Mycoplasma genitalium is associated with symptomatic urethritis.

In order to further investigate the epidemiology of Mycoplasma genitalium, 680 men attending departments of genitourinary medicine in Bristol, Bath and Truro were studied. M. genitalium was detected in 36 men (5.3%) and was present at all three clinics. Clinically, both urethritis and the presence of a urethral discharge and/or dysuria, but not penile irritation were independently associated with the detection of M. genitalium, the former being with the strongest association (odds ratio [OR] 10.76, 95% confidence interval [CI] [3.10-37.29], P < 0.0001; OR 3.01, 95% CI [1.28-7.05], P = 0.011 and OR 1.28, 95% CI [0.61-2.69], P = 0.51, respectively). In men with urethritis, those with a discharge and/or dysuria were more likely to have M. genitalium detected (OR 2.61, 95% CI [1.09-6.25], P = 0.032). We found no association with younger age or a recent change of sexual partner. In conclusion, M. genitalium is associated with symptomatic urethritis.

Occupational exposure to methamphetamine in workers preparing training AIDS for drug detection dogs.

As a part of ongoing testing of personnel preparing training aids for drug detection dogs at the Naval Criminal Investigative Service Regional Forensic Laboratory, personnel handling methamphetamine (MTH) were subject to voluntary urine drug testing. This provided a model of potential unwitting or environmental exposure contribution to MTH concentrations in urine. Urine samples were collected from multiple individuals on the day before, the day of, and the day after the individuals had handled up to 500-g quantities of MTH during the assembly of training aids. Personnel wore gloves, dust masks, and lab coats during the preparation of training aids. A total of 101 urine samples were analyzed for the presence of MTH and amphetamine (AMP) by gas chromatography-mass spectrometry after solid-phase extraction and derivatization. Urine samples collected during and after personnel handled drug yielded a mean MTH concentration of 48 ng/mL with a maximum concentration of 262 ng/mL and a minimum detected concentration of approximately 1.6 ng/mL. Thirty-five of the 52 post drug-handling samples had detectable MTH. Ten of the samples had MTH concentrations above the method limit of quantitation of 15 ng/mL. Only one sample had a concentration greater than 50 ng/mL. None of the samples had detectable AMP. From this limited study, it was evident that handling of MTH under these conditions resulted in minimal exposure and small but detectable concentrations of MTH in urine.

Candidaemia: risk factors in patients with cystic fibrosis who have totally implantable venous access systems.

Patients with cystic fibrosis who have totally implantable venous access devices often have other consequences of their multi-system disease which predispose them to catheter-associated systemic infection. We describe four episodes of fungaemia in three patients. Each case presented with persistent fever during an acute respiratory exacerbation. The four episodes were successfully treated, but removal of the venous access device was necessary in each case. Identified risk factors for systemic fungal injection were: combinations of a severe background respiratory deficiency; an acute respiratory exacerbation; malnutrition; repeated and frequent broad spectrum antibiotic therapy; parenteral nutrition; and diabetes mellitus. Unexplained fever in high risk patients with cystic fibrosis who have indwelling venous access systems should be treated empirically with antifungal agents while awaiting blood culture results. If fungaemia is confirmed the venous access device must be removed. Daily prophylactic fluconazole may prevent recurrences.

Antiretroviral therapy in HIV infection: are we using resources appropriately and cost effectively?

The provision of antiretroviral therapy to HIV-positive patients attending the Department of Genitourinary Medicine at the Royal Infirmary of Edinburgh was assessed, to examine whether clinicians were offering treatment in line with the departmental protocol. A total of 195 patients attended in 1998, of whom 169 fulfilled the protocol criteria for treatment. Although only 115 of these were on therapy, no patient who fulfilled treatment criteria and wished to be treated was denied treatment. Of the 26 patients not fulfilling any treatment criteria, 9 had transferred in from another unit already on treatment. The remaining 17 were not on treatment.

Historical disclosure of rape by women attending genitourinary medicine clinics.

