The laboratory diagnosis of male Chlamydia trachomatis infections--a time for change?

We carried out a two-phased study comparing the effectiveness of first-catch early morning urine (FCU) samples against urethral swabs for the detection of C. trachomatis in men. Four hundred and seventeen new and re-booked consecutive men, who attended the Department of Genito-Urinary Medicine, Bristol, having held their urine overnight, were recruited. Patients who had received antimicrobial chemotherapy in the preceding 2 months were excluded. Early morning FCU samples were obtained from 208 men followed by urethral swabs for the detection of C. trachomatis (phase I) and this order of collection was reversed for the remaining 209 patients (phase 2). A last-catch urine (LCU) was also obtained from all patients. All urethral and urine samples were examined by an amplified enzyme immunoassay (IDEIA, Dako Diagnostics Ltd). Initially, discordant samples were critically examined by direct immunofluorescence (Syva, 'Microtrak') which was used as the 'gold' standard in this study. We have shown that overall 42 and 4.7% of our symptomatic and asymptomatic male patients respectively were positive for C. trachomatis antigen by IDEIA. Furthermore 86.4 and 91.0% (phases 1 and 2) of the total C. trachomatis positive samples were detected by examination of an FCU sample. In contrast only 66.0 and 65.5% (phases 1 and 2) of the total positives were identified by examination of an urethral swab. These results show that an FCU sample not only has the advantage of being a non-invasive procedure but is also a very sensitive method, compared to swabbing the urethra for the detection of C. trachomatis.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaerobic vaginosis: study of male sexual partners.

One hundred male sexual partners of women with anaerobic vaginosis (AV) were screened for the presence of sexually transmitted diseases (STD). Thirty male partners had evidence of non-gonococcal urethritis (NGU), compared to 5 in the control group (P less than 0.05). Chlamydia trachomatis was isolated from 14 male partners, compared to 3 in the control group. Forty-five male partners required treatment for STDs, compared to 11 in the control group (P less than 0.02). Nine (40%) male partners with chlamydia-negative NGU were successfully treated with metronidazole alone while 10 required Deteclo in addition. There was no significant association between Bacteroides ureolyticus and chlamydia-negative NGU. Screening of male partners resulted in the treatment of STDs in 62 additional patients who would have otherwise not received treatment. The results suggest that examination of male partners of women with AV results in an increased yield of STD diagnoses.

Evaluation of a novel solid-phase immunoassay, Clearview Chlamydia, for the rapid detection of Chlamydia trachomatis.

Clearview Chlamydia (Unipath Limited, Bedford, United Kingdom) is a rapid immunoassay for the direct detection of Chlamydia trachomatis antigen. This assay was evaluated against the tissue culture method by using 376 paired endocervical specimens. The Clearview assay had a sensitivity of 93.5% and a specificity of 99% when it was compared with the tissue culture method. This assay does not require specialized equipment or trained personnel and yields results within 30 min from the time that a specimen is collected.

Flat condylomata of the penis presenting as patchy balanoposthitis.

Fifty patients presenting with either primary or recurrent patchy balanoposthitis which became aceto-white after the application of 5% acetic acid underwent biopsy. Microbiological screening, including Grocott staining of the biopsy material for fungal hyphae was performed. Forty nine biopsies showed marked koilocytosis suggestive of human papilloma virus (HPV) infection, and of these, only three showed fungal hyphae. This study suggests that HPV may be associated with some cases of patchy balanoposthitis.