Sexual risk behavior in women with cervical human papillomavirus infection.

In a study of 972 women, sexual characteristics of 66 women with a cervical human papillomavirus infection (CHPI) were compared to the remaining study population. Among a number of sexual variables that were significantly correlated with CHPI were number of lifetime sexual partners, short partnerships, many recent partners, infidelity, casual travel sex, sexual début abroad, oral and anal sex, and sexual abuse. In multifactorial analyses four variables remained significantly correlated with CHPI, i.e., number of lifetime sexual partners, casual travel sex, sexual début abroad, and infidelity. It is concluded that CHPI shows most of the epidemiological characteristics of a sexually transmitted disease.

Seropositivities to human papillomavirus types 16, 18, or 33 capsids and to Chlamydia trachomatis are markers of sexual behavior.

The association of seropositivity to human papillomavirus (HPV) capsids of types 11, 16, 18, or 33 with sexual behavior was investigated. Among 1002 women visiting family planning or youth clinics in Sweden, an age-matched subsample of 274 women stratified according to lifetime number of sex partners was analyzed. The proportion of HPV-16-seropositive subjects increased linearly at approximately 4% per partner (P < .001), from 4% among those with 1 lifetime partner to 35% among those with >5 lifetime partners. Also, HPV-33 and HPV-18 seroprevalences were linearly dependent on the number of partners (P < .001, increase with 4% per partner, and P = .008, increase with approximately 3% per partner, respectively), providing serologic confirmation that the important mode of transmission of HPV-16, -18, or -33 infection in women is sexual. HPV serology appears to be suitable as a marker of sexual behavior in populations.

Efficacy and safety of azithromycin versus lymecyline in the treatment of genital chlamydial infections in women.

To compare the clinical and microbiological efficacy of azithromycin in curing chlamydial infections in women with that of lymecycline, and with a view of the possibility of minimizing the problem of compliance by means of single-dose administration, 146 women with culture-positive Chlamydia trachomatis infections were randomly assigned to treatment with a 1 g bolus dose of azithromycin or a 10-day course of lymecycline 300 mg twice daily. Clinical and microbiological evaluations were performed and adverse effects monitored at check-ups after 15-35 and 40-65 days. Of the 146 patients enrolled in the study, 120 were evaluable. At the second check-up, C. trachomatis was found to have been eradicated in all patients in both treatment groups. Of the 51 patients who had clinical signs and symptoms of genital infection at enrolment, 96% (22/23) of those in the azithromycin group were considered cured (n = 18) or improved (n = 4), as compared with 100% (28/28) of those considered cured (n = 22) or improved (n = 6) in the lymecycline group. Adverse events related, or possibly related, to treatment were reported by 16 (21.6%) of the lymecycline group, but by only 6 (8.3%) of the azithromycin group. The 2 drugs were comparable with regard to microbiological and clinical efficacy in the treatment of genital chlamydial infection in women. The markedly lower rate of side-effects associated with azithromycin may be a feature conducive to patient compliance.

Contraceptive use and reproductive history in women with cervical human papillomavirus infection.

The study was conducted to investigate whether cervical human papillomavirus infections (CHPI) are associated with contraceptive use and reproductive history. The contraceptive and reproductive histories in 972 women seeking contraceptive advice were noted and screening conducted for human papillomavirus infection. The interview included number of pregnancies and childbirths, legal and spontaneous abortions, and menstrual pattern. Information about current use of contraceptive methods, about casual sex, and history of combined oral contraceptive pill (OC) use was obtained. Women with a history of spontaneous abortion showed a significant correlation with CHPI, as did women who used high-dose OCs when compared with the remaining study population (odds ratio 3.0). There was no association between use of low-dose OCs and CHPI. In multifactorial analyses with adjustment for age, number of lifetime sexual partners, number of partners during the preceding six months and age at first intercourse, the significant correlation between use of high-dose OCs and CHPI remained (adjusted odds ratio 2.8). The results indicate a relationship between female steroid hormones and the occurrence of CHPI. An association with high-dose OCs could not be excluded.

Serum tetranectin in patients with acute pelvic inflammatory disease (PID). Correlation to clinical and laboratory findings.

AIM OF STUDY: To clarify the impact of the presence of pelvic inflammatory disease (PID) and activation of the acute phase response on the serum level of tetranectin (Se-TN), a potential new tumor marker for ovarian cancer. MATERIALS AND METHODS: The study group consisted of 70 patients with a laparoscopically verified PID and 47 healthy female controls. RESULTS: Lower Se-TN levels were found for the PID group compared to the control group (p < 0.0001). It was not possible to relate the decreases in Se-TN levels to any distinct bacterial strain. Neither was it possible to find any correlation between Se-TN and severity of PID (p = 0.5). A significant positive correlation was found between Se-TN and ALB (p < 0.001). A just significant negative correlation was found between Se-TN and C-reactive protein (CRP) (p = 0.04), while no correlation was found with any of the other acute phase reactants. Highly significant correlations were found between all the acute phase reactants and grade of PID. CONCLUSIONS: A slight, but significant reduction in Se-TN was found in PID patients. The decrease was minor compared to the reported findings of very low Se-TN levels for ovarian cancer patients. However, the finding is important in the assessment of TN used as a potential screening marker for ovarian cancer, or as a diagnostic tool for pelvic tumors. Furthermore, Se-TN does not seem to behave as a negative acute phase reactant.

Alpha-fetoprotein and the acute phase response. A study using acute pelvic inflammatory disease as a model system.

