Prevalence of concurrent Chlamydia trachomatis infections among men with gonococcal urethritis in Lusaka

The prevalence of Chlamydia trachomatis infections among male patients with gonococcal urethritis in the sexually transmitted diseases (STDs) clinic at UTH, Lusaka, was determined by two methods to be around 4.7%. Methods used were specific for C. trachomatis (Syva Microtrak), and second isolation of C. trachomatis. The results indicate that with a prevalence rate of 4-7% for concurrent gonococcal and chlamydial infection, it is not financially or medically practical to treat all cases of gonorrhoea in Zambia for possible chlamydial infection, as is advocated in some countries. The findings further suggest that the commercially available Syva Microtrak test should probably be considered positive when one or two monoclonal-stained elementary bodies are seen, rather than ten, to avoid false-negative results.

A 2-year quantitative assessment of Chlamydia trachomatis in a sexually transmitted diseases clinic population by the MicroTrak direct smear immunofluorescence test

The MicroTrak direct smear immunofluorescence test was used to determine the prevalence of Chlamydia trachomatis elementary bodies (EBs) in groups of patients in various clinical categories, most of whom were seen in a clinic for sexually transmitted diseases (STD). Overall, 8138 adequate specimens were tested, of which 14.3% were found to contain chlamydial EBs. Of the samples from patients seen in the STD clinic, over 70% were from women and 14.9% of these were positive, as were 15.7% of those from men. EBs were detected in 27% of samples from infants and in 7.0% of those from adults with conjunctivitis. EBs were detected most often in men with nongonococcal urethritis (40.2%), infants with conjunctivitis (30%) and contacts of chlamydiae-positive patients (24.5%) and least often in 'prostatitis' (2.9%) and patients tested to determine the success of treatment (2.7%). Over 40% of samples from both the male urethra and the cervix contained 10 or fewer EBs, highlighting the importance of recognizing small numbers and the sensitivity required of other detection procedures.

Management of intrameatal warts in men

The case notes of 1080 men with genital warts were analysed retrospectively over a 30-month period. One hundred and forty patients were identified with intrameatal warts and an audit of their treatment is discussed. When electrocautery and cryotherapy were compared the former produced a more rapid resolution of the lesions. Cystourethroscopy was performed on 16 patients with intrameatal warts. No patient had involvement beyond the distal 3 cm of the urethra. Data on concurrent sexually transmitted diseases, population characteristics and pattern of referral are presented and compared to previously reported studies.

Sexually transmitted diseases among patients seeking HIV antibody test for AIDS

A total of 489 patients who had blood tests for antibodies to the human immunodeficiency virus (HIV) were given medical advice for sexually transmitted disease (STD) screening. Of 378 patients who had STD screening, STDs were found to be present in 47%. Among various STDs, non-specific urethritis (NSU) in men and chlamydial genital infection in women were found to be common. When the prevalence of these two diseases were compared with those of a control group the difference was significant.

[Cases of Down's syndrome in children of young parents with chronic inflammatory genital diseases and secondary disorders of spermatogenesis]

Nine births affected by Down's disease in young families are reported. The mean age of fathers was 28.5 years and that of mothers 25.2 years. History revealed no parental exposures to occupational or household adverse factors or nutritional contaminants. The parents had normal karyotypes. However, a history of urogenital disease 1-3 years before the affected births was elucidated in all 9 families: three cases of gonorrhea, one case of trichomoniasis and nonspecific inflammation in the rest. After visits to genetic counseling clinics torpid urogenital infections were identified in all 9 couples: nonspecific prostatitis and urethroprostatitis in fathers, hysterosalpingoophoritis and vaginal dysbacteriosis in mothers. Teratozoospermia and oligozoospermia with abnormal sperm cell proportions of 56 to 92% occurred in the fathers. It is suggested that infectious-toxic disorders of chromosomal segregation during the meiosis may be a paternal cause of trisomy 21. The same mechanism is feasible in mothers. After reversal of urogenital infections and normalization of spermograms normal infants were born in 7 of 9 families, the other 2 currently refrain from childbirth.

