Comparison of strand displacement and ligase chain amplification for detection of Chlamydia trachomatis infection in urogenital specimens.

Two amplification tests for the diagnosis of Chlamydia trachomatis infection, namely the ligase chain reaction (LCx) and the strand displacement assay (ProbeTec), were compared using samples from 1183 patients at sexually transmitted disease clinics. The overall prevalence of positive results was 8.0%, with agreement between the two assays of 98.8%. For endocervical, urethral and male urine samples, agreement was 99.3%, 99.4% and 97.7%, respectively. For ten discrepant samples, alternative amplification assays suggested that the LCx and ProbeTec assays gave erroneous results in six and four cases, respectively. Inhibition of amplification was observed with three (0.25%) urine specimens.

Chlamydia trachomatis antigen detection by Chlamydiazyme combined with Chlamydia Blocking Reagent verification.

Several options exist for the detection of chlamydial infection in a routine laboratory setting. Enzyme immuno assay (EIA) technology offers rapid turn around of results and is less technically demanding than chlamydial cell culture. In addition, recently introduced EIA confirmatory reagents have the potential to improve the accuracy of EIA detection. We have evaluated one such confirmatory reagent (Chlamydia Blocking Reagent, Abbott Laboratories) to determine the accuracy of the Chlamydiazyme EIA with special regard to interpretation of low absorbance values. An initial series of 192 male urethral specimens showed that use of a lowered cut off level (absorbance value 0.05) compared with that recommended by the manufacturer increased sensitivity of the EIA from 0.73 to 0.83, thus motivating studies on this interpretative modification. Of 1101 EIA reactive specimens, 65% were determined to be chlamydia positive by the Chlamydia Blocking Reagent. The proportion of female cervical specimens that did not confirm positive was elevated compared with male urethral specimens, 43% vs. 5.7% respectively. In samples yielding absorbance from the recommended cut off level to 0.05 (approximately 50% below), the corresponding figures were 78% and 14% respectively. In 85 selected EIA reactive samples, examination by a direct immunofluorescence staining assay (DFA) (MicroTrak, Syva Inc.) revealed elementary bodies in 85% of 67 blocking test positive and in 24% of 18 blocking test negative samples. The possibility that Gram-negative bacteria were responsible for unconfirmed EIA reactive specimens was investigated using bacterial suspensions. While EIA reactivity was noted with several strains for Gram-negative bacteria, both the blocking reagent and DFA correctly verified the absence of chlamydial antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

PUVA treatment of chronic eczematous dermatitis of the palms and soles.

Thirty-eight patients were treated with PUVA for chronic eczematous dermatitis of the palms. Twenty (53%) were completely free from lesions when treatment was stopped, and 11 (29%) were improved. Patients who showed healing remained in remission for an average of greater than or equal to 11 months (range 3 weeks to greater than or equal to 36 months). When the rash recurred it was often milder than before PUVA. Sixteen of the 38 patients also had chronic plantar dermatitis; PUVA treatment resulted in complete clearing in 7 (41%), and remission persisted for an average of greater than or equal to 16 months.

Pompholyx--a one year series.

During one year 68 patients with pompholyx attending the outpatient clinic at the Department of Dermatology, Lund, were examined with special regard to occupational disability. Owing to pompholyx 56 patients had sick-leave, and in 48 sick-leave lasted more than 1 month. No patient needed change of occupation because of pompholyx, and no disability pension was granted because of the disease.

Recovery of anaerobic curved rods and Gardnerella vaginalis from the urethra of men, including male heterosexual consorts of female carriers.

Three hundred and nine men attending a clinic for sexually transmitted diseases were studied regarding urethral colonization with anaerobic curved rods (CR), Gardnerella vaginalis, Bacteroides ureolyticus, as well as for chlamydiae and gonococci. Ten (3.2%) of the men harboured CR. All strains of CR were of the short variant (approximately 1 micron long). Fourteen (4.5%) men were culture-positive for G. vaginalis and 58 (18.7%) for B. ureolyticus. Of the four men who were culture-positive for CR, but not for any other of the above-mentioned microbes, four had urethritis. From the 309 men, gonococci were isolated from 20 (6.4%) and chlamydiae from 96 (31.1%). Of the 10 men with CR, two concomitantly harboured Chlamydia trachomatis, four B. ureolyticus, and one G. vaginalis. The corresponding figures for those men with urethritis and who were colonized with G. vaginalis only were one of six, and for those carrying B. ureolyticus 14 of 37. None of 19 male consorts of the same number of women, harbouring the long variant (approximately 4 microns) of CR and G. vaginalis, were culture-positive for these two organisms.

Diagnosis and treatment of chlamydial venereal disease.

We examined patients attending an STD clinic (Department of Dermatology, Lasarettet, Lund). Chlamydia trachomatis was demonstrated in 26% of 2021 male patients by culture from the urethra (using cyclo-heximide-treated McCoy cells). The corresponding figure for Neisseria gonorrhoeae was 15%. Both organisms were found in 5% of the patients. In women, culture from the cervix demonstrated C. trachomatis in 16% of 1039 patients. N. gonorrhoeae was found in 14%, and both organisms in 4% of the patients. Men with chlamydial urethritis were more frequently found to have a watery discharge than those with gonococcal urethritis. They also had fewer leucocytes in smears from the urethra. Treatment with different tetracyclines gives good therapeutic results in both men and women infected with C. trachomatis. In contact-tracing, 53% of 95 male partners and 65% of 103 female partners were found to harbour C. trachomatis. About 50% of these contacts were free of symptoms. This indicates the importance of contact-tracing in genital chlamydial infection.

Contact tracing in genital chlamydial infection.

