Detection of Chlamydia trachomatis in first-void urine from men and women as an alternative to swabs

BACKGROUND: Ideally, an effective preventive strategy for the control of Chlamydia trachomatis infection should take into account the following attributes: rapid and simple specimen collection, low cost and noninvasive test processing. Therefore, we compared the performance profile of urine-based detection of C. trachomatis antigen in first-void urine with that of testing urethral and endocervical samples in men and women. MATERIAL AND METHODS: Urethral and endocervical samples and first-void urine from 285 men and 192 women attending the Sexually Transmitted Diseases Outpatient Clinic at the Medical University in Plovdiv, Bulgaria were tested using direct immunofluorescence assay (DFA) (MicroTrak, Syva, Palo Alto, CA, USA). RESULTS: Seventy (25%) of all men tested were positive for C. trachomatis antigen in either urethral or urine samples. 65 men (93%) had both a positive urethral and urine sample, three men (4%) had only a positive urethral sample and two (3%) had only a positive urine sample. Thirty-five women (18%) had C. trachomatis infection. Twenty-six women (74%) had both a positive endocervical and urethral sample, 6 (17%) had only a positive endocervical sample and 3 (8%) had only a positive urethral sample. All women with positive urethral samples tested positive on their urine samples. Two of the women with a negative urethral sample and a positive endocervical sample had a positive urine sample. CONCLUSIONS: These results show that using direct immunofluorescence assay on first-void urine samples is a reliable noninvasive method which can replace urethral swabs in the diagnosis of C. trachomatis infection in symptomatic men. Urine-based strategies are also an acceptable alternative for the diagnosis of C. trachomatis infection in symptomatic women when it is not possible to obtain an urogenital sample.     

Evaluation of the Respiralex test for rapid isolation of Streptococcus pyogenes directly from throat swabs

Results obtained by fast Respiraplex test were compared with findings of classical method of cultivation in order to assess possibilities of this test in isolation of Streptococcus pyogenes directly in the throat swab. The sensitivity of the fast test was 79.4%; specificity 100%. On the basis of gathered results, the following can be concluded: the fast test cannot completely substitute the classic method of cultivation although high specificity occurs, because of low sensitivity especially in patients with small number of colonies in the culture.     

The urethral sling and stress urinary incontinence

We report the case of a 40-year-old Filippino woman, with a 5-year history of a slowly spreading, painful skin lesion on her left foot. Histological examination showed a dermal, granulomatous infiltrate consisting of neutrophils, histiocytes and lymphocytes, with "sclerotic bodies" in the cytoplasm of phagocytic cells. Mycological culture revealed the presence of Phialophora verrucosa and confirmed the histopathological diagnosis of chromo-blastomycosis. Association of surgical curettage of the exuberant, infected tissue with systemic fluconazole administration gave good therapeutic results with no relevant side effects.     

Culture of urinary sediment for the diagnosis of gonorrhoea in women

1,001 consecutive women seen in a V.D. clinic were screened for gonorrhoea by cultures of urinary sediment, the endocervix, and anal canal. Recovery of Neisseria gonorrhoeae on culture of urinary sediment was 81-7 per cent. as productive as culture of the endocervix, and 79-2 per cent. compared to endocervical and anal canal culturing. Urogenital symptoms were present in 55-1 per cent. of women with negative cultures and 64-6 per cent. of those with gonorrhoea. A complaint of dysuria increased the likelihood of a positive urinary sediment or endocervical culture. Culture of urinary sediment is less sensitive than culture of the endocervix. However, the ease with which specimens are obtained and the relative simplicity of the technique could make this method an acceptable tool for screening large numbers of women for gonorrhoea.     

