Meningococcal Disease in Northern Ireland - Past, Present & Future: MeningoNI Forum.

Meningococcal disease has had devastating consequences in Northern Ireland since its first description locally in 1859. The incidence of this disease has significantly declined in recent years, however it is important to understand reasons for this changing epidemiology and to acknowledge the diagnostic and clinical management developments that have been made locally. This review aims to examine the changing face of this disease in Northern Ireland over the years, with particular reference to local disease prevention, epidemiology, diagnosis, clinical treatment and management, post-disease sequelae and the role of meningitis charities locally, in terms of patient support and research.

Symptoms and signs in single and mixed genital infections.

OBJECTIVE: To compare symptoms and signs in women with single and mixed genital infections. METHODS: The study population comprised 996 apparently healthy women. Gynecological symptoms and signs were looked for and diagnostics for the most prevalent gynecological infections were made. RESULTS: When co-infections were excluded, chlamydial infections, bacterial vaginosis and cervical human papillomavirus infections were associated with a fishy malodor; for the two former conditions an easily bleeding ectopy was also found. Vaginal candidosis showed characteristic symptoms and signs. Genital warts were associated with dysuria, general and lower abdominal pain. Out of 494 women with a genital infection, 112 (22.7%) had a mixed infection, which in some cases influenced symptoms and signs. CONCLUSION: Many women who consider themselves gynecologically healthy, may nevertheless harbor one or more infectious agents. The need to exclude multiple infections is obvious. Positive predictive values were for specific symptoms and signs were generally low.

Vaginal flora changes associated with Mycoplasma hominis.

OBJECTIVE: The aim of this study was to investigate any association between vaginal carriage of Mycoplasma hominis and genital signs and symptoms, other microbial findings, and some risk behavior factors in women with and without bacterial vaginosis. STUDY DESIGN: Women who had attended two family planning clinics and a youth clinic for contraceptive advice were divided depending on the result of vaginal culture for Mycoplasma hominis and the occurrence of bacterial vaginosis. The study population included 123 (12.3%) women who harbored Mycoplasma hominis. Those 873 (87.7%) with a negative culture for Mycoplasma hominis served as a comparison group. In the former group, 50 (40.7%) had bacterial vaginosis, which was also the case in 81 (9.3%) of the women in the comparison group. The groups were compared with regard to genital signs and symptoms, results of vaginal wet smear microscopy and other office tests, vaginal flora changes as detected by culture, and other means and detection of sexually transmitted diseases. Any history of sexually transmitted diseases and other genital infections, reproductive history, use of oral contraceptives, and smoking habits were registered. RESULTS: Women who harbored Mycoplasma hominis had significantly more often complained of a fishy odor, had a positive amine test, a vaginal pH > 4.7, and clue cells than did the comparison group; all these statements were true before and after bacterial vaginosis had been excluded. Vaginal discharge was not significantly more often complained of, and a pathologic discharge was not more often detected in the Mycoplasma hominis carriers. Ureaplasma urealyticum occurred in 75% of the Mycoplasma hominis-positive women and in 59% of the comparison group (p = 0.001). The leukocyte/epithelial cell ratio did not differ significantly from that of the Mycoplasma hominis culture-negative controls. CONCLUSION: The study suggests that Mycoplasma hominis is associated with a number of genital signs and symptoms even after exclusion of bacterial vaginosis.

Sexual risk behaviour in women carriers of Mycoplasma hominis.

OBJECTIVE: To study the sexual behaviour of women harbouring Mycoplasma hominis in the vagina. SETTING: Two family planning clinics and a youth clinic for contraceptive advice. METHODS: The vaginal flora of 996 women were investigated microbiologically, including culturing for M. hominis from the posterior vaginal fornix. Cultures and tests were also made to diagnose genital Chlamydia trachomatis infections, gonorrhoea, genital herpes, cervical human papillomavirus infection, trichomoniasis, genital warts and human immunodeficiency virus. The sexual behaviour of these women was investigated by structured in-depth personal interviews. RESULTS: Of the 996 women, 123 (12.3%) harboured M. hominis in the vagina. The remainder (87.7%), who had a negative M. hominis culture, served as a reference group. Those with M. hominis were significantly more likely to have had more than 10 partners during their lifetime, had a greater frequency of more than one sexual partner during the preceding month and the last six months, and reported more frequent experience of "casual sex', including casual "travel sex'. More of them also had experience of group sex and were more likely to have been sexually abused than the women in the reference group. Fewer women with M. hominis had a current steady partner and were less often cohabitors, but more had had sexual intercourse during the previous week than those in the reference group. There was an association between the occurrence of M. hominis and bacterial vaginosis and genital chlamydial infection. Adjustment in multifactorial regression analyses therefore changed the results only marginally. CONCLUSIONS: Women with M. hominis have almost the same sexual risk behaviour as women with classic sexually transmitted diseases.

Seroepidemiologic study of Chlamydia pneumoniae and other chlamydial species in a hyperendemic area for trachoma in the Sudan.

Sera of inhabitants of Angola village in central Sudan were investigated for the prevalence of antibodies to Chlamydia trachomatis, C. pneumoniae, and C. psittaci by the microimmunofluorescence (MIF) test. Clinical examination of 616 persons showed that the village is hyperendemic for trachoma. Of the 448 children examined, 334 (75%) had signs of active trachoma. The corresponding prevalence in the 168 adults was 25%. Using MIF, antibodies to C. trachomatis were found in the sera of 27 (81%) children and of 37 (88%) adults with trachoma. Antibodies to C. pneumoniae occurred in 13% and 24% of the preschool and school trachomatous children, respectively, and in 64% of the adults, which reflects earlier exposure to C. pneumonia in the Sudan than generally reported from temperate zones. Antibodies to C. psittaci were found in 6% of the children less than 16 years old and in 17% of the adults. Of the patients with trachoma, 16% had antibodies to both C. trachomatis and C. pneumoniae. The prevalence of multiple antibodies to Chlamydia increased with age. Antibodies to all three species occurred in 3% of the patients. The study does not support the existence of protective immunity between C. pneumoniae, C. trachomatis, and C. psittaci, as shown by the high prevalence of chlamydial antibodies in the hyperendemic trachoma community studied.