Strategies for Disease Prevention and Health Promotion in Urban Areas: The Erice 50 Charter.

The Erice 50 Charter titled "Strategies for Diseases Prevention and Health Promotion in Urban Areas" was unanimously approved at the conclusion of the 50th Residential Course "Urban Health. Instruments for promoting health and for assessing hygienic and sanitary conditions in urban areas", held from 29th March to 2nd April 2017 in Erice, at the "Ettore Majorana" Foundation and Centre for Scientific Culture and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group "Building Hygiene" of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). At the conclusion of the intense learning experience during the Course, with more than 20 lectures, workshops and long-lasting discussions between Professors and Students, the participants identified the major points connecting urban features and Public Health, claiming the pivotal role of urban planning strategies for the management of Diseases Prevention and Health Promotion activities. The Erice 50 Charter is configured as a Decalogue for Healthy Cities and as a Think Tank for designing effective strategic actions and best practices to develop urban regeneration interventions and improve the urban quality of contemporary cities. The Decalogue is structured into the following key strategic objectives: 1. Promoting urban planning interventions that address citizens towards healthy behaviours; 2. Improving living conditions in the urban context; 3. Building an accessible and inclusive city, with a special focus on the frail population; 4. Encouraging the foundation of resilient urban areas; 5. Supporting the development of new economies and employment through urban renewal interventions; 6. Tackling social inequalities; 7. Improving stakeholders' awareness of the factors affecting Public Health in the cities; 8. Ensuring a participated urban governance; 9. Introducing qualitative and quantitative performance tools, capable of measuring the city's attitude to promote healthy lifestyles and to monitor the population's health status; 10. Encouraging sharing of knowledge and accessibility to informations. Finally, all the participants underlined that a multidisciplinary team, composed of Physicians specialized in Hygiene, Preventive Medicine, Public Health and Technicians as Architects, Urban planners and Engineers, is needed to deepen the research topic of Urban Health.

The sac-4 gene of Neisseria gonorrhoeae correlates with gonococcal subtype not co-existing chlamydial infection.

We examined the hypothesis that the sac-4 gene of Neisseria gonorrhoeae varies with gonococcal subtype and that this could account for an earlier report that sac-4 increased the likelihood of co-infection with Chlamydia trachomatis. A polymerase chain reaction (PCR) assay was used to determine the prevalence of sac-4 in 435 gonococcal isolates. The prevalence of sac-4 was analysed in relation to chlamydial co-infection, serovar, auxotype, gender and sexual orientation. Although the prevalence of sac-4 was higher in isolates from patients with chlamydial co-infection (55%) than in those without chlamydial co-infection (42%) the difference was not significant (P<0.05). Statistically significant differences in association with sac-4 were, however, shown between various serovars and auxotypes. Dual classification based on auxotype/serovar (A/S) classes showed highly significant differences in sac-4 prevalence between groups: 95% in NR/1B18 and 8% in P/1B2 (P<0.001). Sac-4 was also significantly less common (P<0.05) in isolates from homosexual men (35%) than from heterosexual men (49%) or women (49.5%). Sac-4 appears to have an epidemiological association with gonococcal auxotype and serovar rather than a direct association with chlamydial co-infection.

The sac-4 gene of Neisseria gonorrhoeae and co-existing chlamydial infection.

BACKGROUND/OBJECTIVES: Recently, the sac-4 gene in Neisseria gonorrhoeae was postulated to increase the risk of developing mixed gonococcal and chlamydial infection. The aims of this study were to determine the frequency of the sac-4 gene in a larger sample of isolates of different serovars and to assess the prevalence of sac-4 in gonococcal isolates from patients with and without coexisting chlamydial infection. METHODS: Isolates from 259 episodes of gonorrhoea were tested by a PCR assay for the sac-4 gene. The presence of co-existing chlamydial infection was determined from both laboratory and GUM clinical records. RESULTS: The overall prevalence of sac-4 was 57.5% (149/259). The prevalence was not the same in all serovars and ranged from 34.9% in serovar 1B2 to 100% in serovar 1B18. Exact logistic regression analysis indicated significant differences in sac-4 prevalence in isolates of different serovars. The prevalence of sac-4 was 69.5% (41/59) in gonococcal isolates from patients with co-existing chlamydial infection compared with 57.9% (62/107) for those without chlamydial infection. Exact logistic regression analysis showed that the slightly increased sac-4 prevalence among chlamydia positive patients (p = 0.2) virtually disappeared when serovar status was taken into account (p > 0.9). CONCLUSION: The sac-4 gene of the gonococcus does not increase the risk for mixed chlamydial infection.

