Sexually transmitted diseases are common in women attending Jamaican family planning clinics and appropriate detection tools are lacking

OBJECTIVES: To assess sexually transmitted diseases (STD) among women attending Jamaican family planning clinics and to evaluate decision models as alternatives to STD laboratory diagnosis. METHODS: Women attending two family planning clinics in Kingston were interviewed and tested for syphilis seroreactivity using toluidine red unheated serum test and Treponema pallidum haemagglutination, for gonorrhoea using culture, for chalamydial infection using enzyme linked immunoassay, and for trichomoniasis using culture. Urine was tested with leucocyte esterase dipstick (LED). The women were treated based upon a clinical algorithm. Computer simulations explored the use of risk inclusive decision models for detection of cervical infection and/or trichomoniasis. RESULTS: Among 767 women, 206 (26.9 percent) had at least one STD. The prevalence of gonorrhoea was 2.7 percent: chlamydial infection 12.2 percent, gonococcal and/or chlamydial cervical infection 14.1 percent; trichomoniasis 11.5 percent; syphilis seroreactivity 5.9 percent. The clinical algorithm was 3.7 percent sensitive and 96.7 percent specific in detecting cervical infection. Detection of cervical infection and/or trichomoniasis was 63.5 percent sensitive and 60.6 percent specific using LE and 57.7 percent sensitive and 46.2 percent specific using the risk inclusive algorithm employed in Jamaica STD clinics. Either cervical friability or LED (+) or family planning clinic attender less than 25 years old with more than one sexual partner in the past year was 72.5 percent sensitive and 53.3 percent specific. The positive predictive values of the STD clinic algorithm, LED, and two developed decision models ranged from 25.0 percent to 33.4 percent to detect cervical infection and/or trichomoniasis in these women. CONCLUSION: STDs were quite prevalent in these mainly asymptomatic family planning clinic attenders. None of the evaluated decision models can be considered a good alternative to case detection using laboratory diagnosis. Appropriate detection tools are needed. In the meantime, available STD control strategies should be maximised, such as promotion of condom use; adequate treatment of symptomatic STD patients and partners; and education of women and men (AU)

The methylene blue reduction test: evaluation of a screening method for glucose-6-phosphate dehydrogenase deficiency

Male and female neonates, children and adults, and patients with hemolytic anemia, in whom subnormal erythrocye glucose-6-phosphate dehydrogenase deficiency was demonstrated on spectrophotometric assay, were all detected using the methylene blue reduction screening test. This finding and the results of mixing experiments suggested that it is as sensitive as the assay. Offering advantages over the screening tests, it is useful for surveys and for routine laboratory work. (AU)

A histochemical investigation of the concept of placental insufficiency

This thesis is an account of some histochemical characteristics of placental tissue and their relationships to ageing and possibly to conditions associated with placental insufficiency. The introduction is a review of the clinical, experimental, and anatomical evidence for the concept of placental insufficiency. Using histochemical methods, the distribution and quantities of 10 enzymes were studied in 91 placentae representing normal and various types of abnormal pregnancies. Alkaline phosphatase and glucose - 6 - phosphatase showed a rising concentration in the trophoblast in late pregnancy. This rise was more marked and appeared earlier in placentae from patients with severe pre-eclampsia. Placentae from patients with pre-existing hypertension did not appear to differ from normal ones of similar periods of gestation. Acid phosphatase was localised in the trophoblast and decreased in amount in late pregnancy. This decrease was more marked, and occurred earlier in placentae from cases of severe pre-eclampsia and pre-existing hypertension than in normal placentae. Lactate dehydrogenase; malate dehydrogenase; di-phosphopyridine nucleotide diaphorase(D.P.N.D.); alpha-glycerophosphate dehydrogenase; and glucose - 6 - phosphate dehydrogenase were all present in the trophoblast throughout pregnancy without showing any apparent change in concentration. Succinate dehydrogenase could not be found in the trophoblast at any time, occurring only in the decidual cells of the placental bed. Leucine amino-peptidase showed a patchy distribution throughout the connective tissue stroma of the chorionic villi and within the walls of the larger blood vessels. It was concluded that the increasing concentration of alkaline phosphatase and glucose - 6 - phosphatase, and the decreasing concentration of acid phosphatase in the trophoblast are probably features of placental ageing, and may also be associated with placental insufficiency (Summary)