Alpha-fetoprotein (AFP) is used as a tumor marker for hepatomas and germ cell tumors. In healthy non-pregnant adults the serum concentration (S-AFP) is very low and we examined whether it was affected when the acute phase response was activated, using patients with acute pelvic inflammatory disease (PID) as a model system. In 70 PID patients the median S-AFP was 1.2 kIU/l (range: 0.5-5.9 kIU/l), within the normal range. S-AFP did not correlate with the clinical grade of disease nor with the serum concentrations of acute phase reactants and albumin. Thus, S-AFP is not significantly affected by activation of the acute phase response and presence of infection should not per se interfere with the use of S-AFP as a tumor marker. However, a negative correlation was found with the serum concentration of alpha-2-macroglobulin (P = 0.05), but whether this has any biological significance remains to be clarified.

Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis.

In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild (16/64), a moderate (26/64), or a severe (22/64) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3-6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36/64 (56%) (9/16 with a mild form, 13/26 with moderate form and 14/22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15/64 (23%) (5/16 with a mild form, 4/26 with a moderate form and 6/22 with a severe form of the disease). Oviductal cultures for CT were found in 12/64 (19%) (1/16 with a mild form, 4/26 with a moderate and 7/25 with severe form of salpingitis). Oviductal isolates for NG were found in 2/64 (13%) (2/16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).

Second look laparoscopy after treatment of acute salpingitis with doxycycline/benzylpenicillin procaine or trimethoprim-sulfamethoxazole.

To have their diagnosis verified, etiology determined and treatment evaluated, 64 patients with a suspected acute salpingitis underwent laparoscopy during which isolates were taken. The patients were then randomized to one of two groups for treatment; doxycycline/benzylpenicillin procaine (DC + BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated three to six months later by second look laparoscopy when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 37 (58%) patients and for Neisseria gonorrhoeae (NG) in 15 (23%). Isolates from the oviducts were positive in 17 (27%) patients of whom 12 had CT and two had NG. Mild salpingitis (Grade I) was found in 16 patients, moderate (Grade II) in 26 and severe (Grade III) in 22 patients. At second look laparoscopy, two patients had totally occluded oviducts, 31 had adhesions but tubal passage on at least one side while 31 patients had healed without any signs of residue. Results at second look laparoscopy showed no statistical difference between the two treatment groups.

Salpingitis; aspects of diagnosis and etiology: a 4-year study from a Swedish capital hospital.

359 patients underwent laparoscopy to verify the diagnosis of salpingitis. Pelvic inflammatory disease (PID) was found in 187 (52%) cases. Laparoscopy revealed normal conditions in 136 (37%) cases. Other diseases were diagnosed in 36 (10%) cases. Bacteriological cultures from the fimbrial lumen were positive in 24% of the PID cases. Chlamydia trachomatis (CT) was detected in 12%, Bacteroides species (BS) in 5%, Actinomyces israelii (AI) in 3%, Gardnerella vaginalis (GV) in 2%, Neisseria gonorrhoeae (NG) in 1%, and Ureaplasma urealyticum (UU) in 1%. Cervical cultures were positive for NG and/or CT in 71% of the PID cases but only in 19% of the non-PID cases. From these no positive intra-abdominal cultures were detected. Serological tests for CT were carried out. A positive acute titre of greater than or equal to 1/64 was noted in 37%, a seroconversion (X4) 2-3 weeks later was found in 14%. Positive serology despite a negative culture was registered in 19%.

Actinomyces israelii-associated salpingitis.

Actinomyces israelii was identified in samples from the oviducts of 4/100 women with salpingitis diagnosed by laparoscopy. All four cases healed on 'routine' treatment. Possible pathogenic mechanisms for the development of actinomycosis are discussed.

Doxycycline in human oviduct mucosa and plasma 24-30 hours after an oral dose of 100 mg.

Oviductal and peripheral plasma concentrations 24 hours after the last dose of Doxycycline (DC) were studied in 17 patients. The concentration of DC in healthy oviduct mucosa was 1.3 micrograms/g (range 0.6-1.7) and 1.1 micrograms/ml (range 0.6-1.7) in plasma. One patient with severe chronic salpingitis in acute exacerbation showed 3.6 micrograms/g in tissue and 2.4 micrograms/ml in plasma in proliferative phase.

Levels of ampicillin and doxycycline in human oviduct mucosa and serum.

A common treatment for salpingitis today includes ampicillin (AMPI) and doxycycline (DC), the former against Neisseria gonorrhoeae and the latter against Chlamydia trachomatis. The concentrations of doxycycline in oviduct mucosa were found about equal to that of serum and well above the minimum inhibitory concentrations (MIC's) for the bacteriae in question. The concentration of AMPI in the oviduct mucosa was only about 1/40 of that in serum, i.e. 1/10 of the MIC, which jeopardizes the effectivity of AMPI in the treatment of salpingitis.

Levels of trimethoprim and sulfamethoxazole in human oviduct mucosa and plasma.

The oviductal and plasma levels of trimethoprim (TMP) and sulfamethoxazole (SMZ) were studied in 9 women after oral and i.v. administration of a drug combination (Eusaprim R, Wellcome Foundation Ltd). The concentration of TMP in a healthy endosalpinx was found to be twice as high (4.7 microgram/g, range 2.8-8.3) as in plasma (2.6 microgram/ml, range 2.1-3.6). Conversely, the endosalpingeal level of SMZ (38 microgram/g, range 12-65) was about half that in plasma (77 microgram/ml, range 58-95). The agar well diffusion method was used for the concentration determinations. The specimens were collected during surgery for non-infectious genital diseases. The implication of treatment by the given drugs is discussed.