urethritis (N GU), chlamydia antigen, and serostatus for syphilis and human immunode ficiency virus (HIV) among males attending a Malawian STD clinic with complaints of urethral discharge and/or dysuria. To collect demographi c and behavioural data and to determine the effectiveness of five trea tments for urethritis. Methods-Urethritis was diagnosed using microsco py and culture for Neisseria gonorrhoeae. Sera were screened with rapi d plasma reagin (RPR) and if reactive, with microhaemagglutination for Treponema pallidum (MHA-TP). HIV antibodies and chlamydia antigen wer e detected using enzyme immunoassay. Patients were randomised for trea tment, cure was assessed 8-10 days later. Results-At enrolment, GU was diagnosed in 415 (80.3%) and NGU in 59 (11.2%) of 517 males. Chlamydi a antigen was found in 26 (5.2%) of 497 specimens tested. Syphilis ser opositivity rate (RPR and MHA-TP reactive) was 10.7%. Overall HIV sero prevalence was 44.2%; 71.7% of men with reactive syphilis serology wer e HIV(+) compared with 40.9% of syphilis seronegatives (OR: 3.6, p < 0 .001). Trimethoprim 320 mg/ sulphamethoxazole 1600 mg by mouth for 2 d ays (TMPSMX), or the combination of amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg by mouth once (APC), failed to cure gonorrhoea effectively. Amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 m g, by mouth once with doxycycline 100 mg BID for 7 days (APC-D), genta micin 240 mg IM once (GENT), ciprofloxacin 250 mg by mouth once (CIPRO ) cured 92.9% to 95% of gonorrhoea. APC-D treatment did not generate l ess NGU at follow-up. HIV did not affect cure of serostatus urethritis . Conclusion-All patients presenting with urethritis should be treated syndromically using a simple algorithm and screened for syphilis sero reactivity for appropriate treatment and counselling.