STD/HIVcontrol inMalawiandthesearch for affordable andeffective urethritis therapy: afirst field evaluation

Objectives-To evaluate gonococcal (GU) and nongonococcal urethritis (NGU), chlamydiaantigen, and serostatusfor syphilis and human immunodeficiency virus(HIV)among malesattending a MalawianSTD clinic withcomplaints of urethraldischarge andfordysuria. To collectdemographicand behavioural dataandtodetermine theeffectiveness of five treatmentsforurethritis. Methods-Urethritis was diagnosed using microscopy and cultureforNeisseria gonorrhoeae. Serawere screenedwith rapidplasmareagin(RPR)andifreactive,withmicrohaemagglutination for Treponemapallidum(MHA-TP).HIV antibodies andchlamydiaantigen were detectedusingenzyme niminoassay. Patients were randomised fortreatment, cure was assessed 8-10dayslater. Results-At enrolment,GU was diagnosedin415(80.3%)and NGU in 59 (11.2%) of517males.Chlamydiaantigen was foundin26(5.2%) of497specimens tested. Syphilis seropositivity rate(RPR and MHA-TP reactive) was 10-7%. OverallHIV seroprevalence was 44.2%; 71-7%of men withreactivesyphilis serology were HIV(+) comparedwith 40-9%of syphilis seronegatives (OR: 3'6,p < 0.001). Trimethoprim 320mgl sulphamethoxazole