Comparison of radiographic and sonographic urethrography for assessing urethral strictures

The aim of this study was to compare radiourethrography (RUG) and sonourethrography (SUG) for assessment of urethral strictures and to evaluate whether RUG underestimates stricture length, as has been reported. Fifty-one men with suspected urethral strictures were evaluated by both methods performed consecutively. Stricture lengths and diameters measured by RUG were significantly greater (mean 22%, 30%) than those measured by SUG because of radiographic magnification. Both methods, however, detected a similar percentage lumen reduction and similarly graded stricture severity. Equally significant non-correlation between both methods for length measurements in the bulbar and penile urethra ( p<0.001, R(2)=0.33 and 0.34, respectively) supported radiographic magnification. Previous inaccuracies appear to relate to RUG measurements of the central tight stricture (mean 44% of the entire length in our series), not the full stricture length. Use of sonographic contrast medium intra-urethrally improved the definition of long narrow strictures. The SUG gave information about peri-urethral tissues not provided by RUG. Once radiographic magnification was taken into account, there were no major differences in the assessment of urethral strictures by both methods. With correct measurement methods, RUG does not underestimate stricture length. For full assessment, the combination of RUG and SUG, which gives information about peri-urethral disease, is optimal in many patients.     

Comparison of serological tests for the detection of antibodies against Chlamydia trachomatis and Chlamydia pneumoniae in rheumatological patients

In cases of reactive arthritis, a suspected Chlamydia trachomatis infection is often detected by serological methods. However, mostly tests with genus-specific antigens are used, neglecting the fact that antibodies against Chlamydia pneumoniae are highly prevalent in the adult population. Therefore we tested sera of 129 patients with various rheumatological disorders and of 18 healthy persons in parallel with a genus-specific test (IPAZYME) and with the species-specific microimmunofluorescence test for C. trachomatis and C. pneumoniae antibodies. The data showed that 55% of the 64 IPA-positive results were caused by antibodies (IgG) against Chlamydia pneumoniae, only 6% by anti-Chlamydia trachomatis IgG and 20% by both specificities. For IgA antibodies, the percentages were 44%, 12.5% and 12.5% respectively. In 12 IPA-positive cases, the MIF showed no reaction. 58% of all 147 sera tested with MIF had IgG antibodies against C. pneumoniae, 5% had anti-C. trachomatis IgG and 8% IgG against both species. The percentages for IgA were 29%, 2% and 2%, respectively. IgM positivity in MIF disappeared after absorption with rheumatoid factor absorbent. No significant differences were found between the various groups of patients. The data suggest that due to the high prevalence of anti-C. pneumoniae antibody, genus-species tests cannot be used as screening tests for the serological diagnosis of C. trachomatis infections.     

Inhibition of PCR in genital and urine specimens submitted for Chlamydia trachomatis testing

We determined the frequency of PCR inhibition in genital and urine specimens submitted for Chlamydia trachomatis testing using the internal control DNA provided with the COBAS AMPLICOR C. trachomatis test and assessed methods to remove it. Inhibition occurred in 65 of 906 (7%) cervical swabs, 23 of 51 (45%) urethral swabs, and 2 of 175 (1.1%) urine samples. Overall, inhibition was eliminated in processed specimens after storage at 4 degrees C in 77 of 90 specimens (86%), freezing at -70 degrees C in 59 of 82 specimens (72%), storage at 4 degrees C followed by either 1:100 dilution in 37 of 43 specimens (86%) or 1:10 dilution in 42 of 47 specimens (89%), and phenol-chloroform extraction in 79 of 80 specimens (99%). No positive specimens were missed due to inhibition. We conclude that PCR inhibition is rare with urine specimens and infrequent with endocervical swabs but occurs frequently with urethral swabs. The frequency of PCR inhibition may be significantly reduced by methods which can be easily incorporated into the processing of specimens.     

Community-based urine screening for Chlamydia trachomatis with a ligase chain reaction assay

