PubMed Health⌕ Search

Biomedical subjects

William M Geisler

Publications and source records attributed to William M Geisler.

15 recordsLinked to original sources
PubMed2007

Pelvic examination findings and Chlamydia trachomatis infection in asymptomatic young women screened with a nucleic acid amplification test.

BACKGROUND: Nucleic acid amplification tests (NAATs) allow chlamydia screening in asymptomatic women who otherwise may not have pelvic examinations. How often these women have examination findings that may prompt empiric therapy is unclear. OBJECTIVE: The objective of this study was to assess the relationship of chlamydia with pelvic examination findings in asymptomatic women screened by NAAT. METHODS: The authors conducted a retrospective analysis of clinical data from 577 young asymptomatic women screened by chlamydial transcription-mediated amplification (TMA). RESULTS: TMA was positive in 68 (11.8%). The most common examination finding was vaginal discharge (5.9%) followed by cervical ectopy (3.6%), endocervical mucopus (2.3%) or easily induced bleeding (2.3%), and cervical motion (1.4%) or adnexal (0.7%) tenderness. On multivariate analysis, only easily induced bleeding or mucopus predicted chlamydia (adjusted odds ratio [AOR] = 4.7; P = 0.010 and AOR = 4.4; P = 0.015, respectively). CONCLUSIONS: Abnormal pelvic examination findings were infrequent in asymptomatic young women screened by a chlamydial NAAT. However, endocervical bleeding or mucopus, when present, predicted chlamydia.

Adolescent↗
PubMed2006

Two cases of pott disease associated with bilateral psoas abscesses: case report.

STUDY DESIGN: Two case reports and a literature review of spinal osteomyelitis with bilateral psoas abscesses secondary to Mycobacterium tuberculosis. OBJECTIVE: Describe the presentation, diagnosis, treatment, and outcome of spinal tuberculosis (i.e., Pott disease). SUMMARY OF BACKGROUND DATA: Pott disease is a well-known condition in unindustrialized countries causing multiple spinal deformities in children. However, its association with bilateral psoas abscesses in adults with minimal risk factors is not commonly recognized in industrialized countries. METHODS: There are 2 adult cases of Pott disease with psoas abscesses presented, and the relevant literature is reviewed. Plain spine radiographs, spine magnetic resonance imaging (MRI), routine bacterial and acid-fast bacilli cultures of infected material, and other diagnostic testing for M. tuberculosis were performed. RESULTS: Plain radiographs and MRI of the spine showed vertebral osteomyelitis with compression fractures, and MRI also revealed bilateral psoas abscesses. Acid-fast bacilli culture and other M. tuberculosis diagnostic testing of psoas abscess specimens confirmed the diagnosis of M. tuberculosis. CONCLUSION: Although spinal osteomyelitis with psoas abscess is classically associated with Staphylococcus aureus infection, Pott disease should be considered in this clinical setting, and risk factor assessment and testing for tuberculosis should be performed.

Aged, 80 and over↗
PubMed2006

Health insurance coverage, health care-seeking behaviors, and genital chlamydial infection prevalence in sexually active young adults.

BACKGROUND: Genital chlamydial infection remains prevalent in young adults. Differential access to health care and thus the opportunity for testing, treatment, sexual partner services, and risk reduction counseling may be among the factors contributing to variation in chlamydial prevalence. GOAL: We investigated associations of health insurance coverage and health care-seeking behaviors, both indicators of healthcare access, to chlamydial infection in a nationally representative sample of young adults. METHODS: Weighted logistic regression techniques were used to examine associations between indicators of healthcare access and chlamydial infection as determined using Chlamydia trachomatis ligase chain reaction among a subset of sexually active young adults ages 18 to 27 interviewed at wave III of the National Longitudinal Study of Adolescent Health (N = 9347). Analyses were stratified by gender and controlled for age and race/ethnicity. RESULTS: Having continuous health insurance coverage in the preceding 12 months was associated with a lower risk of chlamydial infection in both men and women. Usual site of health care was also associated with chlamydial infection. Men who reported emergency rooms as their usual site of care had a higher risk of infection, whereas women who used school clinics had a lower risk compared with those seen in primary care settings. Having seen a provider in the preceding 12 months was associated with a lower risk of chlamydial infection for men only. These associations remained even after adjusting for racial/ethnic differences in health insurance coverage and health care-seeking behaviors. CONCLUSIONS: Independent of race/ethnicity, indicators of healthcare access are associated with chlamydial infection in young adults. Furthermore, our analyses reveal differences in these associations by gender. Improved healthcare access for young people could help reduce chlamydia-associated reproductive health morbidity potentially through access to chlamydial screening, treatment, sex partner services, and risk reduction counseling.

