Further details on sequelae at the cervical and tubal level of Chlamydia trachomatis infection in infertile women.

OBJECTIVE: Relationships were studied between correlates of sexually transmitted diseases and chlamydial antibodies versus cervical mucus abnormalities and tubal abnormalities. An estimate was also attempted of the baseline prevalence of endogenous tubal abnormalities. DESIGN: Prospective, descriptive. SETTING: The outpatient department of the Fertility Unit of the Department of Obstetrics and Gynaecology of the Groningen University Hospital. PATIENTS: Females (n = 184) of infertile couples consecutively visiting the department for evaluation and treatment. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sexually transmitted disease correlates, cervical chlamydial infection, cervical and serum chlamydial antibodies, cervical mucus qualities according to World Health Organization criteria, tubal abnormalities. RESULTS: Of the 175 cervical mucus samples studied, subnormal quality was because of imperfect timing of collection of 22 of the 23 subnormal samples. Tubal abnormalities correlated with more than five lifetime sexual partners (P less than 0.035), as well as with serum immunoglobulin G antibodies (P less than 0.05), which could be because of interaction between both risk factors. CONCLUSIONS: No correlation was found between subnormal cervical mucus and chlamydial infection. Approximately two thirds of the tubal abnormalities seem unrelated to exogenous factors, although further study seems warranted.

Epidemiological aspects of chlamydial infections and tubal abnormalities in infertile couples.

Demographic and behavioural data on parameters of previous sexual behaviour were collected of both partners of 184 couples visiting the Department of Obstetrics and Gynaecology because of infertility. They were also screened for urogenital infection with Chlamydia trachomatis. Of 131 (71.2%) women, a diagnosis was established by hysterosalpingography and/or laparoscopy about the condition of their fallopian tubes. An unmarried status correlated significantly with a history of sexually transmitted disease, and with past promiscuity of male and female partner. Abnormalities of the fallopian tubes were significantly related to an unmarried status, a history of pelvic inflammatory disease, and past promiscuity. Male promiscuity was not shown to correlate with tubal abnormalities in the female partner. In only three couples, the partners reported to have had a sexual relationship with a partner other than the current one over the past year. The percentage of Chlamydia trachomatis-positive women of 1.8 and men of 3.0 in our study agrees with this low recent promiscuity. Chlamydia trachomatis was shown to be able to maintain itself for at least 4 years within a couple. The results are commented on.

Direct immunofluorescence for Chlamydia trachomatis on urogenital smears for epidemiological purposes.

A population of 197 asymptomatic women, attending an out-patient department for birth-control advice, was screened for urogenital infection with Chlamydia trachomatis by direct immunofluorescence on cervical and urethral smears. A blood sample was obtained for chlamydial serology and demographic, behavioural and clinical data were recorded. Eleven (5.5%) women had a chlamydial infection. Chlamydial infection, as diagnosed with direct immunofluorescence, correlated with a history of sexually transmitted disease (p less than 0.01), promiscuity (p less than 0.01), use of oral contraceptives (p less than 0.02) and high chlamydial antibody titres (p less than 0.01). These last also correlated with a history of sexually transmitted disease (p less than 0.02) and promiscuity (p less than 0.02). These results, obtained with direct immunofluorescence, are indistinguishable from those obtained previously with chlamydial culture. Direct immunofluorescence on urogenital smears seems a valuable tool for epidemiological investigation. Our data also support the hypothesis that oral contraceptive use is correlated with chlamydial infection because of increased cervical susceptibility to infection and not because of a sampling bias towards oral contraceptive users.

[Chlamydia trachomatis infection in women and the use of oral contraceptives]. / Chlamydia trachomatis-infectie bij de vrouw en het gebruik van orale anticonceptiva.

