Hepatitis C virus seroprevalence in patients attending a sexual health centre.

AIM: To determine the prevalence of hepatitis C virus (HCV) infection in patients attending the Christchurch sexual health centre. METHODS: Anonymised unlinked serum specimens from 362 patients sequentially attending the sexual health centre were obtained and tested for HCV antibody using the second generation enzyme immunoassay kit (Abbott). Antibody positive samples were assayed for virus by amplification of hepatitis C ribonucleic acid (RNA). RESULTS: Twelve patients (3.3%) were seropositive and 10 samples were also positive for virus RNA (2.7%). In 50% of cases the patients had no discernible risk factors other than unprotected sexual intercourse. An overall serum prevalence of 22% (4/19) was noted within a sub population who admitted to intravenous drug use. Ninety patients had, at the time of consultation, requested an antibody test for the human immunodeficiency virus (HIV). There were no antibodies to HIV detected in any of these patients nor any statistical difference in HCV antibody prevalence within this group. CONCLUSION: Hepatitis C is a common viral infection within the community. A significant percentage of patients who were anti HCV positive had no discernible risk factors other than sexual transmission which must be considered as a mode of transmission. We concur with the Department of Health guidelines emphasising the need for safer sex practices in a patient with a diagnosis of hepatitis C.

Anogenital non-gonococcal neisseriae: prevalence and clinical significance.

Over a 13-year period non-gonococcal neisseriae (NGN) were isolated from 114 of 88,670 patients (0.13%) screened for anogenital gonorrhoea at a Genitourinary Medicine Unit. During the same period there were approximately 9000 anogenital gonococcal infections (10%). The prevalence of NGN was 0.09% (27/31,500) in women, 0.04% (20/52,800) in heterosexual men and 1.5% (67/4370) in homosexual men: the differences in prevalence between women and heterosexual men (P < 0.01) and between heterosexual patients and homosexual men (P < 0.001) are highly significant. Neisseria meningitidis was isolated most frequently and accounted for 85% (99/114) of the NGN. Whenever possible, N. meningitidis was serogrouped and its occurrence correlated with patient symptoms. Eleven of 18 heterosexual men who had meningococci isolated from their urethras had urethritis but co-existing chlamydial infection was excluded in only 5. None of 9 women with cervical colonization had clinical evidence of pelvic inflammation. Only one of 49 men with rectal colonization had proctitis. The management of anogenital NGN infection is discussed in relation to our findings and those of previously published studies. Within each patient group the prevalence and incidence of anogenital NGN were similar at the beginning and end of the study period indicating that levels have not been influenced by the advent of AIDS.

Preliminary evaluation of "Clearview Chlamydia" for the rapid detection of chlamydial antigen in cervical secretions.

Clearview Chlamydia (Unipath) is a rapid monoclonal antibody based latex immunodiffusion test for detecting chlamydial antigen in endocervical specimens. The assay does not require specialised equipment or extensive training and takes less than 30 minutes from sample to results. The clinical performance of Clearview Chlamydia was evaluated with 478 paired endocervical swabs from patients attending a genitourinary medicine clinic. In the first part of the study, 221 non-randomised specimens were tested by cell culture (1st swab) and Clearview (2nd swab) whereas in the second part of the study 257 randomised swabs were examined by Clearview, cell culture and immunofluorescence. The overall prevalence of chlamydial infection was 8.8% and the sensitivity, specificity, positive and negative predictive values for Clearview were 85.7%, 99.1%, 90% and 98.6%. The test requires further evaluation to establish its role in the management and control of chlamydial infection.

Is coexisting chlamydial infection more common in gonococcal infections with serogroup WI?

Over a 4-year period a total of 8974 women were screened for Neisseria gonorrhoeae and Chlamydia trachomatis. There were 489 cases of cervical gonorrhoea, 261 serogroup WI and 228 serogroup WII/III. A total of 169 (34.6%) cases had a dual infection with C. trachomatis, 92 from the WI serogroup and 77 from the WII/III. Using Fisher's exact test, no statistically significant difference was observed in the rates of chlamydial carriage between the two serogroups (P = 0.39). These findings are at odds with previously reported data, which suggested a biological interaction resulting in a positive correlation between colonization with serogroup WI and C. trachomatis. Possible reasons for the difference between the findings are discussed.

Management of intrameatal warts in men.

The case notes of 1080 men with genital warts were analysed retrospectively over a 30-month period. One hundred and forty patients were identified with intrameatal warts and an audit of their treatment is discussed. When electrocautery and cryotherapy were compared the former produced a more rapid resolution of the lesions. Cystourethroscopy was performed on 16 patients with intrameatal warts. No patient had involvement beyond the distal 3 cm of the urethra. Data on concurrent sexually transmitted diseases, population characteristics and pattern of referral are presented and compared to previously reported studies.