Circulating antibodies to Chlamydia trachomatis in women: relationship to antisperm and antichlamydial antibodies in semen of male partners

The relation between antibodies to Chlamydia trachomatis and spermatozoa in sera of 112 asymptomatic female partners of infertile couples with no history of C.trachomatis infections and antichlamydial antibodies in semen or antisperm antibodies on ejaculated spermatozoa of their male partners was examined. Samples were tested for immunoglobulin (Ig)A and IgG antibodies to C.trachomatis by enzyme-linked immunosorbent assay; antisperm antibodies in sera and on motile spermatozoa were assayed by immunobead binding. IgG antibodies to C.trachomatis were detected in 24 (21.4%) of the women; only five (4.5%) women were positive for antichlamydial IgA. Antichlamydial IgG was detected in sera from 10 (40.0%) of 25 women whose partners had antichlamydial IgA in semen as opposed to 14 (16.1%) of 87 women whose partners' semen were negative for this antibody (P = 0.02). Similarly, antichlamydial IgG was detected in sera from five (50%) of 10 women whose partners had antichlamydial IgG in semen as opposed to 19 (18.6%) of 102 women whose partners' semen lacked this antibody (P = 0.03). There was no relation between antichlamydial antibodies in women and circulating antichlamydial antibodies in men. A strong correlation (P = 0.001) was observed between IgG antichlamydial antibodies in a woman's serum and antisperm antibodies on ejaculated spermatozoa of her partner [8 of 14 (57.1%) versus 16 of 98 (16.3%)]. Conversely, antichlamydial antibodies in a woman's serum was unrelated to the presence of antisperm antibodies in either her own serum or her partner's serum. The data demonstrate that chlamydial infections of the male genital tract, which are associated with antisperm antibody formation on ejaculated spermatozoa, are likely to be transmitted to the female partner. In contrast, the presence of antichlamydial antibodies in sera does not necessarily appear to indicate an infection of the genital tract and is not associated with the heterosexual transmission of C.trachomatis.     

Trend in Chlamydia trachomatis infection among pregnant women in the past ten years in Japan: significance of Chlamydia trachomatis seroprevalence

BACKGROUND AND OBJECTIVES: Chlamydia trachomatis infection is believed to be the most common bacterial sexually transmitted disease (STD) in industrialized countries. The objective of the current study was to assess the recent trend in the prevalence of C. trachomatis in Japan. GOAL OF THIS STUDY: To determine the trend in the seroprevalence for C. trachomatis among pregnant women in Nagasaki, Japan, during the past 10 years. STUDY DESIGN: The seroprevalence for C. trachomatis of 9,652 pregnant women of various ages screened in 1996 and 1997 was compared with those of 275 and 297 stocked samples from 1987 and 1992, respectively. Serum antibodies to C. trachomatis were detected by the enzyme immunoassay. Prospective samples of 33 seropositive cases were also analyzed to determine kinetics of the serum antibody titer. RESULTS: The seroprevalence has decreased in all age groups during the last 10 years. More than 70% of seropositive cases converted to be seronegative within 10 years. CONCLUSION: The prevalence of C. trachomatis has been decreasing among Japanese pregnant women.     

Selective screening for Chlamydia trachomatis infection in a primary care population of women

The potency of food chemicals to induce cell aging was evaluated in human diploid fibroblast cells HAIN-55 having a finite replicative potential by using in vitro aging markers, i.e., decreases of maximum proliferative potential (lifespan) of cells, saturation density in monolayer culture (SD), plating efficiency (PE) and mitotic index (MI), and an increase of cells with polyploid karyotypes. By treatment twice with low concentration of genotoxic chemicals aflatoxin B1, allylisothiocyanate or trans-cinnamaldehyde (severe clastogenic flavoring agent; Kasamaki et al., 1982), lifespan (expressed by the number of cumulative cell population doubling (CPD)) of the treated cells was reduced by 8-12 CPDs accompanied by change of the other aging markers. By successive treatment (29 or 25 times) with non-genotoxic chemical aspartame (N-L-aspartyl-L-phenylalanine) or L-canavanine (structural analogue of L-arginine), lifespan of the treated cells was also slightly shortened (by 2-6 CPDs) compared with the untreated control cells. In the process of cell aging, Mitochondrial activity (MTT activity) decreased almost in parallel with the decrease of SD and MI. On the basis of these results, a variety of genotoxic and non-genotoxic chemicals were examined by using MTT activity as the aging marker for their effects on the aging of HAIN-55 cells and bovine artery endothelial cells which also had a finite replicative potential. The results showed that seven genotoxic and nine non-genotoxic chemicals promoted cell aging.     