We determined the prevalence of genital Chlamydia trachomatis infection in women who visited a clinic for sexually transmitted diseases (STD) and the influence of the number of partners and the use of oral contraceptives (OC), with special attention to the recognition of pelvic inflammatory disease (PID) and to the results of therapy. Of 217 women, with a mean age of 26 years (range 14-56), who visited the STD clinic of the University Hospital of Groningen from July 1985 until November 1987, anamnestic data were collected as well as the results of swabs from cervix and urethra taken for culture and direct immunofluorescence test of C. trachomatis and for gonococcal culture. The influence of the number of partners (1 versus greater than 1) and OC on the prevalence of C. trachomatis infection was evaluated by logistic regression analysis. PID was excluded in coöperation with the department of gynaecology. C. trachomatis-infected women were treated by doxycycline orally (day 1 2 x 100 mg, day 2-7 1 x 100 mg) according to the dosage scheme advised by the Dutch Health Council in 1986. A control culture was taken 2-3 weeks after treatment. C. trachomatis was detected in 72/217 (33%) women by culture and (or) direct IF test and in 22/41 (54%) women with gonorrhoea. In connection with the number of partners in the year preceding the examination, the following prevalences were found: 18/74 (24%) (1 partner), 43/108 (40%) (2-5 partners) and 10/27 (greater than 5 partners).(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: The authors determined the prevalence of genital Chlamydia trachomatis infection in women who visited a clinic for sexually transmitted diseases (STDS) and the influences of the number of partners and of the use of oral contraceptives (OCs), with special attention paid to the recognition of pelvic inflammatory disease (PID) and to the results of therapy. Of 217 women with a mean age of 26 years (range 14-56), who visited the STD clinic of the University Hospital of Groningen from July 1985-November 1987, anamnestic data were collected as well as the results from swabs of the cervix and urethra taken for culture and direct immunofluorescence (IF) test of C. trachomatis and for gonococcal culture. The influence of the number of partners (1 vs 1) and OCs on the prevalence of C. trachomatis infection was evaluated by logistic regression analysis. PID was excluded in cooperation with the department of gynecology. C. trachomatis-infected women were treated by doxycycline orally (day 1, 2x 100 mg, days 2-7, 1x 100 mg) according to the dosage scheme advised by the Dutch Health Council in 1986. A control culture was taken 2-3 weeks after treatment. C. trachomatis was detected in 72/217 (33%) of the women by culture and/or direct IF test and in 22/41 (54%) women with gonorrhea. In connection with the number of partners in the year preceding the examination, the following prevalences were found: 18/74 (24%, 1 partner), 43/108 (40%, 2-5 partners), and 10/27 (5 partners). The prevalence among OC-using women was significantly higher (p0.05) than in non-OC using women: 44.101 (44%) vs 21/93 (23%). This was also true when OC users were compared to sterilized women (9/47, 19%), regardless of number of partners and age. Active PID was found in 2 women, both infected. After treatment with positive C. trachomatis cultures, control cultures were negative in 39/40 (98%). A relatively high prevalence of genital C. trachomatis infection is found in women visiting STD clinics, as well as in women with only 1 partner during the year preceding the examination. This study supports the hypothesis of OC use being a risk factor. How OC use influences PID risk is not fully understood. Within the framework of reliable contraception and prevention of STD complications, the combination of OC + a barrier method should be advised to women without a steady partner. Further study is necessary to determine whether preventive antibiotic treatment of asymptomatic adolescents with anamnestic risk factors for C. trachomatis infection is indicated at the start of a new relationship. (author's modified)

[An adenovirus epidemic in patients with kidney transplantation]. / Een adenovirusepidemie onder niertransplantatiepatiënten.

During weekly routine virological screening of kidney transplant patients 12 out of 15 patients within a period of four months were found to be infected with adenovirus. All isolates were of the same serotype, type AdII + 35/HII. However, DNA restriction enzyme analyses showed the presence of two different DNA variants which were associated with three different epidemiological episodes. The epidemic probably started with reactivation of latent virus in a limited number of patients, after which it spread nosocomially. None of the patients showed signs or symptoms clearly attributable to adenoviruses, although adenovirus could not be excluded as a cofactor in the fatal outcome of hepatitis in one of the patients. Adenovirus apparently can easily spread nosocomially. Since literature data suggest that adenovirus infections of transplant patients may result in serious complications, adenovirus should not be neglected in virological screening protocols for kidney transplant patients.

[Chlamydia trachomatis diagnosis in women: the value of serological studies and of culture of cervical and urethral swabs]. / Chlamydia trachomatis-diagnostiek bij de vrouw: de waarde van serologisch onderzoek en van kweek van materiaal uit cervix en urethra.

