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.     

Preliminary evaluation of "Clearview Chlamydia" for the rapid detection of chlamydial antigen in cervical secretions.

Clearview Chlamydia (Unipath) is a rapid monoclonal antibody based latex immunodiffusion test for detecting chlamydial antigen in endocervical specimens. The assay does not require specialised equipment or extensive training and takes less than 30 minutes from sample to results. The clinical performance of Clearview Chlamydia was evaluated with 478 paired endocervical swabs from patients attending a genitourinary medicine clinic. In the first part of the study, 221 non-randomised specimens were tested by cell culture (1st swab) and Clearview (2nd swab) whereas in the second part of the study 257 randomised swabs were examined by Clearview, cell culture and immunofluorescence. The overall prevalence of chlamydial infection was 8.8% and the sensitivity, specificity, positive and negative predictive values for Clearview were 85.7%, 99.1%, 90% and 98.6%. The test requires further evaluation to establish its role in the management and control of chlamydial infection.     

Does detection of chlamydial antibodies by microimmunofluorescence help in managing chlamydial lower genital tract infection in women?

A total of 113 women thought to have chlamydial infection of the lower genital tract were studied prospectively to evaluate the effect of antibiotic treatment on antibodies to chlamydiae detected by microimmunofluorescence. Of them, 81 were randomly selected for treatment with a two week course of either triple tetracycline or erythromycin stearate, and 32 who had microimmunofluorescent antibodies to, but did not yield cultures for, chlamydiae were used as controls and left untreated. Results for the treated patients showed that 22 (27%) had at least a fourfold fall in the microimmunofluorescent titre, but there was a similar rise in titre in 14 (17%), and the titre remained unaltered in 45 (56%) patients. In the control group 10 (31%) patients had at least a fourfold fall in titre, but there was a similar rise in titre in seven (22%), and it remained unaltered in 15 (47%) patients. The differences between these percentages in treated and untreated patients were not significant.     

Sexually transmitted infections in adolescent girls.

Two hundred and ten adolescent girls in residential care with an age range of 12 to 16 years were screened for sexually transmitted infections. The incidences of infection with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis were 13.7%, 16.2%, and 16.0% respectively. Pelvic inflammatory disease was identified in 16.4% of those with C trachomatis or gonococcal infection. The high morbidity from sexually transmitted disease in these adolescent girls reinforces the need for screening similar at risk teenagers.     

Prevalence of chlamydial infection in promiscuous women.

Chlamydia trachomatis was isolated from the cervix of 18 (33%) of 55 women who admitted to two or more casual sexual contacts to one (3%) of 32 women who admitted to one casual contact in the preceding month. The chlamydial infections did not produce characteristic clinical features. Since promiscuous women are at high risk of acquiring chlamydial infection, they should be regarded as a priority group when resources for chlamydial isolation are limited.     

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.     

Importance of chlamydial antibodies in acute salpingitis in central Africa.

Of 35 women with acute salpingitis on laparoscopy, 86% had chlamydial antibodies at a titre of 1/16 or higher and 49% at a titre of 1/512 or higher. Geometric mean titres of chlamydial antibodies correlated significantly with a laparoscopic observation of chronic salpingitis (p less than 0.001), with a history of infertility (p less than 0.05), and with severe inflammation (p less than 0.10), but not with a history of salpingitis or a positive cervical culture for Chlamydia trachomatis. In the subgroup of infertile women, the geometric mean titre of antibodies to chlamydiae correlated significantly with the presence of chronic salpingitis (p less than 0.005). These data indicate that chlamydial infections play a major part in salpingitis and infertility in central Africa. In this area, which is known as the "infertility belt", programmes to control chlamydial infections should be implemented.     

