Vaginal and cervical abnormalities associated with trichomonal infection.

Cytological changes were studied among 393 women, reporting to Samir Health Centre, Khartoum (Sudan), using Papanicolaou staining. Vaginal trichomoniasis was confirmed by wet-mounts and cultural methods. Non-specific inflammatory changes were prominent (17.4%). In 33.5% of parasitised patients, the cervix was found healthy. Cancer of the cervix was not detected in patients investigated.

Evaluation of the laboratory diagnosis of vaginal trichomoniasis in Khartoum.

A total of 403 vaginal discharge specimens were investigated for Trichomonas vaginalis using fresh wet-mounts, culture and Papanicolaou staining. By fresh wet-mounts, 58 specimens (14.4%) were found harbouring the parasite. On culture 67 isolates (16.7%) were identified. Both wet-mount and cultural procedures detected 18.3% positive isolates. Papanicolaou staining detected 40 positive cases (9.9%) from the patients investigated. Two culture media were tried in this study to isolate T. vaginalis, namely Lumsden's medium and Diamond's medium. Their efficacy was found to be 16.9% and 14.8%, respectively.

Vaginal trichomoniasis at a sexually transmitted disease clinic at Khartoum.

At a sexually transmitted disease clinic at Khartoum 613 Sudanese women presenting with vaginal discharge were investigated. Specimens were examined by microscopy and culture. Trichomonas vaginalis infestation was found in 123 patients (20.1%), predominantly in the age groups 16-19 years (27.1%) and 46-65 years (27%). Frequency of trichomonal vaginitis was highest (35.9%) among divorced women. Of the pregnant women investigated, 16.3% were found to harbour the parasite. There was no significant difference in the parity of parasitized and non-parasitized patients.

PIP: This investigation was carried out to evaluate the prevalence of vaginal trichomoniasis in relation to subjects' age, marital status, parity, pregnancy and the intensity of the discharge. The subjects were 613 Sudanese women presenting with vaginal discharge, investigated at a sexually transmitted disease clinic in Khartoum. On the day of examination, a full history was taken, and particular attention was paid to the duration and amount of any vaginal discharge, as well as to past antitrichomonal therapy. 123 (20.1%) of the patients examined were found infested with T. vaginalis. The duration of the vaginal discharge ranged from a few days to 10 years. The discharge in parasitized women was copious in 30 cases (24.2%), moderate in 42.3%, scanty in 26.9% and absent in 6.6% of the cases. In non-parasitized patients, the discharge was copious in 8.1% of cases. The frequency of vaginal trichomoniasis was 20.1% in all patients examined. Trichomonal infestation was predominant in the age groups 16-19 years (27.1%) and 46 years and above (27%), thus confirming reports that trichomonal infestation may occur during the period of greatest sexual activitiy, as well as at older ages. The highest frequency was among divorced women (35.9%), followed by widowed women (29.4%) and may be related to promiscuity and to variety of sexual contacts. 16.3% of the pregnant women investigated were found harboring the parasite; there was no significant difference in the parity of parasitized (81.6%) and non-parasitized patients (82.3%). Association of T. vaginalis with gonorrhea and candidiasis was significant, though this did not modify the symptoms and signs of trichomoniasis. The results suggest that there is no significant difference between whites and dark-skinned peoples.

Social and psychological factors in the distribution of STD in male clinic attenders. I Demographic and social factors.

We describe three related studies of possible aetiological risk factors for sexually transmitted diseases (STDs) in men attending an STD clinic. In this paper we present the results for a variety of social and demographic variables traditionally associated with STD. In contrast to the results in the next two papers, these were largely negative. Occurrence rates of overall STD or of hepatitis, syphilis, gonorrhoea, or non-specific urethritis (NSU) had no aetiologically relevant association with age, nationality, marital status, social class, occupation, non-sexual social contact, drug abuse, or aggressive attitudes and behaviour. Gonorrhoea, however, was the only STD which correlated with alcohol abuse and with eating out rather than at home. We conclude that, with the possible exception of gonorrhoea, social factors contribute little to the distribution of STD risk within the study population.