We studied the value of the determination of the serum IgM antibody level for the diagnosis of genital Chlamydia trachomatis infection in women and the value of the urethra in addition to the cervix as a sampling site for the diagnosis of C. trachomatis infection by culture and direct immune-fluorescence (IF) test. Of 205 women, mean age 26 years (range 14-56), who visited the Sexually Transmitted Disease clinic of the University Hospital Groningen from July 1985 until November 1987, single serum samples were obtained for the determination of IgM and IgG anti-C. trachomatis antibodies using FITC conjugates, in addition to swabs of cervix and urethra for culture and direct IF test. In women with a negative culture and positive IgM serology the culture was repeated. The culture was used as golden standard. In 17/205 (36%) women positive C. trachomatis IgM serology (greater than or equal to 1:32) and in 190/205 (93%) positive IgG serology (greater than or equal to 1:40) was found. In 67/205 (33%) women the C. trachomatis culture of cervix and (or) urethra was positive. The positive and negative predictive values of C. trachomatis IgM serology were 41% and 72%. In 3/20 women with negative culture results and positive IgM serology a second culture was positive. In 176 women, of whom samples from both cervix and urethra were available, the only C. trachomatis positive site by culture was the urethra in 7/54 (13%) and by direct IF in 3/42 (7%). The increase in the prevalence obtained by collecting material not only from the cervix but also from the urethra was 4% by culture and 2% by direct IF.2+n

[Lambing ewes as a source of severe psittacosis in a pregnant woman]. / Lammerende schapen als bron van ernstige psittacose bij een zwangere.

The first documented Dutch case of an ovine Chlamydia psittaci infection concerned a 20-year-old woman in the 26th week of pregnancy, following contact with lambing sheep. She had a severe sepsis and had to be artificially ventilated. Finally, the patient made a full recovery. The preterm born child died directly after birth. The placenta showed an acute intervillitis in which chlamydial antigen was demonstrated immunohistologically. Infection with an ovine C. psittaci was confirmed by sequence analysis of amplified chlamydial DNA from the placenta. Infections with C. psittaci are typically associated with contact with (sick) birds. However, mammals also may act as a source of human infection, especially sheep in which C. psittaci is an important cause of abortion. Infections with ovine C. psittaci are a particular hazard for pregnant women, in whom there is severe placentitis and frequently foetal loss. Such infections are mainly associated with contact with lambing sheep.

Acute facial paralysis: a virological study.

A serological study using the complement fixation reaction for herpes zoster virus (HZV) and herpes simplex virus (HSV) was carried out on 120 patients with Bell's palsy and 5 with Ramsay-Hunt syndrome. Three Bell's palsy patients (2.5%) showed a significant HZV antibody titre rise. In no case was a rise of HSV antibody titre observed. Two Ramsay-Hunt patients showed a significant rise of HZV antibody titre. Rise of HSV antibody titre was not observed in this group either. The Monosticon test to exclude infectious mononucleosis, proved to be negative in all cases of Bell's palsy. In 2 cases of Bell's palsy, a biopsy specimen for virus isolation was obtained during a decompression operation. No virus could be cultured from the epineurium of the first patient. That of the second patient was found to contain HSV type I. There was no serological evidence of a HSV antibody titre rise.

Chlamydia trachomatis infection in a high-risk population: comparison of polymerase chain reaction and cell culture for diagnosis and follow-up.

