Can serology diagnose upper genital tract Chlamydia trachomatis infections? Studies on women with pelvic pain, with or without chlamydial plasmid DNA in endometrial biopsy tissue.

BACKGROUND: Upper genital tract chlamydial infections in women are on the increase, and serology might be a convenient tool for diagnosis. Evaluations of this approach are needed in women with or without microbiologic evidence of organisms in the upper genital tract. GOALS: To compare the results of antibody assays with cervical culture and upper genital tract histopathology in women with pelvic pain and chlamydial plasmid DNA in endometrial biopsies. STUDY DESIGN: Chlamydia trachomatis plasmid DNA was detected by polymerase chain reaction (PCR) on extracted deparaffinized endometrial biopsy tissue. Five antichlamydial antibody assays were performed measuring total antibodies or immunoglobulin G (IgG), IgM, and IgA classes on sera from 14 women with plasmid DNA as well as 31 without plasmid DNA. RESULTS: Accepting the presence of plasmid DNA as the gold standard, no single test had total diagnostic accuracy. The best sensitivity and specificity occurred with the following assays: whole inclusion fluorescence (WIF) (100% and 80.6%); microimmunofluorescence IgM (MIF IgM) (78.6% and 93.6%); and heatshock protein-60 enzyme immunoassay (42.9% and 100%). Although recombinant anti-lipopolysaccharide enzyme-linked immunosorbent assays measured anti-chlamydial antibodies in a large proportion of these women, specificity was low. The sensitivity and specificity of cervical culture was 28.6% and 100% and of endometrial histopathology was 71.4% and 48.4%. Analysis of patient serological profiles suggested that and 6 women without plasmid DNA may have been cases that were missed by PCR. CONCLUSIONS: Evaluations of assays to diagnosis Chlamydia trachomatis upper genital tract infections could use the presence of organisms or their markers in the upper genital tract as a standard of comparison. Some of these serological assays, such as WIF or MIF IgM, may be helpful in diagnosis, but more studies are needed.

Hormonal factors and the laboratory detection of Chlamydia trachomatis in women: implications for screening?

One thousand and fifty-six new and re-registered consecutive women attending a genitourinary medicine clinic requiring speculum examination were screened for Chlamydia trachomatis by enzyme immunoassay (IDEIA, Dako Diagnostics Ltd). Of 1022 women who had results available for both cervix and urethra C. trachomatis was detected in 8.8% (89/1022) in any site, 2.3% (23/1022) in both sites, 4.9% (51/1022) at the cervix alone and 1.5% (15/1022) at the urethra alone. Thus sampling at the urethra increased detection by 17% (15/89). Analysis of 808 women with a regular menstrual cycle showed a significant association of combined oral contraceptive use, age and ectropion with the detection of C. trachomatis. The detection of C. trachomatis showed a significant variation with the menstrual cycle (P = 0.023) (relative risk (rr) 1.7 (95% confidence intervals (CI) 1.0-2.8)). It was detected significantly more often in the latter part. Stepwise logistic regression analysis revealed that ectropion and age were the stronger determinants of C. trachomatis detection and not oral contraceptive use or menstrual cycle. The variation in detection of C. trachomatis with the menstrual cycle was independently associated with combined oral contraceptive use and the lack of a cervical ectropion. The increased detection at the cervix was present after the second week in combined oral contraceptive users (P = 0.008) (rr = 2.3 (1.2-4.5)) but only after the 3rd week in women without an ectropion (P = 0.004) (rr = 2.7 (1.3-5.5)). Combined oral contraceptives, ectropion and youth, are markers for the carriage of C. trachomatis in the lower genital tract of women. It is also detected significantly more often in the latter part of the menstrual cycle in women who are oral contraceptive users.

