Chlamydia trachomatis PCR (Cobas Amplicor) in women: endocervical specimen transported in a specimen of urine versus endocervical and urethral specimens in 2-SP medium versus urine specimen only.

The sensitivity of Roche Cobas Amplicor Chlamydia trachomatis polymerase chain reaction (PCR) including the internal control (IC) programme to identify inhibition, was investigated on 3 different samples from women: (1) swab samples from the urethra and the cervix pooled in 2-SP transport medium, (2) swab sample from the cervix transported in a urine sample from the same patient, and (3) urine sample alone. Out of the 2412 patients, 193 (8.0%) were chlamydia positive and in 14 of these the results showed discrepancies between sampling methods. The sensitivity of PCR on urethra/cervix, urine/cervix and urine was 98.4% (190/193), 97.9% (189/193) and 93.3% (180/193) respectively. The higher sensitivity of PCR on urethra/cervix and urine/cervix as compared with urine alone was statistically significant. Without the IC, the sensitivity of PCR on urethra/ cervix, urine/cervix and urine would have been 95.9% (185/193), 94.8% (183/193) and 90.7% (175/193) respectively. Factors influencing the rate of inhibition were also studied.

Magic Lite Chlamydia immunoassay in urogenital samples and urine versus chlamydial culture.

Magic Lite Chlamydia assay (commercial test kit for the identification of Chlamydia trachomatis) was evaluated on urogenital samples and urine with chlamydial culture as the reference method. The sediment of the transportation buffer of specimens which were Magic Lite positive but culture negative or toxic was investigated for elementary bodies with fluorescein-labelled anti-chlamydial antibodies. The prevalence of chlamydial infection among the 577 men investigated was 13.7% as estimated by culture and direct immunofluorescence and 6.4% among the 173 women. In order to improve the sensitivity a cut-off value below that recommended by the manufacturer was used. The sensitivity of Magic Lite in male urethral specimens was then 60.8% and that in female urethral/cervical specimens 90.9%. The specificity was 99.6% and 100%, respectively. In urine specimens the sensitivity of Magic Lite was 63.3% (men) and 63.6% (women). The specificity was 99.4% and 100%, respectively. The sensitivity of Magic Lite on male urethral specimens was related to the number of inclusion bodies per well in culture and it was higher among men attending with clinical findings of urethritis (69%) than among asymptomatic men sampled as a screening procedure (36%) (P < 0.05). Corresponding differences between the sexes and between those with and without symptoms were not noted for Magic Lite applied on urine samples.

Stomatococcus mucilaginosus septicemia in two bone marrow transplanted patients.

A 44-year-old man with chronic myeloid leukemia and a 10-year-old boy with adrenoleukodystrophy, both admitted for bone marrow transplantation in December 1992, developed clinical signs of septicemia within 2 weeks after transplantation. Three strains of Stomatococcus mucilaginosus were isolated from blood cultures. These were among the first cases of S. mucilaginosus infection diagnosed at our Laboratory and the first reported from Scandinavia. S. mucilaginosus is part of the endogenous oral flora. Both patients had signs of oral mucositis. All 3 strains were isolated earlier with the Laboratory's present blood culture system, compared with the one in use before spring 1992.

Endemic versus non-endemic gonorrhoea in Stockholm: results of contact tracing.

The aim of the present study was to characterize endemic versus non-endemic gonorrhoea to identify risk groups for transmission and to evaluate the effects of intensified contact tracing performed by specially trained social workers at venereal clinics. A total of 671 gonorrhoea patients (283 women and 388 men) comprised the study group. Seventy percent of the women and 48% of the men had an endemic infection (P < 0.001). Men without a steady partner had an increased risk of non-endemic infection. A decrease from 75% to 40% was noted in the proportion of endemic infection in Stockholm from the first quarter of the study period (2 years) to the last. Contact tracing resulted in 1.2 identified partners per patient. A total of 736 partners were examined either as a result of contact tracing efforts or because they had sought medical care on their own prior to intervention. Forty-seven percent of these partners were infected, 44% were not infected and 9% were examined outside the study with results unknown to us. The partner notification efforts yielded 161 new untreated cases. Contact tracing of women generated one new case per 4.0 interviewed women and contact tracing of men one new case per 4.3 interviewed men. Interviewing index patients with endemic infection yielded the highest number of new cases. Forty-three percent of the patients were infected outside Stockholm but only a smaller part of these patients spread their infection further into the community.(ABSTRACT TRUNCATED AT 250 WORDS)

