How adequate is adequate for the collection of endocervical specimens for Chlamydia trachomatis testing?

BACKGROUND: Endocervical specimen adequacy has been assessed by subjective criteria that are based on arbitrarily chosen thresholds for the presence of target cells observed on microscopic slide examinations. GOAL OF THIS STUDY: To assess the relationship of chlamydia test positivity to specimen adequacy with the use of a semi-quantitative cytologic staining method for assessing endocervical specimen collection cellularity. STUDY DESIGN: Endocervical specimens for chlamydia testing (PACE 2, GenProbe, San Diego, CA) and for a slide cytologic examination (n = 3,500) were collected in parallel. A semi-quantitative cytologic examination to determine a specimen adequacy (SA) score was performed for every chlamydia-positive result (n = 163) and approximately every fifth negative result (n = 626). The Chi-square test for linear trends was used to assess the relationship between SA scores and chlamydia positivity. The median SA scores for chlamydia-positive and negative slides were compared. RESULTS: The median SA scores for chlamydia-positive and -negative slides were 27 and 20, respectively (P < 0.001). Chlamydia positivity rates increased with increasing specimen adequacy scores (0-9, 2.7%; 10-19, 15.1%; 20-29, 24.8%; and 30-45, 31.3%; Chi-square for linear trend: P < 0.001). CONCLUSION: These results demonstrate a linear relationship between the numbers of cells observed on an endocervical smear and chlamydia positivity rather than the threshold concept in practice. The semiquantitative cytologic technique offers an objective method for further evaluating specimen adequacy for Chlamydia trachomatis testing.

A tale of two sexually transmitted diseases. Prevalences and predictors of chlamydia and gonorrhea in women attending Colorado family planning clinics.

BACKGROUND: The comparative prevalences and predictors of chlamydia and gonorrhea have not been studied in the family planning clinic population. GOALS: To determine the comparative prevalences and predictors of chlamydia and gonorrhea among Colorado family planning clinic patients. STUDY DESIGN: Cross-sectional study of public and private family planning clinic patients in Colorado tested for both chlamydia and gonorrhea (n = 12,926). RESULTS: Among women tested for both infections, the chlamydia prevalence rate was 4.5% and the gonorrhea prevalence rate was 0.5%. Multivariate analysis showed that independent predictors of chlamydia were age younger than 25 years, black or Hispanic race-ethnicity, cervical friability, mucopus, exposure to a sex partner with chlamydia, or multiple recent sex partners. Independent predictors of gonorrhea were age younger than 20 years, black or Hispanic race-ethnicity, or exposure to a sex partner with gonorrhea; adjusted odds ratios for exposure to gonorrhea and black race were the highest for either infection. CONCLUSIONS: The gonorrhea prevalence rate was very low compared to that of chlamydia in patients at Colorado family planning clinics. Cost-effective gonorrhea testing strategies are needed for this population.

PIP: In Colorado, state health department laboratory personnel used the DNA probe assay, Gen-Probe, to test specimens from 12,926 women for both Chlamydia trachomatis and Neisseria gonorrhoeae infections and from another 9416 women for Chlamydia alone. All the women had attended public and private family planning clinics state-wide during July 1994 to May 1995. Researchers conducted a comparative analysis to determine the prevalence and the predictors of each sexually transmitted disease (STD) among the family planning clinic population in Colorado. Women tested for both chlamydia and gonorrhea had a higher chlamydia prevalence rate than those tested for only chlamydia (4.5% vs. 3.5%; p 0.001). 64 (0.5%) of the women who were tested for both chlamydia and gonorrhea tested positive for gonorrhea. The gonorrhea prevalence was 9 times lower than that of chlamydia. Among the 64 women with gonorrhea, 25 (39.1%) also tested positive for chlamydia. Among the 577 women with chlamydia, 4.3% also tested positive for gonorrhea. The multivariate analysis revealed that variables independently associated with chlamydia included age under 20 or 20-24 years (odds ratio [OR] = 3.84 and 2.44, respectively), African-American or Hispanic race-ethnicity (OR = 2.41 and 1.65, respectively), cervical friability (OR = 2.26), mucopus (OR = 2.64), exposure to a sex partner with chlamydia (OR = 3.79), and multiple recent sex partners (OR = 1.4). Variables independently associated with gonorrhea included age under 20 years (OR = 3.42), African-American or Hispanic race-ethnicity (OR = 12.71 and 3.07, respectively), and exposure to a sex partner with gonorrhea (OR = 39.29). Cost-effective analyses would help determine appropriate selective screening strategies for gonorrhea. The researchers found that the criteria of urban residency, African-American race, and exposure to a sex partner with gonorrhea would involve the testing of 82% of patients, which would identify 94% of gonorrhea infections.

