Enzyme immunoassay in the diagnosis of Chlamydia trachomatis infections in diverse patient groups

An enzyme immunoassay (EIA) in parallel with cell culture was used to investigate the extent of infections due to Chlamydia trachomatis. EIA reactive confirmed in cell culture was taken as positive. C. trachomatis was found in 6 (26.0%) of 23 men with symptomatic non-gonococcal urethritis (NGU), ten (17.2%) of 58 symptom-free males and in three of 4 with postgonococcal urethritis. Among 106 asymptomatic pregnant women studied the incidence of C. trachomatis was 8.5% while a higher incidence (16.7%) was found in those with symptoms. C. trachomatis positivity in asymptomatic and symptomatic post-natal screening were 11.4% and 7.7%. Of 43 symptomatic non-pregnant females investigated, 7 (16.3%) were found to be positive for C. trachomatis. Of 3 women with PID, 2 (66.7%) harboured C. trachomatis in their cervix while in another 29 infertile women, C. trachomatis was positive in 3 (8.1%). Contraceptives appeared to have an effect on the chlamydial positivity. Comparative testing of EIA with the standard cell culture method in this study indicate EIA as a suitable alternative for the definitive diagnosis of chlamydial infection in high prevalence settings and with caution in low prevalence settings.     

Infection uro-génitale masculine àChlamydia trachomatis: Vers une meilleure approche diagnostique

Chlamydia trachomatis is the most frequently sexually transmitted pathogen in humans, with an estimated 92 million new cases occurring worldwide each year, However, this number is probably underestimated, particularly for men who are less likely to be screened than women. C. trachomatis serovar D-K causes a variety of clinical syndromes in men and women. C. trachomatis may cause urethritis, epididymitis and prostatitis in young sexually active men, less than 35 years of age. 50% of infected men remain asymptomatic. Sexually active males with asymptomatic urethritis constitute a significant reservoir of potential infection for women, in whom the consequences of lower genital tract infection are likely to be more severe. Chlamydial infections have never been easy to diagnose. Because Chlamydiae are obligate intracellular pathogens, the objective of specimen collection should usually be to include the host cells that harbour the organisms. The sensitivity and specificity of diagnostic tests forC. trachomatis have been shown to be directly related to the adequacy of the specimen. Infection may be symptomatic or asymptomatic with a small number of elementary bodies present at the site of infection. The conventional approach to laboratory diagnostic testing forC. trachomatis infections consisted of cell culture of inocula prepared from urogenital specimens. Cell culture requires appropriate collection of cell scrapings from the urethra, and optimal transport and storage conditions of specimens to preserve viable organisms. Antigen and nucleic acid detection technologies were developed during the 1980s and have been extensively applied to diagnosis due to their lower cost, a lower level of expertise, preservation of infectivity during transport, and a shorter time to obtain the results. Unfortunately, most of these tests are less sensitive thanin vitro cell culture, and may miss a large number ofChlamydia infected individuals. Nucleic acid amplification technologies have therefore been developed, and application of these tests has shown that culture is not as sensitive as previously believed and that the prevalence ofC. trachomatis infection is higher in most populations. These assays can use non-invasive specimens such as first void urine and semen, and do not require special storage conditions. Advantages of nucleic acid amplification tests are their ability to detect even a small amount of organisms. This enables a high detection rate forC. trachomatis in symptomatic persons, diagnosis of chlamydial infections in asymptomatic individuals with a small number of elementary bodies, and diagnosis of persistent infections.     

Diagnosis and treatment of urethritis in men.

Gonococcal and nongonococcal urethritis are the most common sexually transmitted diseases in men. Failure to control these infections is a result of improper treatment of index cases and their sexual contacts. The proper management of urethritis in men is reviewed.     

Topical use of cortisone in urology

Cortisone was instilled into the bladder in the treatment of interstitial cystitis and contracted bladder, trigonitis and urethritis in females, nonspecific urethritis in males, and inflammation of the wall of the bladder. In infectious cases the hormonal therapy was used after antibacterial measures had failed. Improvement occurred quickly in most cases soon after cortisone therapy was given. In a few cases of interstitial cystitis and contracted bladder the relief obtained was inadequate and it was necessary to carry out overdistention procedures under visualization. When that was done, however, it was noted that the condition of the bladder was improved as compared with the conditions usually observed in cases in which cortisone treatment is not given before the procedure. Results of tests of the blood during therapy indicated that the benefits of the treatment were not owing to systemic absorption of cortisone.     