BACKGROUND: Urine tests for Chlamydia trachomatis permit expansion of screening beyond traditional clinic environments. Prevention of infection in teenagers is a high priority. OBJECTIVE: To define the prevalence of C. trachomatis among teenagers by using the ligase chain reaction assay on urine specimens and to evaluate leukocyte esterase testing of urine specimens as an indicator of infection. DESIGN: Cross-sectional study. SETTING: An adolescent clinic, a juvenile detention facility, seven school-based clinics, and three community-based youth organizations in Seattle, Washington. PARTICIPANTS: 10,118 sexually active teenagers and young adults. MEASUREMENTS: Chlamydia trachomatis infection detected in urine specimens by ligase chain reaction assay and leukocyturia detected by leukocyte esterase testing. RESULTS: The prevalence of chlamydial infection among female participants was 8.6% and declined with increasing age; among male participants, it was 5.4% and increased with increasing age. In female participants, independent predictors of infection were being 17 years of age or younger (odds ratio [OR], 1.49), having had two or more sex partners in the previous 2 months (OR, 1.61), and having genitourinary symptoms (OR, 1.46). In male participants, independent predictors were being of nonwhite race or ethnicity (OR, 2.00 to 3.08), having had two or more sex partners in the previous 2 months (OR, 1.57), and having used a condom during the most recent sexual encounter (OR, 0.67). For identifying infection in male participants, the sensitivity of leukocyte esterase testing was 58.9%, the specificity was 94.9%, the positive predictive value was 38.4%, and the negative predictive value was 97.7%. CONCLUSIONS: Chlamydial infection is common in teenagers and young adults in community settings. The urine ligase chain reaction assay will permit widespread screening for C. trachomatis, but leukocyte esterase testing had low sensitivity for selecting persons for screening with this assay. Indicators of chlamydial infection differed substantially in male and female participants.     

Correction of urinary calcium levels for urine osmotic pressure]

This study was performed to clarify the relationship between isocapnic buffering and maximal aerobic capacity (VO2max) in athletes. A group of 15 trained athletes aged 21.1 (SD 2.6) years was studied. Incremental treadmill exercise was performed using a modified version of Bruce's protocol for determination of the anaerobic threshold (AT) and the respiratory compensation point (RC). Ventilatory and gas exchange responses were measured with an aeromonitor and expressed per unit of body mass. Heart rate and ratings of perceived exertion were recorded continuously during exercise. The mean VO2max, oxygen uptake (VO2) at AT and RC were 58.2 (SD 5.8) ml x kg(-1) x min(-1), 28.0 (SD 3.3) ml x kg(-1) x min(-1) and 52.4 (SD 6.7) ml x kg(-1) x min(-1), respectively. The mean values of AT and RC, expressed as percentages of VO2max, were 48.3 (SD 4.2)% and 90.0 (SD 5.2)%, respectively. The mean range of isocapnic buffering defined as VO2 between AT and RC was 24.4 (SD 4.5) ml x kg(-1) x min(-1), and the mean range of hypocapnic hyperventilation (HHV) defined as VO2 between RC and the end of exercise was 5.8 (SD 3.0) ml x kg(-1) x min(-1). The VO2max per unit mass was significantly correlated with AT (r = 0.683, P < 0.01). In addition, VO2max/mass was closely correlated with both the range of isocapnic buffering (r = 0.803, P < 0.001) and RC (r = 0.878, P < 0.001). However, no correlation was found between VO2max per unit mass and the range of HHV (r = 0.011, NS.). These findings would suggest that the prominence of isocapnic buffering, in addition to the anaerobic threshold, may have been related to VO2max of the athletes. The precise mechanisms underlying this proposed relationship remain to be elucidated.     

Comparison of four selective agars for the isolation of pseudomonads

Significant differences were found between Dettol (chloroxylenol) agar, nalidixic acid-cetrimide agar, and two other cetrimide-containing agars used for the isolation of small numbers of pseudomonads.     

Comparison of axenic and monoxenic media for isolation of Acanthamoeba

Acanthamoeba is a genus of ubiquitous, free-living amebae that can be difficult to isolate by standard microbiologic techniques. We retrospectively reviewed the laboratory records of patients with ocular acanthamoebic infection for the period from January 1973 to June 1996 and found that Acanthamoeba isolates were recovered from 73, 71, and 70% of clinical specimens inoculated onto buffered charcoal-yeast extract agar (BCYE), nonnutrient agar with live or dead Escherichia coli, and tryptic soy agar (TSA) with horse or sheep blood, respectively. We then prospectively compared the recovery of a corneal isolate of Acanthamoeba on commercial media from Remel and BBL (TSA with 5% sheep blood, TSA with 5% horse blood, TSA with 5% rabbit blood, V agar, chocolate agar, BCYE, and selective BCYE with polymyxin B, anisomycin, and vancomycin) and on axenic and monoxenic media prepared with live or dead bacteria (Enterobacter aerogenes, E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, and Stenotrophomonas maltophilia). Good recovery of trophozoites was obtained on BCYE, TSA with rabbit blood, TSA with horse blood, and Remel TSA with sheep blood. BBL TSA with horse blood or rabbit blood provided good recovery of cysts. All species of live or dead bacteria yielded good recovery of trophozoites; however, only nonnutrient agar with live P. aeruginosa, live E. aerogenes, or live S. maltophilia gave good recovery of cysts. TSA with either rabbit blood or horse blood, BCYE, and nonnutrient agar prepared with live P. aeruginosa, E. aerogenes, or S. maltophilia offer optimal recovery of Acanthamoeba.     