Roxithromycin compared to doxycycline in the treatment of genital chlamydial infection and non-specific urethritis.

A single-blind randomized follow-up study was conducted to evaluate the efficacy and tolerance of roxithromycin 300 mg once a day compared to doxycycline 200 mg day 1 and 100 mg day 2-10 in the treatment of genital chlamydial infection in men and women and non-specific urethritis (NSU) in men. A total of 211 patients (200 men and 11 women) between 18 and 46 years were enrolled. The women were excluded from the efficacy analysis because of the low number, but were included in the tolerance analysis. The clinical (clearance of polymorphonuclear leucocytes in urethral smears) and bacteriological response was evaluated one and 11 days after the treatment. Of 113 included men with chlamydial infection, 105 (93%) and 96 (85%) were evaluable on respective follow-up visits and of 87 included men with NSU, 74 (85%) and 64 (74%) were evaluable one and 11 days after treatment, respectively. The bacteriological eradication rate immediately after the treatment in chlamydia positive patients was 92.7% and 100% for roxithromycin and doxycycline, respectively, and 91.8% and 100% at follow-up. The clinical cure rate of all evaluable patients was 83.1% and 80.7% for roxithromycin and doxycycline, respectively, one day after the treatment and 80.5% and 85.3% for the two drugs, respectively, 11 days after treatment. None of these observed differences was statistically significant. The diagnosis did not influence the clinical response rate with either drug. Probable and possible drug-related side-effects were more common after doxycycline than after roxithromycin, 35% and 19% respectively (P = 0.0032).(ABSTRACT TRUNCATED AT 250 WORDS)

Antibiotic susceptibility, serovars and auxotypes of gonococcal isolates in Stockholm. Relation to geographical origin of the infection.

The antibiotic susceptibility, serovars and auxotypes were investigated in gonococcal strains isolated from all patients with gonorrhoea during one year in Stockholm, Sweden. The results were correlated to geographical origin of the infection. A total of 394 gonococcal strains were isolated from 392 patients, 135 (34%) women and 257 (66%) men. Beta-lactamase-producing gonococcal strains (PPNG) were isolated from 5% of the women and 16% of the men. Men had acquired their infection abroad more often than women (54% vs 33%) (P < 0.001). The majority (81%) of the PPNG infections were imported. Some serovars and auxotypes were more common among imported strains than among indigenous ones. All strains were sensitive to spectinomycin and 2 strains had decreased susceptibility to norfloxacin and ciprofloxacin. Decreased susceptibility to benzylpenicillin, ampicillin, doxycycline and cefuroxime was related to the geographical origin of the strains with strains imported from regions other than Europe being the most resistant.

Prevalence of urogenital Chlamydia trachomatis infection in El Salvador. II. Gynaecology outpatients.

The prevalence of urogenital infection caused by Chlamydia trachomatis was examined in 100 non-pregnant women with cervicitis, and 100 healthy women, in San Salvador City, El Salvador. Pharmacia Chlamydia EIA test was used for the detection of chlamydial antigen in urethral and cervical specimens from all the women. Direct immunofluorescence was used for confirmative tests on the EIA positive and the negative gray zone samples. C. trachomatis antigen was detected in 28% of the women with cervicitis compared with 5% in the group of healthy women (P < 0.001). The cervicitis group were also screened for Neisseria gonorrhoeae which was isolated from 12% of them. One strain out of 12 was beta-lactamase producing (PPNG). Five per cent of the women with cervicitis had simultaneous C. trachomatis and N. gonorrhoeae infections.

