Value and feasibility of screening women attending STD clinics for cervical chlamydial infections.

A chlamydial screening service was provided in Bristol over a three-month period for women attending the sexually transmitted disease (STD) clinic either for the first time or with a new complaint. Isolation of Chlamydia trachomatis was attempted in cytochalasin-treated McCoy cells. Of 919 specimens, valid results were obtained in 796. Chlamydial infections were identified and treated in 154 (19%) of these 796 women. Chlamydia were isolated from 52 (37%) of 152 female partners of men with nongonococcal urethritis (NGU); these patients already routinely receive treatment with tetracylcines in this clinic. The remaining 102 infections (34 (48%) of 71 women with gonorrhoea and 68 (12%) of the other 573 women) would have been unrecognised and usually untreated without chlamydial isolation studies. These figures confirm the need to provide chlamydial diagnostic services for selected STD clinic attenders.     

性病门诊就诊妇女中3种阴道感染的研究

为了解性病门诊中就诊妇女阴道感染的检出率、临床表现、疗效及性传播性，在5家性病门诊选择具有阴道分泌物异常主诉、初诊、年龄在16岁或以上、既往2周内未用过抗生素的妇女作为研究对象。取泌尿生殖道标本，应用常规实验室检查方法，检测淋球菌、沙眼衣原体、阴道毛滴虫、白念珠菌及细菌性阴道病。用常规治疗方法观察治疗效果。结果在649例女性中，共检出淋病123例（19．0％），衣原体感染130例（20．0％），滴虫感染63例（9．7％），念珠菌病143例（22．0％），细菌性阴道病109例（16．8％），另有205例未检出上述病原体。单一病原体感染为325例，一种以上病原体复合感染119例。3种阴道感染中，具有典型阴道分泌物性状者为36．7％－64．3％，对常规治疗的临床治愈率为46．3％－72．9％。滴虫病（OR＝6．67，P＜0．05）和细菌性阴道病（OR＝2．23，P＜0．05）分别与未坚持使用安全套有关。但是如果剔除合并宫颈感染的病例，则无这种相关性。表明在性病门诊就诊妇女中，阴道感染比宫颈感染更多见，复合感染也常见。阴道感染的临床表现不典型，对常规推荐治疗的疗效不理想，需要密切随访。阴道感染与性传播的危险因素无显著相关性。     

Serological study for sexually transmitted diseases in patients attending STD clinics in Calcutta

Total 457 patients attending different STD clinics of Calcutta were studied for serological tests for STD. TPHA positivity was maximum (18.60%), followed by chlamydia infection (15.97%), VDRL reactivity (8.98%), HIV infection (6.35%), and HBs Ag (3.72%). Total 37.20% samples were positive for one or more infection. Out of these, one, two, three and four tests positivity was seen in 65.29%, 25.88%, 8.24% and 0.59% respectively. The age group which had maximum infection (20.13%) was 15-30 years.     

Urethritis in women attending an STD clinic.

Of an unselected group of 159 women attending a sexually transmitted diseases (STD) clinic 20% (32) had symptoms of urethritis. A positive correlation existed between the finding of more than 10 polymorphonuclear leucocytes (PMNL) per high-power field in the Gram-stained urethral smear and the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Conversely, these organisms were rarely isolated if no PMNL were present. Fewer cultures gave positive results for these organisms if micturition had occurred less than four hours before examination. C trachomatis was recovered from the urethra or endocervix in 29/150 (19 . 3%) and from the urethra alone in six women. In contrast, N gonorrhoea was never recovered from the urethra in the absence of endocervical infection. Of the 159 women 10% had bacteriuria due to non-sexually transmissible agents; 50% had asymptomatic bacteriuria. All, however, had other urethral pathogens isolated as well. Thus, sexually transmitted disease agents are highly prevalent in women attending an STD clinic who have signs and symptoms of urethritis. As in non-gonococcal urethritis in men, C trachomatis may be an important cause of urethritis in women.     

Self-reported sexual activity and condom use among symptomatic clients attending STD clinics.

BACKGROUND AND OBJECTIVES: A cross-sectional survey of sexually transmitted disease (STD) patients assessed sexual activity and condom use during the time between STD symptom onset and clinic attendance. STUDY DESIGN: Patients were asked to report sexual activity and condom use while STD symptoms were present. Medical records were abstracted for diagnoses. RESULTS: The study population (n = 3025) was predominately African American (75.3%) and male (63.5%), with a mean age of 28.1 years. Sexual activity while experiencing STD symptoms was reported by 39.7% of 2,508 symptomatic patients, 17.2% of whom reported always using a condom. Logistic regression models identified the significant independent determinants of sexual intercourse while symptomatic were duration of symptoms before clinic visit [0-7 days versus 8 or more days, OR = 5.9]; race [African American versus other races (primarily Hispanics), OR = 2.1]; and gender [men versus women, OR = 1.5]. Older age [> or = 30 years versus 18-29 years, OR = 1.5] and higher education attainment [> or = high school versus > high school, OR = 1.5] were the significant factors associated with reporting always using a condom. CONCLUSION: These data suggest patient groups with behaviors likely to enhance STD transmission could be targeted for educational messages.     

