Background Sexually transmitted infections (STIs), and HIV especially, are a major health problem in Malaysia. The emergence of HIV infection has increased the importance of early and effective treatment of STIs as any delay may lead to enhance transmission or acquisition of HIV infection. A proper understanding of the patterns of STIs is necessary for effective planning and control strategies. The present study is designed to determine the changing pattern of STIs in the Genito-urinary Medicine Clinic (GUM), Hospital Kuala Lumpur (HKL). Objective To study the sociodemographic characteristics of patients with STIs attending the GUM Clinic in HKL and to analyze any changes in the pattern of STIs seen between the 2 study periods of 1995-1999 and 2001-2005. Method A retrospective review of case notes of new patients with STIs attending the GUM clinic, HKL was done during two study periods of 1995-1999 (Poster presentation on “Pattern of STDs” at 14th RCD, Asia-Australasia, 26-30 July 2000, KL, Malaysia by HB Gangaram et al) and 2001-2005. Results In 1995-1999, a total of 3150 STI patients were studied. Among them, 2016 (64%) were males and 1134 (36%) were females. In 2001-2005, a total of 2909 STI patients were examined, of which 1862 (64%) were males and 1047 (36%) were female. There was a decrease of 8.3% in the total number of cases seen in 2001-2005 as compared to 1995-1999. The decline was more evident with bacterial STIs which included syphilis, gonorrhoea, NGU and chancroid. Viral STIs which consisted of herpes genitalis, genital warts and HIV showed an increasing trend. A younger age group (20-39 years old) appeared to be infected with STIs in 2001-2005. Males outnumbered females in the ratio of 1.8:1, which remained unchanged in both the study periods. Based on ethnicity, there was an increase in the percentage of Malays being infected in STIs in the later study period. Syphilis was the commonest STI seen in both the study periods. The second commonest STI seen in 1995-1999 was gonorrhoea and non-gonococcal urethritis (NGU). In 2005, there were 184 patients with syphilis; 64% were heterosexuals; 39.6% homosexuals and 1.6% bisexuals. Majority (82%) were asymptomatic (latent syphilis with positive syphilis serology at presentation. Symptomatic patients with early infectious syphilis constituted 15% (Primary 8%; Secondary 7%). Screening for HIV was positive in 31 (16.8%) patients. HIV infection was noted to be the commonest STI associated with syphilis. Conclusion was an overall decline in the number of patients with STIs attending the GUM clinic, HKL. The decline was more evident with bacterial STIs; viral STIs however showed an increasing trend. Syphilis was still the commonest STI seen in the two study periods although the percentage has declined. Non specific urethritis has superseded gonorrhoea as the second commonest STI. HIV was found to be the commonest STI seen in association with syphilis.

Background Gonorrhoea is the third most common sexually transmitted infection (after syphilis and non-gonococcal urethritis) seen in patients attending the Genitourinary Medicine (GUM) Clinic in Hospital Kuala Lumpur (HKL). Its association with poor reproductive health outcomes and the increasing prevalence of antimicrobial resistance has made it a major public health concern. Objective To determine the antibiotic resistance pattern of Neisseria Gonorrhoeae in patients attending the GUM Clinic in HKL and its comparison with other countries. Method A retrospective study of all patients with gonorrhoea (new and recurrent) between 2001-2005. Antimicrobial susceptibility testing by standard disc diffusion method was performed to detect sensitivity to penicillin, tetracycline, kanamycin, ciprofloxacin, spectinomycin, ceftriaxone and cefuroxime. Results A total of 416 positive culture isolates of N.gonorrhoeae from 2001-2005 were reviewed. Highest level of resistance was detected to tetracycline (86.8% of 296 isolates). Resistance to penicillin was noted in 64.4% of all isolates. Penicillinase Producing N.gonorrhoeae (PPNG) accounted for 62% of cases. Both penicillin and tetracycline showed an increasing resistance trend from 2001-2005. The third commonest antibiotic resistance was to kanamycin (38.3%), followed by ciprofloxacin (10.4%). The resistance to spectinomycin was 1.7%. No resistance was detected to ceftriaxone and cefuroxime. All gonorrhea patients in GUM Clinic, HKL were treated with ceftriaxone, and subsequent cultures on follow-up were negative. We compared our results with the data obtained from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP)6 and the WHO Western Pacific Gonococcal Antimicrobial Surveillance Programme (GASP)7. Conclusion Penicillin and tetracycline resistance remain high in Malaysia and other Western Pacific countries. Resistance to ciprofloxacin was however lower in Malaysia compared to other countries. There was no resistance to ceftriaxone and cefuroxime. The current first line antibiotic for treating gonorrhoea in GUM Clinic, HKL is ceftriaxone.

