Biomedical subjects
Publications and source records attributed to R D Catterall.
Cytological changes were studied among 393 women, reporting to Samir Health Centre, Khartoum (Sudan), using Papanicolaou staining. Vaginal trichomoniasis was confirmed by wet-mounts and cultural methods. Non-specific inflammatory changes were prominent (17.4%). In 33.5% of parasitised patients, the cervix was found healthy. Cancer of the cervix was not detected in patients investigated.
A total of 403 vaginal discharge specimens were investigated for Trichomonas vaginalis using fresh wet-mounts, culture and Papanicolaou staining. By fresh wet-mounts, 58 specimens (14.4%) were found harbouring the parasite. On culture 67 isolates (16.7%) were identified. Both wet-mount and cultural procedures detected 18.3% positive isolates. Papanicolaou staining detected 40 positive cases (9.9%) from the patients investigated. Two culture media were tried in this study to isolate T. vaginalis, namely Lumsden's medium and Diamond's medium. Their efficacy was found to be 16.9% and 14.8%, respectively.
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A study was conducted to collect information from consultants about the facilities and diagnostic criteria used in clinics for sexually transmitted diseases in England and Wales. Most of the information was obtained by personal interview with a response rate of 92%. Half the clinics were open for 10 hours or less a week, the mean length of time for all clinics was 14 1/2 hours a week. Eighty per cent of clinics had a full or part-time contact-tracing service. All the clinics had microscopical and serological services and almost all (99%) had cultural facilities. The policy concerning the most efficient use of these facilities is discussed.
Samples of semen and urine were obtained from 37 male contacts of women with proved Trichomonas vaginalis infection; on culture, eight (22%) of the men were shown to harbour the parasite. However, significant amounts of antitrichomonal antibody were found in only two of these samples, and the amounts present were very small. A further 10 samples were tested but none was found to contain antibody. The asymptomatic nature and low parasite numbers commonly described in infections in men is thus unlikely to be due to a vigorous local immune response.
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Medical, social, and sexual histories were taken from 198 men attending a department for sexually transmitted diseases. Their blood was tested for hepatitis B surface antigen and its antibody, and also for syphilis and liver function. Infection with hepatitis B virus was found to be common among practising homosexuals and to occur much more frequently in them than in heterosexuals. Hepatitis B appeared to be transmitted sexually rather than by other means, but it was not possible in this study to link its transmission with any particular homosexual practice. However, risk of infection increased considerably with the number of sexual partners and nearly half of those with more than 40 sexual partners had been infected.
In the future it seems probable that cases of neurosyphilis will be seen sporadically by physicians and neurologists. As a result of the almost universal ingestion of antibiotics for trivial conditions, many cases of syphilis will be modified or arrested and some patients will be cured of the disease without ever knowing that they have acquired it. In others, developing neurosyphilis may be attenuated by inadequate chance treatment and the clinical and laboratory manifestations may become more subtle and difficult to recognize, leading to errors in diagnosis. Clinical experience of the varied manifestations of neurosyphilis has become less widespread among physicians and consequently greater care should be taken to ensure that the diagnosis is not missed.
Direct urethral and cervical smears for gonorrhea in women are useful because of their high specificity. Male rectal smears are less efficacious. Direct tests for candidiasis and trichomoniasis are also specific, but less sensitive than generally thought. Most tests exhibit only moderate month-to-month variability. No association between infection with trichomonads and gonococci was demonstrated. The gonococcal tests all perform best under conditions of high prevalence, such as those that obtain in venereal disease clinics in the United States.
A retrospective study of 209 consecutive cases of gonorrhoea showed that more than 98 per cent. of cases were detected by two sets of examinations at weekly intervals. This was compared with earlier results obtained at this clinic when only 86 per cent. of cases were detected by two examinations. It is believed that modifications in culture techniques were responsible for the improvement and that two tests are now sufficient to screen for gonococcal infection in the majority of patients when an efficient microbiological service is available. Because of the high incidence of infection in contacts of men with gonorrhoea, a third test is recommended for the small number of such patients who have negative results of their first two tests. This also serves to monitor the efficiency of the culture techniques. The majority of women with gonorrhoea attended because they were believed to be contacts of men with the disease but many attended of their own accord because they had symptoms. Mild symptoms were described by as many as 53-5 per cent. of all infected women. Nine cases of gonorrhoea were detected during the follow-up period. Three of the four cases which were thought to be due to treatment failure were detected at the first test, in contrast to the cases which were thought to be due to re-infection, the majority of which were diagnosed at subsequent tests. Constant surveillance of the accuracy of the diagnostic methods used in the detection of gonorrhoea in women is of great importance if errors are to be reduced to a minimum.
Undergraduate and postgraduate training in sexually transmitted diseases and genitourinary medicine in the UK is described. The course for overseas postgraduate students is briefly described. It is noted that once funds are available it has been agreed to establish a professorial chair of venereology at the Middlesex Hospital Medical School. This will be a major advance and is the most desirable goal to aim at in the encouragement of education in STD for the next few years.
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Vaginal secretions from 508 women were examined for evidence of infection by Trichomonas vaginalis, and for antibodies directed against this organism; 42 women (8-3 per cent.) were found to be infected. Secretions from 29 of these women were assayed and antibody apparently directed against T. vaginalis was found in 22 (76 per cent.) of them. Eight out of nineteen secretions (42 per cent.) from apparently uninfected women also contained antibody. Amongst the infected women, no correlation could be found between the presence or absence of antibody and the degree of inflammation, duration of symptoms, use of oral contraceptives, or additional sexually-transmitted disease; there was, however, a slight suggestion that low parasite counts in the vaginal secretions were associated with the presence of antitrichomonal antibody.
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