PIP: In England, clinical researchers enrolled 1056 women aged 13-56 years attending the genitourinary medicine clinic in Bristol during February-October 1994 in a study on the relationship between the menstrual cycle and the detection rate of Chlamydia trachomatis from the cervix. They conducted a routine speculum examination and an amplified enzyme immunoassay (EIA) to take a swab from the cervix and a swab from the urethra. The chlamydia incidence rate was 8.8% (93 women) at any site, 2.3% at both sites, 4.9% at the cervix alone, and 1.5% in the urethra alone. Sampling at the urethra increased the detection of C. trachomatis by 17%. 808 women had a regular menstrual cycle. C. trachomatis was more likely to be detected in women aged under 25 years than in those of older age groups (14% for age 15-19 and 12.2% for 2-24 vs. 3.6-8%; p 0.0001). Detection of C. trachomatis at the cervix had a significant association when weeks 1-2 were compared to weeks 3 and later (5.4% vs. 9.4%; p = 0.029) and when weeks 1-3 were compared to week 4 and later (6.2% vs. 10.8%; p = 0.023). It had a relative risk (RR) of 1.7. Detection of C. trachomatis at any site was also significant when weeks 1-3 were compared to weeks 4-5 (11.8% vs. 7.5%; p = 0.048) (RR = 1.6). Combined oral contraceptive (OC) use and the lack of a cervical ectropion (i.e., cervix turning outward) both had an independent association with the variation in detection of C. trachomatis with the menstrual cycle. Specifically, the elevated detection at the cervix occurred after the second week in OC users (14.2% vs. 6%; RR = 2.3; p = 0.008) and only after the third week in women without a cervical ectropion (9.3% vs. 3.5%; RR = 2.7; p = 0.004). Based on these findings, the authors recommend sampling the urethra in addition to the cervix to increase chlamydia detection and chlamydia screening for young women with no cervical ectropion who use OCs. They also recommend that screening for chlamydia be performed in the latter part of the menstrual cycle in OC users who do not have a cervical ectropion.

Observational study of effect of intrauterine transfusions on outcome of fetal hydrops after parvovirus B19 infection.

The role of intrauterine transfusion for fetal hydrops arising from maternal paravirus B19 infection is unclear. 66 cases of fetal hydrops arising from B19 infection were reported in England and Wales between June, 1992, and September, 1994. In 29 cases the fetus was dead at the time of the first abnormal ultrasound or a therapeutic abortion as performed; 12 of the 38 alive at the first abnormal scan received intrauterine transfusions and 3 of the 12 died. 26 did not receive intrauterine transfusions and 13 died. After adjustment for the severity of the hydrops as assessed by the ultrasound and for gestational age, the odds of death among those who received an intrauterine transfusion was significantly less than among those who did not (odds ratio 0.14, 95% CI 0.02-0.96). These findings suggest that intrauterine transfusion will benefit some fetuses with hydrops arising from parvovirus B19 infection.

Ocular cowpox: transmission from the domestic cat to man.

A clinicopathological case of ocular cowpox is reported. Cowpox is no longer regarded as being enzootic in cattle. The most likely mode of transmission of cowpox to man appears to be from the domestic cat or wild rodents.

Clinical manifestations of human parvovirus B19 in adults.

Human parvovirus B19 has been associated with various clinical effects in a number of uncontrolled reports. To define the usual manifestations of B19 infection in adults and the factors that influence them we present a clinicoepidemiological study of an outbreak of B19 infection centered on a junior school. Four hundred fifty-three of 475 adults in this community were interviewed and blood was obtained for serological diagnosis. Fifty-four cases of recent infection were identified and were HLA typed. Fourteen of the cases were asymptomatic; 32 had an influenzalike illness; 23 a rash; and 26 an acute-onset polyarthropathy that was more common in women and lasted for up to 7 months. HLA-A, -B, and -C antigen frequencies were similar to a local control population and showed no association with symptoms except that HLA-DR1 was absent in those with persistent arthropathy.

Leptospiral and hepatitis A antibodies amongst windsurfers and waterskiers in Bristol City Docks.

Previous epidemiological studies have detected a substantial risk of gastroenteritis associated with snorkel swimming events in the Bristol City Docks. The event has since been discontinued. Similar risks were not identified at that time for surface-based events. A subsequent fatality from Weil's disease (Leptospirosis) and a case of Hepatitis A associated with surface water immersion in the Bristol City Docks water prompted this study of Leptospiral and Hepatitis A immunity amongst regular windsurfers and waterskiers. Although one person showed evidence of past Leptospiral infection and several people showed evidence of previous Hepatitis A, a causal association with Docks water exposure was not established. Nevertheless, there was sufficient public concern to justify the introduction of precautions against the potential health risks associated with immersion in the City Docks. The study findings and these preventive measures are described.