Comparison of four Mycoplasma pneumoniae IgM-, IgG- and IgA-specific enzyme immunoassays in blood donors and patients.

Mycoplasma pneumoniae antibodies were studied in 504 blood donors and 102 patients with infections not caused by M. pneumoniae with the use of enzyme immunoassay kits from ThermoLabsystems (L), Savyon (S), Bio-Rad (B) and Novitec (N). Detection frequencies of M. pneumoniae IgM in blood donors were 14.9% (L), 16.0% (S), 2.8% (B) and 3.8% (N), and in patients were 40.2% (L), 42.2% (S), 9.8% (B) and 16.7% (N). Detection frequencies of M. pneumoniae IgA were 68.5% (L) and 22.8% (S), and in 65 respiratory disease patients were 100% (L) and 53.8% (S). Thus, use of some kits may lead to overdiagnosis of M. pneumoniae infections.

An international study of the interobserver variation between interpretations of vaginal smear criteria of bacterial vaginosis.

An international workshop on vaginal smear-based diagnosis of bacterial vaginosis was organized where 13 investigators scoring 258 slides with smears from vaginal fluid. Interobserver reproducibility of interpretations of Nugent scores, Hay/Ison scores and wet smear scores for the diagnosis of bacterial vaginosis was shown to be high. Detailed analysis of individual scoring results however indicated that basic standards of quality control to ensure robust individual readings of slides must be adhered to.

Respiratory tract infection due to Chlamydia pneumoniae in military personnel.

The objective of this investigation was to determine whether Chlamydia pneumoniae was involved in an outbreak of respiratory disease among military recruits, 92 patients (average age 20.1 years) were included in the study if they had a sore throat or cough for more than 1 week. In addition to sore throat and cough, fatigue, headache, dyspnoea and vertigo were the most frequent symptoms. The patients received standard treatment with 100 mg of doxycycline b.i.d. for 14 days. In 38.8% of cases symptoms were alleviated after 1-2 weeks of treatment, and in 22.4% of cases after 2-3 weeks of treatment. Pretreatment throat washings and sera were sampled for Chlamydia. Sera were drawn for Chlamydia, Mycoplasma and adenovirus serology. Cell culture (Hep-2) and 3 different serological methods-microimmunofluorescence (MIF), enzyme immunoassay with a recombinant glycoconjugate antigen (r-EIA) and immunoperoxidase assay (IPA)-were used. Cell culture was found to have too low a sensitivity to be of diagnostic value. Acute infection was demonstrated in 13% by MIF IgM and in an additional 21% by MIF IgG (titre rises). Enzyme immunoassay IgM was found in 17% and IPA IgM in 19% of individuals without MIF IgM antibodies. Microimmunofluorescence was found to be the most useful test for serodiagnosis. The combination of serological methods showed that 40 out of 52 (76.9%) had an acute infection with possible chlamydial aetiology. In conclusion, methodological improvements are necessary for the aetiological diagnosis of chlamydial respiratory infections.

Serum reactivity to Chlamydia trachomatis and C. pneumoniae antigens in patients with documented infection and in healthy children by microimmunofluorescence and immunoblotting techniques.

Chlamydia trachomatis and C. pneumoniae are both important human pathogens. Antigenic cross-reactivity between the two species may complicate serologic diagnosis of infection with one or the other agent. In this study we examined sera of persons with chlamydia infections and of healthy children by microimmunofluorescence (MIF) against C. trachomatis L2 antigen and against C. pneumoniae TW-183 antigen to explore the degree of cross-reactivity found by these two methods. Likewise, the cross-reactivity seen by immunoblot with sera of rabbits immunized against one of the antigens when tested on the other was examined. While among healthy children stratified by age, MIF seropositivity to C. pneumoniae TW-183 increased with age, no such trend was observed with respect to seropositivity to C. trachomatis L2 antigens, and 81% of children seropositive to TW-183 did not react on L2 antigen. Moreover, 27% of those positive on L2 antigen were negative on TW-183. Immunoblot analysis showed much greater antibody cross-reactivity than that detected by MIF. The immunoblot cross-reactivity was probably not attributable solely to double infection since sera of rabbits immunized to only one species of chlamydia reacted strongly with both chlamydiae in immunoblot analysis. The data presented need to be taken into account in the development of serologic tests based on a small number of antigens or on partially denatured antigens.