Which dogs bite? A case-control study of risk factors.

OBJECTIVE: Dog bites cause an estimated 585,000 injuries resulting in the need for medical attention yearly and children are the most frequent victims. This study sought to determine dog-specific factors independently associated with a dog biting a nonhousehold member. METHODS: A matched case-control design comprising 178 pairs of dogs was used. Cases were selected from dogs reported to Denver Animal Control in 1991 for a first-bite episode of a nonhousehold member in which the victim received medical treatment. Controls were neighborhood-matched dogs with no history of biting a nonhousehold member, selected by modified random-digit dialing based on the first five digits of the case dog owner's phone number. Case and control dog owners were interviewed by telephone. RESULTS: Children aged 12 years and younger were the victims in 51% of cases. Compared with controls, biting dogs were more likely to be German Shepherd (adjusted odds ratio (ORa) = 16.4, 95% confidence interval (CI) 3.8 to 71.4) or Chow Chow (ORa = 4.0, 95% CI 1.2 to 13.7) predominant breeds, male (ORa = 6.2, 95% CI 2.5 to 15.1), unneutered (ORa = 2.6, 95% CI 1.1 to 6.3), residing in a house with > or = 1 children (ORa = 3.5, 95% CI 1.6 to 7.5), and chained while in the yard (ORa = 2.8, 95% CI 1.0 to 8.1). CONCLUSIONS: Pediatricians should advise parents that failure to neuter a dog and selection of male dogs and certain breeds such as German Shepherd and Chow Chow may increase the risk of their dog biting a nonhousehold member, who often may be a child. The potential preventability of this frequent public health problem deserves further attention.

Seroepidemiological characterization of a syphilis epidemic in the Republic of the Marshall Islands, formerly a yaws endemic area.

The annual numbers of reported cases of syphilis in the Republic of the Marshall Islands (RMI) increased from none in 1983 to more than 600 in 1989, suggesting a large outbreak of syphilis. Much of the increase resulted from expanded serological screening. The apparent outbreak of syphilis, therefore, may have been partly the result of increased surveillance or, since the RMI was formerly a yaws endemic area, possibly due to a resurgence of yaws. To address this problem and better characterize the epidemic, we analysed results from a 1989/90 Ministry of Health Services mass serological screening on Majuro Atoll, the main population centre. Serum specimens from 9160 people (86% of residents aged 15-44 years) on Majuro were screened with the rapid plasma reagin (RPR) card test; we repeated the RPR and performed a confirmatory microhaemagglutination assay for Treponema pallidum-specific antibodies (MHA-TP) on a sample of serum specimens. To estimate the seroprevalence of syphilis, we also tested a sample of RPR nonreactive specimens by MHA-TP. Among people less than 45 years of age, total (11.5%) and high-titre (5.2%) seropositivity rates were highest in the 20-24 year age group, as was MHA-TP seroprevalence (15.9%). These results suggested that a large outbreak of syphilis was responsible for the observed seroreactivity. Cumulative incidence modelling and comparisons with the results of a previous serosurvey conducted in 1985 suggested that the duration of the syphilis epidemic was approximately 10 years and that incidence had not increased appreciably since 1985.

Diverging gonorrhea and syphilis trends in the 1980s: are they real?

BACKGROUND: The purpose of this study was to evaluate whether the divergence in national trends of gonorrhea and syphilis from 1986 to 1989 in the United States was real and if overall trends masked a contemporaneous increase in both diseases in a core group. METHODS: We analyzed the following: (1) reported cases of gonorrhea and primary and secondary syphilis in the United States for the years 1981 to 1989, (2) gonorrhea screening results from six states for the years 1985 to 1989, and (3) reported cases of gonorrhea and primary and secondary syphilis by census tract for the years 1986 to 1989 in one city. RESULTS: The incidence of gonorrhea decreased 22% in the United States from 1986 to 1989 while the incidence of primary and secondary syphilis increased 59%. Among Blacks, syphilis incidence increased 100% and gonorrhea incidence decreased 13%; among Whites and Hispanics, the incidence of both diseases decreased. Results from gonorrhea screening among females in six states agree with gonorrhea incidence trends in those areas. Race-specific and census tract analyses of data from a number of metropolitan areas where overall rates diverged did not demonstrate a group in which the incidence of both diseases increased. CONCLUSIONS: We conclude that diverging trends of gonorrhea and syphilis from 1986 to 1989 are real and emphasize differences in the epidemiologic characteristics of these two sexually transmitted diseases.