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Rymark, P; Forslund, O; Hansson, B G; Lindholm, K
doi: 10.1136/sti.69.1.18pmid: 8383095
OBJECTIVES--To investigate the prevalence of human papillomavirus (HPV) infections in a group of female teenagers, and to analyse to what extent HPV DNA was also detectable, in urethra and cervix samples among the patients with macroscopic genital warts compared with those without. DESIGN--The patients were interviewed about their sexual habits and history of venereal diseases. They underwent a gynaecological health control examination, including macroscopic inspection for genital warts and collection of a cytological vaginal smear (Pap smear). Cell samples were also taken from endocervix and urethra and from vulva lesions, when found. These samples were tested for HPV DNA of the types 6, 11, 16, 18 and 33 using the polymerase chain reaction (PCR) technique. SETTING--An adolescence out-patient clinic in Malmö, Sweden. SUBJECTS--Forty-nine female teenagers consulting for gynaecological complaints, some of them for genital warts. RESULTS--Twenty patients had present and four had a history of genital warts (group A). The other 25 patients had no visible lesions (group B). In the first group (A) 18 of the 24 patients were positive for HPV DNA in one or more of the three locations studied. More patients were positive in urethra (17) than in cervix (15). In group B four of the 25 patients were positive for HPV DNA in urethra, three of these also in cervix. In the two groups 11 and four patients, respectively, showed pathological Pap smears. CONCLUSIONS--The finding of HPV DNA in urethra, both from women with and without visible genital warts, indicates that there is a high probability that the infection is also present in cervix, suggesting that the genital HPV infections are multifocal. Thus, patients with genital warts are most likely to have cervical HPV infections and will more often have pathological Pap smears than patients without warts.
Fennema, J S; van Ameijden, E J; Coutinho, R A; van Doornum, G J; Henquet, C J; van den Hoek, J A
doi: 10.1136/sti.69.1.23pmid: 8444476
INTRODUCTION--Patients attending a clinic for sexually transmitted diseases (STD) in general have engaged in at risk sexual behaviour. Therefore they are at increased risk of acquiring HIV through sexual contact. OBJECTIVE--To determine the HIV prevalence among patients attending a STD clinic in Amsterdam. METHODS--An anonymous cross sectional study was conducted in two 5-week periods in Spring and Autumn 1991. RESULTS--Of the 2362 patients attending the clinic during the study period, 2292 (97%) consented to participate; of these, 2138 (93%) were interviewed and anonymously tested, while 154 (7%) consented to be interviewed but refused HIV antibody testing. The HIV prevalence was 4.2% (90/2138); 93% of seropositive participants reported homosexual contacts and/or intravenous use of drugs (IVDU). HIV prevalence among heterosexual non-IVDU men was 0.5% and among non-IVDU women 0.1%. Among all heterosexually active participants, including IVDU and bisexual men, the HIV prevalence was 1.5%. The 28 of 90 HIV infected participants that were heterosexually active reported together approximately 135 heterosexual partners in the six months preceding the study; 13 of these 28 heterosexually active participants had a STD diagnosed at their present clinic visit, while four (30%) of them already knew they were HIV infected. CONCLUSIONS--From these data we conclude that there is a substantial risk of further transmission of HIV through heterosexual contact. In order to try to reduce this potential for further sexual transmission of HIV, services offered by the STD clinic should not only include voluntary confidential counselling and HIV testing, but also notification of partners of HIV infected clinic-attendants. Finally, we conclude that anonymous HIV prevalence studies that link HIV test results to risk behaviour for HIV infection can be performed with a high rate of participation. Repeating such prevalence studies in time can help in monitoring the HIV incidence in the heterosexually active population.
Hunt, A J; Connell, J; Christofinis, G; Parry, J V; Weatherburn, P; Hickson, F C; Coxon, A P; Davies, P M; McManus, T J; Sutherland, S
doi: 10.1136/sti.69.1.29pmid: 8444477
AIMS--To assess the reliability of saliva samples as a means of testing for HIV-antibodies outside clinic settings. METHODS--Men taking part in a non-clinic longitudinal study of homosexually active men provided samples of saliva and blood. Sera were screened using a competitive ELISA (Wellcozyme) and positive sera were confirmed by an indirect ELISA (Abbott). Saliva samples were screened either using an IgG captive radioimmunoassay or an amplified ELISA. RESULTS--A total of 534 paired saliva and blood samples were tested. Overall sensitivity was 96.2% and specificity was 100%. None of the saliva tests were falsely positive for HIV-1 antibodies. CONCLUSIONS--HIV-1 saliva tests can reliably be used in a non-clinic or field setting. However, if results are to be given to respondents, it is necessary to offer adequate counselling and consider the mechanisms for referral and follow-up for those that are found to be HIV-1 antibody positive.