Performance and cost-effectiveness of selective screening criteria for Chlamydia trachomatis infection in women. Implications for a national Chlamydia control strategy

At 9 mM glucose, experimental results show that mitochondrial phosphate depletion (induced by glucose phosphorylation, catalyzed by mitochondrial hexokinase) reduces the activities of the respiratory chain, oxidative phosphorylation, and glutaminase. Consequently, the 14C-lactate oxidation to 14CO2 is lowered in the presence of glucose. The fall of ATP level triggers a high aerobic glycolysis by deinhibiting fructose-6-P kinase. NADH, generated by enhanced glyceraldehyde-3-P dehydrogenase activity, increases the reducing power. Moreover, the lactate dehydrogenase (LDH) system is shifted toward lactate formation, while NAD+ is regenerated and the oligomycin-inhibited ATP production is replaced by the iodoacetate-inhibited ATP production. From 14CO2 production and lactate accumulation it is calculated that about 60% of 14C-glucose which disappears is channelled into extraglycolytic reactions. On the contrary, 82% of glucose below l mM is metabolized through non-glycolytic reactions. The pyruvate kinase-M2 (PK-M2) inhibition does not limit the glycolytic flow from 9 mM glucose, but it may cause sustained gluconeogenesis.     

The frequency of Chlamydia trachomatis infection in women with intraepithelial neoplasia of the uterine cervix

A case of a rare form of Sanfilippo disease, mucopolysaccharidosis type III D is presented. The cause of the disease is a deficit of N-acetylglycosamine-6-sulfate sulfatase. Differences in clinical course and symptoms with type A and B Sanfilippo disease are shown (later presentation of symptoms, milder course, lack of distinct psychomotor regression and differences in characteristic phenotypic traits, such as facial features, joint contracture, tall height). It is suggested that type III D mucopolysaccharidosis be taken into account in the differentiation of mental retardation syndromes with hyperactivity.     

Incidence of Chlamydia trachomatis in women with PID: effectiveness of therapy

The pelvic inflammatory disease (PID) can be caused by various germs. Of the two thousand seven hundred thirty one women screened for different microbiological agents in the genitourinary tract and for PID, three hundred sixty nine patients were Chlamydia trachomatis (Ct) positive; one hundred and three patients were affected by PID. Seventy out of them were resulted to be Ct positive. One hundred twenty two women were Ct positive but not affected by PID. The antibiotic treatment resulted to be less effective in women Ct positive but affected by PID. Results of the present study demonstrate that Ct is the primary cause of PID.     

Screening for Chlamydia trachomatis in asymptomatic women attending family planning clinics. A cost-effectiveness analysis of three strategies

