Screening for Chlamydia trachomatis in pregnancy: a retrospective analysis in a German urban area.

OBJECTIVE: Chlamydia trachomatis infection is the most common bacterial sexual transmitted disease. Nearly 75% of all cases appear clinically unapparent and can cause, especially when getting chronically, infertility. Regarding pregnancy, a nationwide screening for C. trachomatis was established since April 1995. The aim of this study was to determine the percentage of tested patients throughout these 7 years to evaluate the execution of the German guidelines. MATERIALS AND METHODS: Between 2001 and 2007, 12,865 patients were evaluated retrospectively concerning a Chlamydia trachomatis testing. RESULTS: A test was performed for chlamydial infection in 10,088 patients (78.4%). 65 pregnant patients (0.5%) out of 1,008 tested patients were positive for Chlamydia trachomatis. The part of tested patients was rising significantly from 2001 to 2007. In 2001, 68.3% pregnant patients were tested. The number of screened patients increased continuously up to 85.2% in 2007 (p < 0.001). The percentage of positive tested patients ranged from 0.27% in 2003 to 0.74% in 2005 (mean 0.50%). CONCLUSION: Since 1995, a screening for Chlamydia trachomatis has to be offered to every pregnant woman according to the German guidelines. The number of tested pregnant patients was rising from 68.3 to 85.2% within the evaluated 7 years, which would be a necessary and welcome trend. Interestingly, the mean prevalence of 0.5% of positive tested patients in this analysed urban population seems to be very low. An explanation might be the usage of the point-of-care (POC) tests and its low sensitivity. Testing by nucleic acid amplification might lead to a higher detection rate. Although the awareness concerning Chlamydia trachomatis testing during pregnancy seems to have been changed over the recent years, these data are still dissatisfactory.

Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified?

For classification of breast cancer (BC), tumor-node-metastasis (TNM) staging has been considered state of the art for more than 50 years. The T category is well defined, and in multicentric and multifocal tumors, tumor size is assessed by the largest tumor focus. The aim of this study was to compare multicentric/multifocal tumor spread in breast cancer with unifocal disease and to evaluate the diagnostic relevance of multifocality. A retrospective analysis was performed on survival related events in a series of 5,691 breast cancer patients between 1963 and 2007. By matched-pair analysis, patients were entered into two comparable groups of 288 patients after categorizing them as having multifocal/multicentric or unifocal breast cancers. Matching criteria were tumor size, grading, and hormone receptor status, which were equally distributed between both groups (P = 1.000 each). Disease free survival and the occurrence of relapse or of metastatic disease were evaluated. Cox's regression analysis was used for multivariate analysis. In the unifocal group, the mean breast cancer-specific survival time was 221.6 months as opposed to 203.3 months in the multicentric/multifocal group (P < 0.001, log-rank test). The occurrence of local relapse and distant metastasis was significantly increased in the multifocal group in comparison to the unifocal equivalent group (P < 0.001 and P < 0.003, respectively). Cox regression analysis for multivariate analyses demonstrated focality and centricity to be highly significant predictors for reduced overall survival (P = 0.016), local relapse (P = 0.001) and distant metastasis (P = 0.038). Tumor size, histopathological grading, hormone receptor status, and staging of lymph nodes are well-established prognostic parameters. Additionally, the number of foci should be considered as an independent prognostic parameter, which is currently not reflected in the TNM classification. We conclude that multicentric/multifocal BC is an independent BC risk factor and should be included in the risk assessment by re-evaluating the current TNM classification of the UICC.

Relationship between recurrent vulvovaginal candidosis and immune mediators in vaginal fluid.

OBJECTIVE: Recurring vulvovaginal candidosis (RVVC) is a common vaginal discharge, affecting 75% of all women at least once in their life. In 5% of these women, this infection is recurring. Recent studies have focused on determining the importance of vaginal-associated immunity. To investigate the effects of immune mediators and the probability of an immune defect as well as localized allergic responses due to candida, we examined the cytokines IL-4, IL-5, IL-13 as well as prostaglandin E(2) (PgE(2)), candida-specific IgE and total-IgE in patients with a clinical diagnosis of RVVC. STUDY DESIGN: In 104 symptomatic and 41 asymptomatic patients, regarding clinical symptoms of RVVC, vaginal fluids were measured by ELISA for the immune mediators IL-4, IL-5, IL-13, PgE(2), candida-specific IgE and total-IgE. Polymerase chain reactions as well as culture were used for candida detection. RESULTS: Concerning IL-5, IL-13 and total-IgE no statistically significant difference was found. Those women with a history of RVVC and who were currently symptomatic had elevated concentrations of IL-4 (p<.0001), PgE(2) (p<.0001) and candida-specific IgE (p<0.02) in their vaginal fluids compared to women with no clinical symptoms. Those three interleukins showed no significant differences between symptomatic patients who were positive or negative for Candida albicans or Candida glabrata. CONCLUSION: These findings indicate that women with clinical vaginal symptoms have a localized vaginal immunosuppression which might be the cause of their symptoms. Greatly elevated vaginal PgE(2) levels can be a consequence of a localized allergic response. An allergic reaction to candida components may be the cause of the allergic response in those women with high levels of candida-specific IgE. In women with elevated PgE(2), treatment with an antihistamine or prostaglandin synthesis inhibitor might be beneficial.