Adolescent↗
PubMed2006

Association of Chlamydia trachomatis Serovar Ia infection with black race in a sexually transmitted diseases clinic patient population in Birmingham, Alabama.

BACKGROUND: Black race is a risk marker for Chlamydia trachomatis infection. Because chlamydial serovar and race could both influence the transmission dynamics of chlamydia, studies characterizing serovars in a predominantly black population are of interest, yet remain sparse. STUDY DESIGN AND GOALS: C. trachomatis isolates collected consecutively from 109 female and 98 male patients presenting to a sexually transmitted disease clinic in Birmingham, Alabama, were serotyped. Our goal was to evaluate serovar distribution and associated demographic characteristics in a predominantly black population. RESULTS: The median age was 23 years and 91% were black. Serovars E (29%), D (19%), F (19%), Ia (16%), and J (9%) were the most prevalent. Blacks were less often infected with serovar E (30% vs. 41%) and J (9% vs. 24%), but more often infected with serovar Ia (17% vs. 0%) compared with individuals of other racial groups (P = 0.07). The overall serovar distribution did not significantly differ by gender or age; however, serovar Ia infections were associated with older age (21% in age >or=23 years vs. 10% in those age <23 years; P = 0.03). CONCLUSIONS: Although the overall C. trachomatis serovar distribution in this predominantly black population in Birmingham was similar to that reported elsewhere, serovar Ia was only found in blacks, in whom it was commonly isolated. Finding differences in serovar distribution by race, particularly serovar Ia, may be of epidemiologic significance and deserves verification in similar cohorts.

Adolescent↗
PubMed2005

Human leukocyte antigen and cytokine gene variants as predictors of recurrent Chlamydia trachomatis infection in high-risk adolescents.

Antigen presentation and immune activation are essential to the effective control of infectious diseases. In 485 North American adolescents at high risk for genital Chlamydia trachomatis infection, we found 2 human leukocyte antigen variants (DRB1*03-DQB1*04 and DQB1*06) to be associated with recurrent Chlamydia infection (adjusted relative odds [RO], >2.0; P<.01, for both variants). A G-C-C haplotype corresponding to variants at IL10 (encoding interleukin-10 [IL-10]) promoter positions -1082, -819, and -592 was underrepresented in individuals with recurrent infection (RO, 0.59; P=.046). These genetic associations were independent of nongenetic factors, including number of sex partners, race, sex, duration of follow-up, and human immunodeficiency virus type 1 seropositivity. Consistent with the observed IL10 association, cervical secretions in female adolescents without the IL10 G-C-C haplotype had elevated IL-10 concentrations after Chlamydia infection, which may reflect involvement of a Chlamydia-specific mechanism for genetically mediated, differential IL-10 expression in the genital tract.

Adolescent↗
PubMed2005

Chlamydial and gonococcal infection in men without polymorphonuclear leukocytes on gram stain: implications for diagnostic approach and management.

BACKGROUND: Gram stain is used to detect urethral inflammation, suggestive of infection, in men and guide therapeutic decisions. In the absence of signs, symptoms, or polymorphonuclear leukocytes (PMNs) on urethral Gram stain, treatment and sometimes testing is deferred. GOAL: Determine the proportion of men with chlamydia or gonorrhea diagnosed by nucleic acid amplification testing (NAAT) or culture who lack Gram stain evidence of inflammation and compare their clinical characteristics to men with inflammation. METHODS: Records from 2629 men presenting for routine sexually transmitted disease care with urethral PMN count and NAAT data were retrospectively analyzed. A subpopulation tested by NAAT and culture was analyzed. Men receiving antibiotics within the prior month or those reporting a sexual partner with trichomoniasis were excluded. RESULTS: Among 2266 eligible men, 353 (16%) had chlamydia and 462 (20%) had gonorrhea. Among chlamydia-infected men, PMNs per oil-immersion field (oif) on Gram stain were > or =5 in 291 (82%), 1 to 4 in 20 (6%), and none in 42 (12%). In men with gonorrhea, PMNs/oif were > or =5 in 433 (94%), 1 to 4 in 6 (1%), and none in 23 (5%). Urethral symptoms, discharge, and/or > or =5 PMNs/oif were absent in 47 (13%) and 22 (5%) of chlamydial and gonococcal infections, respectively (including no PMNs/oif and 1-4 PMNs/oif). None of these 47 chlamydial-infected men and only 4 of 22 men with gonorrhea received therapy at the time of initial examination. CONCLUSIONS: Twelve percent of chlamydial and 5% of gonococcal infections had no Gram stain evidence of urethral inflammation. Absence of symptoms and discharge is not uncommon in chlamydial infection detected by NAAT, and without testing, many infections will go untreated, furthering the possibility of complications or partner transmission.