Resistance to Gonorrhea Possibly Mediated by Bacterial Interference

Two men with no prior history of urethritis failed to develop gonorrhea after sexual exposures to women with genital gonococcal infection. Usual methods of prophylaxis, such as antibiotics or condoms, were not employed. The aerobic bacterial flora of these men's urethras consisted of several bacteria, some of which inhibited the in vitro growth of Neisseria gonorrhoeae. The hypothesis is suggested that bacterial interference may have played a role in protecting these men from gonorrhea.     

Empiric therapy of common bacterial infections in Saudi Arabia; a review.

The common infective conditions encountered at King Khalid Teaching Hospital, Riyadh, Saudi Arabia were described. These data were collected mostly during a period of 8 years between 1981 to 1988. These infections included brucellosis, cholecystitis, conjunctivitis, enteric fever, gastroenteritis, infective endocarditis, meningitis, otitis media, pneumonia, septicaemia, sorethroat, treponemal infections, urethritis, urinary tract infections, and vaginitis. A scheme for empiric chemotherapy has been suggested for these infections based on the sensitivity results obtained mostly from the microbiology laboratory at Teaching Hospital, Riyadh. This scheme of empiric therapy is offered as a guide only. It does not cover all possibilities and is not intended as a rigid dogma. Empiric therapy has also been suggested for some other infective conditions where sufficient data were not available from the Teaching Hospital. Empiric therapy should be started after relevant specimens are collected. Culture and sensitivity tests are invaluable in the management of patients with infectious diseases. As soon as sensitivities of the infecting organisms' are known, treatment should be adjusted accordingly. In some cases, Gram-staining is valuable to guide the initial therapy (eg. meningitis, pneumonia, and urethritis). Finally, close liaison between physicians and clinical microbiologists is mandatory for successful therapy.     

Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women

Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women including cervicitis, pelvic inflammatory disease (PID), and infertility. This comprehensive review critically examines epidemiologic studies of M. genitalium infections in women with the goal of assessing the associations with reproductive tract disease and enhancing awareness of this emerging pathogen. Over 27,000 women from 48 published reports have been screened for M. genitalium urogenital infection in high- or low-risk populations worldwide with an overall prevalence of 7.3% and 2.0%, respectively. M. genitalium was present in the general population at rates between those of Chlamydia trachomatis and Neisseria gonorrhoeae. Considering more than 20 studies of lower tract inflammation, M. genitalium has been positively associated with urethritis, vaginal discharge, and microscopic signs of cervicitis and/or mucopurulent cervical discharge in seven of 14 studies. A consistent case definition of cervicitis is lacking and will be required for comprehensive understanding of these associations. Importantly, evidence for M. genitalium PID and infertility are quite convincing and indicate that a significant proportion of upper tract inflammation may be attributed to this elusive pathogen. Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women.     

Experimental Mycoplasma infection of the urogenital tract in monkeys

The possibility of the experimental reproduction of infectious urethritis in monkeys by infecting them with mycoplasma and ureaplasma cultures, newly isolated from human patients, has been shown. In monkeys inoculated with the mixture of mycoplasmas and ureaplasmas, more pronounced infectious urethritis with the symptoms of ascending infection develops. The animals who have had the disease do not develop resistance to repeated infection.     

The first case of lymphogranuloma venereum in a woman in East-Central Europe and its multiple co-infections

We are reporting the first case of lymphogranuloma venereum in women in East-Central Europe. A 22-year-old heterosexual woman attended our department of venereology. She complained about a burning sensation in the urethra and vaginal discharge. Many tests were performed, and lymphogranuloma venereum, syphilis, gonorrhea, chlamydial urethritis and cervicitis, genital herpes, genital warts, and hepatitis C were diagnosed. Lymphogranuloma venereum was originally endemic in tropical and subtropical areas, but since 2003, outbreaks of this infection have been reported in North America, Europe, and Australia in men who have sex with men (MSM) community. To date, all cases of lymphogranuloma venereum in the Czech Republic appeared in men, predominantly in HIV-positive MSM. There are not many evidences about lymphogranuloma venereum (LGV) in women in developed countries. This report underlines the need for awareness of lymphogranuloma venereum in women among gynecologists, venereologists, and other physicians not only in Western Europe, but across all European countries.     

COMMON LESIONS OF THE URETHRA IN WOMEN

Urethral disease in women and girls often is overlooked. As the urine may seem to be normal as determined by repeated urinalysis, the symptoms—urinary frequency and burning—may be attributed entirely to other pelvic disease or to functional disorder. Since erroneous diagnosis may lead to unnecessary procedures or to neglect of treatment with consequent development of severe disease in the kidneys or ureters, it is important to consider urethral lesions as a possible cause in any case of abdominal discomfort in women.The most common lesions of the urethra in women are urethritis, stricture, caruncle, inflammatory polyps and cysts, prolapse of the urethra, and diverticulum. In some cases diagnosis can be made simply on the basis of inspection and palpation. In others more extensive diagnostic procedures must be carried out in order that treatment may be definitive.The methods of treatment, varying with the nature of the lesion, are outlined herein.     

