Comparison of direct fluorescent antibody, acridine orange, wet mount, and culture for detection of Trichomonas vaginalis in women attending a public sexually transmitted diseases clinic

To define the performance characteristics of two newer tests for Trichomonas vaginalis (TV), the authors compared direct fluorescent antibody (DFA) (mixed monoclonal antibody, Integrated Diagnostics, Inc, Berkeley, CA) and acridine orange (AO) tests to standard wet mount (WM) preparations and culture (modified Diamond medium) of vaginal wash specimens in consecutively examined women presenting to a public sexually transmitted diseases (STD) clinic. Cultures for Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and yeast were also performed on all patients. Of 104 women, 59 (57%) were infected with one or more pathogens. Trichomonas vaginalis was detected by WM and/or culture in 38 (37%) women and was the most prevalent infection. Of the 38 patients with TV, 95% were detected by culture, 83% by DFA, 66% by AO, and 66% by WM. An additional patient was DFA positive but negative for TV by all other methods. The sensitivity of DFA was superior to AO and WM in women with TV infection alone (96% compared to 67% and 53%, respectively). It was comparable to AO and WM in women with multiple infections (67% compared to 53% and 73%). Even in the presence of other pathogens, DFA appears to be a reasonable alternative to culture for detection of TV. In addition, DFA is rapid, easy to perform, and relatively inexpensive.     

Prevalence of Trichomonas vaginalis in men at high risk for sexually transmitted diseases

This study determined the prevalence of Trichomonas vaginalis in young men who were at high risk for sexually transmitted diseases; compared different diagnostic tests for trichomonads; and compared sexual behavior of men with positive and negative trichomonas test results. Men (85) aged 16-22 years inclusive, were recruited from a job-training program to participate in this study. Urethral specimens were obtained after prostatic massage for the isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, and trichomonads. The diagnosis of trichomonas infection was made by urethral culture, urine sediment culture, direct examination of urine sediment, direct specimen test (DFA), and Papanicolaou (PAP) smear of urethral swab. Trichomonas vaginalis was seen in 58% of the men, gonorrhoea in 23.5%, chlamydia in 29%, pediculosis in 6%, and condyloma acuminata in 7%, respectively. There was no statistically significant difference in age of the participants, frequency of intercourse, and number of sexual partners in the last 3 months in men with positive and negative trichomonas test results. After controlling for gonorrhoea, pyuria was significantly associated with trichomonas-positive urine (P = .01). No single test was ideal for the diagnosis of trichomonas infection. Using a combination of urethral culture and urine sediment culture as the "gold standard," DFA was 60% sensitive and 73.0% specific. However, urine sediment culture along with DFA identified 94% of all men with positive trichomonas test results.     

Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic

OBJECTIVE: Although established in women as a common cause of vaginal discharge, the prevalence of Trichomonas vaginalis (TV) in men compared with other classic urethral pathogens has not been well characterized. To assess this issue, the authors compared the prevalence of Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and TV in consecutive men attending a sexually transmitted diseases (STD) clinic. METHODS: From June 1, 1998 to July 27, 1998, 454 consecutive men presenting to the Denver Metro Health Clinic with a new problem were tested for GC by urethral swab culture, for CT by polymerase chain reaction of urine, and for TV by urine sediment culture. RESULTS: GC, CT, and TV were detected in 23 (5.1%), 34 (7.5%), and 13 (2.8%) of men, respectively. There were significant differences by age for both CT (11.3% in men younger than 30 years versus 3.3% in men 30 years and older, P < 0.05) and TV (0.8% in men younger than 30 years versus 5.1% in men 30 years and older, P < 0.05). In 50 men 30 years or older with symptoms of urethral discharge, TV prevalence (12.0%) rivalled that of GC (12.0%) and CT (14.0%). In 45 men 30 years and older with nongonococcal urethritis, the prevalence of TV and CT were each 13.3%. Multivariate logistical regression analysis showed the presence of discharge and nongonococcal urethritis in men 30 years and older to be an independent predictor of TV. CONCLUSIONS: TV is common in men attending sexually transmitted disease clinics, especially in those 30 years or older, in whom it may account for as much urethritis as GC or CT. These findings suggest that in older men with nongonococcal urethritis, diagnostic evaluation, empiric treatment, and partner management should include the possibility of TV infection.     

A comparison of the sensitivity of the InPouch TV, Diamond''s and Trichosel media for detection of Trichomonas vaginalis.