Antimicrobial susceptibility of Neisseria gonorrhoeae in Zaire: high level plasmid-mediated tetracycline resistance in central Africa.

OBJECTIVE: To determine the in vitro antimicrobial susceptibility of gonococcal strains isolated in 1988 among female prostitutes in Kinshasa, Zaire and to characterise strains with high level tetracycline resistance. METHODS: Minimal inhibitory concentrations of 8 antimicrobials were measured by agar dilution technique. Plasmid-profiles and serovars were determined. RESULTS: Two hundred and thirteen strains of Neisseria gonorrhoeae were tested of which 59% were beta-lactamase producers and an additional 21% showed intermediate or chromosomal resistance to penicillin (MIC = 0.5-8 mg/l). Eleven percent of the strains were resistant to the combination sulfamethoxazole-trimethoprim (MIC greater than 8 mg/l) and 57% of the isolates showed decreased susceptibility to thiamphenicol (MIC = 1-4 mg/l). All strains were sensitive to spectinomycin, norfloxacin and ceftriaxone and moderately sensitive to kanamycin. Chromosomal resistance to tetracycline was observed in 45% of strains (MIC = 2-8 mg/l). Ten percent were highly resistant to tetracycline (TRNG, MIC = 16-128 mg/l) and were shown to carry a plasmid borne Tet M determinant; such strains were not found in Kinshasa in 1985. TRNG belonged to 4 different serovars, which were also the dominant serovars in non-TRNG. CONCLUSION: These findings illustrate the high frequency of multiresistant gonococci in Zaire and suggest that high level tetracycline resistant strains of N. gonorrhoeae have become endemic in Central Africa.

Prevalence of urogenital Chlamydia trachomatis infection in El Salvador. I. Infection during pregnancy and perinatal transmission.

One-hundred and twenty-nine pregnant women in labour (age range 15-46 years; median age 23) and 42 infants born to chlamydia-positive mothers (age range 5-15 days; median age 10) were investigated to estimate the prevalence and incidence, respectively, of Chlamydia trachomatis infection in San Salvador, El Salvador. Urethral and cervical samples were obtained from all women and conjunctival specimens were taken from both eyes of each child. The chlamydial antigen was detected with the commercial Pharmacia Chlamydia EIA kit. Direct immunofluorescence (DFA) (Syva MicroTrak) was used for confirmation. In the newborns both EIA and DFA tests on direct preparations from ocular smears were performed on all the samples. The prevalence of chlamydial infection in pregnant women was 44% (57/129). The incidence of chlamydial infection in neonates was 64% (27/42), and the majority of the infected children (56%) had conjunctivitis. Referring to individuals rather than specimens the sensitivity of EIA tests on conjunctival samples from the infants was low (37%) as compared with 91% on urethral and cervical specimens from the pregnant women.

Characterisation of PPNG and non-PPNG Neisseria gonorrhoeae isolates from Singapore.

