GENITAL INFECTION IN ASSOCIATION WITH TRIC VIRUS INFECTION OF THE EYE. III. CLINICAL AND OTHER FINDINGS. PRELIMINARY REPORT

Laboratory diagnosis of human chlamydial infections

Chlamydia trachomatis is a human pathogen that causes ocular disease (trachoma and inclusion conjunctivitis), genital disease (cervicitis, urethritis, salpingitis, and lymphogranuloma venereum), and respiratory disease (infant pneumonitis). Respiratory chlamydioses also occur with infection by avian strains of C. psittaci or infection by the newly described TWAR agent. Diagnosis of most acute C. trachomatis infections relies on detection of the infecting agent by cell culture, fluorescent antibody, immunoassay, cytopathologic, or nucleic acid hybridization methods. Individual non-culture tests for C. trachomatis are less sensitive and specific than the best chlamydial cell culture system but offer the advantages of reduced technology and simple transport of clinical specimens. Currently available nonculture tests for C. trachomatis perform adequately as screening tests in populations in which the prevalence of infection is greater than 10%. A negative culture or nonculture test for C. trachomatis does not, however, exclude infection. The predictive value of a positive nonculture test may be unsatisfactory when populations of low infection prevalence are tested. Tests that detect antibody responses to chlamydial infection have limited utility in diagnosis of acute chlamydial infection because of the high prevalence of persistent antibody in healthy adults and the cross-reactivity due to infection by the highly prevalent C. trachomatis and TWAR agents. Assays for changes in antibody titer to the chlamydial genus antigen are used for the diagnosis of respiratory chlamydioses. A single serum sample that is negative for chlamydial antibody excludes the diagnosis of lymphogranuloma venereum.

Colposcopy, biopsy, and cytology results in women with chlamydial cervicitis

Colposcopy and biopsy were carried out at diagnosis and at follow up of 222 women. Of 322 cervical biopsy specimens taken, 174 were from women with chlamydial cervicitis (patients) and 48 from control women (both at diagnosis) and 100 from 76 patients and seven controls at follow up. Of the 174 patients with chlamydial cervicitis, 158 (91%) had erythema compared with 9/48 (19%) controls, and 140 (81%) had "follicles" and lumps compared with three (6%) controls. The cervical polymorphonuclear leucocyte (PMNL) count in a high power (x 1000) field (HPF) was 85 in patients compared with 47/HPF in controls. Cervical ectopia was found in 154 (89%) patients compared with 32 (67%) controls. After treating the 174 patients, we found erythema in nine (5%) and "follicles" in 16 (9%); both conditions were disappearing. Lymphocytic germinal follicles were found on histology in only 5/165 patients compared with none in controls or in patients at follow up examination (after treatment for chlamydial cervicitis). Inclusions were found in 6/165 patients compared with none in controls or patients at follow up. Chlamydiae were found on electron microscopy in slides from seven out of 159 patients compared with none from controls or 81 subjects at follow up. Estimating numbers of inflammatory cells and measuring vascularity showed diffuse increases in lymphocytes and plasma cells and increases in vascularity in both endocervical and exocervical tissue of patients with chlamydial cervicitis. These increases were lessened by treatment.

Occult chlamydial ophthalmia in men with non-gonococcal urethritis

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Oral doxycycline in the treatment of adult chlamydial ophthalmia

Ninety-three consecutive patients with adult chlamydial ophthalmia were treated with four different regimens of oral doxycycline. In patients treated with a single dose of 5 mg/kg of body weight (300 mg) of doxycycline the severity of clinical signs was reduced, and in half of the patients shedding of the infective agent was stopped. Treatment with a weekly dose of 300 mg of doxycycline for three weeks or a daily dose of 1.5 mg/kg of body weight (100 mg) for one week produced a clinical and microbiological cure in 100% of patients. However, in some of these patients mild to moderate papillary responses were present up to six months from completion of the treatment. The best results were obtained with a daily dose of 100 mg for two weeks, which produced rapid clinical and microbiological cure in all patients.

A reappraisal of non-specific genital infection with reference to the work of the late Dr E. Weston Hurst

It is easy to overlook work that is before its time, especially if it has been done in the recent past. In his animal experimental work with Chlamydia spp, the late Dr E. Weston Hurst found that although he was able to effect a clinical cure in his intraperitoneally infected mice, he was unable to eradicate their infections. As his work appears to have relevance to today's growing problems concerning genital infections associated with chlamydiae, it should not fall into obscurity.

The rectum as viewed by the venereologist

About 2-2 1/2 million people do, or will repeatedly, participate in ano-rectal sexual intercourse in Britain alone. The anus and the rectum of these individuals are thus vulnerable to all the sexually transmitted diseases (except trichomoniasis). Male homosexuals appear to be more prone to these conditions than female heterosexuals, possibly because a large minority is indiscriminately promiscuous. Over the last 20 years homosexually acquired infections--particularly syphilis--have increased in Britain; these are now more readily admitted to because of changes in the law and in public opinion. The frequent changes of sexual partner among male homosexuals is the most notable epidemiological factor in the spread of venereal disease.

The rôle of Chlamydia trachomatis in genital-tract and associated diseases

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Effect of silver nitrate application on the conjunctival flora of the newborn: and the occurrence of clostridial conjunctivitis

Newborn conjunctival cultures were obtained from 35 babies prior to silver nitrate application and 48 hours later. On initial culture, 46 facultative bacteria and 27 anaerobes were recovered; 48 facultative and 18 anaerobes were recovered after 48 hours. Haemophilus vaginalis, Bacteroides species and anaerobic cocci decreased in numbers, whereas S. epidermidis, Micrococcus and Propionibacterium acnes increased during this time interval. Clostridial species were isolated from two cases who developed conjunctivitis, along with Peptostreptococcus in one of the cases. In vitro experiments demonstrated lack of killing of C. perfringens in silver nitrate concentrations of 0.1 percent, even after 24 hours exposure.

Chlamydial, gonococcal, and herpes virus infections in neonates

The incidence, type of lesions, portal of entry and treatment of chlamydial, gonococcal, and herpetic infections of neonates are briefly discussed. Herpes neonatorum is potentially the most serious of these conditions and major efforts in its prophylaxis are called for.

Comparison of urethral swabs, urine, and urinary sediment for the isolation of Chlamydia

In 70 male patients with urethritis, Chlamydia was recovered from 18 urethral swabs (26%), 5 urinary sediments (7%), and 3 urine specimens (4%). All Chlamydia isolates were recovered from urethral swabs.

Infection of the eye, genitalia, and rectum by a new serotype (type G) of TRIC agent. Clinical and laboratory aspects

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Methyl green-pyronin stain for the diagnosis of trachoma

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Sero-negative polyarthritis. The Bedsonia (Chlamydia) group of agents and Reiter's disease. A progress report

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TRIC agent; characteristics and detection by laboratory methods

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