Chlamydia trachomatis PCR (Cobas Amplicor) in women: endocervical specimen transported in a specimen of urine versus endocervical and urethral specimens in 2-SP medium versus urine specimen only.

The sensitivity of Roche Cobas Amplicor Chlamydia trachomatis polymerase chain reaction (PCR) including the internal control (IC) programme to identify inhibition, was investigated on 3 different samples from women: (1) swab samples from the urethra and the cervix pooled in 2-SP transport medium, (2) swab sample from the cervix transported in a urine sample from the same patient, and (3) urine sample alone. Out of the 2412 patients, 193 (8.0%) were chlamydia positive and in 14 of these the results showed discrepancies between sampling methods. The sensitivity of PCR on urethra/cervix, urine/cervix and urine was 98.4% (190/193), 97.9% (189/193) and 93.3% (180/193) respectively. The higher sensitivity of PCR on urethra/cervix and urine/cervix as compared with urine alone was statistically significant. Without the IC, the sensitivity of PCR on urethra/ cervix, urine/cervix and urine would have been 95.9% (185/193), 94.8% (183/193) and 90.7% (175/193) respectively. Factors influencing the rate of inhibition were also studied.

HIV testing in Swedish STD clinics 1986-1994.

In 1986 Swedish STD clinicians decided on a national policy of offering HIV tests routinely to all their patients. During the period July 1986 through December 1994, 224,722 tests were performed. HIV tests for one or more specific reasons were carried out on 7% of the patients, and 20% requested the test solely because of anxiety. The remaining 73%, accepted the test as part of the clinical routine without giving any specific reason. Of those offered a test, 54% had been tested at least once before. Twenty-three per cent did not accept the test. Among those tested, 373 persons (0.2%) were found to have a newly detected HIV infection. Contact tracing was the reason for testing in 11%, whilst 32% were tested for other specific reasons, 29% requested testing for no stated specific reason and 28% had been tested as a routine. Of all the tested men who reported sex with men, 7% proved to be HIV positive. The 373 persons with newly detected HIV infection constituted 14% of the total newly detected cases in Sweden during the period in question.

Temporal changes in the gonococcal serovar patterns in Stockholm during two years with special reference to PPNG strains.

OBJECTIVE: To analyse temporal changes in gonococcal serovar patterns in Stockholm during a two year study period (1987-1989) to elucidate the dynamics of gonorrhoea epidemiology. DESIGN: The study population comprised 857 patients with culture proven gonorrhoea and with serotyped gonococcal isolates. The probable geographical origin of the infection was determined in 690 of the patients. RESULTS: A total of 108 Ph/GS-serovars were identified. Most (73%) of the serovars were recognised only during one or two quarters of the study period and comprised 16% of the isolates. Seven serovars were encountered during all eight quarters. Three of these serovars i.e. Arost/Aedgkih (IA-1, IA-2), Bropt/Bajk (IB-3, IB-6), Brpyust/Bacejk (IB-1, IB-2) were the most prevalent in the overall study, accounting for 60% of the isolates during the first quarter of the study and 36% of the isolates during the last quarter. Fifty-seven percent of the patients were infected in Stockholm (endemic infection). The proportion of endemic isolates among the three most common serovars declined throughout the study period (77% during the first quarter; 47% during the last quarter). A total of 32 Ph/GS-serovars were recognised among 80 PPNG strains. Only four of these 32 serovars were encountered during more than two quarters. Of 57 patients with PPNG strains and with geographical origin of the infection known, only seven (12%), all infected in Sweden, might have transmitted their infection further into the society. CONCLUSIONS: The decline in the total number of gonorrhoea cases seen in Stockholm during the study period, was due mainly to a decline of endemic isolates of the three most prevalent serovars. Results from contact tracing and serotyping indicated that PPNG infections acquired abroad seldom become established in the community. Serovar determination seems valuable mainly as a tool for surveillance whereby the introduction and circulation of gonococcal strains in the community can be pursued.

Endemic versus non-endemic gonorrhoea in Stockholm: results of contact tracing.

The aim of the present study was to characterize endemic versus non-endemic gonorrhoea to identify risk groups for transmission and to evaluate the effects of intensified contact tracing performed by specially trained social workers at venereal clinics. A total of 671 gonorrhoea patients (283 women and 388 men) comprised the study group. Seventy percent of the women and 48% of the men had an endemic infection (P < 0.001). Men without a steady partner had an increased risk of non-endemic infection. A decrease from 75% to 40% was noted in the proportion of endemic infection in Stockholm from the first quarter of the study period (2 years) to the last. Contact tracing resulted in 1.2 identified partners per patient. A total of 736 partners were examined either as a result of contact tracing efforts or because they had sought medical care on their own prior to intervention. Forty-seven percent of these partners were infected, 44% were not infected and 9% were examined outside the study with results unknown to us. The partner notification efforts yielded 161 new untreated cases. Contact tracing of women generated one new case per 4.0 interviewed women and contact tracing of men one new case per 4.3 interviewed men. Interviewing index patients with endemic infection yielded the highest number of new cases. Forty-three percent of the patients were infected outside Stockholm but only a smaller part of these patients spread their infection further into the community.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of Chlamydia trachomatis in urine from men with urethritis.