A study to compare the polymerase chain reaction (PCR) test with the cell culture method in diagnosing urogenital Chlamydia trachomatis infections was performed. From 497 patients (212 women, 285 men) attending an outpatient clinic for sexually transmitted diseases, a total of 814 samples (female patients, cervix and urethra; male patients, urethra) were collected. This total included follow-up samples from 35 women and 35 men positive for C. trachomatis by cell culture and/or PCR test, which were collected 2 weeks after treatment with doxycycline (two 100-mg doses per day for 7 days). The PCR test was performed directly on clinical samples without performing phenol-chloroform extraction and ethanol precipitation of DNA. The prevalence of C. trachomatis as measured by positive cell culture was 64 of 497 (12.9%) for all patients, 31 of 212 (14.6%) for women, and 33 of 285 (11.6%) for men. The prevalences as measured by positive PCR test were 71 of 497 (14.3%), 36 of 212 (17.0%), and 35 of 285 (12.3%), respectively. The sensitivities of the cell culture and the PCR test compared with that of true-positive samples were 77.5 to 78.4% and 99.0 to 100.0%, respectively. Discrepancies between cell culture and the PCR test were found for 23 of 497 patients (4.9%), 19 of 212 females (9.0%), and 4 of 285 males (1.4%). Nineteen pretreatment samples from 19 patients (4 female endocervical, 13 female urethral, and 2 male urethral samples) were cell culture negative and PCR test positive, while 1 pretreatment female endocervical sample was cell culture positive and PCR test negative. The posttreatment samples from all patients were cell culture negative, but the PCR test remained positive for 3 of 70 patients (1 female endocervical and 2 male urethral samples). One of these samples became spontaneously negative in three more weeks. The medical history of the individual patient and the negative PCR tests after treatment for nearly all patients support our hypothesis that the positive PCR test results were clinically relevant for the cell culture-negative but PCR test-positive but PCR test-positive patients of the population studied.

Rapid detection of respiratory viruses using mixtures of monoclonal antibodies on shell vial cultures.

Eleven hundred and thirty-three clinical specimens submitted to the laboratory for diagnosis of respiratory virus infections were tested by direct immunofluorescence (DIF) for respiratory syncytial virus (RSV), by shell vial culture, and by conventional cell culture. The shell vial cultures were stained with 8 different monoclonal antibodies both 1 day and 3-7 days after inoculation. In order to limit the cost and the workload, mixtures of monoclonal antibodies were used. Coverslips with HEp-2 cells were incubated with a mixture of FITC-labeled monoclonal antibody to RSV and nonlabeled monoclonal antibody to adenovirus. When no RSV positive IF staining was observed after the first incubation step, the same coverslip was incubated once more with FITC-labeled anti-mouse antibody. A positive reaction at this stage indicated the presence of adenovirus. Similarly, cultures of tertiary monkey kidney cells were investigated with a mixture of two FITC-labeled monoclonals to the influenza viruses A and B and three nonlabeled monoclonals to the parainfluenza viruses 1, 2 and 3. If influenza virus or parainfluenza virus was detected, the exact type was determined by staining different parts of a duplicate coverslip. Shell vial cultures for cytomegalovirus (CMV) were always performed separately on human embryonic lung fibroblasts. Using this approach, we detected RSV (n = 248), CMV (n = 42), parainfluenza virus (n = 31), influenza virus (n = 28), and adenovirus (n = 6), in most cases after only one day of culture. For RSV, the sensitivity of the shell vial method was too low (74%) to allow omission of DIF (sensitivity 95%).(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiological evidence of cervical intraepithelial neoplasia without the presence of human papillomavirus.

The aim of this paper was to provide epidemiological evidence to support the notion that cervical intraepithelial neoplasia (CIN) without human papillomavirus (HPV) is a true entity. If a diagnosis of HPV-negative cervical neoplasia is erroneous, one would not expect there to be any differences in risk factors between HPV-positive and HPV-negative patients. Patients at a gynaecological outpatient clinic of a university hospital [a total of 265 consecutive women with dyskaryotic cervical smears who were subsequently diagnosed with CIN I (n=37), CIN II (n=48) or CIN III (n=180)] completed a structured questionnaire regarding smoking habits and sexual history. Analysis of an endocervical swab for Chlamydia trachomatis, analysis of a cervical scrape for HPV, and morphological examination of cervical biopsy specimens were also performed. HPV was found in 205 (77.4%) out of the 265 women. Univariate analysis showed that current age (P=0.02), current smoking behaviour (P=0.002) and the number of sexual partners (P=0.02) were significantly associated with the presence of HPV. Age at first sexual intercourse, a past history of venereal disease or genital warts, and current infection with Chlamydia trachomatis were not associated with the presence of HPV. Using multivariate logistic regression analysis, the number of sexual partners and current smoking behaviour showed an independent significant association with HPV. HPV-negative and HPV-positive CIN patients differ with respect to the risk factors for HPV. These findings suggest that HPV-negative CIN is a separate true entity.

Cold urticaria and virus infections: a clinical and serological study in 39 patients.