Subtyping of high-level plasmid-mediated tetracycline resistant Neisseria gonorrhoeae isolated in Scotland between 1992 and 1998.

Tetracycline resistant Neisseria gonorrhoeae (TRNG) contain a 25.2 MDa TetM plasmid encoding a 68 KDa cytoplasmic protein which confers high-level tetracycline resistance. The aim of this study was to subtype all TRNG isolated in Scotland between 1992 and 1998. Subtyping was performed by a polymerase chain reaction (PCR) assay which characterizes the TetM plasmid as either the Dutch variant (443 base pair product) or the American variant (777 base pair product). Of the 78 TRNG isolates, 35 were the American variant and 43 were the Dutch variant. TRNG were distributed amongst 30 serovar/auxotype classes, the most common being 1A6/NR (11.5%), 1A6/P (14.1%) and 1B4/NR (14.1%). The country where infection was acquired was known for 36 of the 46 TRNG strains isolated between 1996 and 1998. All infections acquired in Asia and South America were the Dutch variant whereas all infections acquired in Africa were the American variant. A penicillinase plasmid was present in 66% (23/35) of the American variant TRNG compared with 51% (22/43) of the Dutch variant: the 3.2 MDa penicillinase plasmid was found in 87% of the American variant TRNG whereas the 4.4 MDa penicillinase plasmid was found in 68% of the Dutch variant TRNG. We conclude that subtyping of TRNG by PCR is a useful tool in studying the epidemiology of gonococcal infection due to plasmid-mediated resistant isolates.

Non-invasive screening of teenagers for Chlamydia trachomatis in a family planning setting.

One hundred women aged 20 or younger attending two family planning clinics specifically targeting teenagers were screened for Chlamydia trachomatis using first void urine specimens. An overall prevalence of 6.2 per cent was found, but there was a marked difference between women attending a city centre site (three per cent) and those attending a clinic in a small rural town.

PIP: Responsible for a significant proportion of all cases of pelvic inflammatory disease, Chlamydia trachomatis has been described as the most common treatable sexually transmitted infection in the developed world. Findings are presented from a study conducted to estimate the prevalence of chlamydial infection among young women under age 21 years attending 2 specialized family planning/sexual health clinics in Lothian, by using a urine test. One clinic was in the city at Dean Terrace Center, while the second clinic was a peripheral family planning clinic in a small West Lothian rural town approximately 15 miles from Edinburgh. 100 women aged 20 years or younger attending the 2 clinics specifically targeting teenagers were screened for infection with Chlamydia trachomatis using first void urine specimens. The overall prevalence of infection was 6.2%, 3% at Dean Terrace Center and 12.5% in the peripheral clinic, a statistically significant difference. All 6 women infected with Chlamydia were asymptomatic, nulliparous, and with no prior history of sexually transmitted disease. None of the 6 women were consistent users of condoms. Further research examining peripheral clinic settings in West Lothian is currently underway.

PCR testing of genital and urine specimens compared with culture for the diagnosis of chlamydial infection in men and women.

Our aim was to determine the number of chlamydial infections detected by Cobas Amplicor CT/NG multiplex polymerase chain reaction (PCR) testing of genital and first-voided urine (FVU) specimens compared with routine culture. Two hundred and eighty-six female and 276 male patients attending the Genito-Urinary Medicine (GUM) Unit at Edinburgh Royal Infirmary were included in the study. Case notes were analysed retrospectively to determine how many infected patients would not have been treated had diagnosis relied on routine culture. Polymerase chain reaction on FVU from women had a sensitivity, specificity, positive and negative predictive value of 91%, 100%, 100% and 99.1%: corresponding values for genital PCR and culture were 96%, 100%, 100%, 99.6% and 65%, 100%, 100%, 96.7% respectively. PCR on FVU from men had a sensitivity, specificity, positive and negative predictive value of 96%, 99.1%, 92.6% and 99.5%: corresponding values for genital PCR and culture were 89%, 99.5%, 95.8%, 98.6% and 48%, 100%, 100%, 94.3% respectively. In both men and women genital PCR and urine PCR were significantly more sensitive than culture. PCR almost doubled the number of patients detected by culture (49 vs 27). Of the 22 cases detected only by PCR 8 would not have received treatment on the basis of clinic treatment policy.