Social and psychological factors in the distribution of STD in male clinic attenders. II Personality disorders, psychiatric illness, and abnormal sexual attitudes.

Using standardised questionnaires we examined the possible contributions of psychiatric illness, delinquent and other abnormal personality traits, and disturbed attitudes to sex to the risk of sexually transmitted disease (STD) infection in men attending an STD clinic. We found certain differences in personality and in attitudes between the clinic sample and control men. These differences, however, a) were not comparable with those found in groups of clinically abnormal subjects, b) were confined to homosexual and bisexual men, and c), with the possible exception of gonorrhoea, were not related to risk of STD infection.

Social and psychological factors in the distribution of STD in male clinic attenders. III Sexual activity.

We report on the relation between various aspects of sexual activity and risk of infection with sexually transmitted disease (STD) in two groups of men attending an STD clinic. Sexual promiscuity appeared to have little effect on the distribution of most STDs, showing a strong association only with gonorrhoea. This finding was contrary to expectation but consistent with the results reported in the first two papers in this series. In contrast to promiscuity, however, sexual orientation subgroups showed a sharp difference in incidence of the major STDs. Hepatitis and syphilis occurred equally commonly among bisexual and homosexual men, but much less commonly among heterosexuals; NSU occurred more commonly among heterosexual men; and gonorrhoea, though common in all three groups, occurred most commonly in bisexual men and least commonly among heterosexuals. For certain STDs the form of intercourse may be as important a risk factor as sexual promiscuity but the precise mechanisms by which sexual orientation influences risk of STD remain undefined.

Clinical aspects of Reiter's disease.

The clinical manifestations and results of investigations in a series of 221 patients diagnosed as suffering from Reiter's disease are described in detail. Attention is drawn to the very varied natural history of the disease, the relapse rate of 60% and the development of serious complications and disability in young people. The failure to establish the cause of the condition or to unravel its relationship to nonspecific urethritis and bacillary dysentery contrasts with the reported presence of the human leucocyte antigen HLA-B27 in 76% of patients. There is no curative treatment but symptomatic treatment will relieve pain and stiffness and may shorten the duration of individual attacks. Prolonged follow-up of established cases, monitoring of activity of the disease by regular measurements of the erythrocyte sedimentation test and prompt treatment of relapses may prevent the development of serious locomotor disability.

Isoenzyme characterisation of Trichomonas vaginalis.

Clones of 32 strains of Trichomonas vaginalis isolated from patients attending a venereal diseases clinic were compared among themselves and with authentic Pentatrichomonas hominis on the basis of their isoenzyme patterns for eight enzymes by thin-layer starch-gel electrophoresis. The enzymes examined were: glucose phosphate isomerase (GPI); phosphoglucomutase (PGM); malic enzyme (NADP+) (ME); hexokinase (HK); malate dehydrogenase (NAD+) (MDH); glucose-6-phosphate dehydrogenase (G6PD); aldolase (ALD); and lactate dehydrogenase (LDH). From the isoenzyme patterns of four enzymes (LDH, MDH, HK, and GPI) the strains of T vaginalis could be divided clearly into five groups. PGM showed differences in only one strain, while two other enzyme patterns (ME and ALD) were the same for all the strains of T vaginalis tested. All isolates were clearly distinguishable from P hominis. Although G6PD patterns were not sharp some differences were evident among T vaginalis strains.

Sexually transmitted diseases in Sabah and Sarawak.

Despite being part of one of the few remaining primitive areas of the world, both Sabah and Sarawak are provided with adequate, though simple, urban and rural general medical services. At present no reliable data on the incidence of sexually transmitted diseases in these areas have been collected and no organised treatment services are available. Gonorrhoea appears to be the commonest notifiable infectious disease in Sarawak, and beta-lactamase-producing strains have been isolated. Because of the rapidly expanding economy and the encouragement of the tourist trade, sexually transmitted disease is likely to prove an increasing problem, for which a specialised service for diagnosis and treatment is badly needed.