Predicting pregnancy risk in women attending an STD clinic

BACKGROUND: Although sexually transmitted disease (STD) clinics focus mainly on STD treatment and prevention, women attending these clinics are also at high risk for pregnancy. GOAL: To evaluate the relationship between certain demographic and behavioral characteristics and the probability of pregnancy in women attending an urban STD clinic. STUDY DESIGN: Non-contraceptive-using women in an STD clinic-initiated randomized controlled contraception study (n = 877) were interviewed at baseline, and incident pregnancies within 1 year of enrollment were measured. Association between baseline demographic and behavioral characteristics with incident pregnancy was assessed by chi-square analysis, and logistic regression was used to assess factors associated with an incident pregnancy. RESULTS: Among the 673 women (76.7%) for whom follow-up pregnancy information was available, 220 (32.7%) incident pregnancies occurred within 1 year. By logistic regression controlling for study assignment, incident pregnancy was associated with age < or =19 years (odds ratio [OR], 2.8; 95% CI: 1.5-5.2), previous abortion (OR, 3.1; 95% CI: 1.7-5.4), frequency of sexual encounters of at least once a week (OR, 1.8; 95% CI: 1.2-2.6), and having a chlamydial infection at the time of enrollment (OR, 1.8; 95% CI: 1.0-3.2). With a combination of demographic and behavioral characteristics correlated by univariate analysis with incident pregnancy (i.e., age < or =19 years, nonwhite race, high school/general equivalency diploma or less education, previous pregnancy, no use of birth control with last intercourse, sex at least once a week, previous abortion, > or =3 partners within the past month, and <17 years of age at first pregnancy), the cumulative risk of pregnancy with 6 or more of the 9 characteristics was 51%, compared with 25.6% for women with < or =5 characteristics. CONCLUSION: For this STD clinic population, a combination of demographic and behavioral characteristics was useful when combined for identifying a subgroup of women at higher risk for subsequent pregnancy. Targeted intervention by STD care providers should include the provision for both pregnancy and STD prevention counseling.     

Cost-benefit analysis of selective screening criteria for Chlamydia trachomatis infection in women attending Colorado family planning clinics.

Women attending family planning clinics in Colorado during 1988 were screened for Chlamydia trachomatis infection by enzyme immunoassay (EIA, Chlamydiazyme, Abbott Laboratories; Abbott Park, IL). Cervical specimens from 11,793 women attending 22 family planning clinics were analyzed. Patient history and physical exams were used to assess risk factors for infection. A total of 913 individuals (7.7%) had positive culture results for C. trachomatis. Multivariate analysis showed that infection was significantly related to endocervical bleeding, cervical mucopurulent discharge, a new sexual partner in the last 3 months or multiple previous sexual partners (greater than 3) in the last year, pregnancy, the use of oral contraceptives, and age. Increased odd ratios were observed for the combination of endocervical bleeding and mucopurulent discharge and sexual history that included partners over the previous year as well as the most recent 3 months. A combination of these criteria was used to selectively screen women attending Colorado family planning clinics on an ongoing basis. A cost-benefit analysis employing a model reported previously showed a significant financial benefit associated with universal screening over either selective screening or no screening for C. trachomatis in this population.     

Genital chlamydial infections in patients attending a gynaecological outpatient clinic.

Investigation for genital chlamydial infections was carried out on 160 patients of fertile age attending a gynaecological outpatient clinic. Thirteen (9%) of the 144 patients with valid specimens were found to be Chlamydia-positive. Seven (54%) of them had antichlamydial antibodies by the complement-fixation test, and 11 (85%) antichlamydial antibodies by a single-antigen immunofluorescence test compared with 21 (16%) and 70 (53%), respectively, of the 131 Chlamydia-negative patients. Patients with overt genital chlamydial infection often complained of ocular and urethral symptoms. Usually there was clinical evidence of cervical infection as well as of inflammation on cervicovaginal smears. Colposcopical and histological examinations did not show any specific alterations.     

Genital chlamydial infections in patients attending a gynaecological outpatient clinic.