Background Herpes genitalis (HG) is the commonest cause of sexually transmitted ulcerative disease in the world, including Malaysia1. Herpes simplex virus (HSV) type 2 is more frequently implicated than HSV type 1. This pattern has seen some changes in many parts of the world, with increasing HSV type 1 rates2. Objective The aim of this study was to determine the type of HSV implicated in patients with herpes genitalis at the Genito-Urinary Medicine Clinic, Department of Dermatology, Hospital Kuala Lumpur. Methods A retrospective study was undertaken on 242 patients with a diagnosis of herpes genitalis at the Genito-Urinary Medicine Clinic from January 2000 to December 2004. The study included all cases of genital herpes in patients aged over 12 years. The typing was done by a immunofluorescent - labeled monoclonal antibody technique specific for HSV antigens. Results Majority (76%) were between the ages of 20-49 years. Males outnumbered females by 1.6:1. Younger women (20-29 years old) tend to be more frequently affected than their male counterpart. One fourth (25.7%) of the patients reported having sex with sex workers and less than 1% (0.4%) were sex workers. A significant percentage (30.5%) of married men reported extramarital relationship with sex workers or had a casual or regular partner. Usage of condoms was low at 12%. Clinical diagnosis at presentation was primary herpes genitalis (56%) and recurrent (44%). 162 (67%) out of a total of 242 patients had the herpes immunofluorescent test done. 110 (68%) of those done were negative. Only 34 (21%) of patients with herpes genitalis had a positive immunofluorescent antibody test. Of the 21%, herpes simplex virus type 2 was found in 19 (12%) of patients with herpes genitalis, HSV type 1 in 10 (6%) and HSV types 1 & 2 coinfection in 5 (3%) patients. Conclusions In our study, HSV-2 was still more common causing 57% of the cases seen, HSV-1 29% and HSV-1 and HSV-2 coinfection in 14%. An increased rate of HSV-1 seen could possibly be due to a change in sexual behavior of the patients especially with regards to oro-genital sexual contact.

Backround Gonorrhoea is the third most common sexually transmitted infection (STI) in the Genitourinary Medicine Clinic. Despite high cure rates achieved with the use of intramuscular ceftriaxone, all patients with gonorrhoea are followed up with one test of cure (gonococcal culture) after treatment. This is essential to ensure success of cure hence preventing complications, to screen for and treat concomitant STIs, and to reduce the possibility of re-infection through repeated patient education. A defaulter is defined as a patient who fails to attend follow-up and undergo test of cure within a period of 2 weeks after completion of treatment. Previous studies showed high defaulter rates of 41.1% and 43.8% in 1996 and 1997 respectively. This study aims to determine the defaulter rate of follow-up of patients with gonorrhoea, and to formulate remedial measures to reduce defaulter rate and thereby improve the management of gonorrhoea specifically and all sexually transmitted infections in general. Materials and Methods An audit of defaulter rate of patients diagnosed as gonorrhoea was performed from January 1998 to December 2005 in the Genitourinary Medicine Clinic, Department of Dermatology, Kuala Lumpur Hospital. All patients who failed to attend follow-up visit within 2 weeks after treatment were recorded as defaulters. An analysis was performed on all defaulters from January to December 2005. Results Defaulter rates for patients with gonorrhoea were generally high throughout the years studied, ranging from 35.0% to 48.2%, the highest being in year 2001. Despite continuous and relentless efforts in patient education and counseling, there has been no decreasing trend. In the year 2005, all defaulters were males. Majority (72.1%) of the defaulters were young adults aged between 21 and 40 years. 67.4% of the defaulters were Malay, followed by Indian 14.0%, Chinese 7.0% and other ethnic groups 11.6%. Among the defaulters, 30.2% had repeated gonococcal infection and 38.5% had concomitant STIs. Conclusions More effort is necessary in educating patients to attend follow-up visit after treatment of gonorrhoea. Emphasis has to be made on the importance of confirming cure and thereby preventing complications and transmission to sexual partners. Counseling should also be given to all patients regarding practice of safe sex to prevent gonococcal re-infection and other STIs.

Background According to the Department of Public Health Malaysia, the total number of HIV patients up to December 2006 was 76,389. More than 90% were males with Malays being the majority. IVDU was the main mode of transmission followed by heterosexual contact. Objectives To determine the sociodemography, associated risk factors and clinical presentation of patients with HIV attending the Genitourinary Medicine (GUM) clinic. Method A retrospective study analyzing the data using a standard questionnaire. All HIV patients seen in the GUM clinic between 1/1/2000-31/12/2005 were recruited. Results A total of 191 patients with HIV were seen, with 84% being males and 16% females. This constituted 4.2% of the total number of patients seen in the clinic. 64% were Chinese, 18% Malays, 15% Indians and 2% other races. 90% were between 21-50 years of age. The major risk factors for males were sexual promiscuity (61%) and IVDU (14%). 41% frequented commercial sex workers. 74% were heterosexuals, 18% homosexuals and 8% bisexuals. The major risk factors for females were being sexual partners of HIV infected males (48%), IVDU (16%) and sex workers (6%). Majority reported no usage of condom. The main diagnoses at presentation were herpes genitalis (24%), genital warts (22%), gonorrhoea (10%) and syphilis (10%). Non venereal disease accounted for 23%. Conclusions The major risk factor for HIV transmission in patients attending the GUM clinic was exposure to sex workers, and the predominant race was Chinese. According to the national figure the main mode of HIV transmission was IVDU with Malays being the majority. The main diagnoses at presentation were herpes genitalis, genital warts, gonorrhoes and syphilis.