The performance of a commercial EIA (Chlamydiazyme) for detection of Chlamydia trachomatis in urine specimens was compared with that of culture of urethral samples from men with urethritis. The incidence of chlamydial infection on the basis of culture results was 34% (56/167). The sensitivity, specificity, positive and negative predictive values for the EIA were 55% (31/56), 98% (109/111), 94% (31/33) and 81% (109/134), respectively, compared with culture. Although this EIA has a high specificity, the low sensitivity makes it valueless as a clinical tool for demonstrating chlamydial antigen in urine from men with urethritis.

Antibiotic susceptibility, serovars and auxotypes of gonococcal isolates in Stockholm. Relation to geographical origin of the infection.

The antibiotic susceptibility, serovars and auxotypes were investigated in gonococcal strains isolated from all patients with gonorrhoea during one year in Stockholm, Sweden. The results were correlated to geographical origin of the infection. A total of 394 gonococcal strains were isolated from 392 patients, 135 (34%) women and 257 (66%) men. Beta-lactamase-producing gonococcal strains (PPNG) were isolated from 5% of the women and 16% of the men. Men had acquired their infection abroad more often than women (54% vs 33%) (P < 0.001). The majority (81%) of the PPNG infections were imported. Some serovars and auxotypes were more common among imported strains than among indigenous ones. All strains were sensitive to spectinomycin and 2 strains had decreased susceptibility to norfloxacin and ciprofloxacin. Decreased susceptibility to benzylpenicillin, ampicillin, doxycycline and cefuroxime was related to the geographical origin of the strains with strains imported from regions other than Europe being the most resistant.

Screening for Chlamydia trachomatis genital infection in young men in Stockholm.

The purpose of this study was to investigate the prevalence of genital chlamydial infection in male military recruits in Stockholm, Sweden. Two hundred and thirty-eight men who admitted to sexual experience were included in the study. One hundred and five (44%) of these 238 men consented to a specimen being taken for chlamydial culture. Eleven (10%) of these 105 men had a positive chlamydial culture. All 11 men were 17-18 years old and 10 were asymptomatic. In order to decrease the prevalence of chlamydial infection, screening of young men is as essential as screening of women.

Markers of Neisseria gonorrhoeae for epidemiological studies.

Numerous attempts have been made to subclassify Neisseria gonorrhoeae. The properties of these various systems are reviewed. Classification based on the nutritional requirements, i.e. auxotyping, or on the reactivity against epitopes on protein I, the major outer membrane protein, i.e. serovar determination, are the most widely used systems. With the aid of these two classification systems, gonococcal infection can be viewed as a number of microepidemics each with its own dynamics. The tools now exist for a better understanding of gonococcal epidemiology. In many settings it is now feasible to amplify the decreasing prevalence of gonococcal infection by programs aimed at eradication of endemic gonorrhoea.

Evaluation of a commercial enzyme immunoassay versus culture for the detection of Chlamydia trachomatis.

A commercial EIA (Chlamydiazyme) for detection of Chlamydia trachomatis was evaluated in comparison to culture using genital specimens from 472 men and 279 women. The sensitivity of the EIA compared with culture was 66.0% in men and 71.4% in women, while the specificity was 99.7% and 95.9% respectively. The EIA failed more often to detect chlamydial antigen when the number of inclusion bodies found in the corresponding cultures was less than or equal to 100/well. A direct test (MicroTrak) was performed on the EIA samples which showed discordant results compared to corresponding cultures. One of 17 EIA positive samples, and 12 of 36 EIA negative samples were positive in the direct test (p less than 0.05). A cut-off absorbance value of 0.1 is recommended by the manufacturer in the EIA. However, 84.2% of the EIA negative samples in the negative absorbance interval 0.05-0.099 corresponded with a positive culture. In view of variations in the sensitivity of the culture technique between laboratories and the low sensitivity of the EIA found in this study, it is recommended that each laboratory using the EIA compare it to culture. It is also recommended that an equivocal zone around the cut-off value be used in the EIA, the zone to be established by each laboratory using the test.

Comparison between serological classification and auxotyping in the analysis of Neisseria gonorrhoeae infections.

Auxotyping and serological classification, using monoclonal antibodies, were performed on 730 gonococcal strains. These strains were isolated from 725 consecutive patients seen at the Venereal Outpatients Clinic at the Department of Dermatology, Södersjukhuset, Stockholm, during one year, up to April 1983. Strains from patients with repeated gonococcal infections were, besides auxotyping and serological classification, analysed with restriction endonuclease cleavage. The strains were distributed into 16 auxotypes, of which the eight most common accounted for 97.4% of all isolates. The same strains were distributed into 38 serovars, of which the eight most common accounted for 88.4% of all isolates. When the two methods were combined, 98 combinations of auxotypes and serovars were seen. The eight most common combinations included 60.0% of all strains. Correlations were found between auxotypes and serogroups as well as serovars. The serological classification gave a better resolution compared with auxotyping; however, when the two systems were combined the sensitivity was highly increased.

