Comparison of DNA amplification methods for the detection of Chlamydia trachomatis in first-void urine from asymptomatic military recruits.

OBJECTIVE: To evaluate the performance of DNA amplification-based tests for the diagnosis of urethral chlamydia infection from the urine of asymptomatic young men. DESIGN: First-void urine was analyzed by two amplified DNA technologies, the ligase chain reaction (LCR), the polymerase chain reaction (PCR), and enzyme immunoassay (EIA). Specimens yielding discrepant results were subjected to retesting using either the original or a newly processed sample, and for evaluation of truly infected persons they were analyzed by the direct fluorescence antibody assay and by a second LCR directed against a segment of the gene encoding for the major outer membrane protein of Chlamydia trachomatis. SETTING: The military hospital in which military recruits underwent medical examination before departing for a United Nations mission. STUDY GROUP: Asymptomatic military recruits (705 young men) were screened between January and May 1994. In addition to providing urine specimens, the recruits completed questionnaires concerning previous genital infections and number of sexual partners. RESULTS: Overall prevalence of urethral chlamydia infection in the study group was 4.1% (29/705), as determined by confirmed results in all tests collectively. The performance of the DNA amplification methods was markedly better than that of the EIA antigen detection methods. Using an expanded gold standard, the sensitivity of the LCx assay was 93.1% (27/29) compared to 62.1% (18/29) by the PCR assay Amplicor and 37.9% (11/29) by EIA. Repeat testing after freezing and thawing increased the number of positive PCR results to equal the number of positive LCR results. There were three false-positive Amplicor results and no false-positive LCR results. CONCLUSIONS: The LCx assay performed better than the Amplicor assay and appears reliable for urine testing. The low sensitivity of the Amplicor assay requires further evaluation of possible inhibitors of PCR in fresh specimens. It was found that freezing and thawing the specimens before testing enhanced the performance of PCR.

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.

Sensitization to aeroallergens depends on environmental factors.

Respiratory allergies and subclinical sensitization to aeroallergens were investigated in 129 rural and in 222 urban probands. The incidence of respiratory allergies was not significantly higher in the urban residents. Sensitization to aeroallergens was investigated with Phadezym RAST (house dust mite, Cladosporium, orchard grass, birch pollens) and the Phadiatop multi RAST and found to be significantly more frequent in polluted than in unpolluted areas. Allergen-specific IgE was detected n 37.8% of urban probands and in 25.6% of rural probands with Phadezym RAST (P less than 0.025) and a positive Phadiatop multi RAST was found in 43.7% versus 32.6 (P less than 0.05).

[Single-dose penicillin therapy of acute gonorrhea]. / Einzeitige Penicillintherapie der akuten Gonorrhoe.

A new penicillin preparation (sodium-penicillin G3.5 mill. I.U., clemizolpenicillin G 1.0 mill. I.U.) has been tested with regard to the treatment of uncomplicated gonococcal infections during a multicenter trial in Vienna. 101 out of 102 patients could be sufficiently cured by one single injection of the preparation.

[Psychogenic purpura]. / Psychogene Purpura.

A 27 year old women revealed chronic relapsing, spontaneously developing hematomas without coagulopathy. The lesions were reproducible by intradermal injection of erythrocyte membranes as well as DNA. Positive test reactions could be elicited or suppressed by psychological influences on the patient. This case and similar reports in the literature raise the question whether Gardner-Diamond syndrome and the autosensitization to DNA are different entities.

[Skin necroses in cryoglobulinemia]. / Hautnekrosen bei Kryoglobulinämie.

The dermatological symptoms of cryoglobulinemia and the simple demonstration of cryoproteins by cooling of serum and plasma respectively is described in a patient.

Diagnosis of neurosyphilis by examination of the cerebrospinal fluid.

Thirty-six patients with reactive results in the cerebrospinal fluid to the Treponema pallidum haemagglutination assay (CSF-TPHA) were investigated by further serological tests for confirmation of active neurosyphilis. The results of the TPHA and fluorescent treponemal antibody tests were reactive in all CSF samples from patients with acute untreated neurosyphilis and from most patients with late latent syphilis but no signs of involvement of the central nervous system. The demonstration of 19S-IgM antibodies against Treponema pallidum in the CSF was a better indication of activity of the disease than the Venereal Disease Research Laboratory test. Ten of 11 patients with untreated acute neurosyphilis had reactive results in the solid-phase haemadsorption test for CSF-IgM (CSF-IgM-SPHA test). The TPHA index, which relates the CSF-TPHA titre to the albumin quotient and thus excludes errors from disturbed function of the blood-brain barrier, was above 100 in all but one of the patients with acute neurosyphilis but below 100 after treatment. Patients with late latent syphilis and without CNS signs had TPHA indices below 5. Thus a nonreactive CSF-TPHA test result excludes neurosyphilis but reactive CSF-IgM-SPHA results and TPHA indices above 100 strongly indicative active disease.

Specificity of the Treponema pallidum haemagglutination test. Analysis of results.

The automated haemagglutination assay using Treponema pallidum antigen (AMHA-TP) and the Venereal Disease Research Laboratory (VDRL) test were used to examine 330 163 sera. Reactive results were checked by the fluorescent treponemal antibody-absorption (FTA-ABS) test. When isolated reactivity or non-reactivity in the AMHA-TP test was investigated an estimated margin of error of 0.7% probably wrongly non-reactive and 0.008% presumably false non-reactive results were found. These figures were confirmed by randomised FTA-ABS tests on 504 sera with repeat AMHA-TP tests. The latter is therefore still the most reliable and practicable method for mass screening for syphilis.