Investigation for genital chlamydial infections was carried out on 160 patients of fertile age attending a gynaecological outpatient clinic. Thirteen (9%) of the 144 patients with valid specimens were found to be Chlamydia-positive. Seven (54%) of them had antichlamydial antibodies by the complement-fixation test, and 11 (85%) antichlamydial antibodies by a single-antigen immunofluorescence test compared with 21 (16%) and 70 (53%), respectively, of the 131 Chlamydia-negative patients. Patients with overt genital chlamydial infection often complained of ocular and urethral symptoms. Usually there was clinical evidence of cervical infection as well as of inflammation on cervicovaginal smears. Colposcopical and histological examinations did not show any specific alterations.     

Urine-based screening for Chlamydia trachomatis in men attending sexually transmitted disease clinics

BACKGROUND: Nucleic acid-amplified tests for Chlamydia trachomatis are accurate but costly. Screening strategies for asymptomatic men are needed. GOAL: To assess C trachomatis screening strategies for asymptomatic males. STUDY DESIGN: Men attending a sexually transmitted disease clinic were tested for C trachomatis with ligase chain reaction and culture, and for urethral inflammation with urine leukocyte esterase and urethral Gram stain. RESULTS: C trachomatis prevalence was 5.5% among 1,625 asymptomatic men. Ligase chain reaction increased detection by 49% among men without urethral inflammation. An age of younger than 25 years and urethral inflammation were associated with positive ligase chain reaction results. The negative predictive value of urine leukocyte esterase was highest among older men, but urethral Gram stain was equally sensitive in predicting infection regardless of age. An age of younger than 30 years or urethral inflammation identified the highest proportion of infections (92%) and reduced the percentage of men screened by 43%. CONCLUSIONS: Urine ligase chain reaction increased C trachomatis detection, particularly among men without urethral inflammation. Testing all asymptomatic men younger than 30 years is optimal, whereas negative urine leukocyte esterase or urethral Gram stain results in men 30 years or older support no testing.     

Urinary symptoms, sexual intercourse and significant bacteriuria in male patients attending STD clinics.

OBJECTIVE: To assess the relationship between sexual behaviour, urinary symptoms, urinalysis and bacteriuria in men attending STD clinics. DESIGN: A prospective study recording sexual behaviour, urinary symptoms and collecting mid-stream urine specimens. SETTING: Two West Midlands STD clinics, UK. SUBJECTS: 1086 new male patients. RESULTS: 704 patients had had sexual intercourse (SI) within 14 days of testing, 424 had urinary symptoms and 122 had pyuria. All 13 patients with positive culture had SI < 14 days before testing, urinary symptoms and pyuria. No association was found between sexual orientation, type of SI, number of sexual partners, condom usage and bacteriuria. CONCLUSION: Bacteriuria does not behave as an STD but SI may be a factor in acquiring bacteriuria. Dysuria with or without urethral discharge is the most predictive symptom of bacteriuria. Pyuria has a high sensitivity for predicting bacteriuria among males.     

Risk factors for gonorrhoea, syphilis, and trichomonas infections among women attending family planning clinics in Nairobi, Kenya.

OBJECTIVE--To identify the risk factors for gonorrhoea, syphilis, and trichomonas infections among low risk women in Nairobi, Kenya. METHOD--In a cross-sectional study, 4,404 women attending two peri-urban family planning clinics between 1989 and 1991 were interviewed using a structured questionnaire and examined for signs of sexually transmitted disease (STD) infection. Cervical cultures for gonorrhoea, PAP smear (including microscopy for trichomonas), RPR and HIV testing were done. RESULTS--Positive cervical cultures for gonorrhoea were found in 3.2% of women, positive syphilis serology in 1.9%, and positive trichomonas microscopy in 5.2%. Genital ulcers were found in 1.9% of women. Although unmarried status and reporting more than one sex partner in the previous year were both significantly associated with each disease in the crude analysis, these associations were attenuated after controlling for each other and for other risk factors. The population attributable risks (PARs) for these factors were low (7-16%) owing to the high proportion of cases who were married and monogamous. The majority of women with microbiological evidence of infection had normal pelvic examinations. Clinical diagnostic algorithms for STDs in this population had a low sensitivity and positive predictive value. Nevertheless, a strong association between HIV seropositivity and STDs was observed. CONCLUSION--The low population attributable risks found in this study suggest that behaviour change messages directed to women, particularly if they are married have a low potential for preventing STDs. The poor performance of clinical diagnostic algorithms illustrates the desirability of testing these algorithms in a variety of populations and reinforces the need for low-cost methods of microbiologic diagnosis if populations with relatively low prevalences of these infections are to be included in programmes to diagnose and treat STDs.     