Because of increasing reports of multiple-antibiotic-resistant strains of Streptococcus pneumoniae and associated clinical failures, this study was performed to determine the prevalence of multiresistance among strains from nine Louisiana medical centers. Using a National Committee for Laboratory Standards broth microdilution method, 481 strains were tested. Of these, 70% were penicillin-susceptible (PS), 23% had intermediate minimum inhibitory concentration values to penicillin (I), and 7% were fully resistant to penicillin (PR). The isolation rates (15% to 40% for I strains and 0% to 33% for PR strains) at the various medical centers varied appreciably. The prevalence of penicillin resistance was highest among upper respiratory isolates, while cross-resistance to other antimicrobials varied. The least cross-resistance was noted among PS strains. However, strains with reduced penicillin susceptibility had high levels of cross-resistance. Among I strains, the prevalence of cross-resistance (%) was noted for amoxicillin/clavulanate (6%), cefuroxime (71%), cefaclor (91%), ceftriaxone (13%), cefotaxime (34%), erythromycin (67%), azithromycin (32%), and clarithromycin (32%). For PR strains, the prevalence of cross-resistance was 97% for amoxicillin/clavulanate, cefuroxime, and cefaclor; 67% for ceftriaxone and erythromycin; 89% for cefotaxime; and 69% for azithromycin and clarithromycin. These data emphasize the high prevalence of multiple-antimicrobial-resistance among strains of S pneumoniae with reduced penicillin susceptibility in this geographic area.     

Quantification of Chlamydia trachomatis in cervical and urine specimens from women attending a genitourinary medicine clinic: implications for screening strategies

Population screening and intervention programmes can reduce the prevalence and incidence of infection with Chlamydia trachomatis, especially if sensitive molecular diagnostic tests are used. However, diagnostic tests that perform well on genitourinary medicine (GUM) clinic populations may be less useful for screening, particularly if the majority of infected subjects are asymptomatic and their samples contain fewer organisms. We have compared the extent of low organism load in cervical and urine samples from symptomatic and asymptomatic chlamydia-positive women, by using a direct fluorescent antibody staining method and counting the chlamydial elementary bodies (EBs). We have investigated the ability of an enzyme immunoassay (EIA; MicroTrak) and a DNA amplification (ligase chain reaction; LCR) assay to detect low numbers of organisms in cervical samples and the ability of the LCR assay to detect low numbers of organisms in urine. A low organism load (< 10 EBs) was seen by direct fluorescent antibody (DFA) staining in about 30% of cervical samples and in about 75% of urines from chlamydia-positive women; the proportions in symptomatic women were not significantly different from those in asymptomatic women. The EIA identified only 16% of cervical samples that contained < 10 EBs by DFA staining; the LCR identified 100% of cervical samples and 93% of urine samples that contained < 10 EBs by DFA staining. The findings suggest that the ability of chlamydial diagnostic tests to identify positive women should be similar among patients attending a GUM clinic and those taking part in a population screening programme, and that sensitive molecular assays such as the LCR should identify subjects with a low organism load in both groups.     

Urinary inhibitors of polymerase chain reaction and ligase chain reaction and testing of multiple specimens may contribute to lower assay sensitivities for diagnosing Chlamydia trachomatis infected women

Clinical and morphologic features of a progressive polyneuropathy in young mature Alaskan Malamutes are described. Clinical signs included progressive paraparesis, synchronous pelvic limb gait, exercise intolerance, hyperesthesia, hyporeflexia, muscle atrophy, and tetraplegia. Electromyographic testing revealed diffuse fibrillation potentials and positive sharp waves in limb muscles, especially in muscles below the elbow and stifle. Pathologic findings in skeletal muscles and peripheral nerves included neurogenic muscle atrophy, focal or diffuse loss of myelinated nerve fibers, myelinoaxonal necrosis, and variable demyelination or remyelination. Ultrastructural changes included axonal degeneration, presence of numerous Büngner bands, and denervated Schwann cell subunits. The nature and distribution of abnormal electrophysiologic and pathologic findings were suggestive of a distal sensorimotor polyneuropathy, which we have termed idiopathic polyneuropathy of Alaskan Malamutes to distinguish this condition from hereditary polyneuropathy of Norwegian Alaskan Malamutes, last described in 1982.     