HPV-DNA联合TCT对宫颈病变的诊断价值及效能分析

目的探讨人乳头状瘤病毒(HPV-DNA)、液基薄层细胞学检测(TCT)在宫颈病变患者中的诊断价值。方法选择2016年1月至2018年1月入院治疗的200例宫颈病变患者作为研究对象,所有患者均经过病理学活检最终得到确诊,病理学活检前对所有患者进行HPV-DNA、TCT检测,将HPV-DNA、TCT检测结果与病理学活检结果进行比较,分析HPV-DNA联合TCT检测敏感性、特异性及准确度;记录并统计宫颈病变患者HPV-DNA、TCT检测所需费用,分析HPV-DNA联合TCT检测对宫颈病变患者中的诊断价值。结果 200例患者均顺利完成TCT检查与HPV-DNA检查,TCT检查下SCC组织及正常组织占据比例最大,分别为75.50%和10.0%;而HPV-DNA检测阳性患者为40例,占26.49%;与TCT检查结果比较HPV检查具有较高的符合率,差异无统计学意义(P0.05);HPV-DNA检查与TCT检查结果与病理学检查CINII、SCC比较差异无统计学意义(P0.05);HPV-DNA联合TCT检查CINI、CINII与CINIII检查与病理组织学诊断符合率,均高于单一HPV-DNA检查和TCT检查,差异具有统计学意义(P0.05);HPV-DNA和TCT检查在宫颈疾病中的诊断敏感性、特异性比较差异无统计学意义(P0.05);HPV-DNA联合TCT检查在宫颈疾病中诊断敏感性、特异性,均高于单一HPV-DNA检查和TCT检查,差异具有统计学意义(P0.05)。结论将HPV-DNA联合TCT检测用于宫颈病变中具有较高的诊断价值,能获得良好的诊断效能,值得推广应用。     

Milk consumption and acne in adolescent girls

There has been a remarkable paucity of evidence for an association between diet and acne. Our previous studies suggest that there is an association between milk intake and teenage acne. This is a prospective cohort study to evaluate that relationship. We studied 6,094 girls, aged 9-15 years in 1996, who reported dietary intake on up to three food frequency questionnaires from 1996 to 1998. Presence and severity of acne was assessed by questionnaire in 1999. We computed multivariate prevalence ratios (PR) and 95 percent confidence intervals for acne. After accounting for age at baseline, height and energy intake, the multivariate PRs (95 % CI; p-value for test of trend) for acne comparing highest (2 or more servings per day) to lowest (<1 per week) intake categories in 1996, were 1.20 (1.09, 1.31; <0.001) for total milk, 1.19 (1.06, 1.32; <0.001) for whole milk, 1.17 (1.04, 1.31; 0.002) for low fat milk and 1.19 (1.08, 1.31; <0.001) for skim milk. This result did not change appreciably when we excluded girls who reported use of contraceptives and when we restricted our analysis to those younger than 11 years of age at baseline. We found a positive association between intake of milk and acne. This finding supports earlier studies and suggests that the metabolic effects of milk are sufficient to elicit biological responses in consumers.     

Seroepidemiological and socioeconomic studies of genital chlamydial infection in Ethiopian women.

