Time trends in prevalence of cervical cytological abnormality in women attending a sexually transmitted diseases clinic and their relationship to trends in sexual activity and specific infections.

Trends in prevalence of cytological evidence of cervical intraepithelial neoplasia (CIN) and cervical infection with human papilloma virus (HPV), as indicated by HPV infection and dyskeratosis, were studied in 2,992 new attenders at a sexually transmitted diseases (STD) clinic between 1978 and 1982. Crude prevalence of CIN increased from 1.3% to 4.3% (P less than 0.001) and crude prevalence of HPV infection increased from 2.8% to 9.3% (P less than 0.001). Age adjustment had little effect on these trends. Review, in 1984-85, of samples of smears taken in 1978 and 1982 showed that recognition of koilocytosis by the laboratory had increased substantially over time while a tendency had developed to downgrade nuclear changes in the presence of koilocytosis. Correction of the 1978 and 1982 smear results to the 1984-85 classifications suggested that prevalence of koilocytosis had increased little (from 13.4% to 16.1%, P = 0.20) while there had been a substantial real increase in CIN (0.8% to 2.4%, P less than 0.001). To try to explain the trend in CIN, other characteristics of a sample of attenders at the STD clinic were studied. There were no appreciable trends in prevalence of past STD, number of sexual partners in the last 3 months, method of contraception, genital warts and culture of N. gonorrhoea, T. vaginalis, C. albicans and Chlamydia sp. from the vagina. There was an increase in the proportions in socioeconomic group I, as classified by postcode of residence (17.0% to 26.9%, P = 0.04), referred as contacts rather than with symptoms (24.0% to 41.6%, P less than 0.001), with a clinical diagnosis of genital herpes (5.0% to 8.6%, P = 0.08) and with herpes virus cultured from the cervix (2.1% to 6.3%, P = 0.03). The trend in prevalence of herpes virus infection was not explained by the other trends. It may explain the trend in prevalence of CIN.

Penicillin-sensitive spectinomycin-resistant Neisseria gonorrhoeae.

The first identification in Australia of a penicillin-sensitive spectinomycin-resistant Neisseria gonorrhoeae organism is reported. The method of identification is detailed. Caution is recommended in the use of spectinomycin for the primary treatment of gonorrhoea.

Association of genital adenovirus infection with urethritis in men.

Adenoviruses were isolated from the urethral swabs of 129 male patients in an STD clinic. After exclusion of patients with Chlamydia trachomatis or Neisseria gonorrhoea infections, 85 of the remaining 120 patients had urethritis, compared with 28 men with urethritis detected in a control group which was closely matched for age, sex, and date of specimen collection. This statistically significant difference suggests that genital adenovirus infection may be a cause of urethritis in some male patients.

Circumcision and sexually transmissible disease.

The relationship between circumcision and sexually transmissible disease was studied in 1350 men who attended the Public Health Department Special Treatment Clinic in Perth, Western Australia. Evidence of circumcision was obtained by examination. More than 98% of the men studied gave a verbal report of their circumcision status which was consistent with the examination findings. Eight hundred and forty-eight men had STD; 471 men, who presented to the clinic for diagnosis and treatment but who were found not to have STD, constituted the control group. The results of the study show significant associations between the state of being uncircumcised and four major sexually transmissible diseases--herpes genitalis, candidiasis, gonorrhoea and syphilis. Estimates of the relative risk suggest that uncircumcised men are twice as likely as circumcised men to develop herpes genitalis or gonorrhoea, and five times as likely to develop candidiasis or syphilis. However, the data for syphilis should be interpreted with caution because of the small number of cases. No significant increase in risk was found for any of the other sexually transmissible diseases diagnosed at the clinic.

Laboratory support in the management of syphilis.

Recent developments in syphilis serology are set down. The approach today is more rational as it has some basis in immunological understandings. In spite of improvements, syphilis serology continues to have limitations, and differentiating active from inactive cases remains taxing. In primary and secondary syphilis, dark-ground microscopy is still the quickest and surest way to make the diagnosis. In latent syphilis and in late and congenital cases, as well as in instances of other treponemal infections, serological evidence of disease needs to be considered along with each patient's medical, social and sexual history, when and why they may have been given antibiotic treatment, and the results of radiological studies and cerebrospinal fluid examination. For some syphilitics, the decision to treat or not to treat remains a matter of art rather than science.