Genitourinary Medicine最新文献

Objective: To determine the number of Neisseria gonorrhoeae organisms in urine and semen in men with gonococcal urethritis, and to compare selected phenotypic characteristics of organisms harvested from the urethra and semen.

Design: Samples from two groups of subjects were examined. Patients with symptomatic urethritis receiving treatment at an STD clinic, as well as six subjects with experimental urethritis. Semen and urine specimens were obtained after the urethral exudate was sampled.

Results: Using quantitative cultures, we found an average of 6 x 10(6) gonococci in urine or semen of 17 men with symptomatic urethritis seeking treatment at an STD clinic, and 2 x 10(4) gonococci in secretions of six male subjects with early experimental infection. Gonococcal outer membrane opacity (Opa) proteins and lipo-oligosaccharide (LOS) recovered from urine and semen of these subjects were very similar.

Conclusions: Men with symptomatic gonorrhoea excrete a large number of gonococci in semen which is not affected by the duration of symptoms. The similar phenotype of organisms in urine and semen suggests the bacteria come from the same compartment. These data help to explain the efficiency of gonococcal transmission from men to their partners, and identify an appropriate target for a preventative vaccine or immunotherapy designed to reduce the inoculum in infected patients.

Objectives: To describe the role and current status of vaccine research against sexually transmitted diseases (STDs).

Methods: The available literature was reviewed with particular emphasis on bacterial STDs.

Results: Strategic approaches to possible implementation of STD vaccine programmes were analysed. The status of vaccines against bacterial STDs (syphilis, chancroid, gonorrhoea, and chlamydia) is described in detail.

Conclusions: The development of safe and effective STD vaccines offers a potent tool for the control of STDs, including direct and indirect prevention of HIV infection. Future priorities should be in the development of vaccines against gonorrhoea, chlamydia, and syphilis. When such vaccines become available, caution should be exercised to ensure that they do not interfere with the effectiveness of other prevention programmes.

Background and objectives: Although women attending STD clinics are at high risk for cervical cancer, most STD programmes do not include Papanicolaou (Pap) smears in their routine screening procedures. Concerns regarding reliability of this test in a population with a high rate of active infection are often raised. The objective of this study was to analyse the associations between STD diagnosis/clinical syndromes and unsatisfactory and abnormal Pap smears.

Methods: Retrospective analysis of Pap results and medical records from women attending an inner city STD programme.

Results: Of the 1202 patients analysed, 3.2% had squamous intraepithelial lesions (SIL) and 3.5% had smears which were unsatisfactory because of the thickness of the specimen. There were no associations between STD diagnoses and SIL; however, the presence of cervical inflammation was significantly associated with SIL. Pap smears which were unsatisfactory because they were too thick were also associated with the clinical finding of cervical inflammation.

Conclusions: The presence of active infection did not preclude the detection of SIL on Pap smears. The percentage of unsatisfactory smears resulting from inflammation was low.

Objectives: To determine the penile, perianal, and oropharyngeal candidal colonisation rates among homosexual and heterosexual males attending an STD clinic. To determine the prevalence of balanitis and candidal balanitis in the two groups.

Subjects: 252 heterosexual and 210 homosexual male patients attending consecutively the STD clinic in Coventry, England.

Design: A prospective study recording sexual behaviour, relevant history, symptoms, and examination. Specimens for candida culture were collected from the glans penis, perianal area, and oropharynx.

Results: Among the 462 men studied, penile, perianal, and oropharyngeal colonisation rates were 74 (16%), 70 (15%), and 116 (25%) respectively. On examination, 47 (10%) were found to have balanitis. Of the 74 patients with penile colonisation, 26 (37%) were symptomatic and 20 (27%) had balanitis. The 223 heterosexual and the 196 homosexual males who had sexual intercourse within 3 months had comparable colonisation rates of candida on the penis, perianal area, and oropharynx. Balanitis was seen in 31 heterosexuals (14%) and candidal balanitis in 16 (7%); the incidence was significantly less in homosexuals where balanitis was seen in 12 (6%) and candidal balanitis in four (2%).

Conclusions: Itching or burning sensations after sex were the most common symptoms associated with penile colonisation with candida and were present in more than one third. Candidal balanitis was commoner in those who had vaginal than those who had anal intercourse within 3 months.

Objective: To describe the establishment and outcomes of a regional programme of continuing long term surveillance of antibiotic susceptibility of Neisseria gonorrhoeae over the period 1992-4.

Methods: Laboratories in 17 countries in the WHO Western Pacific Region participated in a continuing programme of surveillance of the susceptibility of gonococci to an agreed group of antibiotics over 3 years. Established techniques were used and these included quality control and proficiency testing systems.

Results: About 20,000 gonococci were examined over a 3 year period. Resistance to the penicillins through beta lactamase production or chromosomal mechanisms was widespread, with further changes evident over the 3 years. Spectinomycin resistance was infrequently encountered but high level tetracycline resistance was present in most participating centres, with some having high proportions of tetracycline resistant organisms. Quinolone resistance increased and became widespread throughout the region in the 3 years, ultimately involving all but one centre. Both the number and minimum inhibitory concentrations of quinolone resistant isolates increased markedly.

Conclusions: Patterns of gonococcal resistance to antibiotics continue to evolve, at times rapidly, and have the potential for wide and rapid dissemination. Regional surveillance programmes can be developed by using and expanding existing resources. Data thus derived were applied to the development of appropriate treatment regimens in the region, and emphasised further the need for a global expansion of the programme of integrated surveillance of gonococcal resistance.

Objectives: To determine the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica.

Methods: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmunofluorescence (MIF) test.

Results: The DFA detected C trachomatis in 16% (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24% (31/129) and 25% (33/129) respectively. The overall prevalence of current chlamydial infection detected by the isolation techniques used was 25% (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95%, 61/64) was found in CSSW compared with blood donors (53%, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9%) and Candida albicans (7%) were found in comparatively low frequencies, while Trichomonas vaginalis (0%) was not found in specimens from the CSSW.

Conclusions: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequelae of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.