OBJECTIVE--To measure the prevalence of chlamydial genital infection in Ethiopian women attending gynaecological, obstetric and family planning clinics; to identify the epidemiological, social and economic factors affecting the prevalence of infection in a country where routine laboratory culture and serological tests for chlamydial species are unavailable; to determine the risk factors for genital chlamydial infection in those with serological evidence of other sexually transmitted diseases. SUBJECTS--1846 Ethiopian women, outpatient attenders at two teaching hospitals and a mother and child health centre in Addis Ababa, Ethiopia. SETTING--Gynaecological outpatient department, antenatal, postnatal and family planning clinics. METHODS--Sera were tested for type-specific anti-chlamydial antibodies using purified chlamydial antigens (C. trachomatis A-C (CTA-C), C. trachomatis D-K (CTD-K), Lymphogranuloma venereum (LGV1-3), and C. pneumoniae (CPn)), in a micro-immunofluorescence test. The genital chlamydia seropositivity was analysed against patient's age, clinic attended, ethnic group, religion, origin of residence, age at first marriage and first coitus, income, number of sexual partners, duration of sexual activity, marital status/profession, obstetric and contraceptive history, and seropositivity for other sexually transmitted diseases. RESULTS--Overall exposure to chlamydia species was found in 84%, genital chlamydial infection in 62%, and titres suggestive of recent or present genital infection in 42% of those studied. Genital chlamydial infection was highest (64%) in family planning and lowest (54%) in antenatal clinic attenders. Exposure to genital chlamydia species was influenced by ethnic group and religion. Those married and sexually active under 13 years of age had greater exposure (69%) to genital chlamydial infection than those first sexually active aged over 18 (46%). Prevalence of infection was highest in those with more than five sexual partners (78%) and in bargirls (84%). The lowest income groups had a higher prevalence (65%) of genital chlamydial infection than the wealthiest (48%). Multivariate analysis showed the most important factors to be age at first coitus, religion, prostitution and present age of the woman in that order. Risk for genital chlamydial infection was increased in those with seropositivity for syphilis, gonorrhoea, HSV-2 but not HBV infection. CONCLUSION/APPLICATION--Chlamydial genital infections are highly prevalent in both symptomatic and asymptomatic Ethiopian women. The high prevalence of infection reported reflects a complexity of socioeconomic factors: very early age at first marriage and first coitus, instability of first marriage, subsequent divorce and remarriage or drift into prostitution, all of which are influenced by ethnic group, religion and poverty--together with transmission from an infected group of prostitutes by promiscuous males to their wives, lack of diagnostic facilities and inadequate treatment of both symptomatic and asymptomatic men and women. The problem of chlamydial disease in Ethiopia needs to be addressed urgently in the context of control of STD.     

Topical microbicide use by adolescent girls: concerns about timing, efficacy, and safety

BACKGROUND AND OBJECTIVES: Adolescent girls could benefit from topical microbicide use if the product is acceptable to them. GOAL: The goal was to evaluate girls', mothers', experienced healthcare providers', and medical students' views on timing of use, efficacy, and safety of topical microbicide use by adolescents. STUDY DESIGN: Focus groups were conducted with girls, mothers, healthcare providers, and medical students. All groups were videotaped, transcribed, and coded for relevant themes. RESULTS: A delay between insertion and coitus presented a problem, and pre- and postcoital use had advantages depending on the group. Efficacy was evaluated by timing of use, smell, ability to feel the product, and confidence that it would spread sufficiently. There were concerns about physical side effects and the impact on normal vaginal flora. CONCLUSION: This study demonstrated the importance of understanding the unique needs and perspectives of adolescent girls and the adults who have an influence on their use.     

Prevalence of bacterial vaginosis in adolescent girls

The age-related increase in the prevalence of bacterial vaginosis was determined in adolescent virginal and sexually active girls aged 13 to 18 years. Higher rates were recorded for girls with two or more sexual partners. Considering the potential spectrum of consequences of bacterial vaginosis, preventive strategies are required in this age group, not only for bacterial vaginosis but also for other sexually transmitted diseases.     

The changing pattern of sexually transmitted disease in adolescent girls.

When girls aged 15-19 attending a sexually transmitted diseases (STDs) clinic in 1972 and 1982 were studied retrospectively, the prevalence of recognised STDs declined both absolutely and as a proportion of the total women studied. The increased number of attendances was accounted for by "other conditions requiring, or not requiring, treatment." An alternative approach for the classification of these conditions is proposed.     

