High prevalence of antibodies to Mycoplasma penetrans in human immunodeficiency virus-seronegative and -seropositive populations in Brazzaville, Congo.

In industrialized countries, the prevalence of antibodies to Mycoplasma penetrans is higher among human immunodeficiency virus (HIV)-seropositive homosexuals than other HIV-seropositive and HIV-seronegative groups. In an African heterosexual population, we found a higher prevalence of M. penetrans antibodies in HIV-seronegative blood donors (15.5%) than in France (0.9%) or the United States (0.3%) and a prevalence of 13.4% in HIV-seropositive individuals. HIV-seropositive individuals with less than 5% CD4 cells had a higher prevalence of M. penetrans antibodies than individuals with 5% or more CD4 cells (25.0 versus 8.5%).

PIP: Numerous studies in developed countries have revealed a higher prevalence of antibodies to Mycoplasma penetrans in homosexuals infected with HIV than in other HIV-positive and HIV-negative population groups. To confirm whether this association prevails in African countries, a cross-sectional analysis was conducted in Brazzaville, Congo, in 1993-94. Tested were 116 HIV-negative blood donors and 149 HIV-infected hospital patients. The prevalence of antibodies to M. penetrans was 13.4% in the HIV-positive and 15.5% in the HIV-negative group. Among HIV-infected patients, M. penetrans seropositivity was more frequent among patients under 30 years of age, those with CD4 lymphocyte counts below 200 cells/cu. mm, and those with CD4 lymphocyte percentages below 5%. This correlation between the prevalence of antibodies to M. penetrans and the severity of immunosuppression has been documented in studies from France and the US as well. The high prevalence of antibodies to M. penetrans in the late stages of HIV infection in Western homosexuals and Congolese heterosexuals may reflect a cohort effect in which the groups most exposed to HIV at the beginning of the epidemic were also those most exposed to M. penetrans infection. It is also possible that the development of M. penetrans is due to immunosuppression or, alternatively, infection influences HIV multiplication.

Prevalence of vaginal infections with bacterial vaginosis, Trichomonas vaginalis and Candida albicans among pregnant women at the Port Moresby General Hospital Antenatal Clinic.

A clinico-sociodemographic and microbiological survey was carried out at the Port Moresby General Hospital Antenatal Clinic to determine the prevalences of bacterial vaginosis, Trichomonas vaginalis and Candida albicans vaginal infections in pregnancy and to examine if the infections had any association with some suspected sociodemographic risk factors. The study was carried out between December 1990 and January 1991. Of 206 consecutive subjects surveyed, 79 (38%) had symptomatic infection. However, on speculum examination, abnormal discharge was seen in 188 (91%). 118 (57%) had microbiologically confirmed infection. The prevalences of the individual infections were T. vaginalis 19%, C. albicans 23% and bacterial vaginosis 23%. Combined infection, i.e. two infections occurring together in the same subject, was uncommon. None of the infections had an association with any of the sociodemographic characteristics studied. Of the 118 positive subjects, 52 (44%) complained of vaginal discharge and 55 (47%) complained of pruritus.

PIP: The prevalences of vaginal infections with Trichomonas vaginalis, bacterial vaginosis, and Candida albicans were investigated in 206 consecutive pregnant women presenting to Port Moresby (Papua New Guinea) General Hospital in 1990-91 for their first antenatal visit. Bacteriologic investigation identified Candida in 48 women (23%), T. vaginalis in 39 (19%), and bacterial vaginosis in 48 (23%). Overall, 118 women (57%) were bacteriologically positive for at least one infection. 79 (38%) of the infected women complained of a vaginal discharge and 78 (38%) reported vulvar irritation; however, vaginoscopy revealed abnormal discharge in 188 (91%) of women with an infection. Infection was not associated with gestational age or any of the sociodemographic variables examined (age, parity, ethnic group, residence, husband's education). The fact that the majority of pregnant women in this series had a vaginal infection is alarming in light of the hypothesized association of such infections with intra-amniotic infection, endometritis, premature rupture of the membranes, preterm labor or birth, and low birth weight. A randomized, controlled prospective study is needed to assess the extent to which, if any, these infections are related to the high perinatal morbidity and mortality from low birth weight at Port Moresby General Hospital.

HIV serosurveillance in Papua New Guinea.