OBJECTIVE: To characterise Neisseria gonorrhoeae isolates from Singapore. DESIGN: Characterisation of Neisseria gonorrhoeae isolates by auxotyping, serological analysis and plasmid profile analysis. SPECIMENS: Sixty randomly collected isolates from 41 symptomatic, untreated males and 19 female prostitutes were studied. RESULTS: Auxotyping of 25 PPNG and 35 non-PPNG strains showed that the Pro-auxotype was prevalent among both PPNG (56%) and non-PPNG (42.5%) strains. Prototrophic strains comprised 28% of PPNG and 32.5% of non-PPNG strains respectively. Serovar analysis showed that with the exception of seven serogroup WI strains, the majority belonged to serogroup WII/III. Serovar Aedih was predominant among both serogroup WI PPNG (80%) and non-PPNG (100%) strains. Serogroup WII/III PPNG strains were represented by nine serovars with the predominant serovars being Bacjk (28%) and Bcgjk (16%). Eleven serovars were identified in the WII/III non-PPNG strains and the major serovars were Bajk (20%), Bacjk (17%), Back (11.4%) and Beghjk (11.4%). Analysis of the 25 PPNG strains showed that 16 of them carried the 4.4 MDa (Asian type) resistance plasmid and nine strains harboured the 4.4 MDa plasmid in conjunction with the 24.5 MDa transfer plasmid. The cryptic plasmid of 2.6 MDa was present in 27 of the 35 non-PPNG strains. Five of the non-PPNG strains harbouring the cryptic plasmid also contained the 24.5 MDa transfer plasmid. The plasmid combination of 2.6 + 7.8 + 24.5 MDa was detected in three non-PPNG strains. CONCLUSION: The combination of epidemiological methods used in this study indicated the heterogeneity of N gonorrhoeae strains in Singapore. A total of 16 different combinations of auxotype, plasmid profile and serovar were seen in the 25 PPNG strains compared with 24 such combinations in the 35 non-PPNG strains. Such sensitive differentiation would otherwise not be possible using either auxotype-serovar (A/S) or auxotype-plasmid analysis.

Gonorrhoea and urogenital chlamydial infection in female prostitutes in Tegucigalpa, Honduras.

The prevalence of gonorrhoea and urogenital chlamydial infection was investigated in female prostitutes in Tegucigalpa, Honduras. Epidemiological data were recorded according to a standardized questionnaire. The median age of the prostitutes was 27 years and the median period of prostitution was 2-4 years. Most of the women (91%) had no occupation other than prostitution and 57% of them had not even completed primary school. In 233 cases when both gonococcal culture and chlamydial antigen detection with a commercial EIA kit were performed the prevalence of gonorrhoea was 25% (59) and that of chlamydial infection 31% (72). Both diseases were recorded in 9%. The women who had been prostitutes for 2 years or longer had gonorrhoea (P less than 0.01) or chlamydial infection (P less than 0.05) less frequently than those who had practised prostitution for a shorter time period. Among 70 different gonococcal isolates from 241 prostitutes, 40 (57%) belonged to serogroup W II/III. Most (83%) of the 30 W I isolates were beta-lactamase producing (PPNG) like 42% of the W II/III isolates. All non-PPNG isolates, except one had decreased susceptibility to benzylpenicillin (MIC greater than or equal to 0.125 mg/l) and all isolates were susceptible to spectinomycin. Four out of five isolates from the throat were PPNG and the fifth had a benzylpenicillin MIC of 0.5-2.0 mg/l.

PIP: The prevalence of gonorrhea and urogenital chlamydia infection was investigated among female prostitutes in Tegucigalpa, Honduras. Epidemiological data were recorded according to a standardized questionnaire. The median age of the prostitutes was 27 years old and median period of prostitution was 2-4 years. Most of the women (91%) has no other occupation besides prostitution and 57% of them had not even completed primary school. Among 233 cases when both gonococcal culture and chlamydial antigen detection with a commercial EIA kit were performed, the prevalence of gonorrhea was 25% (59) and that of chlamydial infection 31% (72). Both diseases were recorded in 9%. The women who had been prostitutes for 2 or more years had gonorrhea (p0.01) or chlamydial infection (p0.05) less frequently than those who had practiced prostitution for a shorter time period. Among 70 different gonococcal isolates from 241 prostitutes, 40 (57%) belonged to serogroup W II/III. Most (83%) of the W I isolates were beta-lactamase producing (PPNG) as were 42% of the W II/III isolates. All non-PPNG isolates except 1 had decreased susceptibility to benzylpenicillin (MIC or= o.125 mg/1) and all isolates were susceptible to spectinomycin. 4 of 5 isolates from the throat were PPNG and the 5th had a benzylpenicillin MIC of 0.5-2.0 mg/l.

