Endocervical chlamydial infection in women with gonorrhoea.

Eighty six women attending Middle Road Hospital with endocervical gonococcal infection were evaluated. Chlamydia trachomatis was isolated in 27% of them. Women co-infected with C. trachomatis were similar to those with gonococcal infection alone in terms of demography, type of sexual contact, previous sexually transmitted disease, genitourinary symptoms, and clinical signs.

Chlamydial infection in female prostitutes in Singapore.

Three studies conducted in 1982, 1985 and 1988 investigated chlamydial infections in female prostitutes. In 1982, 115 prostitutes with culture-positive gonorrhoea were studied; 8% were coinfected with Chlamydia trachomatis. In 1985, 86 female prostitutes and in 1988, 100 female prostitutes attending for routine tests were examined. Chlamydia trachomatis was isolated in 12% and 9% of the cases, respectively. Gonorrhoea was detected in 10% and 11% of the cases. In the 1988 study, one (9%) of the 11 women with gonorrhoea had concomitant chlamydial infection. Syphilis was diagnosed in 3% of the female prostitutes investigated in 1988. Our findings indicate that concomitant chlamydial infection occurs in about 8-9% of female prostitutes with gonorrhoea and that 9-12% of the female prostitutes screened harboured Chlamydia trachomatis in their endocervices. A chlamydial control programme in prostitutes is desirable.

PIP: Studies conducted in 1982, 1985, and 1988 among female prostitutes in Singapore documented the need for a chlamydial control program in this population. In the 1982 study, which included 115 prostitutes infected with gonorrhea, Chlamydia trachomatis was recovered from 8%. In 1985 and 1988, the prevalence of endocervical chlamydia infection in prostitutes presenting for routine testing was 12% and 9%, respectively. The prevalence of gonorrhea in 1985 and 1988 was 10% and 11%, respectively. In the 1988 study, 1 of the 11 prostitutes with gonorrhea also harbored chlamydia. The prevalence of syphilis, ascertained only in the 1988 study, was 3%. These findings suggest that 8-9% of prostitutes with gonorrhea are co-infected with chlamydia. At present, prostitutes in Singapore are screened only for gonorrhea and syphilis. The high rate of C trachomatis infection recorded in this study indicates that chlamydia infection--on the increase in the West--should be added to this list. In addition, health education efforts are needed to stress the need for additional anti-chlamydial treatment. Currently utilized regimens for the treatment of gonorrhea are ineffective against C trachomatis.

Endocervical chlamydial infection in women attending a sexually transmitted disease clinic in Singapore.

Two hundred women attending the sexually transmitted disease (STD) clinic at Middle Road Hospital were investigated. Chlamydia trachomatis was isolated from 32% of women who were contacts of men with nongonococcal urethritis, 15% of contacts of gonococcal urethritis, 27% of contacts of unspecified STD, and 13% of women without any history of STD in their sex partners. Overall, Chlamydia trachomatis was isolated from 17% of 200 women, Neisseria gonorrhoeae from 13% of 199 women, Candida albicans from 34% and Trichomonas vaginalis from 6% of 197 women. Three per cent of the patients had positive VDRL results. A history of bilateral lower abdominal pain and the presence of cervicitis were significantly associated with chlamydial infection. Forty one per cent of the 34 chlamydia-positive women were asymptomatic. The results of this study show that C. trachomatis infection is more common than infection with N. gonorrhoeae in women who attend STD clinics. The need for routine screening and treatment on the basis of epidemiological and clinical markers of infection has to be carefully examined.

Chlamydia trachomatis infection in unmarried women seeking abortions.

Fifty consecutive unmarried women seeking termination of pregnancy in a state run general hospital in Singapore were screened for cervical Chlamydia trachomatis infection before abortion. Chlamydial infection was diagnosed by taking a cervical swab, culturing the organism in tissue culture media, and identifying the inclusion bodies by dark ground fluorescent microscopy. Chlamydia trachomatis was recovered in as many as 14% of cases. None of the patients gave any history suggestive of promiscuity. Compared with gonorrhoea in the non-prostitutes sexually active women of the population studied, the incidence of infection with Chlamydia trachomatis was found to be high. Patients with positive cultures often defaulted from follow up, thus posing a genuine risk of the spread of the disease by vertical and horizontal transmission.

PIP: 50 consecutive unmarried women seeking termination of pregnancy in a state-run general hospital in Singapore were screened for cervical Chlamydia trachomatis infection before abortion. Chlamydial infection was diagnosed by taking a cervical swab, culturing the organism in tissue culture media, and identifying the inclusion bodies by dark ground fluorescent microscopy. Chlamydia trachomatis was recovered in as many as 14% of cases. None of the patients gave any history suggestive of promiscuity. Compared with gonorrhea in the nonprostitute sexually active women of the population studied, the incidence of infection with Chlamydia trachomatis was found to be high. Patients with positive cultures often defaulted from follow-up, thus posing a genuine risk of the spread of the disease by vertical and horizontal transmission.

Isolation of Chlamydia trachomatis in Singapore.

With the introduction of the culture method for isolating Chlamydia trachomatis in Singapore, several studies have been carried out to define its prevalence in different patient populations. The organism was isolated from a variety of clinical conditions. In certain clinical settings it appears to be even more prevalent than the gonococcus. Over 10% of the prostitutes are carriers, and they are probably the major transmitters. A control programme is needed to reduce the infective reservoir.