Measurement of microbicide acceptability among U.S. adolescent girls

BACKGROUND AND OBJECTIVE: Topical microbicides will only be effective if they are acceptable to potential users. The purpose of this study is to develop a scale to evaluate characteristics and aspects of topical microbicides that are important to adolescent girls. STUDY DESIGN: Girls (n = 207) completed a questionnaire on perceptions of microbicide-like products. RESULTS: A principal components factor analysis with a varimax rotation produced a 6-factor solution. The mean factor scores suggested that girls saw the products positively. Age was positively correlated with "comparison to condoms" and "comfort while using" factor scores and inversely correlated with "negative impact on interpersonal relationships" factor score. Sexually transmitted infection (STI) history was related to higher scores on the "health benefits" and "pleasure" factors. Age, race/ethnicity, and STI history were not related to the other factor scores. CONCLUSION: The current scale shows promise in assessment of microbicide acceptability, and in general, girls expressed positive views about microbicides.     

Secretory IgA against herpes simplex virus in cervical secretions.

A recently developed method to recover proteins from cervical secretions was combined with methods to detect minute concentrations of herpes simplex virus (HSV) type specific antibodies to measure the concentrations of locally produced antibodies in women with genital infections. Forty nine women attending a sexually transmitted disease (STD) clinic were included. Cervical secretions were obtained by suction into a plastic catheter. Soluble proteins were recovered from the secretions by elution with hyperosmolar sodium chloride. A rabbit antibody to human secretory component, which was conjugated to horseradish peroxidase, was used to measure secretory IgA (S-IgA) that was HSV type specific. For comparison, HSV type specific IgG was measured in serum samples from the patients. Of the 49 women, 16 yielded detectable HSV type 2 (HSV 2) S-IgA in secretions. Twelve of them also reacted to the HSV type common antigen, but only five had HSV 2 IgG detectable in their serum. S-IgA against HSV was found in significantly more women with a clinical diagnosis of acute cervicitis than in others. This could be explained by a general increase in local antibody production and immunity triggered by previous contacts with HSV. It is concluded that local mucosal immunity to HSV 2 can be detected in women who do not have a specific humoral antibody response to the virus. For seroepidemiological studies of infection with HSV 2 this local immunity may be considered to be a factor that gives an underestimation of the true incidence of HSV 2 infection.     

Syphilis in pregnant women in Mozambique.

To establish the prevalence of syphilis in pregnant women in Mozambique and evaluate present diagnostic methods, 1468 pregnant women in eight of the country's 10 provinces were examined using the Venereal Disease Research Laboratory (VDRL) test. Positive serum samples were also analysed using the Treponema pallidum haemagglutination (TPHA) assay and one group was also analysed using the fluorescent treponemal antibody absorbed (FTA-ABS) test. The prevalence of VDRL seroreactivity was found to be between 4.5% and 14.6%, whereas the prevalence of treponemal disease as verified by TPHA or FTA-ABS tests was between 1.6% and 9.8%. It is concluded that syphilis is relatively common among pregnant women in Mozambique. The predictive value of a positive VDRL test, when adequately performed, was     

Syphilis in pregnant women in Zambia.

Because of the high incidence of congenital syphilis at the University Teaching Hospital, Lusaka, Zambia, the potential risks of congenital infection and fetal loss due to syphilis were assessed by screening 202 antenatal patients, 340 pregnant women admitted to the hospital whose pregnancies ended in either spontaneous abortion or stillbirth, and 469 consecutive babies delivered at the hospital. Primary serological screening was performed with the rapid plasma reagin test, and reactive sera were confirmed by the Treponema pallidum haemagglutination test. In all cases detailed histories were obtained and patients were examined for clinical signs of syphilis. The TPHA test result was reactive in 12.5% of antenatal patients and in 42% of women who aborted in the later half of pregnancy. Among 469 consecutive babies delivered at the hospital, 30 had reactive results to the TPHA test; of these two were stillborn and four had signs of congenital syphilis at birth. Thus, syphilis appears to affect adversely an appreciably high number of pregnant women in Zambia. For this reason a special campaign to screen adequately and treat pregnant women and neonates is needed.