Adolescent↗
PubMed2004

Epidemiological and genetic correlates of incident Chlamydia trachomatis infection in North American adolescents.

Epidemiological and genetic correlates of Chlamydia trachomatis infection were examined prospectively in 124 male and 361 female adolescents at high risk for human immunodeficiency virus type 1 (HIV-1) infection. Seventy percent of subjects were African American, and 68% had HIV-1 infection. As expected, younger age (<17 years), multiple sex partners (> or =2), and prior chlamydial infection predicted chlamydial infection during a 6-56-month follow-up period (P=.02, P=.02, and P=.03, respectively). Human leukocyte antigen (HLA) class II variant DQB1*06 (mostly *0602 and *0603) was associated with chlamydial infection (49% vs. 34%; adjusted relative odds [RO], 1.8; P=.005), as was HLA class I haplotype B*44-Cw*04 (10% vs. 4%; RO, 3.2; P=.009). DQB1*06 was found in 9 (75%) of 12 female adolescents with chlamydial pelvic inflammatory disease. In contrast, sex, ethnicity, and HIV-1 infection did not predict chlamydial infection. These findings suggest that antigen presentation in adaptive immune responses may serve as a major factor in effective control of C. trachomatis infection. The underlying mechanisms remain to be experimentally elucidated.

Adolescent↗
PubMed2004

Assessing the impact of a comprehensive sexually transmitted disease curriculum on learning outcomes.

OBJECTIVE: Our purpose was to assess the impact of a curriculum designed to improve third-year medical students' knowledge of sexually transmitted diseases, measured by sexually transmitted disease-related items from the National Board of Medical Examiners subject examination and by a locally developed sexually transmitted disease test. STUDY DESIGN: All students (n = 108) were exposed to a new sexually transmitted disease curriculum: a 2-hour laboratory module, lectures, syllabus, and locally developed pretest/posttest with review of the test prior to taking the National Board of Medical Examiners subject examination. Students were randomized to a attend sexually transmitted disease clinic (n = 47) versus no sexually transmitted disease clinic (n = 61). RESULTS: Students performed equal to or better than the national average on 85% of the National Board of Medical Examiners sexually transmitted disease-related items after curriculum institution, compared with 56% of the test items prior ( P < .001). Magnitude of improvement was dependent on clerkship timing, with greater improvement in students taking the obstetrics-gynecology clerkship earlier in the third year. Mean postcurriculum test scores of sexually transmitted disease improved significantly ( P < .001), independent of clinic site and clerkship timing. CONCLUSION: The curriculum for sexually transmitted disease produced significant improvement in third-year medical students' knowledge of sexually transmitted disease. This might have an impact on future prevention and control of sexually transmitted diseases in communities in which these students practice.

Alabama↗
PubMed2004

Approaches to the management of uncomplicated genital Chlamydia trachomatis infections.

Genital chlamydial infection remains a highly prevalent sexually transmitted infection in the USA. A multifaceted approach to the management of chlamydial infection is essential to ensure cure and prevention of reinfection. This article will review current approaches to the management of uncomplicated genital chlamydial infection, discussing: the pathogen; antimicrobials that are and are not recommended for therapy by the US Centers for Disease Control and Prevention; partner treatment; follow-up; antimicrobial resistance; and potential future therapies.

Anti-Bacterial Agents↗
PubMed2003

The relationship of serovar to clinical manifestations of urogenital Chlamydia trachomatis infection.