Performance of a commercial polymerase chain reaction test for endocervical Chlamydia trachomatis infection in a university hospital population

The rate of survival and causes of mortality in a cohort of 2103 psychiatric patients registered on a psychiatric case register and followed up for 7 years are compared with those of a general population sample (n = 2382) randomly extracted from the municipal census in Valencia (Spain). Using multivariate analysis by Cox regression, patients suffering organic psychoses and those diagnosed with drug abuse or dependency exhibited a greater risk of death than the general population for the total causes of death; no interaction was found between sociodemographic variables and psychiatric pathology. In terms of the causes of death, and controlling for the effect of age and sex, organic psychoses involved a greater risk of death due to cardiovascular and respiratory causes, and a greater risk of non-natural deaths than the general population. Schizophrenia and related conditions, the abuse of alcohol/ other drugs, and neurosis/personality disorders all presented a higher risk of death from liver disease. The major affective disorders involved a greater risk of death due to suicide or accidents. The study concludes with a discussion of the possible explanations of these results.     

Detection of Chlamydia trachomatis infections in women by Amplicor PCR: comparison of diagnostic performance with urine and cervical specimens

We used the Roche Amplicor PCR assay to compare urine and cervical swabs as sample material in the detection of Chlamydia trachomatis causing genital infections. The diagnostic performance of Amplicor PCR was compared with that of cell culture and the Gen-Probe PACE 2 assay with cervical specimens. If discrepant from other results, the specimens negative by PCR were diluted and reanalyzed to reveal PCR inhibitors. Of 666 patients, 39 (5.9%) were confirmed to have chlamydial infection. The respective sensitivity and specificity of Amplicor PCR were as follows: urine specimens, 82.0 and 99.7%; cervical specimens, 82.0 and 99.8%. Those for cell culture with cervical specimens were 84.6 and 100%. For the Gen-Probe PACE 2 assay, the sensitivity and specificity with cervical specimens were 79.5 and 100%, respectively. Without the effect of PCR inhibitors, the sensitivity of PCR with urine would have been 97.4%. Provided that the problems currently caused by inhibitors will be solved, the Amplicor PCR assay with urine specimens offers a tempting alternative for the diagnosis of C. trachomatis infection in women.     

Gonorrhoea in the asymptomatic patient: presentation and the role of contact tracing for heterosexual men and women and for homosexual men

Clinically silent gonorrhoea is the major problem in the control of the disease. Only 12 per cent of infected women reported in 1974 because of symptoms, compared with 97 per cent of infected heterosexual men and only 35 per cent of homosexual men with gonococcal proctitis alone. Homosexual men, compared with heterosexual men, had twice as many subsequent sexual contacts after infection and had a higher incidence of early syphilis. Eighty-four per cent had experienced passive anorectal intercourse. Ninety-seven per cent of men with gonococcal urethritis reported because of symptoms, but occasionally (particularly after unsuccessful treatment) urethral gonorrhoea in men may be clinically silent and even require tests of the overnight urethral secretion for diagnosis. For women, and for homosexual men who have had passive anorectal (or oral) intercourse, the indication for attendance for tests for gonorrhoea should be having run the risk, and not the presence of symptoms. Routine tests of the anorectum for gonorrhoea are essential in cases of 80 women at risk, and for most homosexual men since over 80 per cent of these men will have had passive anorectal intercourse. Because gonococcal infections following treatment-failure are often clinically silent in both women and men, symptoms cannot be relied upon to indicate such failure. Follow-up smears and cultures are always essential.     

Evaluation of the Gen-Probe PACE 2 assay for the detection of asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in male arrestees

BACKGROUND: The LET and Gen-Probe PACE 2 assay are used to screen male arrestees for evidence of infection with chlamydia and gonorrhea in the intake/booking area of the Jefferson Parish Correctional Center. GOAL OF THIS STUDY: To determine the accuracy of the Gen-Probe PACE 2 assay for the detection of asymptomatic infection with Chlamydia trachomatis and Neisseria gonorrhoeae infections in male arrestees. STUDY DESIGN: From December 1993 to March 1994, 196 arrestees younger than 22 years were screened with the Gen-Probe PACE 2 assay and McCoy shell vial culture for Chlamydia trachomatis. From April to October 1994, 444 arrestees of all ages were screened with the Gen-Probe PACE 2 assay and standard culture for Neisseria gonorrhoeae. The sensitivity, specificity, and predictive values of the Gen-Probe PACE 2 assay, compared with culture, were calculated with 95% confidence intervals. RESULTS: The Gen-Probe PACE 2 assay compared with culture had a sensitivity, specificity, and positive predictive value for Chlamydia trachomatis of 84%, 99%, and 93% and for Neisseria gonorrhoeae of 54%, 99.5%, and 78%. CONCLUSION: The Gen-Probe PACE 2 assay is useful for screening young males in this jail setting and is more accurate for detecting Chlamydia trachomatis compared with Neisseria gonorrhoeae.     