To determine human immunodeficiency virus-1 (HIV-1) prevalence in low- and high-risk populations in Papua New Guinea (PNG), anonymous unlinked serosurveillance was conducted in government-administered antenatal and sexually transmitted disease (STD) clinics at six sites beginning in June 1989. Although 3 of 1233 samples were HIV positive in a pilot study, none of 7948 samples was HIV positive during the first full year of serosurveillance (June 1989--May 1990). HIV-infected people are also identified in PNG through clinical diagnostic testing. Although underreporting is probably substantial, 45 HIV-infected people had been identified in PNG (population 3.6 million) through diagnostic testing between 1987 and the end of the first serosurveillance year (May 1990). In view of the steadily emerging clinical problem of acquired immune deficiency syndrome (AIDS) in PNG, the negative results of serosurveillance required explanation. Three possibilities are proposed: 1) the sample size chosen could fail to detect a case 5% (or more) of the time under the likely conditions of this survey; 2) the populations chosen for surveillance may not, yet, be those in which HIV is circulating at this early stage of the epidemic in PNG; and 3) laboratory error could account for some false negative results. The first two of these, alone or in combination, are most likely. Limited surveillance continued in PNG in 1991 and 1992. By June of 1992, 5 of an additional 6035 serosurveillance samples had tested positive. All 5 were among 2000 samples from a single site, the Port Moresby STD Clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: To determine human immunodeficiency virus-1 (HIV-1) prevalence in low- and high-risk populations in Papua New Guinea (PNG), anonymous unlinked serosurveillance was conducted in government-administered antenatal and sexually transmitted disease (STD) clinics at 6 sites beginning in June 1989. Samples were tested in each local hospital laboratory for syphilis reactivity (VDRL) and for antibodies to HIV-1 (Serodia-HIV, Fujirebio). Positive Serodia specimens were forwarded for enzyme immunoassay (EIA) testing. If positive or indeterminate on EIA testing, Western blot confirmatory testing was conducted. Although 3 of 1233 samples were HIV positive in a pilot study, none of 7948 samples were HIV positive during the first full year of serosurveillance (June 1989-May 1990). HIV-infected people are also identified in Papua New Guinea through clinical diagnostic testing. Although underreporting is probably substantial, 45 HIV-infected people had been identified in Papua New Guinea (population 3.6 million) through diagnostic testing between 1987 and the end of the first serosurveillance year (May 1990). Limited surveillance continued in Papua New Guinea in 1991 and 1992. By June of 1992, 5 of an additional 6035 serosurveillance samples had tested positive. All 5 were among 2000 samples from a single site, the Port Moresby STD Clinic. In addition to surveillance, further clinical diagnostic testing had identified a total of 118 HIV-infected people by June of 1992. In STD clinics, genital sores were found to be common at all sites and in both sexes, occurring in 21% of males and 19% of females. Overall, 7.5% of STD patients had a reactive VDRL, as did 3.5% of antenatal women. Explanations for negative results of serosurveillance may be: 1) the sample size chosen faces a 5% (or higher) chance of failing to detect a case under the likely conditions of this survey; 2) the populations chosen for surveillance may not be those in which HIV is circulating at this early stage of the epidemic; and 3) laboratory error. The first two of these, alone or in combination, are most likely.

The prevalence of toxoplasma antibodies in pregnant patients attending the Port Moresby General Hospital antenatal clinic: a seroepidemiological survey.

In a survey of 197 consecutive pregnant patients who were attending the Port Moresby General Hospital antenatal clinic for the first time in the index pregnancy, the prevalence of IgG antibodies to Toxoplasma gondii was 18%. Only one patient had IgM antibodies. Of the sociodemographic characteristics examined, only highlands origin of the patient had a significant association with the presence of IgG antibodies.

A quality assurance for rural laboratories: a report on a trial distribution in Momase Region, Papua New Guinea.

The strengthening of laboratory services in rural health centres is an important component of the Papua New Guinea National Health Plan. As part of the management support scheme for these services a National Quality Assurance Scheme has been formulated to monitor their technical performance. A trial distribution of quality assurance specimens to 44 laboratories in the Momase Region was met with enthusiastic response and encouraging results. The trial will be used as a model for a nation-wide distribution.

Endocervical Chlamydia trachomatis infection in pregnancy: direct test and clinico-sociodemographic survey of pregnant patients at the Port Moresby General Hospital antenatal clinic to determine prevalence and risk markers.

The prevalence of endocervical C. trachomatis infection in 181 consecutive antenatal clinic patients at the first attendance and who had not received antibiotic therapy in the previous 4 weeks, was 17.7%. The direct fluorescent antibody test was used for diagnosis. There was no significant clinical or sociodemographic factor which distinguished patients who tested positive from those who tested negative.