Gonorrhoea in heterosexual men. Correlation between gonococcal W serogroup, Chlamydia trachomatis infection and objective symptoms.

Among 292 heterosexual men with gonorrhoea seen during one year, 59 (20%), had a co-existing chlamydial infection. Of the men infected with a serogroup WI strain 30% had a chlamydial infection compared with 16% of those infected with a serogroup W II/III strain (p less than 0.01). Heterosexual men infected with WI strains had less objective symptoms as judged by the number of leucocytes per high power field and by discharge, than men infected with W II/III strains (p less than 0.05 and p less than 0.01, respectively).

Analysis of serovar distribution as a tool in epidemiological studies in gonorrhoea.

During one year 738 gonococcal isolates from 731 consecutive patients with gonorrhoea were collected and classified by co-agglutination using W I and W II/III specific monoclonal antibodies. Eight W I and 30 W II/III serovars (serovariants) were seen. In both serogroups the most frequent serovar among isolates from women and heterosexual men differed from that among isolates from homosexual men. Forty-two per cent of the serovars, were confined only to one subpopulation, i.e. women, heterosexual men or homosexual men, representing 19 (3%) of the 738 isolates. Out of these 19 isolates 42% were acquired abroad compared with 12% of the 653 isolates in the serovars shared between two or all three subpopulations (p less than 0.005). Imported W I isolates were often of the same serovar that dominated in Stockholm. W II/III isolates acquired abroad were often of unusual serovars (p less than 0.0005) and might be a source of future changes of the serovar pattern in Sweden. In this way we can follow the introduction of new serovars into our society and their circulation between the subpopulations.

Gonococcal serovar distribution in Stockholm, with special reference to multiple infections and infected partners.

Serological classification with co-agglutination, using monoclonal antibody reagents, was used to classify gonococcal strains from 731 consecutive patients seen at the Venereal Outpatients clinic at the Department of Dermatology, Södersjukhuset, Stockholm, up to April 1983. The strains could be divided into two serogroups, WI and WII/III. For the identification of strains belonging to serogroup WI, six Protein IA specific antibody reagents were used, and for strains of serogroup WII/III, seven Protein IB specific antibody reagents. The serogroup WI could be further subdivided into eight different serovariants (serovars), and serogroup WII/III into 30 different serovars. All strains reacted with at least one monoclonal antibody reagent and no strain reacted with both WI and WII/III specific reagents. In both serogroups there was one serovar that was common among women and heterosexual men and another which was more frequent among homosexual men. The 84 contact pairs had strains of corresponding serovar in 95%. Among 258 patients with two or more gonococcal isolates on the same occasion, the isolates from 93% had the corresponding serovar. Repeated gonococcal infections were more frequent among heterosexual men than among women and more frequent among homosexual than among heterosexual men. The serological classification of N. gonorrhoeae is a stable and rapid method and a useful epidemiological tool.

Use of gonococcal W serogrouping in the evaluation of a clinical trial of rosoxacin.

Serogrouping by co-agglutination was used for the characterization of isolates of Neisseria gonorrhoeae in a clinical trial of rosoxacin in Stockholm. Twenty-four isolates (56%) belonged to serogroup WI, 17 (40%) to WII, and two (5%) to WIII. The proportion of WI isolates in Stockholm was reported in earlier studies to be approximately 40%. On the basis of serogrouping data and clinical information, five (10%) of 48 patients in this study were classified as therapeutic failures. Of the initial WI isolates, 22 (92%) of 24 were inhibited by less than or equal to 0.03 microgram of rosoxacin/ml, as compared with ten (59%) of 17 of the initial WII isolates (.05 greater than P greater than .01). Thus, this study might underestimate the failure rate as compared with that for patient populations in which WII isolates are more prevalent, since WI isolates are more susceptible to rosoxacin than WII isolates. A certain WII serovar was correlated with decreased susceptibility to rosoxacin (P less than .001). Correlations were found between decreased susceptibility to rosoxacin and decreased susceptibility to other antibiotics (P less than or equal to .01). A high frequency of side effects (40%) was seen among the patients studied.

Topical treatment of penile condylomata acuminata with colchicine at 48-72 hours intervals.

We previously demonstrated that 8% solutions of colchicine in ethanol eradicated penile warts in 36% of patients after a single application and in an additional 12% after a second application performed at least a week after the first. In the present study only 30% of 115 men were cured when penile warts were painted twice at intervals of 48 hours with 2% solutions and 72 hours with 4% and 8% solutions of colchicine. The lack of additive therapeutic effect accruing from the second application and the high frequency of intolerable side effects when using the latter treatment program indicate that this regimen is unsuitable for condylomata therapy.