Value of screening for oro-pharyngeal Chlamydia trachomatis infection.

AIMS: To determine whether oro-pharyngeal colonisation by Chlamydia trachomatis occurs in patients at risk of genital chlamydia infection; to determine whether screening pharyngeal specimens by polymerase chain reaction (PCR) increases detection of C trachomatis compared with isolation and the immune dot blot test; and to correlate the detection of C trachomatis and Neisseria gonorrhoeae in the pharynx with a history of oro-genital contact. METHODS: Thirteen homosexuals and 11 heterosexuals were included in the study. Urogenital and pharyngeal specimens were tested for C trachomatis and N gonorrhoeae using standard clinical diagnostic procedures. Two different PCR methodologies were also used to detect C trachomatis in the pharyngeal specimens. Results were correlated with the mode of sexual practice. RESULTS: Oro-genital sexual contact was practised by 64.9% (72/111) of heterosexuals in addition to penetrative penovaginal intercourse. Additionally, 62.1% (77/124) of all patients did not use any form of barrier protection. Of those who admitted to oro-genital sexual contact, 17.6% of patients with a genital chlamydial infection and 36.4% of those with genital gonorrhoea also had asymptomatic pharyngeal colonisation. C trachomatis was detected in three of 124 (2.4%) pharyngeal specimens by PCR which were reported as negative by chlamydial culture; one was positive by the immune dot blot test. CONCLUSION: The majority of patients practised unprotected oro-genital contact and significant pharyngeal colonisation by C trachomatis and N gonorrhoeae occurred if genital infection was present. Despite the use of PCR in a population at high risk of sexually transmitted disease, the prevalence of chlamydia in the pharynx was very low. This indicates that transmission of C trachomatis to the oro-pharynx does not pose a serious health risk and that screening of patients for oro-pharyngeal C trachomatis is not worthwhile.

Lifetime cost of treating a person with HIV infection.

A study was conducted to examine the inpatient, outpatient and drug therapy costs incurred from initial presentation with HIV infection or AIDS to death, where death occurred between 1990 and 1994. The average lifetime cost per patient was 18,729 pounds being made up of 8428 pounds for inpatient care, 2086 pounds for outpatient care and 8215 pounds for drug therapy. Sixty per cent of patients died at home. Active cytomegalovirus infection was the most common condition encountered in the high cost patients. Escalating drug costs may eventually lead to priority setting for the management of certain opportunistic infections.