OBJECTIVE: This study compared the ability of three culture media (InPouch TV, Diamond's, and Trichosel) to support the growth of clinical isolates of Trichomonas vaginalis and their relative sensitivity for detection of the organism. METHODS: The majority of the clinical isolates were obtained from two San Francisco Bay Area clinics. T vaginalis was subcultured in 4 ml of one of the InPouch, Diamond's, or Trichosel media for 24-48 hours before evaluation. Twenty isolates were initially cultured in the InPouch test, 13 with Diamond's, and 10 with Trichosel. A haemocytometer was used to measure the initial concentrations of the organisms. Then serial dilutions were made in saline to yield approximately 2.0 x 10(4), 2.0 x 10(3), and 2.0 x 10(2) motile T vaginalis per ml. A 30 microliter inoculum from each dilution was transferred into 4 ml aliquots of the three media (387 individual tests, 43 x 3 dilutions x 3 media). Microscopic examinations for viable trichomonads were made at 24, 48, and 96 hours. Microscopy was through the pouch wall for the InPouch medium, and through a cover slipped slide with one drop of Diamond's and Trichosel media. RESULTS: At 24 hours, the InPouch demonstrated 84/129 positive, Diamond's 23/129, and Trichosel 18/129. At 48 hours, an accumulative positive rate for the InPouch was 98/129, for Diamond's 55/129, and Trichosel 47/129. At 96 hours the total positives for each test were 112/129 for the InPouch, 78/129 for Diamond's, and 74/129 for Trichosel. CONCLUSIONS: The InPouch TV test was significantly more sensitive than either Diamond's or Trichosel (at 0.01 level of significance, pInPouch > pDiamond's; pInPouch > pTrichosel on all three dilutions at 24, 48, and 96 hours). This increased sensitivity was the result of either a reduced generation time or the larger volume of media examined microscopically.     

Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea.

An unlinked seroprevalence survey of human immunodeficiency virus (HIV) antibody was conducted using stored sera from all patients who attended the sexually transmitted disease (STD) clinic in Halifax, Nova Scotia between 1980 and 1986. None of the sera collected from 584 patients during 1980 were HIV positive. Of the 2867 patients who visited the clinic between 1981 and 1986, 27 (0.9%; 95% CI 0.6% to 1.2%) had the antibody. None of the 784 female patients were HIV seropositive. Of the 1,884 heterosexual men in the study, 5 (0.3%; 95% CI 0.1% to 0.5%) were HIV seropositive, and 22 (11.1%; 95% CI 6.7% to 15.5%) of the 199 homosexual men were HIV seropositive. There was a strong association between a history of syphilis and HIV antibody among heterosexual men (OR = 76.8; 95% CI 12.0 to 491.3; P = 0.001). Among homosexual men younger than 30 years of age, HIV infection was associated with a history of syphilis (OR = 18.2; 95% CI 5.1 to 64.7; P = 0.035) and a history of gonorrhea (OR = 8.2; 95% CI 4.2 to 16.0; P = 0.001). The association between a history of gonorrhea and HIV infection was strongest among homosexual men who had three or more sexual partners in the last month. These findings supplement existing evidence that STDs increase the likelihood of HIV transmission.     

Prevalence and patterns of condom use among patients attending a sexually transmitted disease clinic.

The purpose of this study is to evaluate prevalence and patterns of condom use among patients attending a sexually transmitted disease (STD) clinic, who are at increased risk of developing STDs. Interviews of 800 patients attending a Baltimore STD clinic were conducted. The prevalence of condom use was dependent on the measure of use employed. For example, 9 out of 10 patients reported ever having used condoms, slightly less than one-third of the patients reported having used condoms in the past 30 days, and only 17% of the patients reported using a condom at last sex. Use also varied somewhat by type of sexual partner, and within any given relationship, from first to last sexual encounter. The most significant factor corresponding to condom use in the 30 days prior to the interview was number of sexual partners (lifetime and in the last month). Multivariate analyses revealed number of lifetime partners to be the most significant predictor of condom use for men, whereas age was the most significant variable for women. These findings suggest that interventions should focus not only on the individual, but the couple.     

Psychological morbidity in a clinic for sexually transmitted disease.

100 first attenders at a clinic for sexually-transmitted diseases were interviewed using a semistructured schedule. 20 per cent. were regarded as probable psychiatric cases and a considerable amount of psychosocial morbidity was observed. Whilst the majority reported anxiety about their possible illness, in a quarter the anxiety and distress appeared to be of long standing, having arisen before the genital symptoms or risk of infection and being related to chronic social and psychological difficulties. There were no significant differences between those diagnosed as having or not having STD in such characteristics as psychological symptoms, mean psychiatric score, and delya in consulting. Whilst those without a sexually-transmitted infection were less likely to be female, and more likely to feel guilty, to have had a casual sexual partner, and not to complain of specific genital symptoms, there was no evidence to support the concept of a syndrome of 'venereophobia'.     

Psychological morbidity in a clinic for sexually transmitted disease.

