Seroepidemiologic study of hepatitis C virus in sexually transmitted disease risk groups.

To identify the importance of heterosexual activity as a possible route for the transmission of the hepatitis C virus (HCV), a screening of antibodies against HCV (anti-HCV) was performed in 200 sexually transmitted disease patients with different risks for incurring genital infections as well as in 100 registered prostitutes. Out of all 300 persons tested, 14 cases of HCV infection were detected. Anti-HCV was present in 3 of the prostitutes and in 11 of the STD patients. Evaluating known risk factors, such as intravenous drug use or blood transfusion, 6 out of the 11 STD patients and all of the prostitutes in whom anti-HCV was present were intravenous drug users and exhibited highly promiscuous behavior. Intravenous drug use was the probable means of acquisition in 9 of the 14 subjects in whom anti-HCV was present, and homosexual promiscuous behavior was assumed to be the means of acquisition in another 2 subjects. In heterosexual patients engaging in high-risk behavior (high number of sexual partners and genital infections), the exclusion of intravenous drug use decreased the prevalence of anti-HCV from 12.1% to 4.1%, demonstrating no significant increase from the prevalence among low-risk persons. Most of the patients were screened for STDs, such as syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, human immunodeficiency virus (HIV), hepatitis B virus (HBV), trichomoniasis, and yeast infections. The highest rate of coinfection with anti-HCV was found in patients with serologic evidence of an HIV infection (50%).(ABSTRACT TRUNCATED AT 250 WORDS)

Coincidence of hepatitis B-virus markers and other sexually transmitted diseases in different STD-risk groups.

To evaluate the prevalence of hepatitis-B-virus (HBV)-markers in STD patients and the significance of promiscuous heterosexual activity as a risk factor for the transmission of HBV, a serological screening was performed in 499 patients, in addition to the routine STD diagnostic programme. Two groups of patients were evaluated: group 1 (120 patients) was drawn from the STD clinic of the Public Health Office (PHO), group 2 (379 patients) from a private STD outpatient clinic. Promiscuous activity was reported significantly more often by persons of group 1 than by those attending the private clinic (59.3% vs. 5.1%). The infection rate of gonorrhea, syphilis and Chlamydia trachomatis was high in patients of the PHO (46.7%, 35.3%, 27.5%) whereas most of the STDs were seldom ascertained in patients of the private clinic (1.1%, 0%, 5.6%). Similar to other STDs, the prevalence of HBV markers differed significantly between patients of the PHO and those of the private clinic (33.3% vs. 6.3%; p = .0000). Comparison of HBV and other STDs showed the highest coincidence of HBV markers in patients with serological evidence of syphilis (44.2%), and in one third of patients with Neisseria gonorrhoeae as well as HIV infection. The data obtained in the present study demonstrate that also in Austria, in addition to homosexual preference and drug abuse, promiscuous heterosexual activity must be considered a substantial risk factor for the transmission of HBV.

Chlamydial antigen detection in urine samples by immunofluorescence tests.

To investigate the diagnostic value of a direct immunofluorescence test (DIF-test), urethral samples and first catch urine (FCU) from 153 male patients attending an outpatient clinic for sexually transmitted diseases (STD) were studied. Of the male patients, 40 (26.1%) had a positive urethral culture, 39 (25.5%) had a positive urethral DIF-test, and 32 (20.9%) were positive in urine according to the DIF-test. The sensitivity and the specificity of the DIF-test in male urine specimens were 75% and 98.2%, respectively, as compared with the chlamydial culture, and 69.2% and 95.6%, respectively, as compared to the DIF-test of the urethral samples. Out of the positive urethral samples, 31% had less than 5 elementary bodies (EBs) and 41% greater than 10 EBs, detected by the DIF-test. The corresponding data for FCU were 47% and 22%, indicating a smaller number of chlamydiae in urine than in urethral samples. False negative results in the urine DIF-test were mostly observed in males with a low number of EBs in the urethra. The DIF-test was less sensitive for FCU than for urethral specimens. Therefore, urine DIF-tests cannot replace conventional methods for chlamydial diagnosis in symptomatic STD patients, but may be recommended when genital sampling is not possible and may serve as an important approach in the control of genital chlamydial infections.

Rapid diagnosis of Chlamydia trachomatis in male patients by antigen detection in urine samples.

To investigate the diagnostic value of testing urine samples as a rapid method for the detection of chlamydial antigen in males, first-catch urine (FCU) and urethral swab samples were obtained from 668 male patients and examined by an enzyme immunosorbent assay (EIA). Positive results were further analyzed by direct fluorescence antibody tests of the EIA sediment. Antigen detection was possible in 12.7% out of the urethra, in 10.8% out of FCU and in a total of 14.5% of the tested persons. Testing only FCU would have missed chlamydia detection in 25 (25.8%) out of a total of 97 chlamydia-positive males. Testing only genital samples would have missed 12 positive cases (12.4%). The sensitivity and specificity of the EIA test of FCU as compared with urethral swabs were 70.6 and 97.9%, respectively, and differed between urine collected before (sensitivity: 84%; specificity: 98.6%) and after (sensitivity: 65%; specificity: 97.7%; p = 0.1254) urethral sampling. The quantitative evaluation of the EIA results demonstrates that the mean value of the extinction rates was highest in specimens corresponding to a positive result from both sampling sites. This study indicates that the chlamydial detection rate was lower in FCU than in urethral samples. FCU testing may be suitable when urethral sampling is not possible; due to its high rate of unconfirmed borderline extinction, positive results should be confirmed with another chlamydial antigen detection test such as direct immunofluorescence.

Screening for Chlamydia trachomatis in military personnel by urine testing.

In order to determine the infection rate of Chlamydia trachomatis in young males in Austria an epidemiological study was performed on 335 male Austrian soldiers attending the military hospital for a health check-up procedure. Three hundred twenty-nine (98.2%) of the screened males were clinically asymptomatic. Chlamydial diagnosis was established by testing first catch urine (FCU). Urine sediment was tested by an enzyme immunosorbent assay (EIA) and by a direct immunofluorescent test (DIF test). Positive results in both tests were defined "true positives." In 41 (12.2%) of all the 335 soldiers a genital chlamydial infection could be demonstrated by a positive result of the sediment of the FCU in both tests. 93% of the positive results in the DIF test could be confirmed by the EIA whereas only 77% of the positive EIA tests were also positive in the DIF test. Data on genital symptoms and the history of sexually transmitted diseases (STDs) as well as information about sexual relationships were available from all persons included in the study and did not differ between chlamydia positive and negative ones. The study demonstrates a high infection rate with C. trachomatis in mostly asymptomatic young males when using FCU for chlamydial diagnosis. Due to the discrepancy between the EIA and the DIF test, positive results of the sediment of FCU in the EIA test should be confirmed by the DIF test to eliminate false positive cases.