A service evaluation of the Gen-Probe APTIMA nucleic acid amplification test for Trichomonas vaginalis: should it change whom we screen for infection?

OBJECTIVE: A service evaluation of the new Gen-Probe APTIMA nucleic acid amplification test was performed to determine the prevalence of Trichomonas vaginalis (TV) infection in a UK sexual health clinic and identify risk factors to inform an appropriate TV screening strategy. METHOD: Unselected patients presenting with a new clinical episode were offered TV testing with Gen Probe transcription-mediated amplification (TV TMA) in addition to routine sexually transmitted infection screening. Asymptomatic females provided a self-collected vulvovaginal specimen and asymptomatic men a first-void urine sample. Symptomatic patients were examined and a urethral swab taken from men and two posterior vaginal swabs from females; one for culture and one for TV TMA testing. Demographic and clinical data were collected on all patients positive for TV infection and 100 randomly selected TV-negative controls. RESULTS: 3503 patients underwent TV TMA testing during the evaluation period. The prevalence of TV infection was 21/1483, 1.4% (95% CI 0.9% to 2.2%) in men and 72/2020, 3.6% (95% CI 2.8% to 4.5%) in women. The rate of TV positivity was higher in Black Caribbean patients compared with Caucasian patients (men 5.4% vs 0.1%, p<0.001; women 9.0% vs 1.2%, p<0.001). TV TMA detected an additional 16 infections (38%) in symptomatic women compared with culture. CONCLUSIONS: While screening all patients with TV TMA will identify more TV infections, the UK prevalence remains low and this approach is unlikely to be cost effective. In addition to testing symptomatic patients, targeted testing of high-risk asymptomatic groups using TV TMA should be considered.

Dermatosis inflamatorias vulvares / Vulvar Inflammatory Dermatoses

La patología cutánea vulvar constituye un motivo frecuente de consulta en el momento actual. La vulva, al igual que el resto de la piel, puede verse afectada por múltiples enfermedades de diferentes etiologías, pero sus especiales condiciones anatómicas y fisiológicas hacen que tenga algunas peculiaridades que pueden suponer una dificultad añadida en su manejo. El estudio de la patología vulvar está emergiendo como una nueva área en la Dermatología. En este artículo, tras valorar la características de la vulva normal, sistematizaremos y realizaremos una breve revisión de las dermatosis inflamatorias vulvares, grupo heterogéneo de enfermedades en las que es clave un abordaje amplio y multidisciplinar (AU)

Vulvar skin disease is a common reason for consultation. The vulva, like the rest of the skin, can be affected by numerous diseases of various etiologies, but its particular anatomic and physiologic characteristics create additional diagnostic and therapeutic difficulties. The study of vulvar disease is emerging as a new branch of dermatology. In this article, we examine the characteristics of the normal vulva, and perform a brief, structured review of vulvar inflammatory dermatoses, which comprise a heterogeneous group of diseases in which a broad, multidisciplinary approach is essential (AU)

Genital myiasis by Wohlfahrtia magnifica (Diptera, Sarcophagidae) in Sicily (Italy).

Wohlfahrtia magnifica (Schiner, 1862; Diptera: Sarcophagidae), known also as flesh fly or screwworm, is a fly distributed especially in south Europe, Middle East, North Africa and China. Maggots of W. magnifica are responsible for traumatic myiasis in warm-blooded vertebrate animals and humans. In Italy data on wohlfahrtiosis in animals and humans are scant. This paper reports three cases of genital myiasis by W. magnifica in Sicily that occurred in a goat, a ram and a dog, respectively. Maggots were found in the vulva of a goat, in a wound localised in the scrotum of a ram and in the prepuce of a dog. Although the disease was not recorded before in the region, data collected from a questionnaire specifically designed for the study suggest that the disease is endemic in the area for more than 20 years. Larger epidemiological studies in the region are needed to get more data on disease prevalence and pattern of infestation as well as more information and education is needed for both farmers and veterinarians on wohlfahrtiosis and its strategies of control and treatment.

Ultrastructural observations on the surface of Thelazia lacrymalis (Nematoda: Spirurida, Thelaziidae).