100 first attenders at a clinic for sexually-transmitted diseases were interviewed using a semistructured schedule. 20 per cent. were regarded as probable psychiatric cases and a considerable amount of psychosocial morbidity was observed. Whilst the majority reported anxiety about their possible illness, in a quarter the anxiety and distress appeared to be of long standing, having arisen before the genital symptoms or risk of infection and being related to chronic social and psychological difficulties. There were no significant differences between those diagnosed as having or not having STD in such characteristics as psychological symptoms, mean psychiatric score, and delya in consulting. Whilst those without a sexually-transmitted infection were less likely to be female, and more likely to feel guilty, to have had a casual sexual partner, and not to complain of specific genital symptoms, there was no evidence to support the concept of a syndrome of 'venereophobia'.     

Predictors of repeat testing and HIV seroconversion in a sexually transmitted disease clinic population

OBJECTIVE: This study assessed the extent of and characteristics associated with repeat HIV testing in persons presenting to a sexually transmitted disease (STD) clinic. METHODS: The study population included all 101 newly diagnosed HIV-infected subjects and 411 matched HIV-uninfected subjects identified over a 5-year period in a publicly funded STD clinic in the southeastern United States. RESULTS: Of the 508 subjects (99%) with available records, 160 (32%) had tested previously. Age, race, return for posttest counseling, and the client's stated reason for coming to the clinic were associated with repeat testing. Among the 160 subjects who had tested previously, self-identifying as a man who has sex with men or having a history of incarceration was strongly associated with HIV seroconversion (adjusted odds ratio [OR], 51.82; 95% confidence interval [CI], 9.10-295.13; adjusted OR, 83.98, 95% CI, 17.26-408.69, respectively). Presenting for STD-related reasons (STD symptoms or requesting an STD check) had a negative association with HIV seroconversion (adjusted OR, 0.07; 95% CI, 0.01-0.90) compared with presenting for the sole purpose of requesting an HIV test. CONCLUSIONS: Repeat HIV testing is common among patients receiving services at an STD clinic. The role of repeat testing in HIV prevention efforts is complex and poorly understood. Results from this study could be used to identify and target those testing previously at highest risk for contracting HIV for risk-reduction interventions.     

Prevalence of antibody to HTLV-III/LAV in a population attending a sexually transmitted diseases clinic

To determine whether HTLV-III/LAV is transmitted to men by heterosexual contact and whether contact with prostitutes plays a role in such transmission, a serosurvey was conducted in clinics for sexually transmitted diseases in New York City. Two hundred ninety-five male heterosexual nonusers of intravenous drugs were studied. Antibody to HTLV-III/LAV was found in sera from ten men (3.4%); this rate is approximately 15 times the prevalence found in healthy blood donors. Seropositivity was associated with serologic evidence of syphilis (odds ratio, 11.2; 95% confidence interval, 2.1-52) and hepatitis B infection (odds ratio, 9.1; 95% confidence interval, 2.0-55). Antibody to HTLV-III/LAV was not associated with self-reported exposure to prostitutes (odds ratio, 0.8; 95% confidence interval, 0.08-4.2). These findings suggest heterosexual transmission of HTLV-III/LAV to men but fail to implicate contact with prostitutes as a mode of such transmission.     

Prevalence of sexually transmitted pathogens among women attending a methadone clinic in Israel.

OBJECTIVE--To assess the prevalence of sexually transmitted pathogens in drug-addicted women in Tel Aviv, Israel. DESIGN--A prospective study conducted between March and July 1987. SETTING--A methadone clinic in Tel Aviv, Israel. SUBJECTS--Sixty four asymptomatic female drug addicts were studied; 38 of them were declared practising prostitutes. METHODS--Cervical specimens were obtained for cultures, and blood samples were drawn for serological tests. Demographic data and sexual histories were obtained using a standard questionnaire. RESULTS--Chlamydia trachomatis was detected in the cervix of 25% of women; 98% had antibody titres (greater than 1:64). Mycoplasma hominis and Ureaplasma urealyticum were isolated in 57% and 65% respectively. Gardnerella vaginalis was detected in 17% of women, and herpes simplex virus was cultured from two prostitutes. Five per cent of women were carriers of HBsAg, while 57% had HBSs and/or HBc antibodies. Only one prostitute had specific treponemal antibodies. In no case were gonococci or group B streptococci isolated, and HIV serology was invariably negative. CONCLUSION--Chlamydia and genital mycoplasmas appear to be the prevailing pathogens in Israeli drug-addicted women, while gonococci and Treponema pallidum occur only rarely.     

Recurrent genital herpes in a population attending a clinic for sexually transmitted diseases.