Test-of-cure for asymptomatic genital chlamydial infections in women. A cost-benefit analysis.

Asymptomatic genital infection caused by Chlamydia trachomatis is common, and one or more test-of-cure consultations in such cases is routine. The economic implications of two post-treatment strategies, either no test-of-cure, or one test-of-cure consultation with a single test for C. trachomatis, renewed treatment, and another test-of-cure of those still chlamydia-positive, and so on, have been compared. The costs of the test-of-cure strategy are twice those of the no-test regimen. Without test-of-cure, 79 more cases of pelvic inflammatory disease, 8 cases of infertility requiring treatment, and 2 cases of ectopic pregnancy would occur for every 10,000 patients. It is concluded that routine test-of-cure of asymptomatic genital chlamydial infections after treatment is not cost beneficial.

Papillomavirus infection among abortion applicants and patients at a sexually transmitted disease clinic.

The base-line prevalence of human papillomavirus (HPV) infection among applicants for first trimester induced abortion and among a sexually transmitted disease (STD) clinic population with macroscopically visible condyloma is investigated. Cervical cells were collected from 505 women applying for induced abortion. Cell scrapes were obtained from the surface of the warts from 81 female and 32 male STD patients. HPV DNA 6/11, 16/18, and 31/33/35 were detected by a dot blot technique (ViraPap and ViraType, Life Technologies, Gaithersburg, MD). Of the 505 abortion applicants, 31 (6.1%) had HPV DNA. In the STD population, 64 (79.0%) patients had positive test results for HPV DNA from cervical, introital cell scrapes, or both. Of the 32 male STD patients from whom preputial, urethral samples, or both were taken, 24 (75%) had HPV DNA. After typing, the relative proportion of HPV 6/11 was 9.7% in abortion applicants, 72.2% in female STD patients, and 91.3% in male STD patients. The relative proportion of high-risk HPV types, such as 16/18 and 31/33/35, was 89.7% among abortion applicants, 38.9% among female STD patients and 13.0% among male STD patients. The majority of abortion applicants infected with HPV were thus infected with a potentially oncogenic HPV type, and the prevalence of HPV type 16/18 and 31/33/35 was also high among female STD patients.

[Asymptomatic genital infection by Chlamydia trachomatis in women. A cost analysis of control check-ups]. / Asymptomatisk Chlamydia trachomatis-genitalinfeksjon hos kvinner. Kostnadsanalyse av kontrollundersøkelse.

Asymptomatic genital infection by Chlamydia trachomatis is common in women, and one or more consultations to test for cure is the routine practice. We have compared the economic implications of two post-treatment regimens: 1) no control, and 2) one control involving a single test for C trachomatis, with renewed treatment and another test for cure in women who were chlamydia-positive, etc. The costs of the control regimen were double those of the no-control regimen. With no control, 79 more cases of pelvic inflammatory disease, eight more cases of infertility requiring work-up and two more cases of ectopic pregnancy would occur per 10,000 patients. We conclude that routine post-treatment control of asymptomatic genital chlamydial infections is not cost beneficial.

[Bacterial vaginosis associated with Mobiluncus species in general practice]. / Bakteriell vaginose assosiert med mobiluncusspecies i allmennpraksis.

Bacterial vaginosis is a common disease in outpatient gynaecological practice. Mobiluncus is one of the bacterial species recently described as associated with bacterial vaginosis. In our study, bacterial vaginosis and Mobiluncus sp. morphotype were identified by means of a Gram-stained smear of the vaginal secretions. 40 women with Mobiluncus sp. associated bacterial vaginosis were treated with 500 mg metronidazole three times daily for seven days. 38 (95%) of the 40 patients showed no signs or symptoms of bacterial vaginosis after treatment, and the Mobiluncus sp. morphotype was absent from the Gram-stained smears in all 38 women. At the second control visit one month later, the Gram-stain was normal and no complaints of discharge were noted. The treatment had a favourable effect on the following signs and symptoms of bacterial vaginosis: homogeneous discharge, spotting/postcoital/intermenstrual bleeding, low abdominal pain, pH greater than 4.7. The reduction of these symptoms was statistically significant. The treatment reduced the presence of Mobiluncus, G vaginalis and led to the restoration of Lactobacillus flora. Mobiluncus associated bacterial vaginosis can be treated successfully with 500 mg of metronidazole three times a day for seven days.