In the treatment of sexually transmitted diseases (STD), contact tracing plays an important role. In the Scandinavian countries, contact tracing in patients found to be infected with Chlamydia trachomatis is not, except in cases of lymphogranuloma venereum, encompassed by any of the official recommendations concerning STD. In Sweden, contact tracing in gonorrhea cases is stipulated by law, which in STD clinics generally enlist the help of social officers. In genital infections of chlamydial origin, however, contact tracing must be performed on the basis of voluntary cooperation by patients and their contacts. Female partners of men infected with C. trachomatis have been found to harbor chlamydiae in the cervix in up to 70% of cases, while in the case of Chlamydia-positive women, about half of all their male partners are culture-positive for this organism. Partners usually have difficulty in determining just when they might have contracted their chlamydial infection. Contacts of several months' duration probably should be examined. Serological studies in male partners of chlamydiae-infected women have been found to have very limited value. It is most important both that patients with signs of genital infection be examined for the presence of C. trachomatis, and that culture-positive patients be offered a contact-tracing service.

Effect on plasma cortisol level and urinary cortisol excretion, in healthy volunteers, after application of three different topical steroid ointments under occlusion.

The systemic effect of the topical glucocorticoid ointments budesonide 0.025% (Preferid), hydrocortisone-17-butyrate 0.1% (Locoid) and betamethasone-17,21-dipropionate 0.5% (Diproderm) was studied in 9 healthy volunteers. Five g ointment was applied on about 13% of the total body surface, using occlusive technique for three consecutive nights. The cortisol values in plasma and urine were measured before, during, and 3 days after applications. Although budesonide and betamethasone-17,21-dipropionate are equipotent drugs from a therapeutic point of view, the halogenated betamethasone-17,21-dipropionate caused significantly greater decrease in both plasma- and urinary cortisol levels. Between the two non-halogenated glucocorticosteroids, budesonide and hydrocortisone-17-butyrate, no significant difference was found despite the large difference in anti-inflammatory effects. The results indicate that it is possible to improve the ratio between the local therapeutic effect and the systemic activity of a glucocorticosteroid. Budesonide represents such an improvement.

Contact-tracing in patients with genital chlamydial infection.

Of 2021 men attending a venereal disease clinic during a 20-month period, 527 (26·1%) harboured Chlamydia trachomatis, 310 (15·3%) Neisseria gonorrhoeae, and 94 (4·7%) both organisms. C trachomatis and N gonorrhoeae were isolated in 163 (15·7%) and 141 (13·8%) respectively of 1039 women attending the same clinic over a one-year period; 44 (4·2%) women harboured both organisms.Contact-tracing was carried out for 112 male and 88 female patients infected with chlamydia, none of whom had gonorrhoea. Of the 144 female contacts, 103 (71·5%) attended for examination and 67 (65%) were found to harbour chlamydia. Of the 103 male contacts, 95 (92·2%) attended for examination and 50 (52·6%) were found to harbour chlamydia. Of the 67 female contacts, about 55% were symptomless as were 50% of the male contacts. Cultures for N gonorrhoeae from the sexual contacts of patients with genital chlamydial infections showed positive results in 37 (18·5%) of the 200 contacts examined.For comparison the results of contact-tracing in 201 male and 231 female patients with gonorrhoea were analysed. Of the male and female contacts, 64·5% and 66·1% respectively attended the clinic for examination. N gonorrhoeae was isolated from 77·7% of the female and from 85·6% of the male contacts; about 40% and 50% respectively were symptomless.The high percentage of symptomless carriers of C trachomatis among sexual contacts emphasises the need for tracing contacts of this infection.

Staphylococcus saprophyticus in the aetiology of nongonococcal urethritis.

The occurrence of Staphylococcus saprophyticus, Chlamydia trachomatis, and Neisseria gonorrhoeae in urethral specimens of 252 men attending a venereal disease clinic was studied. When using a selective broth medium containing novobiocin and nalidixic acid, Staph. saprophyticus was isolated from 20.8% of 178 men with symptoms of urethritis and from 14.9% of 74 men without such symptoms. Staph. saprophyticus was found significantly less often in controls (7.1% of 56) than in the men with symptoms of urethritis. In the 35 men from whom Staph. saprophyticus was recovered more than 10 leucocytes per high power field in urethral smears occurred more often than in those from whom this organism, or either of the other two agents, were not isolated. No differences were found in the symptoms reported by the men harbouring Staph. saprophyticus or C. trachomatis or those with negative cultures. The results of the present study tend to suggest that Staph. saprophyticus is the aetiological agent of some cases of nongonococcal urethritis.

Contact allergy to lidocaine.

Two cases of contact allergy to lidocaine are reported. They also reacted to chemically related anesthetics of the amide type: one to bupivacaine, mepivacaine and prilocaine and the other to mepivacaine only. The patients also reacted to the chemically nonrelated cincaine, an anesthetic of the ester type. The lidocaine metabolites o-toluidine and mxylidine gave negative reactions.

Chlamydia trachomatis urethritis in men attending a venereal disease clinic: a culture and therapeutic study.

Urethral specimens from 459 male patients attending a venereal disease clinic were studied for presence of Chlamydia trachomatis and Neisseria gonorrhoeae. Of the 459 patients, 362 had symptoms suggestive of urethritis. In these 362, gonorrhoea was diagnosed in 78 (22%), while 88 (24%) harboured C. trachomatis; 15 harboured both organisms. Of those patients from whom C. trachomatis was isolated, 17% had no subjective symptoms of urethritis; the same percentage of symptomless carriers of gonococci was found. Watery discharge occurred more frequently in patients with chlamydial urethritis than in patients with gonorrhoea, while in the latter condition purulent discharge was more often found. Treatment with doxycycline for 9 days rendered 28 of 29 chlamydia-positive patients culture negative at control.