Ethnic differences in women with HIV infection in Britain and Ireland. The study group for the mrc collaborative study of HIV infection in women

Homeobox (hox) genes are of considerable importance in the formation of the body axis of invertebrates and vertebrates. The postulation of a hox-code (i.e. the simultaneous activity of a certain subset of hox genes) for structures at different metameric levels and which differ from each other in shape suggests a relationship between hox-code and shape, which is reinforced by the possibility of homeotic transformation when the hox-code is changed experimentally. This paper considers the possible nature of such a relationship between the hox genes governing vertebral formation in the upper part of the mouse vertebral column and the shape of the adult vertebrae formed in this region.     

Demonstration of Chlamydia trachomatis in inguinal lymphadenitis of lymphogranuloma venereum: a light microscopy, electron microscopy and polymerase chain reaction study

Intravacuolar organisms in vacuolated macrophages were associated with areas of necrosis and suppuration in 12 patients with suppurative inguinal lymphadenitis. The intravacuolar organisms measured 0.2 to 2.0 micrometers in diameter, stained Gram negative with the Brown-Hopp's tissue Gram stain, faintly blue with hematoxylin and eosin stain, and black with the Warthin-Starry silver impregnation stain. The organisms lined vacuolar membranes and/or clumped in centers of vacuoles. Electron microscopy revealed elementary and reticulate bodies and intermediate forms characteristic of the genus Chlamydia. Cultures of three lymph nodes in McCoy cells grew Chlamydia trachomatis, lymphogranuloma venereum (LGV) serovars. Polymerase chain reaction using primers for chlamydial 16S ribosomal DNA confirmed the organisms as Chlamydia in lymph nodes from nine patients. Recognition of chlamydial organisms by light microscopy in tissue sections of lymph nodes allows a definitive diagnosis of lymphogranuloma venereum.     

Sclerotherapy versus sclerotherapy and propranolol in the prevention of rebleeding from oesophageal varices: a randomised study

BACKGROUND: This trial was carried out to assess the value of propranolol in the prevention of recurrent variceal bleeding when combined with longterm endoscopic sclerotherapy. PATIENTS AND METHODS: Two hundred patients (161 male, 39 female, age range 20-68 years) with portal hypertension resulting mainly from schistosomal periportal fibrosis or posthepatitic cirrhosis presenting with their first episode of haematemesis or melena, or both were included. This was confirmed endoscopically to result from ruptured oesophageal varices. After initial control of bleeding, patients were randomised into two groups: group 1 treated with endoscopic sclerotherapy alone and group 2 treated with sclerotherapy plus propranolol. They were followed up for two years. RESULTS: Group (2) had a lower rebleeding rate (14.3% v 38.6% in group 1), lower variceal recurrence after obliteration (17% v 34% in group 1), longer period between variceal obliteration and recurrence (36 weeks v 21 weeks in group 1); but no change in mortality (12% in both groups). CONCLUSIONS: Patients treated with sclerotherapy should be given propranolol for longterm management.     

Screening women for chlamydia trachomatis in family planning clinics: the cost-effectiveness of DNA amplification assays

This study illustrates that cultural differences arise among similarly trained health professionals. Health professionals must learn to communicate sensitively with colleagues from other cultures, to respect their values, and to recognize and resolve cultural differences that affect patient care. In this shrinking, multicultural world, health professionals cannot afford the comfortable illusion that all similarly trained practitioners share the same values about the care of patients and professional conduct.