Urethral inflammatory response to ureaplasma is significantly lower than to Mycoplasma genitalium and Chlamydia trachomatis.

A non-syndromic approach to treatment of people with non-gonococcal urethritis (NGU) requires identification of pathogens and understanding of the role of those pathogens in causing disease. The most commonly detected and isolated micro-organisms in the male urethral tract are bacteria belonging to the family of Mycoplasmataceae, in particular Ureaplasma urealyticum and Ureaplasma parvum. To better understand the role of these Ureaplasma species in NGU, we have performed a prospective analysis of male patients voluntarily attending a drop in STI clinic in Oslo. Of 362 male patients who were tested for NGU using microscopy of urethral smears, we found the following sexually transmissible micro-organisms: 16% Chlamydia trachomatis, 5% Mycoplasma genitalium, 14% U. urealyticum, 14% U. parvum and 5% Mycoplasma hominis. We found a high concordance in detecting in turn U. urealyticum and U. parvum using 16s rRNA gene and ureD gene as targets for nucleic acid amplification testing (NAAT). Whilst there was a strong association between microscopic signs of NGU and C. trachomatis infection, association of M. genitalium and U. urealyticum infections in turn were found only in patients with severe NGU (>30 polymorphonuclear leucocytes, PMNL/high powered fields, HPF). U. parvum was found to colonise a high percentage of patients with no or mild signs of NGU (0-9 PMNL/HPF). We conclude that urethral inflammatory response to ureaplasmas is less severe than to C. trachomatis and M. genitalium in most patients and that testing and treatment of ureaplasma-positive patients should only be considered when other STIs have been ruled out.

Analysis of direct-to-consumer marketed Chlamydia trachomatis diagnostic tests in Norway.

UNLABELLED: Background In 2014, and for the first time in Norway, a pharmacy chain started selling home sampling kits for Chlamydia trachomatis (C. trachomatis) detection. Direct-to-consumer diagnostic kits for C. trachomatis have been available in Norway from an Internet company since 2005. There has been little assessment of persons who purchase direct-to-consumer diagnostic tests for sexually transmissible infections (STIs) detection and if low-risk populations are being unnecessarily encouraged to buy these tests. METHODS: The prevalence of C. trachomatis in customers who purchased home sampling kits from the pharmacy chain and from the commercial Internet Co. were compared to that of patients attending STI clinics and other free primary healthcare services. Prevalences of other STIs in pharmacy and Internet customers were also determined. RESULTS: The prevalence of C. trachomatis among pharmacy customers was 11%, almost identical to the prevalence among Internet customers (12%). In comparison, the prevalence among patients attending STI clinics in Oslo was 7.2%, which is similar to the prevalence among patients who have been tested through primary healthcare services. The prevalence of Mycoplasma genitalium was two-fold less than that of C. trachomatis in the STI and primary physician population, and significantly less in the Internet and the pharmacy population. Neisseria gonorrhoeae was not detected in urine samples from pharmacy customers or from Internet customers. CONCLUSIONS: Both pharmacy and Internet C. trachomatis home-sampling kits seem to be purchased by the right risk population. Marketing of direct-to-consumer N. gonorrhoeae tests and possibly M. genitalium tests cannot be justified in Norway. Direct-to-consumer diagnostic tests should be actively utilised as part of national programs in preventing the spread of C. trachomatis.

Recovery of Bordetella pertussis from PCR-positive nasopharyngeal samples is dependent on bacterial load.

Viable Bordetella pertussis isolates are essential for surveillance purposes. We performed culture of 223 PCR-positive nasopharyngeal samples. B. pertussis was recovered from 45 (20.2%) of the samples. Growth was associated with a high bacterial load, as determined by PCR. Culture from PCR-positive samples is a feasible approach to recover B. pertussis isolates, and culture can be limited to samples with a high bacterial load.

IL28B genetic variation and treatment response in patients with hepatitis C virus genotype 3 infection.