Sexually transmitted infections among female sex workers in Kupang,Indonesia: searching for a screening algorithm to detect cervical gonococcal and chlamydial infections

BACKGROUND AND GOAL: Notifications of HIV infection in Indonesia are increasing, but there are few data on other sexually transmitted infections (STIs), especially in the eastern islands of Indonesia. We aimed to measure the prevalence of STIs among female sex workers (FSWs) in Kupang, West Timor, and to develop screening algorithms to detect cervical infections with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT). STUDY DESIGN: During 6 months in 1999, we recruited all the FSWs at Kupang's only brothel complex and a smaller number of independent FSWs. The women were examined at dedicated clinics and most laboratory tests were performed at provincial laboratories. Algorithms based on the strongest associations of variables with NG/CT were compared with the laboratory diagnoses. RESULTS: We recruited 288 women. The prevalence of N gonorrhoeae infection was 31%, that of C trachomatis infection was 24%, that of Trichomonas vaginalis infection was 5%, and that of syphilis was 13%. No case of HIV infection was detected. Few women had symptoms of STI. The only variables significantly associated with NG/CT after logistic regression analysis were the presence of cervical discharge (either yellow or clear) and a high count of polymorphonuclear leukocytes on gram-stained endocervical smear. Several algorithms to screen for NG/CT achieved high (>80%) sensitivity, but the highest specificity among these was only 50%. CONCLUSIONS: Although several of the generated algorithms may be useful in the absence of simple, accurate, affordable diagnostic tests, the high rates of STIs in this population could justify a more aggressive strategy incorporating periodic presumptive treatment to rapidly reduce prevalence.     

Genital human papillomavirus infections in patients attending an inner-city STD clinic.

One hundred and sixteen consecutive women attending a Baltimore City STD clinic were studied for the prevalence of human papillomavirus (HPV) infection of the genital tract using three criteria: presence of clinically recognized (visible) genital warts, cytopathologic evidence suggestive of HPV infection in a Papanicolaou smear, and analysis of cervical scrapes for genital tract HPV genomic sequences by Southern hybridization. The women were young (median age: 22 years) and more than 80% had a history of one or more STDs. The prevalences were 17% for visible warts, 41% for cytologic findings suggestive of HPV infection, and 12% for HPV DNA in cervical scrapes. Comparing the results of the three techniques, HPV DNA was found significantly more often in cytopathology-positive women than in cytopathology-negative women (18% vs. 5%, P = 0.05) and in women with visible warts than in women without visible warts (29% vs. 6%, P = 0.01). Visible warts were more common in women with HPV-DNA-positive cervical scrapes than in HPV-negative women (50% vs. 14%, P = .01). Although 52% of women were judged as infected by at least one of the three criteria, only 4% were infected by using all three criteria. The prevalence of infection was 23% if cytopathology alone was excluded as evidence of HPV infection. These results indicate the difficulty in an accurate estimation of the prevalence of HPV infections, even in a high-risk population.     

宫颈拭子混合标本PCR法在检测淋球菌和衣原体感染中的应用

背景：多聚酶链反应在衣原体和淋球菌感染的检测中，具有高敏感性和特异性的特点，但价格相对比较昂贵，在检测大宗筛查标本时较为费力；目的：确定混合标本法在对宫颈拭子标本衣原体和淋球菌检测中的可用性。方法：对人工流产妇女宫颈标本采用混合标本PCR法检测衣原体和淋球菌。结果：在2020份宫颈拭子标本中，衣原体检出率4.8%，淋球菌检出率为0.4%，与单个标本检测相比，混合标本法可节约经费62%，且明显减少了工作量。结论：在妇女衣原体和淋球菌筛查中，混合标本PCR法不仅可用于尿液标本，亦可用于宫颈拭子标本。     

Molecular epidemiology of genital chlamydial infection among male patients attending an STD clinic in Taipei, Taiwan

OBJECTIVE: To assess the epidemiology of genital Chlamydia trachomatis infection among men attending an STD clinic in Taipei, Taiwan. STUDY: Between July 2004 and June 2005, a total of 426 first-void urine specimens from male patients were tested for C. trachomatis by using a urine-based PCR DNA amplification assay. RESULTS: The overall prevalence of genital C. trachomatis infection was 16.4%. Youth, current symptoms, the presence of N. gonorrhoeae infection, and inconsistent use of condoms were positively associated with C. trachomatis infection. The most common chlamydia strain present was genotype E, followed by D and Da, F, K, J, G, and H. CONCLUSIONS: C. trachomatis genital infection was prevalent among male patients attending a STD clinic in Taipei. Young Taiwanese men attending STD clinics should be counselled on condom use.