Human immunodeficiency virus infection and syphilis in Hondurian female prostitutes.

The seroprevalence of human immunodeficiency virus (HIV) infection and syphilis was investigated in 181 female prostitutes in Tegucigalpa, Honduras. One particle agglutination test and two enzyme immunoassays, as well as one immunofluorescence test were used for the screening of HIV antibodies. Confirmation of positive results by the screening tests was carried out by Western blot. The prevalence of HIV seropositivity was 4% (8 women). Specific treponemal antibodies were found in 50% (90/181) of the prostitutes as judged by Treponema pallidum haemagglutination assay (TPHA) and/or fluorescent treponemal antibody-absorption (FTA-ABSIgG) test. As estimated by the positivity of any or both non-treponemal tests (VDRL and RPR), a total of 31 (17%) out of the 181 women had active syphilis. A good correlation was found between the results obtained by TPHA and FTA-ABSIgG. IgM antibodies were found in 72% of sera positive by TPHA and/or FTA-ABSIgG. Four out of the 181 women were found to have antibodies to both HIV and Treponema pallidum.

PIP: The seroprevalence of human immunodeficiency virus (HIV) infection and syphilis was investigated among 181 female prostitutes in Tegucigalpa, Honduras. 1 particle agglutination test and 2 enzyme immunoassays, as well as 1 immunofluorescence test, were used for the screening of HIV antibodies. Confirmation of positive results by the screening tests was carried out by western blot. The prevalence of HIV seropositivity was 4% (8 women). Specific treponemal antibodies were found in 50% (90/181) of the prostitutes as judged by Treponema pallidum hemagglutination assay (TPHA) and/or fluorescent treponemal antibody-absorption (FTA-ABSIgG) test. As estimated by the positivity of any or both nontreponemal tests (VDRL and RPR), a total of 31 (17%) of 181 women had active syphilis. A good correlation was found between the results obtained by TPHA and FTA-ABSIgG. IgM antibodies were found in 72% of sera positive by TPHA and/or FTA-ABSIgG. 4 of 181 women were found to have antibodies to both HIV and Treponema pallidum.

Syphilis and human immunodeficiency virus seroconversion during a 6-month follow-up of female prostitutes in Mogadishu, Somalia.

A total of 155 prostitutes inhabiting 4 different districts in Mogadishu, Somalia, were enrolled in a 6 month prospective study of syphilis and HIV infection. Blood samples were taken on entry, at 3 months and at 6 months. Differences were seen between the prostitutes in the 4 districts regarding possible risk factors for the acquisition of STDs. Initially 107 (69%) were found to have syphilis serum markers and 47% had active syphilis as judged by positivity in both Treponema Pallidum Haemagglutination (TPHA) test and non-treponemal (VDRL and RPR) tests. TPHA positivity was correlated to the number of sexual partners. Sixty-nine prostitutes were followed for 6 months. Two of the 16 initially TPHA negative women seroconverted for syphilis during the follow-up. HIV antibodies were detected in one (0.6%) of the 155 prostitutes at the start of the study and one out of 68 seroconverted during the 6 months follow-up. To control the spread of HIV infection health education targeting the risk groups like prostitutes must be given a high priority.

Severity and location of venous valvular insufficiency: the importance of distal valve function.

Venous calf pump function was evaluated with special reference to distribution and severity of deep venous reflux at different levels. A combination of ultrasonography, foot volumetry and venous plethysmography was used in 100 consecutive patients, 32 of whom were also studied with phlebography and intravenous pressure measurements. A clear relationship was found between clinical stage of chronic venous insufficiency and number of segments with reflux. Clinically important deep venous insufficiency was found particularly in patients with reflux in the distal posterior tibial veins, even in the presence of competent popliteal valves. The results demonstrated the calf pump to be functionally divided into a series of pumps, with the distal part more important than the proximal. The importance of evaluating venous valvular function at different levels for adequate assessment of venous calf pump function is emphasized.