In a previous internal audit of women attending the department of genitourinary medicine following rape, we noted that data from diagnostic coding seemed to underestimate the problem and that anecdotally, a number of women had been seen with concerns relating to historical assault. We therefore decided to record attendance following rape prospectively. Between 1 June 1996 and 31 May 1997 staff at the Department of Genitourinary Medicine (GUM) at the Royal Infirmary of Edinburgh completed a data collection form for every female patient aged >15 years who attended the clinic and spontaneously disclosed a history of rape, either recent or historical. Seventy-five women attending GUM disclosed a history of rape. Sixty-six per cent were aged <25 years. Thirty women presented more than 12 months after the incidence, of whom 50% presented to the health adviser requesting HIV antibody testing. The incidence of sexually transmitted infections was low and in no case could be specifically attributed to the rape. None of the 38 HIV antibody tests performed were positive. A number of women present to GUM a long time after an incident of rape, most commonly due to concerns about HIV. They may have endured a great deal of mental anguish before summoning up the courage to seek help. This can have a substantial effect on workload, especially for health advisers.

Loss of THCCOOH from urine specimens stored in polypropylene and polyethylene containers at different temperatures.

The loss of delta9-tetrahydrocannabinol (THCCOOH) from urine specimens stored in polypropylene and polyethylene containers at 4 degrees C and 25 degrees C was examined. All specimens were analyzed by GC-MS after sampling at various times over a one-week period. Data were analyzed by one-way analysis of variance and fitted with a first order kinetic equation. Rapid loss of THCCOOH was seen at 4 degrees C for both polypropylene (14% maximal loss, t(1/2) = 0.53 min) and polyethylene (17% maximal loss, t(1/2) = 5.77 min) bottles. At 25 degrees C, a small loss (< 5%) was observed in polypropylene and no significant loss was seen for urine in polyethylene. All losses stabilized within 1 h, and no further losses were seen over one week. The results indicate that THCCOOH binding may be due to decreased solubility of THCCOOH at lower temperatures and subsequent association of THCCOOH with the more lipophilic plastic. The results also indicate that polypropylene and polyethylene do not bind THCCOOH to such an extent as to compromise the integrity of specimens.

Solid-phase extraction and GC-MS analysis of THC-COOH method optimized for a high-throughput forensic drug-testing laboratory.

In order to facilitate the confirmation analysis of large numbers of urine samples previously screened positive for delta9-tetrahydrocannabinol (THC), an extraction, derivitization, and GC-MS analysis method was developed. This method utilized a positive pressure manifold anion-exchange polymer-based solid-phase extraction followed by elution directly into the automated liquid sampling (ALS) vials. Rapid derivitization was accomplished using pentafluoropropionic anhydride/pentafluoropropanol (PFPA/PFPOH). Recoveries averaged 95% with a limit of detection of 0.875 ng/mL with a 3-mL sample volume. Performance of 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH)-d3 and THC-COOH-d9 internal standards were evaluated. The method was linear to 900 ng/mL THC-COOH using THC-COOH-d9 with negligible contribution from the internal standard to very weak samples. Excellent agreement was seen with previous quantitations of human urine samples. More than 1000 human urine samples were analyzed using the method with 300 samples analyzed using an alternate qualifier ion (m/z 622) after some interference was observed with a qualifier ion (m/z 489). The 622 ion did not exhibit any interference even in samples with interfering peaks present in the 489 ion. The method resulted in dramatic reductions in processing time, waste production, and exposure hazards to laboratory personnel.

Gonococcal serovar patterns in Glasgow: 1990-1992.

Using monoclonal antibodies directed against protein 1 (major outer membrane protein) in the cell wall of Neisseria gonorrhoeae it is possible to serotype the gonococcus into different sub-groups. This study was designed to analyse the distribution of such serovars in Glasgow, Scotland, and report associations between serovars and clinical features of infection. N. gonorrhoeae isolated from all patients with a diagnosis of gonorrhoea attending genitourinary medicine clinics in Glasgow were serotyped between January 1990 and December 1992. The results were then correlated with sexual orientation of patients, penicillin sensitivity, site of infection, location of acquisition of infection and presence of symptoms. Six hundred and four episodes of gonococcal infection were analysed and an association between certain serovars with sexual orientation, penicillin sensitivity and asymptomatic infection was found. No association between serovar type and locality of acquisition of infection was apparent. Although there was a decreasing trend in the incidence of gonorrhoea overall, infections in homosexual men increased over the three-year study period. The associations between serovars and other features of gonococcal infection are discussed. The observed increase in homosexually-acquired infection has implications with regard to the spread of human immunodeficiency virus infection in this area, and suggests that attempts to promote safer sex in this group are failing.