Antibodies to Chlamydia trachomatis in cervicovaginal secretions: relation to serum antibodies and current chlamydial infection.

Concentrated cervicovaginal washings obtained from women attending a venereal disease clinic were tested for Chlamydia-specific immunoglobulins by means of a single-antigen, indirect immunofluorescence technique. Chlamydial antibodies (IgA and/or IgG) were present in washings from 22 (42%) of 52 patients tested. These Chlamydia-specific antibodies were significantly (P less than 0.001) associated with Chlamydia-specific antibodies in serum, which suggests that the former antibodies may have been derived from the serum rather than synthesized in the cervix. The association between chlamydial antibodies in cervicovaginal washings and isolation of Chlamydia from the cervix was much weaker. These results indicate that the diagnostic value of detection of Chlamydia-specific antibodies in sera and in cervical secretions is questionable.

Epidemiological investigation of patients with vulvovaginal candidosis. Application of a resistogram method for strain differentiation of Candida albicans.

The resistogram method was applied to 420 isolates of Candida albicans obtained from 30 selected patients undergoing treatment for vulvovaginitis. Of these, 16 patients each harboured a particular strain of C. albicans which persisted in the mouth or intestinal tract or both. In three of these patients, this strain persisted in the genital tract, and, in eight patients, it later recolonised the genital tract. Fourteen patients harboured more than one strain of C. albicans: one failed to respond to treatment and continued to harbour the same strain in the genital tract; in five the original strain later recolonised the genital tract and a second strain remained confined to the mouth or intestinal tract or both; and in three a second strain, present in the intestinal tract, later colonised the genital tract. Each of the male partners of seven patients harboured a strain of C. albicans that was identical to the strain, or to one of the strains, that had been isolated from his female partner.

Urinary tract infection in young women, with special reference to Staphylococcus saprophyticus.

Acute urinary tract infections in young women attending a clinic for sexually transmitted diseases were caused by the same bacteria, in the same proportions, as those that caused infections in women students. Staphylococcus saprophyticus biotype 3 (formerly called Micrococcus subgroup 3) was the commonest organism after coliform bacilli and caused about 30% of the infections. It was uncommon in women over 25 years of age and rarely caused asymptomatic bacteriuria in pregnancy. Most infections, irrespective of the causative organism, started soon after sexual intercourse, but neither the staphylococci nor the other organisms were associated with promiscuity, as judged by numbers of sexual partners or the incidence of sexually transmitted diseases. There was no evidence that the staphylococci were sexually transmitted. The reasons for the virulence of Staph. saprophyticus and its predilection for the urinary tract of young women remain unknown.

A trial of adenine arabinoside in genital herpes.

Twenty-four episodes of genital herpes in 22 men, all confirmed by virus isolation, were studied in a double blind trial. They were treated either with 3% adenine arabinoside (Ara-A) in petrolatum ointment base or with the base alone applied four times daily for one week. The lesions were counted and sketeched on days 0, 2, and 7. There was no demonstrable advantage to be gained from the use of Ara-A ointment. The results of the Papanicolaou smears and virus isolation agreed in the diagnosis of 75% of cases. The presence of continuing lesions or fresh ones in some patients after the acute phase of the initial or recurrent attack of herpes necessitates the man taking precautions on resuming sexual intercourse.

Treatment of vaginal candidiasis with miconazole.

An open trial was carried out in 50 women with clinical signs and mycological evidence of vaginal candidiasis to compare the effectiveness of treatment with 2% miconazole cream with that of nystatin pessaries. Both groups were given intravaginal treatment for 14 days and were followed up at monthly intervals for 3 months. Relief of symptoms and clinical signs was comparable in the two groups but the mycological cure rate at 1 month was higher with miconazole. At 2 and 3 months, however, there was no significant difference between the cure rate obtained with the two treatments in the patients still included in the study.

Value of the indirect immunofluorescence test in the diagnosis of vaginal candidiasis.

An indirect immunofluorescence test was used to determine the titre of serum antibodies to Candida albicans in 300 female patients. Titres from 1:4 to 1:6 were detected in 85 uninfected subjects and nineteen subjects with gonococcal infection. Titres from 1:4 to 1:16 were also detected in 166 of 169 patients found to be harbouring C. albicans, C. parapsilosis, or C. tropicalis in the digestive tract, genital tract, or both, without overt clinical infection. Titres from 1:32 to 1:128 were detected in one of four patients with vaginal candidiasis as compared with eleven of 23 patients with vaginal candidiasis who were also harbouring C. albicans or C. parapsilosis in the digestive tract. It is emphasized that titres of less than 1:32 did not preclude vaginal candidiasis.

Vaginal candidiasis and the role of the digestive tract as a source of infection.

Of 300 female patients seen in a Venereal Diseases clinic, 84 (28-0 per cent) were found to be harbouring Candida albicans or C. parapsilosis in the genital tract and 33 per cent of these patients had clinical signs of vulvovaginitis. Of the 84 patients, 71-4 per cent harboured yeasts in the ano-rectal tract; of the remaining 216 patients, 25-9 per cent harboured yeasts in the ano-rectal tract. There was no evidence to suggest that the incidence of yeasts in the mouth, ano-rectal or genital tracts changed with age or use of oral contraception.

Neutral red with photoinactivation in the treatment of herpes genitalis.

A clinical trial was undertaken to compare the efficacy of neutral red photodynamic inactivation treatment of genital herpes infections with that of a non-photoactive dye, phenol red, as a control. In a series of nineteen patients with virologically proven herpes genitalis who were adequately followed, eleven were treated with neutral red, and eight with phenol red; no difference in response to therapy was found between the two groups, and it is concluded that under the conditions of this trial neutral red with photoinactivation was not effective in the treatment of acute genital herpes infections. Approximately 75 per cent. of those with vulval lesions also had concurrent cervical infection, so that an effective topical treatment would need to be applicable to both anatomical sites.