BACKGROUND: The patient-administered tampon specimen has proven to be an easy and sensitive method for the diagnosis of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections in women by polymerase chain reaction (PCR). This method avoids the need for endocervical sampling and stringent criteria for transport. GOAL: To evaluate two commercial amplification systems for the detection of C trachomatis and N gonorrhoeae from tampon specimens. STUDY DESIGN: A group of 400 positive and negative tampon specimens tested by an in-house PCR method were selected from a pool of more than 2,000 previously collected tampons. Overall, 93 C trachomatis-positive and 77 N gonorrhoeae-positive specimens were evaluated. Each specimen was tested by Roche Cobas Amplicor and Abbott LCx (LCR), and results were compared to the in-house PCR method. RESULTS: Detection of C trachomatis by both assays was not significantly different from the in-house PCR assay. Fewer tampons were positive for N gonorrhoeae by LCR than either the in-house assay (P = 0.0001) or by Roche Amplicor (P = 0.01). However, tampon specimens tested by Roche Amplicor required DNA extraction to achieve comparative sensitivity. CONCLUSION: Both commercial assays can be applied to tampon-collected specimens for automated detection of sexually transmitted diseases. The detection of C trachomatis was similar to the in-house PCR test for both assays (P = 0.73, 0.68). Detection of N gonorrhoeae resulted in fewer positive tampon specimens when tested by ligase chain reaction than both Roche Amplicor and in-house PCR.

Chlamydia Infections↗

PubMed2000

Epidemiology and control and curable sexually transmitted diseases: opportunities and problems.

BACKGROUND: Despite the availability of safe and effective treatment, infection with bacterial sexually transmitted diseases persists at a high prevalence in many populations. GOAL: To review the difficulties of parameter estimation when a cure is readily available and to explore the impact of different treatment and screening strategies that might maximize the benefits of using available treatments. STUDY DESIGN: A standard deterministic model for the spread of a bacterial sexually transmitted disease that causes symptomatic and asymptomatic infections, in which the population is stratified according to sex and sexual activity, is further stratified into two host groups to enable the modeling of different treatment and screening strategies. RESULTS: In the presence of a core group, if an infection has a high transmission probability, then screening for asymptomatic infections has a short-lived benefit. Repeated screening is slightly better if it is not restricted to a fraction of the at-risk population, but targeting of high-risk groups should be effective. Screening to treat asymptomatic infections in men could be beneficial if a substantial fraction of cases remain asymptomatic. CONCLUSIONS: After the initial gains achieved through treating symptomatic infections, further reductions in the prevalence of infections can be achieved by finding asymptomatic infections. However, these gains are difficult to achieve, especially in the case of gonorrhea. Because men are likely to have an asymptomatic chlamydial infection, screening of men for chlamydia should be worthwhile.

Female↗

PubMed2000

Reproductive health, infertility and sexually transmitted infections in indigenous women in a remote community in the Northern Territory.

OBJECTIVE: To investigate markers of reproductive health in a remote Indigenous community in Northern Australia. METHODS: A retrospective, cross-sectional analysis of case notes of 342 women between the ages of 20 and 45 years, living in one community in a remote region of the Northern Territory. RESULTS: The total rate of current infertility in the community was 26.3%; 8.2% for primary infertility and 18.1% for secondary infertility. An additional 3.3% of women had resolved infertility. Only 43% of the women had sought medical help for the problem. A history of ectopic pregnancy was recorded in 2.6%, stillbirth in 1.8%, miscarriage in 14.3% and neonatal death in 12.3%. Depot steroidal contraception or tubal ligation were used by 50% of the women but 45.9% used no contraception. A history of pelvic inflammatory disease (PID), T. vaginalis N. gonorrhoeae, genital C. trachomatis infection, syphilis or bacterial vaginosis was noted in 32%, 46%, 27%, 30%, 41% and 9% respectively. Current alcohol consumption was reported in 23% and cigarette smoking in 76%. In multivariate analysis, infertility was strongly associated with PID (adjusted OR 8.5), alcohol consumption (AOR 3.1), T. vaginalis (AOR 2.5), N. gonorrhoeae (AOR 2.2) and bacterial vaginosis (AOR 2.9). CONCLUSION: Reproductive health is poor in this community of Indigenous women, with endemic levels of STDs, PID and tobacco consumption. The absence of barrier contraception (e.g. condoms, diaphragms) has implications for HIV and STD control. Clinical and public health interventions are urgently required but the implementation of these is hindered by a number of structural, social and economic barriers.

Adult↗

PubMed2000

Trichomonas vaginalis epidemiology: parameterising and analysing a model of treatment interventions.

BACKGROUND: Trichomonas vaginalis, which affects at least 170 million individuals globally, may increase the risk of transmission of HIV and predispose pregnant women to premature rupture of membranes and early labour. OBJECTIVE: To more clearly define the epidemiology of trichomoniasis and to develop a mathematical model of disease transmission dynamics in order to explore various treatment strategies. DESIGN: A deterministic model of trichomoniasis was constructed. Parameter values were set to fit the model to known endemic prevalence levels of Trichomonas vaginalis. Two treatment interventions ("screening" and "syndromic management") were simulated. RESULTS: The age specific prevalence of the disease was seen to differ from other STDs in a number of studies. Parameter fitting indicates that the average duration of infection in women is at least 3-5 years and approximately 4 months for men. "Syndromic management" (that is, treating only those with symptoms of disease) had minimal effect upon the endemic prevalence of disease even at high levels of coverage. "Screening" (that is, identification of individuals with both symptomatic and asymptomatic infection) was shown to be the most efficient method of control, but was sensitive to the screening interval. CONCLUSIONS: The control of trichomoniasis seems to have been a success in developed countries because of the regular access to health care, whereas it has remained endemic in many developing countries where control may only be possible by regular screening and treatment. However, without a large investment in services, success in controlling trichomoniasis is likely to be transitory.

Animals↗

PubMed1999

Missing the diagnosis of donovanosis in northern Australia.

Explore the source record for details and available documents.

Diagnostic Errors↗

PubMed1999

Diagnostic polymerase chain reaction for donovanosis.

Explore the source record for details and available documents.

Calymmatobacterium↗

PubMed1999

Phylogenetic evidence for reclassification of Calymmatobacterium granulomatis as Klebsiella granulomatis comb. nov.

By sequencing a total of 2089 bp of the 16S rRNA and phoE genes it was demonstrated that Calymmatobacterium granulomatis (the causative organism of donovanosis) shows a high level of identity with Klebsiella species pathogenic to humans (Klebsiella pneumoniae, Klebsiella rhinoscleromatis). It is proposed that C. granulomatis should be reclassified as Klebsiella granulomatis comb. nov. An emended description of the genus Klebsiella is given.

Calymmatobacterium↗

PubMed1999