Incidence of Chlamydia antibody in patient groups, as measured by the ELISA technique

An ELISA technique has been used to study the incidence of antibody against Chlamydiae: the results obtained with a panel of control sera were compared with those for the complement fixation (CF) and whole inclusion immunofluorescence (WIF) tests. The results indicate that the ELISA results correlate well with the WIF test but poorly with the CF test; and the correlation allows ELISA results to be directly related to WIF antibody titres. Using the ELISA test, the incidence of antibody to Chlamydiae by age was determined in sera collected in Great Britain and Iraq; and in sera collections made at three periods during the last 30 years in Great Britain: the results indicate the higher incidence of antibody in this country compared to Iraq, but do not suggest an increased incidence of antibody in Great Britain during the last 30 years. Studies on sera collected from patients with non-gonococcal urethritis and pelvic inflammatory disease indicate significantly higher titres and incidence of antibody compared to controls, which suggest a contiguous spread of infection for the primary genital lesion to involve more distant tissues and organs. A higher incidence of antibody was also seen in patients with cervical intraepithelial neoplasia (CIN) which may be interpreted as either indicating a causal relationship between Chlamydiae and CIN or indicating the importance of a venereal infection in this condition.

Comparison of three non-culture techniques for detection of Chlamydia trachomatis in genital tract specimens

A direct immunofluorescence (DIF) technique (Imagen) and two enzyme immunoassay (EIA) techniques (Chlamydiazyme and IDEIA) were compared for the detection of Chlamydia trachomatis in genital specimens from 502 attenders at a genitourinary medicine clinic. Eighty-two attenders were regarded as infected: 67 with positive results by at least two of the three techniques and 15 by virtue of elementary bodies detected in stored EIA buffer samples. With a positivity criterion of greater than or equal to 6 bodies Imagen was 76% sensitive for men and 61% sensitive for women. The sensitivity of Chlamydiazyme was 73% for men and 90% for women; comparative values for IDEIA were 80% and 71%, respectively. All three techniques were over 98% specific. Sampling order appeared to influence the sensitivity of IDEIA for specimens from men. All three techniques were less sensitive in the absence of cervicitis. The performances of the EIA techniques compared favourably with that of the more established technique of DIF.

[Oral isolation of Neisseria gonorrhoeae in the presence of gonococcal urethritis]

The Neisseria Gonorrhoeae, the etiologic agent of the gonococcic urethritis, can produce other clinical manifestations, such as stomatitis, TMJ arthritis and sialadenitis. The investigation of this germ in the oral cavity of 50 patients with gonorrhea, was positive in only one case, which did not present any buccal symptom. It was concluded from this study that an oral gonococcic infection is extremely rare, and that the transmissibility of this germ orally is not frequent eventhough possible in theory. However the infection can spread through the blood stream and can induce other pathology.

[Condyloma acuminata in teenage patients]

From 1978 to 1987, 93 new patients with condyloma acuminata visited urological clinic of our hospital. Among them, 16 patients (17%) were teenagers. The number of teenage patients increased gradually year after year as the total number of patients increased. The proportion of females in teenagers was slightly higher than that in adults. Condyloma in male teenage patients frequently occurred around the cornal sulcus. The site of condyloma in female teenage patients were labia minora and anus. None of other sexually transmitted diseases except for urethritis accompanied condyloma. All patients underwent electrocautery. None of teenage patients showed recurrence of condyloma in contrast with relative high recurrence rate (19%) in adult patients.

[Persistent lymphedema of the penis and scrotum after recurrent episodes of cellulitis and urethritis caused by Chlamydia trachomatis]

A 20 year old man affected by a persistent peno-scrotal lymphedema is reported. This condition followed recurrent attacks of cellulitis and a chronic urethritis. From the urethral discharge we isolated Chlamydia trachomatis and, only during the attacks of cellulitis, Group G Streptococcus. This pathogen cannot be isolated from microflora of the normal urethra and rarely cause cellulitis. In our opinion Chlamydial infection favoured the urethral colonization of Group G Streptococci and their passage in the loose connective tissue of the penis and scrotum. Lymphedema, clinically inapparent before the first attack, become progressively more severe and recurrent attacks took place at intervals without obvious re-exposure to an exogenous source of streptococci. The operative treatment of persistent lymphedema is lymphangiectomy and lymphangioplasty.