How often is genital yeast infection sexually transmitted?

We analysed data from a computer-based bank of clinical records of patients seen in a clinic for sexually transmitted diseases over a three-year period to investigate the association between genital yeast infections and sexually transmitted diseases (STDs). We classified STDs as primary and secondary syphilis; gonorrhoea; lymphogranuloma venereum; trichomoniasis; scabies; pediculosis; genital herpes; warts; and molluscum contagiosum. Of a total of 2984 disease episodes among women, 1054 (35-3%) included yeast infections, whereas only 382 (6-9%) of 5501 episodes in heterosexual men were associated with yeast infections, We found a significant association between yeast infection and STD and non-specific genital infection (non-specific urethritis (NSU) and procitis in men, and female contacts of men with NSU), which suggested that yeast infection was sexually acquired in 414 out of 1054 disease episodes in women (39%) and 110 out of 382 episodes in heterosexual men (29%). We conclude that sexually active patients with genital yeast infections should be screened for other STDs particularly non-specific genital infection.     

PCR for diagnosis of male Trichomonas vaginalis infection with chronic prostatitis and urethritis

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.     

Quantitative studies on the role of Ureaplasma urealyticum in non-gonococcal urethritis and chronic prostatitis

Quantitative determinations of U. urealyticum and M. hominis have been performed in 164 men with non-gonococcal urethritis (NGU) and 597 patients with chronic prostatitis. Evidence is provided that U. urealyticum plays an etiologic role in 29.3 percent of patients with non-gonococcal urethritis. Mixed infections of C. trachomatis and U. urealyticum, in high numbers, do occur in 11 percent of NGU cases. A constellation suggesting ureaplasma-associated disease could be observed in 13.7 to 15.2 percent of 597 patients with chronic prostatitis. M. hominis does not appear to be a causative agent of NGU or chronic prostatitis.     

Patients' compliance with follow-up after treatment of gonococcal urethritis.

By means of telephone tracing 96% follow-up was achieved in men treated for gonococcal urethritis. A large proportion (34.8%) of patients required one or more calls before follow-up could be obtained. Frequency of sexual re-exposure, proportion with persistent gonorrhea or reinfection, and interval between initial therapy and follow-up were greater in those who required telephone contact for follow-up than in the group who returned for follow-up. Failure to reappear for follow-up does not imply either bacteriologic cure or disappearance of symptoms. Control of gonococcal infection still depends largely upon aggressive methods of case finding, appropriate therapy and careful follow-up.     

Combined etiological and pathogenetic therapy of urogenital Ureaplasma-Chlamydia-gonococcal infection in men

One hundred and sixteen males with mixed Ureaplasma ++, chlamydial and gonorrheal urethritis were treated. 22 of them suffered from recent torpid urethritis and 94 were chronic patients including those with complications. The diagnosis was confirmed by the laboratory tests. The patients were subjected to complex treatment with immunostimulation (by the gonorrhea vaccine, methyluracil and pyrogenal), local therapy and the use of antibiotic combinations on day 8: gentamicin (0.84 g per treatment course) and doxycycline (2.1 g per treatment course). The treatment course was equal to 14 days. Favourable etiological and clinical results were observed in 114 patients. The recovery was confirmed by 3-fold verification. A high efficacy of the developed method studied clinically was stated.     

Inapparent genital infection with Chlamydia trachomatis and its potential role in the genesis of Reiters syndrome.

An infectious etiology has been suggested for Reiter's syndrome (RS) because the disease has often been observed to follow episodes of urethritis or dysentery. Despite demonstrations of bacterial antigens in the synovial tissues of RS patients, it is not clear whether viable organisms are present in the synovium in any particular stage of this disease. Furthermore, it is not clear how either viable organisms or their product(s) might reach the joints. Infection with the bacterium Chlamydia trachomatis is the most common sexually transmitted disease in the United States, and as such this organism has emerged as a primary pathogen associated with RS. Previous work from our group has shown that synovial biopsy tissues from a majority of RS patients studied show significant levels of apparently intact chlamydial RNA, even when synovial or urethral cultures from the same patients are unequivocally negative for the organism. We show here that inapparent urethral infection with chlamydia occurs with high prevalence in men, and that inapparent cervical infection with the organism occurs at high prevalence in women. These data provide an important link in the relationship between initial chlamydial infection and possible subsequent genesis of RS, and they may give useful insight into mechanisms by which chlamydial infection can lead to development of this disease. Our data argue further that inapparent infection may be a significant factor in pathogenesis for all chlamydia-related diseases, and they suggest that, contrary to current ideas, C. trachomatis can generate disseminated infection.     