UNLABELLED: Polymorphisms near the IL28B gene, which code for interferon (IFN)-λ3, predict response to pegylated interferon-α (PEG-IFN) and ribavirin treatment in hepatitis C virus (HCV) genotype 1 infected patients. Follow-up studies of the effect of IL28B gene in HCV non-genotype 1 infected patients have almost always used predominantly HCV genotype 2-infected or mixed genotype 2/3-infected cohorts with results partly conflicting with HCV genotype 1. We performed a retrospective analysis of 281 patients infected with HCV genotype 3 for association of response to therapy with IL28B polymorphisms. We found that the HCV genotype 1 responder genotypes at rs12979860 and rs8099917 did not associate with sustained virological response to PEG-IFN/ribavirin therapy. However, the responder genotypes of both SNPs showed association with rapid viral response measured at 4 weeks (rs12979860, P = 3 × 10(-5) ; rs8099917, P = 3 × 10(-4) ). In multivariate analysis, age (<40 years), baseline viral load (<4 × 10(5) IU/mL) and the responder genotypes of SNPs rs12979860 or rs8099917 remained significant independent predictors of rapid viral response to therapy. Furthermore, we show that IL28B polymorphisms are associated with relapse in patients who achieve rapid viral response to PEG-IFN/ribavirin therapy. The responder genotypes also showed association with markers of stage and activity of liver disease, namely high aspartate aminotransferase platelet ratio index (APRI, rs12979860, P = 0.018; rs8099917, not significant) and high alanine aminotransferase (ALT, rs12979860, P = 0.002; rs8099917, P = 0.001), in addition to a high baseline viral load (rs12979860, P = 1.4 × 10(-5) ; rs8099917, P = 7.3 × 10(-6) ). CONCLUSION: Polymorphisms near the IL28B gene show association with rapid viral response but not sustained viral response to PEG-IFN/ribavirin therapy in HCV genotype 3-infected patients.

[The Swedish Chlamydia mutant nvC trachomatis in Norway]. / Den svenske chlamydiavarianten nvC trachomatis i Norge.

BACKGROUND: A mutant Chlamydia trachomatis variant (nvC trachomatis) has made it more difficult to diagnose chlamydia in Sweden. The proportion of nvC trachomatis has varied between Swedish counties (25-80 %) in the period 2006-07. Our goal has been to monitor nvC trachomatis among our patients from January 2007 and up to July 2008. MATERIAL AND METHODS: In this time period, all C trachomatis samples at Fürst Medical Laboratory, Norway were analyzed twice. Cobas TaqMan 48 (Roche Diagnostics) was used to detect C trachomatis in isolated DNA and real-time PCR methods developed by us were used to both detect and verify nvC trachomatis. RESULTS: 61 patients of 23 726 patients were identified as carriers of nvC trachomatis. The proportion of C trachomatis carriers who were positive for nvC trachomatis increased from 1.0 % in the first quarter of 2007 to 3.2 % in the second quarter of 2008. INTERPRETATION: Our results show a slow but steady increase in the proportion of nvC trachomatis positive tests. As compared to previous rates reported in Sweden (25-80 %), the occurrence of nvC trachomatis in our data is low. The epidemiology of this chlamydia mutant contributes to the understanding of mechanisms for spread of sexually transmitted infections and emphasize that you only find what you are looking for.

[Mycoplasma genitalium in men with non-gonococcal urethritis]. / Mycoplasma genitalium hos menn med urethritt.

BACKGROUND: C. trachomatis is the underlying cause of 20?-?50 % of sexually transmitted urethritis cases. Data from the last 10?-?15 years indicate that M. genitalium may be a cause, but the prevalence of M. genitalium in Norwegian patients has not previously been assessed or published. MATERIAL AND METHODS: Male patients at the Olafia Clinic in Oslo were examined for non-gonococcal urethritis. First void urine was collected and tested for presence of C. trachomatis and M. genitalium DNA by polymerase chain reaction (PCR). Presence of C. trachomatis or M. genitalium was correlated with microscopic signs of urethritis, quantified by counting polymorphonuclear leucocytes in urethral smears. RESULTS: Both C. trachomatis and M.gentialium were found more frequently in patients with microscopic signs of urethritis than in patients without (21.9 % vs 0.7 %, OR = 40, CI = 6?-?295; 8.7 % vs 0.7 %, OR = 14, CI = 1.8?-?102; respectively). The increase in prevalence correlated with the severity of urethritis, as assessed by the number of polymorphonuclear leucocytes present in urethral smears. INTERPRETATION: Data from Norwegian patients support earlier findings in other European populations, where M. genitalium is defined as a sexually transmitted infection that causes non-gonococcal urethritis in men.