doi: 10.1136/sti.69.1.31pmid: 8444479
OBJECTIVES--To determine the prevalence of infection with HIV-1, HIV2, HTLV-1 and HTLV-2 in female attenders at a central London sexually transmitted disease clinic in an 8 week period in 1989-1990, and compare it with similar samples studied between 1985 and 1987. DESIGN--Anonymous testing of serum samples from consecutive female patients having routine serological investigation for syphilis. Testing was for clinically important retroviruses, Hepatitis B core antibodies (anti-HBc), and p24 and reverse transcriptase (RT) antigens. Age (in 5 year bands), nationality (in broad geographical zones), diagnosis on the day of presentation, and history of intravenous drug usage were recorded for each patient. Annual gonorrhoea rates were analysed from 1981 to 1990. SETTING--Outpatients of the department of genitourinary medicine. PATIENTS--A total of 850 females attending consecutively and having routine syphilis serology. MAIN RESULTS--The prevalence of anti-HIV-1 in female attenders in 1989-1990 was 0.35% (3/850). Prevalence in the same clinic has remained statistically unchanged since the first female cases were identified in 1986. No cases of HIV-2, HTLV-1 or HTLV-2 were identified, and no early HIV-1 infection evidenced by the presence of p24 or RT antigenaemia was found. Female gonorrhoea rates continued to decline but other STD monthly/annual rates have remained unchanged. CONCLUSIONS--Over the last 5 years prevalence of HIV-1 infection in females in our clinic has remained unchanged and other retroviral infections have remained absent. However, the unaltered rates of other genital infections, their potential role in the heterosexual spread of HIV-1 infection, and the lack of evidence for any major changes in female sexual behaviour suggests there is a need to remain vigilant. This work complements the MRC multicentre, unlinked, genitourinary medicine clinic, anonymous testing programme, and our group will continue to apply this simple methodology to specimens from female attenders to contribute to the surveillance of the evolving HIV-1 epidemic.
Pindak, F F; Mora de Pindak, M; Gardner, W A
doi: 10.1136/sti.69.1.35pmid: 8444480
OBJECTIVE--To test the dependency of haemolytic and cytocidal manifestations of pathogenicity of Trichomonas vaginalis on direct contact between the target cells and the organism. TEST ORGANISM--T vaginalis strain Baltimore 42. DESIGN--Haemolysis in the presence of live T vaginalis and of its filter-sterilised metabolic products was compared. The dependence of haemolytic and cytocidal effects on retention of low pH of metabolic products of the organism was demonstrated by parallel titrations of sterile filtrates in normal saline and in phosphate buffered saline (PBS) pH 7.0. RESULTS--Near complete lysis was obtained when erythrocytes mixed with T vaginalis were incubated for 1 h at 37 degrees C in saline containing 1% glucose. The same degree of haemolysis was present in filter-sterilised glucose-saline in which the organism was incubated (1 h/37 degrees C) before erythrocytes were added and incubated under the same conditions as in the mixture with the organism. The degree of haemolysis in filtrates was dependent on retention of low pH (below 5.0) of the suspending fluid in which the organism alone was incubated. Dilution of filtrates in PBS, as opposed to normal saline, abolished or diminished the haemolytic effect. Presence of glucose (energy source) in the saline during incubation of the organism had a pronounced enhancing effect. The production of haemolytic metabolites was temperature dependent, whereas the haemolytic process per se was not. The effect was not an exclusive property of T vaginalis since it was also demonstrated with other trichomonads. The same filtrates applied to tissue culture exerted cytocidal effect strikingly similar to that observed in the haemolysis experiments. CONCLUSION--Neither haemolytic nor cytocidal effect of T vaginalis was contact-dependent.
Boeke, A J; Dekker, J H; Peerbooms, P G
doi: 10.1136/sti.69.1.41pmid: 8444481
OBJECTIVE--To determine the agreement of culture results of Candida albicans and Trichomonas vaginalis from the cervix versus posterior fornix in women with vaginal symptoms. DESIGN--Same patient comparison of culture results from two sample sites. SETTING--Twenty one general practices in Amsterdam and the east of the Netherlands. SUBJECTS--Six hundred and eighty two women aged 15 to 55 years with vaginal symptoms, seen between 1 October 1987 and 31 May 1990. MAIN OUTCOME MEASURES--For each site (cervix and posterior fornix) the proportion of detected C albicans and T vaginalis. The sensitivity of the cervical swab related to the vaginal one. The percentage of concordance for both microorganisms. RESULTS--In 248 (34%) women C albicans was diagnosed and in 38 (6%) T vaginalis. In 99% of the proven C albicans cases, the yeast was found in the vagina. In 94% C albicans was isolated from the cervix. Sensitivity of the cervical swab was 94%. In 98% of the patients a concordant observation was made regarding detection of yeast. In 97% of the proven T vaginalis cases the protozoon was found in the vagina. In 91% T vaginalis was detected from the cervical swab. Sensitivity of the cervical swab was 92%. The culture results were concordant in 99%. CONCLUSION--The yield from the vaginal source was slightly better than that from the cervix for culture of both microorganisms. For screening purposes, specimen-collection for culture of N gonorrhoeae, C albicans and T vaginalis can be combined in one swab taken from the cervix.
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