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This study examined patterns of alcohol use and its association with unsafe sex and related sequelae among female sex workers in Mombasa, Kenya. A community-based cross-sectional study was conducted using snowball sampling. Binge drinkers (> or =5 alcoholic drinks on > or =1 occasion in the previous month) were compared with non-binge drinkers. Of 719 participants, 22.4% were lifetime-alcohol abstainers, 44.7% non-binge and 33.0% binge drinkers. Compared with non-binge drinkers, binge drinkers were more likely to report unprotected sex (adjusted odds ratio (AOR)=1.59, 95% confidence interval [CI]=1.00-2.53; P=0.047) and sexual violence (AOR=1.85, 95% CI=1.27-2.71; P=0.001) and to have either syphilis, Neisseria gonorrhoeae or Trichomonas vaginalis infection (AOR=1.56, 95% CI=1.00-2.41; P=0.048). HIV prevalence was higher among women having ever drunk (39.9%) than lifetime abstainers (23.2%; P<0.001), but was not associated with drinking patterns. Interventions are needed to assist female sex workers adopt safer drinking patterns. Investigation is needed for the effectiveness of such interventions in reducing unprotected sex, sexual violence and sexually transmitted infections.

Background: An expanded Phase I trial was performed to assess the safety and acceptability of 6% cellulose sulfate gel (CS) in comparison with K-Y Jelly., Methods: Sexually abstinent (cohort I) and sexually active (cohort II) women in India, Nigeria and Uganda applied 3.5 ml of either 6% CS gel or K-Y Jelly for seven consecutive days. Safety was assessed by symptoms and signs (including colposcopy) of genital irritation, review of adverse events, and by changes in vaginal health as assessed by microscopy., Results: One hundred and eighty women (90 on CS and 90 on K-Y Jelly) were enrolled. Baseline characteristics of women in both gel groups were similar. In cohort I, six (14%) women on CS and 12 (27%) on K-Y Jelly reported genital symptoms, two (in K-Y Jelly group) of whom withdrew from the study. New colposcopy findings or findings showing deterioration were detected in four (9%) women on CS and nine (21%) women on K-Y Jelly in cohort I. Two women on CS and three on K-Y Jelly in cohort II reported genital symptoms. Five women (11%) in each gel group in cohort II had new colposcopy findings or findings showing deterioration. The differences between the gel groups were not statistically significant. The majority of women had no problem with their assigned product., Conclusion: A vaginal application of 6% cellulose sulfate twice daily for seven consecutive days is as safe and well tolerated as a similar regimen of K-Y Jelly. Further development of 6% CS for prevention of HIV and pregnancy is recommended.

Objective: We examined whether HIV-1 testing using a rapid assay increases the proportion of pregnant women obtaining HIV-1 results and the uptake of perinatal HIV-1 interventions., Methods: Pregnant women attending public health clinics in Nairobi were offered voluntary counselling and testing for HIV-1. Consenting women were randomly assigned to receive either rapid or conventional HIV-1 testing. Women randomly assigned to rapid testing were allowed to receive same-day results or to return later. The results for women randomly assigned to conventional enzyme-linked immunosorbent assay (ELISA) testing were available after 7 days. HIV-1-infected women were referred for antiretroviral prophylaxis to prevent mother-to-child transmission of HIV-1., Results: Among 1282 women offered voluntary HIV-1 testing and counselling, 1249 accepted testing, of whom 627 were randomly assigned to rapid testing and 622 to conventional testing. The median duration between testing and obtaining results was 0 days for women who received rapid testing compared with 11 days for women who received conventional testing. The percentage receiving HIV-1 results was significantly higher among women who received rapid testing compared with conventional testing. Of 161 HIV-1-seropositive women, only 24 received antiretroviral prophylaxis. The uptake of perinatal HIV-1 interventions did not differ between HIV-1-seropositive women randomly assigned to rapid testing or conventional ELISA testing., Conclusion: Rapid HIV-1 testing significantly increased the proportion of women receiving HIV-1 results, which is important for sexual and perinatal HIV-1 prevention. The challenge remains to improve the uptake of perinatal HIV-1 interventions among HIV-1-seropositive women.