Comparison between cell culture and serology for detecting Chlamydia trachomatis in women seeking abortion.

The efficiency of an immunoperoxidase serological assay and culture of Chlamydia trachomatis were compared in 127 women seeking first trimester abortion. Serum IgG and IgA antibodies specific for C trachomatis were detected by a single serovar (L2) inclusion immunoperoxidase assay (IPA). Eighty (63%) women were seropositive for chlamydial IgG and 31 (24%) for IgA antibodies. C trachomatis was isolated from 21 of 127 (17%) women. Twenty of the 80 women (25%) seropositive for specific IgG antibodies and one of 47 (2%) patients without these antibodies were culture positive (p less than 0.001). Compared with isolation, chlamydial antibodies at a titre of greater than or equal to 16 showed high sensitivity and negative predictive value (95% and 98%, respectively), but low specificity and efficiency (43% and 52%, respectively). Chlamydial IgA antibodies at a titre of greater than or equal to 8 showed low sensitivity (52%), but a higher specificity, negative predictive value, and efficiency of 81%, 90%, and 76%, respectively. C trachomatis IgG antibodies at a titre of 16 as determined by IPA can be used as an efficient negative exclusion marker for active chlamydial infection in screening women seeking abortion.

Chlamydia trachomatis serology in ankylosing spondylitis.

Demonstration of chlamydial antibodies in patients with ankylosing spondylitis (AS) could show an etiological role of Chlamydia trachomatis in this condition. We studied serum specimens from 50 HLA-B27 positive patients with AS (Group I), 34 HLA-B27 positive patients with other rheumatic diseases (Group II), 67 HLA-B27 positive healthy blood donors (Group III) and 37 healthy untyped blood donors. (Group IV). Measured by an immunoperoxidase assay (IPA) chlamydial IgA (titre greater than or equal to 1:20) was more prevalent in the HLA-B27 positive persons than in the healthy controls not selected for HLA-group (Groups I + II + III vs IV : p less than 0.02). Chlamydia trachomatis IgA-IPA containing sera also had specific IgG-IPA antibodies (greater than or equal to 1:80) in 29 (96%) out of 30 sera from HLA-B27 positive individuals and controls. Conversely, 45% of specific IgG-positive (greater than or equal to 1:80) AS sera, 27.7% sera in Group II, 39.4% Group III sera vs. 11.1% of sera in Group IV had concomitant chlamydial IgA (greater than or equal to 1:20). The differences in the prevalence of specific IgA were statistically significant: Group I vs. IV : p less than 0.01; Group III vs. IV :p less than 0.05 and Gr. I + II + III vs. IV: p less than 0.05. Our data suggest an enhanced antibody production against Chlamydia trachomatis among the HLA-B27 positive individuals whether they have AS or are healthy.

Effect of amoxicillin on simultaneous Chlamydia trachomatis infection in men with gonococcal urethritis: comparison of three dosage regimens.

Of 92 men with gonococcal urethritis who were treated orally with amoxicillin, 25 (27.1%) had a simultaneous Chlamydia trachomatis infection. At the first visit 25 patients were treated with a single dose of 1 g of amoxicillin plus 1 g of probenecid (group 1); 24 men were treated with 1 g of amoxicillin twice a day for two days (group 2); and 43 men were treated with 0.75 mg of amoxicillin three times a day for seven days (group 3). At the follow-up visit, one patient in each group still had Neisseria gonorrhoeae-positive cultures. C. trachomatis was not isolated again after treatment from men in group 3, but was isolated from 81.8% in groups 1 and 2 combined (P less than 0.05). One (10%) of the ten men in group 3 who were C. trachomatis-positive before treatment developed postgonococcal urethritis, as compared with seven (63.6%) of 11 in groups 1 and 2 combined (P less than 0.05). Thus a multiple-dose amoxicillin regimen may prove to be a useful alternative to the present-day treatment of chlamydial infections of the urogenital tract.

The treatment of Gardnerella vaginalis vaginosis: a randomized comparison of pivampicillin with metronidazole.