[Evaluation of the genetic lactose intolerance test]. / Evaluering av gentest for laktasemangel.

BACKGROUND: Lactose intolerance afflicts 5-10% of the population in western Europe, but is very common (up to 90%) in the southern hemisphere. Traditional analysis methods are based on lactose intake followed by determination of blood glucose concentration or exhaled H 2 and CH 4 . In many diagnostic laboratories, single nucleotide polymorphism (SNP) analysis on C/T-13910 has been introduced as a replacement for the traditional lactose intolerance testing. Homozygozity for the C-allele of this SNP results in very low or absent lactase enzyme activity. We have compared our present routine test (blood glucose measurements) to genetic SNP testing for C/T-13910. MATERIAL AND METHODS: Blood glucose measurements (after intake of lactose) and genotyping of C/T-13910 were performed on 137 adult participants after they had given informed consent. The maximal difference from fasting blood glucose was compared with real-time PCR analysis of C/T-13910. RESULTS AND INTERPRETATION: Lactose intolerance using blood glucose was positive for 20.4% of those tested; for the genetic test the corresponding result was 17.5%. The correlation between the methods was strong (90%) with a kappa-statistics index of 0.67 (0.51 - 0.83, 95% CI). Our results indicate that the genetic test for C/T-13910 complements the traditional phenotype measurements.

[Detection of Chlamydia infection of an Internet-based commercial product]. / Nettbasert selvprøvetaking for påvisning av chlamydiainfeksjon.

BACKGROUND: Free testing, treatment and extensive information campaigns are used to monitor and control the incidence of Chlamydia trachomatis infections in Norway. Most programmes have 15 to 25 year-olds as their target, because of the high incidence of infection in this age group. The potential role and effect of internet-based commercial testing has not previously been assessed in this context. MATERIAL AND METHODS: 1458 urine samples, taken by the patients themselves, were collected from March 2005 to September 2006 according to instructions given on the commercial web site www.testselv.no, and sent to a given address for analysis. Sex, age distribution and prevalence of Chlamydia trachomatis infection were assessed and all costs were paid by the patient buying the service. RESULTS AND INTERPRETATION: More men than women used this service, in contrast to the sex distribution seen in public screening programs. The mean age was 28 years, the 25 % percentile and the 75 % percentile was 24 and 32 years, respectively. The prevalence of infection was high; 7.5 % in women and 12.5 % in men. Our study identifies a demographic group with a high incidence of Chlamydia trachomatis infection that has not been previously been targeted by public screening programmes.

A one-step real-time PCR assay for detection of DQA1*05, DQB1*02 and DQB1*0302 to aid diagnosis of celiac disease.

Celiac disease is an autoimmune disorder that develops after dietary exposure of the small intestine to gluten peptides in cereals. Celiac disease has a strong genetic component associated with HLA-DQ2 and HLA-DQ8, and testing for absence of these genetic markers is useful when serological tests and biopsies are indeterminate, as it renders celiac disease highly unlikely. We have developed a new real-time PCR assay, using sequence-specific primers (PCR-SSP) and TaqMan probes, for detection of DQB1*05, DQB1*02 (coding for DQ2) and DQB1*0302 (coding for DQ8). PCR amplification and detection of DQ2 and DQ8 was accurately and unambiguously performed from genomic DNA isolated from cell lines and human DNA. Amplification was scored digitally, without laboratory manipulation of amplified PCR products and with a higher accuracy than PCR-SSP. This assay should increase accuracy and throughput, and reduce risks of contamination in laboratories where testing for HLA DQ2 and DQ8 is performed as part of diagnosis of celiac disease.