Detection of Chlamydia trachomatis in genital swabs: comparison of commercial and in house amplification methods with culture.

AIMS: To evaluate the sensitivity of the Roche Cobas, Roche Amplicor plate kit, ligase chain reaction (LCR), and an in house polymerase chain reaction (PCR) by titration of purified elementary bodies (EB) and also to test 245 urethral and endocervical specimens for Chlamydia trachomatis by the four assays as well as conventional culture. STUDY DESIGN: EB titrations were run in duplicate in each commercial assay and six times in the in house PCR. Clinical samples were aliquoted and tested by each assay and were considered positive if C trachomatis was detected by two or more separate tests or if the sample was either culture or immunofluorescence positive. Major outer membrane protein (MOMP) specific primers were used as a confirmatory assay for the in house PCR. RESULTS: The in house PCR, Roche Cobas Amplicor, LCR, and Amplicor plate kit gave detection limits of approximately 1, 1-2, 2, and 2-4 EBs respectively. By the criteria described above for definition of a C trachomatis positive result in clinical samples we identified 23 true positives among the 245 clinical specimens. The in house PCR detected all 23 giving a sensitivity of 100% and a specificity of 98%. The Roche Cobas Amplicor, Roche Amplicor plate kit, and LCR detected 21, 19, and 19 of these respectively giving sensitivities of 87.5%, 82%, and 82% respectively and specificities of 99.5%, 99%, and 100% respectively. The culture gave a sensitivity of 78% and specificity of 100%. CONCLUSION: All four amplification assays had a greater sensitivity than the culture used routinely in this laboratory. The in house plasmid PCR had the greatest sensitivity and when combined with confirmation by immunofluorescence detected the greatest number of positives. This increased sensitivity is likely to have been achieved by the use of a DNA purification step and of nested primers in the amplification stage and their combined use in routine diagnostic assays for chlamydia might increase the frequency of C trachomatis detections. However, this assay is much less user friendly than the two semiautomated commercial assays investigated in this study.

Chlamydia trachomatis detection by immunofluorescence: a comparison of two methods of slide preparation.

Two methods of slide preparation for the detection of Chlamydia trachomatis by immunofluorescence were compared. A total of 98 specimens submitted to the laboratory for chlamydial examination were processed using a cytocentrifuge and a microcentrifuge. The resulting slides were stained with a fluorescein-labelled monoclonal antibody and examined for elementary bodies. Of the 98 samples examined, 43 were positive (i.e. had at least 10 elementary bodies) in the cytocentrifuge preparation and 40 were positive in the microcentrifuge preparation. Fifty-two samples were negative in both preparations. The cytocentrifuge method was quicker, and resulted in flatter preparations which were easier to read except where there were too many cells.

Use of a commercial PCR kit for detecting Chlamydia trachomatis.

AIMS: To evaluate a commercial polymerase chain reaction (PCR) kit for the detection of Chlamydia trachomatis. METHODS: Two hundred and fifty seven genital specimens, which had been submitted in 2SP medium for chlamydial isolation and subsequently stored at -70 degrees C, were retrospectively examined by a commercial PCR kit which detects chlamydial plasmid DNA. Culture negative, PCR positive specimens were examined by immunofluorescence and an in-house major outer membrane protein (MOMP)-PCR. RESULTS: All 49 specimens which were culture positive were also PCR positive. Another 14 specimens were also PCR positive. After resolution of these results by immunofluorescence and a PCR assay for MOMP the sensitivity for PCR was 98.4% and that of culture 79%. The specificities were 99.5% and 100%, respectively. CONCLUSIONS: This kit, which is highly sensitive and specific, is straightforward to use and has a built-in safeguard against cross contamination. The role of this test in the examination of routine genital specimens from patients with uncomplicated chlamydial infection is questionable due to its expense. It may have a place in the investigation of trachoma or infertility, however, where it has been shown that DNA can be detected when culture is unsuccessful.