The efficacy of pivampicillin and metronidazole were compared in the treatment of Gardnerella vaginalis associated bacterial vaginosis. In a multicenter trial 86 women were given pivampicillin (P) 700 mg twice daily for 6 days and 86 women received metronidazole (M) 400 mg three times daily for 7 days. At control, 2 weeks from the start of treatment, patients in group P showed the best clinical results, 77.9% in group P vs. 64.0% in group M (p = 0.066). P showed a higher clinical efficacy than M, both in women using intra-uterine device and in patients using other forms of contraception. Negative post-treatment cultures were seen in 43% of women in group P and 64% in group M (p less than 0.002). Bacteriological cure was unrelated to disappearance of discharge, odour and itching, although it correlated significantly with a negative amine test (p less than 0.00005). Pivampicillin in the dosages used in the present investigation is a useful alternative to metronidazole therapy.

A prospective study of Chlamydia trachomatis in first trimester abortion.

Chlamydia trachomatis was isolated from 34 (17.9%) of 190 unselected women applying for first trimester abortion and from 27 (15.9%) of the 170 women who actually had the operation. C. trachomatis was more common among the younger women. Neisseria gonorrhoeae was isolated from 3 (1.6%) of 190 women. Culture positive patients and partners were given antibiotic treatment for 10 days, usually postoperatively. Early postoperative genital infection developed in 2 (7.4%) of the 27 chlamydia-positive and in 3 (2.0%) of the 143 chlamydia-negative women. There were no late infections. The antibiotic treatment significantly reduced the rate of postoperative pelvic inflammatory disease. At examination after 4-7 weeks all cultures were negative. Significantly more women with chlamydia-positive cultures were sero-positive preoperatively: with a microimmunofluorescence method, IgG titres greater than or equal to 1:160 were found in 74.1% of culture positive and in 47.6% of culture negative patients (p = 0.01). However, serological IgG screening does not identify individual high risk patients and so is of little clinical use in this context. We recommend preoperative screening for C. trachomatis in all women requesting an abortion and 10 days antibiotic treatment for all carriers.

Treatment of acute gonococcal urethritis in men with simultaneous infection with Chlamydia trachomatis.

Each of 201 men with symptoms and signs of acute urethritis was randomly assigned to one of two treatment regimens: ampicillin (2g) plus probenecid (1g), or sulphamethoxazole-trimethoprim (SMX-TMP) (sulphamethoxazole 1600 mg plus trimethoprim 320 mg) four tablets twice daily for two days. Before treatment Neisseria gonorrhoeae was isolated from 162 patients, while coexistent Chlamydia trachomatis was recovered from 42 (26%) men. After treatment N gonorrhoeae persisted in 11 (14.3%) of the 77 patients treated with ampicillin and probenecid and in three (3.5%) of the 85 treated with SMX-TMP (p less than 0.05), while C trachomatis persisted in four (16%) of the 25 men treated with SMX-TMP and in all 17 patients treated with ampicillin and probenecid. SMX-TMP was thus more effective than ampicillin in treating acute gonorrhoea in men and in eradicating concurrent C trachomatis infection.

Characterization of Gardnerella vaginalis by gas chromatography.

The principal objective of this study was the characterization of Gardnerella vaginalis by gas chromatography. Thirty-eight isolates and the type strain, ATCC 14018, of G. vaginalis were studied. Hexadecanoic (16:0), octadecenoic (18:1) and octadecanoic (18:0) were the major fatty acids detected. Only insignificant differences between the various isolates could be found. The gas chromatographic analysis of G. vaginalis revealed a characteristic pattern. Gas chromatography in combination with selective growth conditions provides a method for rapid and exact identification.

Method for isolation of gardnerella vaginalis (Haemophilus vaginalis). Characterization of isolates by gas chromatography.

A method for the isolation of Gardnerella vaginalis (Haemophilus vaginalis) is presented. Bacteria isolated from 48-hour cultures grown on human blood agar were identified by means of beta-hemolysis, colony morphology, sensitivity to antimicrobial agents, oxydase and catalase reactions. Thirty-eight clinical isolates and one test strain were examined for fatty acid composition. Hexadecanoic (16:0), octadecenoic (18:1) and octadecanoic (18:0) were the major fatty acids. Also present, but in minor quantities, were myristic (14:0), hexadecenoic (16:1) and octadecadienoic (18:2) acids. Only insignificant differences between isolates could be detected. No hydroxy fatty acids commonly found in gram-negative bacteria were encountered. Gas chromatographic analysis of G. vaginalis revealed a characteristic and relatively simple pattern. The results support the use of the isolation method, which provides conditions highly selective for G. vaginalis.