BACKGROUND AND GOAL: Studies assessing the relationship of serovars or genotypes to clinical manifestations of urogenital disease have produced contradictory results. Possible reasons for this include small sample sizes insufficient to reliably detect associations and failure to address potential confounding factors. Utilizing a large dataset and multivariate analysis to address confounding factors, we undertook this study of the relationship of chlamydial serovars to specific clinical manifestations of urogenital disease. STUDY DESIGN: This was a cross-sectional study of 480 women and 700 heterosexual men with urogenital chlamydial infection attending a sexually transmitted diseases clinic from 1995 to 1999 and a literature review. RESULTS: Women (89%) and men (86%) were infected predominately with serovars D, E, F, Ia, and J. After controlling for age and race, we found that women who reported abdominal pain and/or dyspareunia were more often infected with serovar F (P= 0.048). An association of specific clinical manifestations with serovars was not detected in men. CONCLUSION: We conclude that clinical manifestations of urogenital infection are not strongly influenced by the infecting serovar.

Abdominal Pain↗
PubMed2002

Chlamydia pneumoniae respiratory infection after allogeneic stem cell transplantation.

Chlamydia pneumoniae is a common cause of upper and lower respiratory tract infections in immunocompetent patients; however, its role as a respiratory pathogen in immunocompromised hosts has been infrequently recognized. We describe C. pneumoniae lower respiratory tract infection in a 19-year-old male after allogeneic stem cell transplantation. The patient developed fever on day +14, and a subsequent computed tomography scan of the chest revealed a right lateral pleural-based opacity, which was then resected during thoracoscopy. Diagnosis was made by culture and staining of the resected tissue with C. pneumoniae-specific monoclonal antibodies, and azithromycin was administered. To the best of our knowledge, this is the first report of C. pneumoniae respiratory infection after stem cell or marrow transplantation. C. pneumoniae often coexists with other etiologic agents of pneumonia in immunocompromised patients. Considering the infrequency of infections from this organism in this clinical setting, one must still rule out other more likely respiratory pathogens.

Adult↗
PubMed2002

Epidemiology of anorectal chlamydial and gonococcal infections among men having sex with men in Seattle: utilizing serovar and auxotype strain typing.

BACKGROUND: Bacterial sexually transmitted diseases (STDs) among men who have sex with men (MSM) have recently increased in Seattle. GOALS: Serovar and auxotype typing of strains was used to assess the epidemiology of anorectal chlamydial and gonococcal infections among MSM attending an STD clinic. STUDY DESIGN: The prevalences of anorectal chlamydial infection and gonorrhea among MSM attending an STD clinic during the period of 1994 to 1996 were compared with prevalences during 1997 to 1999. A retrospective case-control study of MSM attending an STD clinic between 1997 and 1999 was performed. Anorectal chlamydial isolates were characterized by serovar and gonococcal isolates were characterized by serovar and auxotype. Infected MSM were mapped by residence and strain type. RESULTS: Prevalences of anorectal chlamydial and gonococcal infections increased from 4.0% and 6.3%, respectively, during 1994-1996 to 7.6% and 8.7%, respectively, during 1997-1999 (P = 0.004 and P = 0.013 for chlamydial infection and gonorrhea, respectively). Most chlamydial infections were caused by serovars G (47.9%) and D (29.6%), and most gonococcal infections were caused by auxotype/serovar classes Proto/IB-1 (43.3%), Proto/IB-3 (16.5%), and Proto/IB-2 (10.3%). MSM with anorectal chlamydial infection more often had chlamydial urethritis (P = 0.005) and were not white (P = 0.046), in comparison with controls. MSM with anorectal gonorrhea more often had pharyngeal gonorrhea (P < 0.001), had a history of gonorrhea (P = 0.003), and were younger than age 30 years (P = 0.039), in comparison with controls. Residences of MSM with anorectal gonorrhea were clustered in urban areas, whereas those of MSM with anorectal chlamydial infection were more dispersed. CONCLUSION: Prevalences of anorectal chlamydial infection and gonorrhea among MSM in Seattle have increased dramatically over the past 3 years. Serovar and auxotype analyses indicate these increases are not clonal but are due to the spread of unique distributions of strains that differ from those causing urogenital infections in the same community.

Adult↗