5 курс / Инфекционные болезни / Доп. материалы / Клинико_лабораторная_и_эпидемиологическая_характеристика

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Table 4.2.1. continued

More MSM were observed in the main group of the patients suffering from syphilis (concurrent with HIV infection): 51.3% vs 31.3% of patients with syphilis from the second comparison group (HIV-free) (χ2 = 22.208; p < 0.001). There were much fewer married persons in the main group: 8.5% vs 22.2 in the second comparison group (χ2 = 19.820; p < 0.001). A total of 70.6% of patients from the main group and 55.3% of patients from the second comparison group said that they had no permanent partner (χ2 = 13.743; p < 0.001). Casual relations were reported in 87.1% of patients in the main group, which was significantly more than among the patients from the second comparison group (59.6%) (χ2 = 52.836; p < 0.001). Patients from the main group had less experience of commercial sex (10.1%), while patients from the second comparison group had more experience thereof (19.6%) (χ2 = 10.965; p < 0.001). Patients from the main group had a reliably more frequent experience of using injecting drugs, namely, in 9.2% of cases and similar experience was reported by a mere 2.5% of patients in the second comparison group (χ2 = 10.220; p = 0.020). Alcohol abuse was similar in both groups among 2.9% and 4.4% of patients, respectively (χ2 = 0.785; p = 0.510). A history of other STIs was equally common in both comparison groups: 9.9% and 8%, respectively (χ2 = 0.622; p = 0.523). Concurrent hepatitis C infection was recorded in

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stated. The commercial sex factor (OR = 0.451, lower confidence limit = 0.275) did not have a reliable effect on the development of the concurrent infection, either. Similarly to the aforementioned factors, alcohol abuse did not have a reliable effect on the development of the concurrent infection (OR = 0.664, lower confidence limit = 0.267).

Casual sex is an appreciable factor that determines the risk of the concurrent infection. The probability of the concurrent infection in patients with casual sex is 4.5- fold higher (OR = 4.583).

The presence of a permanent sexual partner closely correlates with the concurrent infection. The odds of developing the concurrent infection in the patients without a permanent partner are almost twice higher (OR = 1.942).

Among the patients with more than three partners over six months, the probability of the concurrent infection was about 1.5 times higher (OR = 1.594).

The use of injecting drugs increases the probability of the concurrent infection almost 4-fold (OR = 3.875).

4.3. The Characteristics of Risky Behaviour and Social Status of the Patients Suffering from Syphilis Concurrent with HIV Infection Based on Anonymous Polling

When analysing anonymous polling results, the level of the social adaptation of patients with the concurrent infection and a number of behavioural traits could be updated.

The number of patients who were unemployed at the time of the survey amounted to 18.5% in the main group and 26.9% in the comparison group (χ2 = 0.534, р = 0.465). The main group often had patients who were employed as qualified workforce (55.6% and 38.5%, χ2 = 1.553, р = 0.213) and patients with a university degree (62.9% and 42,3%, χ2 = 2.268, р = 0.132). Patients in both groups held management positions equally as often (33.3% and 26.9%, χ2 = 0,681, р = 0.409) and reported that they were not satisfied with their professional status with the same frequency (33.3% and 38.5%, χ2 = 0.151, р = 0.697).

Patients in the main group were married and had children much rarer to a statistically significant degree (18.5% in the main group vs 46.2% in the comparison

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A vast majority of patients in both groups featured risky sexual behaviour. About half of them had an early sex debut (below 16 years old) (44.4% and 53.8%, respectively, χ2 = 0.468, р = 0.494).

A significant number of patients in both groups had episodes of unprotected sex (genital, anal, or oral). Patients from both groups also had equally as often casual relations when under the influence of alcohol (44.4% and 50%, respectively, χ2 = 0.164,

р = 0.685).

Most patients in the main group (70.4%) had homosexual contacts, which was reliably more than in the comparison group (42.3%, χ2 = 4.246, р = 0.039).

An appetite for group sexual contacts was more often reported by patients in the main group (59.3% and 26.9%, χ2 = 5.638, р = 0.018). The use of commercial sex services (as customers) was reported by 18.5% and 23.1% in the comparison groups (χ2 = 0.167, р = 0.682). Only 11.1% of patients in the main group have used PrEP at some point (χ2 = 0.181, р = 0.670), while 37% know that they exist (χ2 = 4.652,

р = 0.031). A total of 74.1% of patients in the main group reported on disturbed psychoemotional state after being diagnosed with HIV infection and only 22.2% of

them sought consultation with a mental health professional.

The use of substances from time to time (22.8% and 30.8 %, χ2 = 0.498,

р = 0.480) or addiction (14.8% and 11.5%, χ2 = 0.124, р = 0.725) was equally often among patients in both groups. The episodes of alcohol abuse were most frequently reported by patients in the comparison group (18.5% and 30.8%, χ2 = 1.074, р = 0.300).

Table 4.3.2 – Risky Behaviour of Patients Over a Lifetime

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Table 4.3.3– Risky Behaviour of Patients Over the Past Six Months

The cases of substances abuse over the past six months were reported by 7.4% and 11.5% of patients in both groups (χ2 = 0.265, р = 0.607). As many as 10.1% and 15.4% of patients in the comparison groups (χ2 = 0.211, р = 0.646) experienced alcohol abuse over the past six months.

A total of 25.9% and 37% of patients in the main group and comparison group, respectively, had unprotected sex under the influence of alcohol in the past six months (χ2 = 0.955, р = 0.328).

Summary

Therefore, over 10 years, there were significant changes in epidemiological, medical and social indicators among patients suffering from syphilis combined with HIV infection. The percentage of men increased significantly from 59.7% to 92.6% (χ2 = 66.203; p < 0.001), while the share of MSM grew from 16.5 to 51.1% (χ2 = 46.001; p < 0.001). A significant reduction in the percentage of patients with a

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CHAPTER 5. CLINICAL STATUS AND LABORATORY CHARACTERISTICS OF SYPHILIS IN PATIENTS WITH HIV INFECTION

5.1.Clinical Status of Patients with Primary Syphilis

When analysing data, primary syphilis was diagnosed in three (1.1%) patients from the main group and six patients (2.2%) in the comparison group. Two patients from the main group had erosive chancres and one patient was found to have an ulcerated chancre. Three and two patients in the comparison group were found to have erosive chancres and ulcerated chancres, respectively, and a primary affect in one patient was located on the palatal tonsil (amygdalitis chancre). All patients, but one from the main group, were observed to have regional lymphadenitis. Due to the small amount of observations, clinical and laboratory data in patients with primary syphilis in both observation groups were not statistically significant. A total of 14 (21.5%) patients in the main group and comparison group with secondary syphilis and early neurosyphilis were found to have remaining clinical signs of primary syphilis. Thus, there were 14 (21.5%) patients with secondary syphilis and 10 (8.7%) patients with early neurosyphilis and concurrent presentations of primary syphilis in the main group. The presentations of primary syphilis were also recorded in 5 (4.8%) patients in the comparison group with early neurosyphilis and in 12 (21.8%) patients with secondary syphilis in the comparison group with secondary syphilis (Table 5.1.1).

Table 5.1.1- Breakdown of Patients with Early Neurosyphilis and Secondary Syphilis by Remaining Clinical Sign of Primary Syphilis