A novel method for isolation of Chlamydia pneumoniae by treatment with trypsin or EDTA

To establish a novel method for the efficient isolation of Chlamydia pneumoniae, experiments were performed to determine the effects of EDTA or trypsin treatment of C. pneumoniae on its adsorption and inclusion body formation. Treatment of C. pneumoniae with 0.1% trypsin or 1 mM EDTA significantly increased inclusion body-forming activity from 8,000- to 10,000-fold higher than that of the control. C. pneumoniae was successfully isolated in cultured cells which were inoculated with clinical specimens after treatment with 0.1% trypsin.     

Diagnostic value of a miracidium in urinary sediment

The Medical School of the Ljubljana University has a long lasting tradition in teaching the history of medicine. Since 1934, all students of medicine and dentistry in Slovenia have attended the courses in history of medicine which were and still are mandatory. The first years of lectures on the history of medicine at the Ljubljana University Medical School coincided with the struggle for the establishment and recognition of a full medical curriculum in Slovenia. Dr Ivan Pintar (1888-1963), the first lecturer of the history of medicine (1934-1963), was a man of great ethical and national values and an ardent advocate for the promotion of Slovene contribution to medical culture in Slovenia, former Yugoslavia, and Europe. Pintar's concept of history of medicine included general historical, sociological, ethical, cultural, psychological, biotechnical, and other aspects. During 30 years of his endeavors, he did a pioneer work in the research on the history of medicine in Slovenia. For many years he was the editor of the Medical Chamber Bulletin, chairman of the Slovene Medical Society, and the founder of the Section for the History of Medicine in 1951. He wrote the first Slovene textbook on the history of medicine and published many articles on prominent physicians from Slovenia. He paved the way for the new generation of medical historians in Slovenia. Owing to him, contemporary Slovene physicians and dentists are aware of the importance of professional tradition. They know how to use the past experiences for new achievements.     

Detection of Chlamydia psittaci in enteric subclinical infections in adult sheep, through cell culture isolation

Heretofore, the function of estrogen in the prostate, other than as an antiandrogen, has been unclear. In this review of a growing fund of knowledge about both estrogen and the plasma protein, sex hormone-binding globulin (SHBG), or testosterone-estradiol binding globulin (TeBG), the hypothesis is proposed that estrogen, mediated by SHBG, participates with androgen in setting the pace of prostatic growth and function. It is suggested that the estrogen not only directs stromal proliferation and secretion, but also, through IGF-I, conditions the response of the epithelium to androgen.     

The use of urethral stents for the treatment of urethral strictures

Three types of urethral stents can be used in the treatment of recurrent strictures: Urolume/Wallstent is a self-expanding mesh which is incorporated into the urethral epithelium; the ASI Titanium stent is a short rigid mesh of Titanium wire which is also incorporated into the urethra; Nitinol is a flexible spring in one or two parts connected by a steel wire. It remains endoluminal. The Urolume/Wallstent has been used since 1987. It is indicated in iatrogenic strictures. No statistical results are presented. The ASI stent should be reserved for strictures of the prostatic and posterior urethra. The Niticol UroCoil system can be used at all levels of the urethra; two models are available: simple or twin. The author has inserted 65 stents in 56 patients. The stent was removed after one year in 41 patients. The use of these stents has considerably decreased the number of repeated dilatations and urethrotomies.     

Comparison of four media for the isolation of Aspergillus flavus group fungi

By digital subtraction angiography (DSA), the authors made observations on 108 normal ophthalmic arteries in 80 patients with regard to the origins, courses, branching, morphology and anastomoses of the vessels. The merits and demerits of DSA in observing the ophthalmic artery were discussed.