A randomized, double-blind, placebo-controlled clinical trial was conducted in Nairobi, Kenya, to compare single-dose ciprofloxacin with a 7-day course of erythromycin for the treatment of chancroid. In all, 208 men and 37 women presenting with genital ulcers clinically compatible with chancroid were enrolled. Ulcer etiology was determined using culture techniques for chancroid, serology for syphilis, and a multiplex polymerase chain reaction for chancroid, syphilis, and herpes simplex virus (HSV). Ulcer etiology was 31% unmixed chancroid, 23% unmixed syphilis, 16% unmixed HSV, 15% mixed etiology, and 15% unknown. For 111 participants with chancroid, cure rates were 92% with ciprofloxacin and 91% with erythromycin. For all study participants, the treatment failure rate was 15%, mostly related to ulcer etiologies of HSV infection or syphilis, and treatment failure was 3 times more frequent in human immunodeficiency virus-infected subjects than in others, mostly owing to HSV infection. Ciprofloxacin is an effective single-dose treatment for chancroid, but current recommendations for empiric therapy of genital ulcers may result in high treatment failure due to HSV infection.

The purpose of the study was to determine the pattern and antimicrobial sensitivity on community acquired bacterial strains in Nairobi, Kenya. Clinical specimens collected from out-patient clinics at the Kenyatta National Hospital were cultured on appropriate media and identified according to Cowen and Steel's manual. The antimicrobial sensitivity was determined using comparative disc diffusion techniques. Between 1991 and 1995, there were a total of 1659 positive cultures comprising 30 different bacterial species. Out of the overall gram negative isolates (61.9%), E.coli and Klebsiella spp formed over 70%. Among the gram positive, Staphylococcus aureus, Enterococcus and coagulase negative staphylococcus spp constituting 41%, 26% and 18% respectively were the most common. Most organisms showed multiple resistance patterns to commonly used antimicrobials similar to hospital acquired infections. The gram negative isolates were resistant to cotrimoxazole, ampicillin, tetracyclines, chloramphenicol, and sulphamethoxazole. However, the sensitivity of these organisms to gentamicin and kanamycin was between 60 and 90%. Among the gram positive isolates, there was a high resistance to penicillin and tetracyclines (60-90%) while the resistance to lincomycin, minocycline and chloramphenicol was low (5-50%). All isolates were, however, highly sensitive to cephalosporins and fluoroquinolones. Beta-lactamase production among, E.coli, Klebsiella spp and Staphylococcus aureus was 48.9%, 76.7%, 76.1% respectively. Methicillin resistance for Staphylococcus aureus was 59.2%. Indiscriminate use of antibiotics in the community may have selected for resistant strains. This calls for urgent need to review policies on prescription practices.

To monitor clinically significant isolates and their antimicrobial susceptibilities, all specimens sent to microbiology laboratory of the Kenyatta National Hospital were cultured on appropriate media. The susceptibility of the isolates was performed on Muller Hinton or diagnostic sensitivity test (DST) agar using comparative discs diffusion technique. The results were then entered into Microbe Base 2 computer programme. A total of 7416 clinically significant isolates were collected from 1991 to 1995. The most commonly isolated organisms were E.coli, Klebsiella and Staphylococcus aureus. Most of these hospital acquired infections had multiple resistance to conventional antimicrobials, namely, penicillin, tetracyclines, gentamicin, trimethoprim/sulphamethoxazole and ampicillin. The resistance pattern was high among both gram negative and positive bacteria isolates. Beta-lactamase production amongst them were 51%, 69.3%, 79.6% respectively. Prevalence of methicillin resistant Staphylococcus aureus was 39.8%. Addition of clavulanic acid to amoxycillin increased Staphylococcus aureus susceptibility three fold. The emergence of multiple drug resistance calls for a continuous monitoring and reviewing of antibiotic policy in the hospital and the country at large.