Biomedical subjects
Publications and source records attributed to J D Oriel.
Today, Kaposi is remembered for giving the first description of the angiosarcoma which bears his name. During his lifetime, he was acknowledged as one of the great masters of the Vienna School of Dermatology, a superb clinician and renowned teacher.
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The role of Chlamydia trachomatis in infections of the male genital tract is reviewed. The organism is an important cause of non-gonococcal urethritis, post-gonococcal urethritis and epididymitis, but does not appear to play a major part in the pathogenesis of chronic abacterial prostatitis or in proctitis in anoreceptive homosexual men.
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There are now known to be many genotypes of human papillomavirus (HPV). Types 6 and 11 are closely associated with benign lesions of genitoanal epithelia; the classical forms are condylomata acuminata and papular warts, collectively known as genitoanal or "venereal" warts, but it is now known that subclinical infections are much more common. These were first identified on the cervix uteri by colposcopy after the application of acetic acid, but they can also be found on penile and vulval epithelia by the same technique. Genitoanal HPV infection is an increasingly common disease; because it is usually sexually transmitted, it is important that before a patient is treated appropriate laboratory tests are used to identify or exclude other infections. It is also important that female patients have cervical cytology, because cervical intraepithelial neoplasia is often associated with genital HPV infection. Treatment of anogenital warts is often difficult, and no one form of therapy is effective. Treatment modalities used include cytotoxic agents (podophyllin, podophyllotoxin, fluorouracil), and destructive procedures (scissor excision, cryotherapy, electrocautery, carbon dioxide laser). Recently, the possibility of using interferons either alone or in association with other forms of treatment has been investigated.
Clinical and subclinical genital HPV infection is most prevalent in people aged 20-24 years. HPV-infected women have an earlier debut of sex activity, more partners and more casual relationships and STD than age-matched controls without HPV; although data are not available, the same risk factors probably operate in men. There is no evidence that the presence of non-genital warts affects the incidence of genital lesions. Between 50 and 70% of sex partners of individuals with condylomatous or non-condylomatous genital HPV infection also have lesions. Nothing is yet known about any relationship between infectivity and the number of lesions or their viral content. The infectivity of non-condylomatous HPV infection is uncertain. Immunological factors affect the clinical behaviour of genital warts, and immunosuppression, for example by drugs, radiation and possibly cigarette smoking and the use of oral contraceptives, may increase liability to genital HPV infection. The main risk factors appear to be young age, sexual promiscuity, intercourse with a partner with HPV disease and perhaps deficient immune responses. The identification of people at high risk requires careful clinical examination supplemented by the use of a magnification system, histology and cervical cytology. The identification of HPV genotypes in genital epithelia does not seem to be useful in this context, because they are present in a proportion of normal epithelia.
Of 1267 women attending a gynaecology clinic, who were screened for the presence of Chlamydia trachomatis, 45 (3.6%) were found to be infected. Infection with C. trachomatis was more common in women who were less than or equal to 25 years of age, unmarried, nulliparous, requesting termination of pregnancy, using oral contraception as opposed to barrier methods, and who had cervical ectopy or cervicitis. Using contact tracing techniques 35% of male sexual partners of women who harboured C. trachomatis were also found to be infected. 86% of these men were symptomless. Asymptomatic chlamydial infection is common in men as well as women. Selective screening to identify women at risk of infection and the use of contact tracing to identify symptomless men with chlamydial infection are shown to be of value.
A novel enzyme immunoassay test (Pharmacia EIA) was evaluated against cell culture for the detection of chlamydial genital infection. Specimens were obtained from 525 patients (257 men and 268 women). Sensitivity, specificity, predictive value of positive (PVP) and predictive value of negative (PVN) for the new test were, respectively, 83.6, 98.5, 94.4 and 95.1% for men and 86, 97.2, 87.8 and 96.8% for women. Discrepancies were further evaluated by repeating the EIA, and by direct immunofluorescence on the EIA transport buffer. The sensitivity, specificity, PVP and PVN of the EIA against the combination of cell culture and direct immunofluorescence were, respectively 85.9, 100, 100, and 95.5% for men, and 90.5, 98.1, 92.3 and 97.7% for women. Overall agreement between the EIA and the combination of cell culture and direct immunofluorescence was 97%. The Pharmacia EIA is rapid and simple to perform and does not require elaborate equipment.
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