Scanning electron microscopy (SEM) was used to study the surface ultrastructure of female Thelazia lacrymalis obtained from naturally infected cattle. At the anterior end, the buccal capsule was cup shaped. The mouth was without lips and was surrounded by four cephalic papillae and two amphids. There were two lateral cervical papillae. Also, a single small papilla was seen on the ventral side, close to the vulvar opening. The vulva was located posterior to the end of the oesophagus and the tail carried an anal pore and a pair of phasmids near the tip. The cuticle was transversally annulated with fine striations.

Bacteriological investigations on wound myiasis of sheep caused by Wohlfahrtia magnifica (Diptera: Sarcophagidae).

The aim of the present investigation was to get further information about obligate aerobic and facultatively anaerobic bacterial communities of the intact and Wohlfahrtia magnifica infested vulval region of sheep. The numbers of aerobic and facultatively anaerobic microorganisms were lower in samples taken from uninfested mucous membrane and myiatic wounds as well as in the wound fluid as compared to samples originating from the uninfested skin surface. Gram-negative bacteria belonging to the family Enterobacteriaceae were isolated only from the skin and mucous membrane of uninfested sheep. Gram-positive microorganisms dominated in all samples. The ratio of facultatively anaerobic bacteria was higher than 80% in the sample taken from a lesion containing third instar Wohlfahrtia larvae and in the wound discharge collected from a vulval wound free of maggots. It is suggested that there is a shift in the composition of the bacterial communities of vulva as staphylococci disappear from the wounds due to the presence of Wohlfahrtia larvae.

Schistosoma haematobium induced lesions in the female genital tract in a village in Madagascar.

Female genital schistosomiasis, FGS, was investigated in a gynaecological study as part of an overall community based morbidity survey, including parasitological and ultrasonographical examination, of a Schistosoma haematobium endemic area in Madagascar. Women (103), of childbearing age (15-49 years), were included for a gynaecological examination and visible lesions of vagina and cervix were biopsied in order to determine the origin of the lesion. Furthermore all women were screened for the presence of schistosome ova using PAP smears from the vagina and the endo/exo cervix. In total 15 women showed schistosome ova in the vagina and/or cervix (median age 24 years and range 15-36 years). Of 36 women with cervical abnormalities, 12 eggs were detected by cervical biopsy (33%). In addition, two of the 12 presented vaginal induration, which contained eggs. Six women had eggs in their PAP smears of which three were egg negative by cervical biopsy. The prevalence of positive S. haematobium egg excretion in the urine among the 103 women was 69% and the geometric mean egg count of positive individuals was 51 eggs/10 ml of urine. Five of the 15 women with confirmed FGS had < or = 1 egg/10 ml of urine. Bladder lesions and congestive changes in the kidneys were demonstrated by ultrasonographic examination in 33 and 9% of the 103 women, respectively. None of the 15 women with confirmed FGS had renal congestion. Our study demonstrates that FGS is a common manifestation of the infection with S. haematobium, even in lightly infected individuals.

Genital myiasis (Wohlfahrtiosis) in camel herds of Mongolia.

Genital infestations caused by Wohlfahrtia magnifica (Schiner, 1862) has been reported as being a common problem encountered in female camels in the Gobi desert. Thus, a field investigation to establish the prevalence of wohlfarthiosis in camel herds in the eastern Gobi district was carried out between May and July 1994. The objectives of the study were to establish the relevance of genital myiasis, and to describe the disease patterns, clinical course and pathomorphological changes associated with it. The field study was designed to suit the specific ecological, infrastructural and logistic conditions. Two cross-sectional samples were taken from 45 selected herds in six different areas of the Chatanbulag Sumon to obtain data on herd structure, age distribution, and the breeding history of infested female animals. Post partum events and previous occurrence of genital myiasis were recorded by use of a standardised questionnaire. Clinically infested animals were first detected visually. All camels to be investigated further were subsequently immobilised using ropes and the genitals were examined for tissue lesions and the presence of larvae. Examination of 1676 Bactrian camels from 45 selected herds in six different areas of the Chatanbulag Sumon in the Eastern Gobi district, Mongolia, led to an estimate of Wohlfahrtia magnifica infestation rates between 8-10%. Most myiasis cases were found in older females (> 4 yr), younger animals were infested at a lower rate. Highest prevalence rates were discovered during June and July, highest levels of infestation occurred in the Aman Us Chudak region with infestation rates up to 15%.