Thirty-nine patients with cold urticaria seen over a 12-year-period were re-examined. All but 12 still had positive skin tests for cold and only five of these had shown a spontaneous cure. Fourteen patients were prone to collapse on cold exposure. The incidence of atopy in this group was comparable to that in control groups. Cold urticaria is an extremely chronic disease. The mean disease duration was 9.3 years. Serum antibodies to Epstein-Barr virus, measles virus, cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), Chlamydia psittaci and Mycoplasma pneumoniae were determined in all 39 patients and compared with control groups. The EBV-antibody patterns (heterophile antibodies and different types of EBV-specific antibodies) showed no evidence of current or of recent primary or secondary infection with EBV. Complement fixing antibody titres to measles virus, CMV, HSV and Mycoplasma pneumoniae were significantly higher in cold urticaria patients than in controls. The existence of a basic immuno-regulatory defect responsible for both the cold urticaria and the elevated antibody levels is proposed.

Prevalence, incidence, and risk of acquiring urogenital gonococcal or chlamydial infection in prostitutes working in brothels.

At two week intervals specimens were taken from 24 prostitutes working in two brothels and cultured for urogenital infection with Chlamydia trachomatis and Neisseria gonorrhoeae. Demographic and clinical data were also collected. C trachomatis was found initially in four and N gonorrhoeae in two of the 20 women at risk of infection. During the study period three new chlamydial and gonococcal infections were diagnosed, resulting from 949 unprotected contacts. Eight women (33%) had developed salpingitis, in contrast to 15% in the general female population. An attempt was made to estimate the infectivity of C trachomatis for the prostitutes. The epidemiological importance of the chlamydial and gonococcal reservoir in the prostitutes was also considered.

Rapid detection of varicella-zoster virus in clinical specimens using monoclonal antibodies on shell vials and smears.

Monoclonal antibodies were used for detecting varicella-zoster virus (VZV) by immunofluorescence (IF) in clinical specimens inoculated on shell vial cultures. Vesicles of 74 patients with varicella or herpes zoster-like eruptions were tested by this method and by conventional cell culture. Further diagnostic tests were direct IF on smears (42 patients), the cytological Tzanck test (28 patients), and serology (30 patients). Both IF assays were performed with the commercial VZV-specific monoclonal antibody 3B3 (Ortho). Using the shell vial technique, we found VZV in 37 (50%) of the patients, on average after 3 days. The conventional culture method yielded 26 positives (35%), on average after 7.5 days. Twenty-nine of the shell vial IF-positive patients were also positive by direct IF on smears (30 tested), while 15 gave positive Tzanck smears (18 tested). The sensitivities of the shell vial IF test, the direct IF test, the conventional culture method, and the Tzanck test were about 95%, 97%, 70%, and 79%, respectively. For the specificities, we found at least 97% for the shell vial IF test, at least 91% for the direct IF test, and about 78% for the Tzanck test. We conclude that both VZV IF tests are much more reliable than the conventional cell culture method and the Tzanck test for the laboratory diagnosis of VZV infections.

Rapid detection of infectious cytomegalovirus in blood with the aid of monoclonal antibodies.

The recently developed early antigen immunofluorescence (IF) method for the detection of infectious cytomegalovirus (CMV) in clinical specimens has hardly been applied on blood samples. We compared the CMV early antigen detection technique with the conventional cell culture method in 415 different buffy coat samples from 85 different immunocompromised patients. Duplicate coverslips were stained with two different monoclonal antibodies 4-6 days after inoculation. The conventional cultures were examined for typical cytopathic effects (CPE) during 10 weeks. Forty samples from 19 patients were positive by the IF technique, most of them with both monoclonal antibodies. Only 22 of these samples were positive in the conventional cell culture assay, on average after 15.8 days. CMV viraemia was detected exclusively by the IF method in 18 samples, 7 of which were from five patients without any further evidence of an active CMV infection. CMV viraemia was detected exclusively by the CPE method in eight samples, on average after no less than 36.6 days. CMV viraemia was not found in blood samples from 10 patients with laboratory proven active CMV infections and 53 patients without any evidence of an active CMV infection. In our hands the early antigen method for the detection of infectious CMV in blood is nearly as specific (at least 98.1%) and clearly much faster and more sensitive than the conventional cell culture method. The early CMV antigen detection method is therefore a very useful tool for the rapid detection of infectious CMV in blood.