[Combined treatment of patients with chronic prostatitis]

Health resort treatment with the purpose of rehabilitation was carried out in 129 patients with chronic prostatitis at health resorts of Lvov Province. Results of the treatment: recovery was noted in 105, improvement--in 19 patients, failures--in 5 patients. The author suggests that it is more rational to treat patients with chronic prostatitis in three stages; stage I--out patient or hospital treatment; stage II--health resort treatment; stage III--treatment at home. Such three-stage treatment of patients with chronic prostatitis increases the recovery rate, prolongs the remission time, reduces the number of readmissions, decrease the time of working capacity loss.

Chlamydia trachomatis infection in sexually active women with no known sexual contacts with urethritis

During the period from March 1985 to March 1986, 216 consecutive patients with vaginal symptoms were screened for cervical infection with Chlamydia trachomatis and other sexually transmitted organisms. Eleven (5%) yielded C. trachomatis without a history of recent contact with males with urethritis.

Prevalence of chlamydial infection in patients with gonococcal urethritis

Using a fluorescein labelled monoclonal antibody ("Microtrak") to identify Chalmydia elementary bodies in urethral smears, we detected Chlamydia trachomatis in 32 (26.67%) of 120 male patients after treatment of their gonococcal urethritis. Sixteen of these 32 patients (50%) had normal urethral smear. Only 16 (50%) of the patients yielding chlamydia would have received treatment in the absence of diagnostic service for chlamydial infection.

[Gonococcus-associated arthritis]

The various forms of arthritis associated with a gonococcus infection are pathogenetically and clinically differentiated. Whereas an infectious systemic process with different clinical symptoms is said to be underlying the arthritis-dermatitis syndrome as well as the septic GO-arthritis, the third form is para-infectious reactive arthritis. It is often difficult to diagnose an infectious GO-arthritis, as direct evidence of the virus found in joint and blood is rarely positive, so that the diagnosis can be affirmed or negated on the basis of clinical facts of the reaction of arthritis after an appropriate antibiotic therapy. Differential diagnostic considerations may help to find the correct diagnosis in view of an acute urethritis arthritis.

[Localized Sweet syndrome in urethro-prostatitis caused by Ureaplasma]

A 36-year-old patient with localized Sweet's syndrome and concomitant Ureaplasma urealyticum infection is presented. In addition to infectious diseases, malignant neoplasms are also associated with this dermatosis.

Dual infection of the conjunctiva with herpes simplex virus and Chlamydia trachomatis

We describe a homosexual man with simultaneous infection of the conjunctiva by Herpes simplex virus and Chlamydia trachomatis. This dual infection was associated with a genital and disseminated Herpes simplex virus infection as well as asymptomatic chlamydial infection of the rectum and "nonspecific" urethritis. The findings in this case show the importance of laboratory investigation in cases of conjunctivitis associated with genital infection.

Seminal tract inflammation and male infertility. Correlations between leukospermia and clinical history, prostatic cytology, conventional semen parameters, sperm viability and seminal plasma protein composition

A retrospective clinical evaluation of various types of semen analyses from infertile couples attending our Infertility Clinic was undertaken with the scope of studying the possible correlation between seminal inflammation and infertility. The parameters considered were leukospermia (severe, slight, constant or non-constant), clinical history (anamnestic data possibly inferring inflammation), conventional semen parameters, sperm viability (as assessed by capillary tube in vitro penetration test) and seminal plasma proteins patterns (SDS-PAGE). History data such as dysuria, urinary infection, cystitis symptoms and hematospermia were found to be significantly more frequent in infertile men with than in those without leukospermia. Leukospermia in itself did not seem to affect the conventional semen parameters such as total sperm count, motility (at 45 and 180 min) and/or morphology. The seminal volume could represent an exception to this rule. Furthermore, leukospermia did significantly affect sperm viability as evaluated by the capillary tube penetration test. Leukospermia was also significantly coupled to alterations of the seminal plasma protein composition (increase of the albumin concentration, decrease of prostatic markers and other anomalies).