Chlamydia trachomatis infections in eastern Europe: legal aspects, epidemiology, diagnosis, and treatment

OBJECTIVES

Knowledge concerning genital Chlamydia trachomatis infections in eastern Europe is scarce. Data on the legal aspects, epidemiology, diagnosis, and treatment of the infection have never been collected, summarised, and presented to the international scientific community. The aim of this study was to present the current situation on the main aspects of chlamydial infections in the countries of eastern Europe.

METHODS

Written questionnaires concerning legal aspects, epidemiology, diagnosis, and treatment of the infection were distributed among national STI operating administrators as well as researchers who had presented papers at earlier meetings of European chlamydia or STI societies.

RESULTS

Most of the countries have not legalised reporting of chlamydial infections and in those who have done so, the quality of the reporting system is poor. Contact tracing is mostly done on a voluntary basis. Reported chlamydia incidence varies from 21 to 276 per 100000 inhabitants. The most commonly used diagnostic test remains the direct immunofluorescence test; however, some tendencies towards nucleic acid amplification are in evidence. Diagnostic services are paid for by the patient himself, while treatment in many countries is partially or completely covered by public insurance.

CONCLUSIONS

This is the first report summarising data concerning the situation on C trachomatis infections in eastern Europe. The reporting system and diagnosis of C trachomatis infections remain suboptimal, which allows neither control of the epidemiological situation nor optimal treatment of the patients. The most urgent work currently necessary is the education of professionals and the general population.

[Prevalence of HBV and HCV infection markers in patients with sexually transmitted diseases]

Sera of 125 patients with sexually transmitted diseases (syphilis, gonorrhoea, chlamydiosis, HPV and HIV infections) were investigated for presence of 3 markers of HBV infection; they were found in 41 (33%) patients. Anti-HBc was present in sera of 35 (28%) patients, in 3 of them antigen HBs was found and in 28 anti-HBs was found as well. Antigen HBs alone was present in sera of 6 other patients but they were not reactive in test for anti-HBc. Moreover in this group of 125 patients anti-HCV were discovered in 4 (3%); in 3 of them occurrence of markers of HBV infection was found.

Susceptibility of clinically important gram-negative bacilli to 15 antibiotics. Comparison of patterns in Poland and Federal Republic of Germany

Three hundred and sixty strains of Gram-negative bacilli (Escherichia coli, Salmonella enteritidis, Enterobacter cloacae, Providencia, indole-positive and indole-negative Proteus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Serratia marcescens), were isolated by random in Poland and Germany, and tested by agar dilution method for susceptibility to 15 antimicrobial agents, including six cephalosporin derivatives, colistin, gentamycin and tobramycin, three newer tetracyclines, ampicillin and carbenicillin, and a combination of trimethoprim and sulfamethoxazole. This investigation revealed existence of growing antibiotic-resistance of Gram-negative bacilli to all antimicrobial agents. A detailed analysis of this problem is described and a list of agents effective in vitro is presented. Some evidence has been found concerning possible existence of geographical differences in antibiotic-susceptibility patterns of strains of Gram-negative bacilli, isolated in Poland and Federal Republic of Germany.

Susceptibility of Staphylococcus aureus, Streptococcus pyogenes and Diplococcus pneumoniae to antibiotics. Comparison of patterns in Poland and Federal Republic of Germany

One hundred and eighty five strains of Gram-positive cocci were tested for susceptibility to 16 antibiotics, including some newer drugs, by agar dilution technique. Of these, 100 strains (50 each isolated in Poland and Germany) were Staphylococcus aureus, 55 Streptococcus pyogenes, and 30 Diplococcus pneumoniae. Previous investigations of streptococci and pneumococci isolated in Poland and Federal Republic of Grmany, revealed no differences in antibiotic-susceptibility patterns in both countries, which was not the case with staphylococci. Present study demonstrates further evidence for existence of differences in antibiotic-sensitivity of staphylococci, depending of their geographical origin, and presents actual state of susceptibility to antibiotics of Streptococcus pyogenes and Diplococcus pneumoniae.

Susceptibility of Streptococcus faecalis to 32 antimicrobial agents. Comparison of patterns in Poland and Federal Republic of Germany

Two hundred and twenty strains of Streptococcus faecalis (103 isolated in Poland and 117 in Federal Republic of Germany), were tested for antibiotic-susceptibility to 32 antimicrobial agents by agar dilution technique. Most effective in vitro appeared ampicillin, penicillin G, and a combination (1:1) of penicillin and streptomycin. Partly effective were also macrolide antibiotics, trimethoprim + sulfamethoxazole and five tetracyclines. Other antibiotics, including five cephalosporin derivatives, five aminoglycoside antibiotics, two lincomycins, two polymyxins, chloramphenicol and fucidin, appeared practically ineffective in vitro. Effectiveness of antimicrobials in vitro was considered on the basis of standard bioavailability of antimicrobial agents. No differences in antibiotic-susceptibility patterns of any practical significance were found, when strains isolated in Poland and Federal Republic of Germany were compared.