Female genital schistosomiasis due to Schistosoma haematobium. Clinical and parasitological findings in women in rural Malawi.

A total of 51 women with urinary schistosomiasis haematobium were examined in order to identify diagnostic indicators for female genital schistosomiasis (FGS). Patients were selected at random from the outpatient department of the Mangochi District Hospital, Malawi. The medical histories were recorded according to a pre-designed questionnaire and the women were subjected to a thorough gynaecological examination including colposcopy and photographic documentation of lesions. Microscopy of genital biopsies revealed that 33 of the 51 women had S. haematobium ova in cervix, vagina and/or vulva in addition to the presence of ova in urine. The most sensitive diagnostic procedure was beside microscopic examination of a wet cervix biopsy crushed between two glass slides, which revealed 25 of the 33 genital infections. There was a significant correlation between the size of genital lesions and the number of ova counted per mm2 of crushed tissue. Women with FGS had significantly more tumours in the vulva than women with schistosomiasis limited to the urinary tract. Most of the observed genital pathology could easily be identified by the naked eye, but colposcopic examination yielded valuable additional information like the demonstration of neovascularisation around cervical sandy patches. Few of the symptoms previously regarded as indicators for FGS could be linked to the presence of schistosome ova in genital tissue. Husbands of infertile women with FGS had children with other women significantly more often than husbands of women who only had urinary schistosomiasis. This, together with the finding that the majority of the divorced women had FGS, indicates that the manifestation of this disease may have implications for the marital and sexual life of the affected women.

Female genital schistosomiasis (FGS): relationship between gynecological and histopathological findings.

Schistosomiasis of the lower female reproductive tract manifests itself in a broad spectrum of clinical features. However, clinical and histopathological findings have never been studied in a synoptic manner. Based on the assumption that any type of pathology present in the female reproductive tract is the expression of a complex pathophysiological reaction towards eggs sequestered in the genital tissues, we decided to analyze colposcopic and histopathological findings in a comprehensive manner. Thirty-three women in Malawi with urinary and genital schistosomiasis were examined parasitologically and gynecologically. A thorough colposcopic examination with photodocumentation was performed and biopsies were taken from the cervix, the vagina and/or the vulva for histological sectioning and immunohistochemistry. The predominant colposcopic findings were sandy patches on the cervical surface similar to those seen in the bladder and polypous/papillomatous tumors with irregular surface on the vaginal wall and in the vulvar area. The histopathological sections of sandy-patch-like lesions demonstrated only a small cellular reaction around S. haematobium eggs in various stages of disintegration. In contrast, in the case of polyps the histology revealed a more pronounced immunological reaction characterized by a heavy cellular infiltrate. One case of invasive squamous cell carcinoma of the cervix was diagnosed. We conclude that colposcopy is a useful tool in the detection of FGS related pathology in the lower female reproductive tract and that the synoptic assessment of surface and of corresponding histological sections helped to understand the pathophysiology of S. haematobium associated disease in genital tissue.

[Human genital myiasis due to Sarcophaga]. / Miasis genital humana por Sarcophaga.

Human myiasis are infestations produced by fly larvae which invade human tissues or cavities. We report a case of semi-specific myiasis which consisted in infestation of the vulvar region of an eighty-six-year old, diabetic patient who was admitted in a clinical center for elderly. The development from larva to adult fly was carried out in the laboratory and it was identified as Sarcophaga. The infestation was resolved extracting the larvae and washing the affected area with an antiseptic solution.

Epidemiology of sheep myiases in São Paulo State, Brazil.

A survey of Diptera species causing cutaneous myiases on sheep in Botucatu, São Paulo, Brazil was made to determine seasonal incidence, predilection sites and the factors predisposing to infestation. Sheep were checked daily for myiases for one year. At two week intervals larvae from wounds were collected for identification. Only larvae of Dermatobia hominis and Cochliomyia hominivorax were found. Myiases due to C. hominivorax were observed during the whole year with high incidence from January to April. The feet, vulva, tail and scrotum were most frequently infested. Wounds were the commonest predisposing factor.