Patients with recurrent genital herpes attending a sexually transmitted disease clinic were studied and transmission of the infection was elucidated by evaluating serostatus in their partners. Of 84 patients attending for recurrent genital herpes, 94% had a herpes simplex virus type 2 (HSV-2) infection and only 6% (5 patients) a type 1 infection. The mean age of the patients was 36 years and the duration of their infection was up to 37 years (median 4 years). In most patients the number of recurrences had not decreased between the first year and the last year. About half had experienced a more severe first episode infection. Of the patients, 64% were not aware of asymptomatic shedding and the risk of sexual transmission without clinical symptoms. Of 67 steady partners of patients with genital HSV-2, 15% had a history of genital herpes. By HSV serology, HSV-2 antibodies (indicating subclinical genital herpes) were demonstrated in more than half of the partners. The duration of the relationship or condom use did not seem to influence the frequency of transmission to the partner, which may indicate an individual susceptibility for acquiring a genital HSV-2 infection. Eleven per cent of the patients were on suppressive antiviral therapy, while 39% had no experience of antiviral therapy. Type-specific HSV serology was found to be of value in counselling partners of patients with genital herpes.     

Effectiveness of self-referral for male patients with urethral discharge attending a sexually transmitted disease clinic in China

BACKGROUND: Although partner notification (PN) has long been considered as an important component in sexually transmitted disease (STD) control programs and has been implemented in both developed and developing world, little information is known about the acceptability and efficacy of the strategy in China. GOAL: The goal of this study was to assess the acceptability and outcome of self-referral for male patients with urethral discharge and to identify the characteristics associated with successful outcome based on a specialized STD clinic. METHODS: From November 2001 to November 2002, 730 patients with confirmed urethral discharge were selected and asked by STD clinicians to bring their sexual contacts to treatment in a specialized STD clinic. The demographic and sexual characteristics of returned and unreturned index patients were analyzed. Univariate and multivariate analyses were applied to identify the characteristics associated with the outcome of self-referral. RESULTS: Of 723 eligible index patients, 294 (40.7%) who returned for follow up identified 534 sexual partners and 429 (59.3%) who did not return for follow up identified 759 sexual partners. Of the total named 1293 sexual partners, 301 (23.3%) were notified by index male patients and 265 (20.5%) presented at the clinic. Of the 265 partners tested, 165 (62.3%) were infected with gonorrhea, chlamydia, or both; of them, 78 (47.3%) were asymptomatic. When the partnerships were married and steady, the informed rate was higher than that when the partnership was casual. For commercial sexual partnerships, only 1.8% of the partners were informed. In multivariate analysis, a prior STD history and condom use during the last sexual contact were associated with successful outcome of notification. CONCLUSION: Patient referral was accepted both by STD clinic attendees and STD clinicians. The results of the study show that use of self-referral for partners of men with urethral discharge in a Chinese STD clinic was, with minimal effort, moderately successful. Further efforts to improve case-finding outcomes are warranted.     

The prevalence of psychiatric disorders in sexually transmitted disease clinic patients and their association with sexually transmitted disease risk

BACKGROUND AND OBJECTIVES: Psychiatric disorders could limit the success of behavioral counseling strategies. We evaluated the prevalence of psychiatric disorders among sexually transmitted disease (STD) clinic patients and their association with STD risk. METHODS: A systematic sample of 201 patients presenting to a public STD clinic in Baltimore, Maryland, participated in the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. RESULTS: Overall, 45% of 201 STD clinic patients interviewed had a current axis I disorder and 29% had an axis II personality disorder. Substance use disorders predominated among axis I diagnoses; antisocial personality disorder (ASPD) predominated among axis II diagnoses, with an ASPD prevalence of 29.4% in men. ASPD was associated with a diagnosis of an STD (odds ratio, 3.67; 95% confidence interval, 1.63-8.30; P = 0.002). Substance use was not associated with an STD diagnosis. CONCLUSIONS: STD clinic patients have complex psychopathology that could increase HIV risk and compromise prevention interventions. Specialized counseling strategies, particularly targeting personality traits of ASPD, could improve prevention outcomes.     

Sexual behaviour and sexually transmitted disease patterns in male homosexuals.

Male homosexual behaviour is not simply either "active" or "passive", since penile-anal, mouth-penile, and hand-anal sexual contact is usual for both partners, and mouth-anal contact is not infrequent. A simplified method for recording sexual behaviour--a "sexual behaviour record (SBR)"--can be of value in determining the sites to be investigated and as a basis for further epidemiological questioning. Mouth-anal contact is the reason for the relatively high incidence of diseases caused by bowel pathogens in male homosexuals. Trauma may encourage the entry of micro-organisms and thus lead to primary syphilitic lesions occurring in the anogenital area. Similarly, granuloma inguinale, condylomata acuminata, and amoebiasis may be spread from the bowel of the passive homosexual contact. In addition to sodomy, trauma may be caused by foreign bodies, including stimulators of various kinds, penile adornments, and prostheses.