Nutritional Status of Adult Patients with Pulmonary Tuberculosis in Rural Central India and Its Association with Mortality

Under-nutrition is a known risk factor for TB and can adversely affect treatment outcomes. However, data from India are sparse, despite the high burden of TB as well as malnutrition in India. We assessed the nutritional status at the time of diagnosis and completion of therapy, and its association with deaths during TB treatment, in a consecutive cohort of 1695 adult patients with pulmonary tuberculosis in rural India during 2004 - 2009.Multivariable logistic regression was used to obtain adjusted estimates of the association of nutritional status with deaths during treatment. At the time of diagnosis, median BMI and body weights were 16.0 kg/m²and 42.1 kg in men, and 15.0 kg/m²and 34.1 kg in women, indicating that 80% of women and 67% of men had moderate to severe under-nutrition (BMI<17.0 kg/m²). Fifty two percent of the patients (57% of men and 48% of women) had stunting indicating chronic under-nutrition. Half of women and one third of men remained moderately to severely underweight at the end of treatment. 60 deaths occurred in 1179 patients (5%) in whom treatment was initiated. Severe under-nutrition at diagnosis was associated with a 2 fold higher risk of death. Overall, a majority of patients had evidence of chronic severe under-nutrition at diagnosis, which persisted even after successful treatment in a significant proportion of them. These findings suggest the need for nutritional support during treatment of pulmonary TB in this rural population.     

Arterial Hypertension and Ischemic Heart Disease: Comparison in Epidemiological Studies

Forty cases of gonococcal urethritis were treated with oxytetracycline using various dosage schedules; there were 37 cures and three failures. The most convenient and most effective dosage was found to be 250 mg. oxytetracycline, given as a single intramuscular injection of 5 c.c.A series of 40 patients with non-gono-coccal urethritis was also collected. Two cases of urethritis due to Trichomonas vaginalis and two due to Candida albicans were removed from the series. Of the 36 cases which remained, cure was obtained with the use of oxytetracycline in different dosages in 30 cases; six cases were failures. The dosage which gave the best result in the therapy of non-gonococcal urethritis was 250 mg. oxytetracycline (5 c.c.), given as a single intramuscular injection, plus 250 mg. orally, four times a day for four days.The effectiveness of oxytetracycline in the treatment of urethritis has not decreased.     

TRICHOMONAS URETHRITIS IN MALES

Trichomonas urethritis in the male should be suspected in all chronic cases of urethritis. The diagnosis is easily established by the hanging-drop method of examining the urethral discharge, or the first-glass urine specimen. Curative treatment is readily accomplished by the use of urethral instillations of Carbarsone suspension using 1 capsule of Carbarsone per ounce of distilled water.     

Differential Survival for Men and Women with HIV/AIDS-Related Neurologic Diagnoses

Objectives

Neurologic complications of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) frequently lead to disability or death in affected patients. The aim of this study was to determine whether survival patterns differ between men and women with HIV/AIDS-related neurologic disease (neuro-AIDS).

Methods

Retrospective cohort data from a statewide surveillance database for HIV/AIDS were used to characterize survival following an HIV/AIDS-related neurologic diagnosis for men and women with one or more of the following conditions: cryptococcosis, toxoplasmosis, primary central nervous system lymphoma, progressive multifocal leukoencephalopathy, and HIV-associated dementia. A second, non-independent cohort was formed using university-based cases to confirm and extend the findings from the statewide data. Kaplan-Meier analysis was used to compare the survival experiences for men and women in the cohorts. Cox regression was employed to characterize survival while controlling for potential confounders in the study population.

Results

Women (n=27) had significantly poorer outcomes than men (n=198) in the statewide cohort (adjusted hazard ratio=2.31, 95% CI: 1.22 to 4.35), and a similar, non-significant trend was observed among university-based cases (n=17 women, 154 men). Secondary analyses suggested that this difference persisted over the course of the AIDS epidemic and was not attributable to differential antiretroviral therapy responses among men and women.

Conclusions

The survival disadvantage of women compared to men should be confirmed and the mechanisms underlying this disparity elucidated. If this relationship is confirmed, targeted clinical and public health efforts might be directed towards screening, treatment, and support for women affected by neuro-AIDS.