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Gaydos CA, Barnes M, Holden J, Silver B, Smith R, Hardick J, Quinn TC. Acceptability and feasibility of recruiting women to collect a self-administered vaginal swab at a pharmacy clinic for sexually transmissible infection screening. Sex Health 2020; 17:392-394. [PMID: 32829744 DOI: 10.1071/sh20077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/26/2020] [Indexed: 11/23/2022]
Abstract
Willingness to self-collect vaginal swabs at a pharmacy clinic is of interest as a venue to increase sexually transmissible infections (STIs) screening for chlamydia, gonorrhoea and trichomonas. Women self-collected vaginal swabs at the pharmacy, completed questionnaires and received STI results within 2 h. Women with STIs were offered free treatment. A total of 313 of 777 (40.3%) women consented and prevalence for any STI was 3.9%. Questionnaires demonstrated acceptability for self-collection at the pharmacy, with 63% (95% CI 57.3-68) and 32.3% (95% CI 27.4-37.8) indicating they 'strongly agreed' or 'agreed' that they felt comfortable with pharmacy collection, respectively. Self-collected vaginal swabs for STI testing for women who were at a pharmacy were feasible and acceptable to women.
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Affiliation(s)
- C A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 211 Preclinical Teaching Building, Fisher Center, 725 North Wolfe Street, Baltimore, MD 21205, USA; and Corresponding author.
| | - M Barnes
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 211 Preclinical Teaching Building, Fisher Center, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | - J Holden
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 211 Preclinical Teaching Building, Fisher Center, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | - B Silver
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 211 Preclinical Teaching Building, Fisher Center, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | - R Smith
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 211 Preclinical Teaching Building, Fisher Center, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | - J Hardick
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 211 Preclinical Teaching Building, Fisher Center, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | - T C Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, 211 Preclinical Teaching Building, Fisher Center, 725 North Wolfe Street, Baltimore, MD 21205, USA; and Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Shin DJ, Athamanolap P, Chen L, Hardick J, Lewis M, Hsieh YH, Rothman RE, Gaydos CA, Wang TH. Mobile nucleic acid amplification testing (mobiNAAT) for Chlamydia trachomatis screening in hospital emergency department settings. Sci Rep 2017; 7:4495. [PMID: 28674410 PMCID: PMC5495747 DOI: 10.1038/s41598-017-04781-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/22/2017] [Indexed: 11/30/2022] Open
Abstract
Management of curable sexually-transmitted infections (STI) such as Chlamydia can be revolutionized by highly sensitive nucleic acid testing that is deployable at the point-of-care (POC). Here we report the development of a mobile nucleic acid amplification testing (mobiNAAT) platform utilizing a mobile phone and droplet magnetofluidics to deliver NAAT in a portable and accessible format. By using magnetic particles as a mobile substrate for nucleic acid capture and transport, fluid handling is reduced to particle translocation on a simple magnetofluidic cartridge assembled with reagents for nucleic acid purification and amplification. A mobile phone user interface operating in tandem with a portable Bluetooth-enabled cartridge-processing unit facilitates process integration. We tested 30 potentially Chlamydia trachomatis (CT)-infected patients in a hospital emergency department and confirmed that mobiNAAT showed 100% concordance with laboratory-based NAAT. Concurrent evaluation by a nontechnical study coordinator who received brief training via an embedded mobile app module demonstrated ease of use and reproducibility of the platform. This work demonstrates the potential of mobile nucleic acid testing in bridging the diagnostic gap between centralized laboratories and hospital emergency departments.
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Affiliation(s)
- D J Shin
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - P Athamanolap
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - L Chen
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - J Hardick
- Division of Infectious Diseases, School of Medicine, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - M Lewis
- Department of Emergency Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Y H Hsieh
- Department of Emergency Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - R E Rothman
- Division of Infectious Diseases, School of Medicine, The Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Emergency Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - C A Gaydos
- Division of Infectious Diseases, School of Medicine, The Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Emergency Medicine, School of Medicine, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - T H Wang
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA.
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA.
- Institute for NanoBioTechnology, The Johns Hopkins University, Baltimore, MD, 21218, USA.
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Gaydos CA, Schwebke J, Dombrowski J, Marrazzo J, Coleman J, Silver B, Barnes M, Crane L, Fine P. Clinical performance of the Solana® Point-of-Care Trichomonas Assay from clinician-collected vaginal swabs and urine specimens from symptomatic and asymptomatic women. Expert Rev Mol Diagn 2017; 17:303-306. [PMID: 28092466 DOI: 10.1080/14737159.2017.1282823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Solana® (Quidel) is a new rapid (<40 min.) point-of-care (POC) test for qualitative detection of Trichomonas vaginalis (TV) DNA. The assay has two steps: 1) specimen preparation, and 2) amplification and detection using isothermal Helicase-Dependent Amplification (HDA). The objective was to demonstrate the performance of Solana for vaginal swabs and female urines based on comparison to wet mount and TV culture. Performance was also compared to the Aptima-TV assay. METHODS Urine and four clinician-collected vaginal swabs were collected. The first two were used for FDA composite reference (wet mount; InPouch TV Culture). The third swab was used for Solana. Sensitivity/specificity were based on the reference method. A specimen was considered positive if either test was positive. The fourth swab was for Aptima-TV. RESULTS Vaginal swabs and urines were obtained from 501 asymptomatic and 543 symptomatic women. Prevalence of TV by was 11.5%. For swabs, Solana® demonstrated high sensitivity and specificity from asymptomatic (100%/98.9%) and symptomatic (98.6%/98.5%) women, as well as for urines from asymptomatic (98.0%/98.4%) and symptomatic (92.9%/97.9%) women, compared to the reference method. Compared to Aptima-TV, the sensitivity/specificity was 89.7%/99.0% for swabs and 100%/98.9% for urines. CONCLUSION The Solana® assay performed well compared to the reference assays.
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Affiliation(s)
- C A Gaydos
- a Division of Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - J Schwebke
- b Division of Infectious Diseases , University of Alabama at Birmingham School of Medicine , Birmingham , Alabama , USA
| | - J Dombrowski
- c Division of Infectious Diseases , University of Washington School of Medicine , Seattle , Washigton , USA
| | - J Marrazzo
- b Division of Infectious Diseases , University of Alabama at Birmingham School of Medicine , Birmingham , Alabama , USA.,c Division of Infectious Diseases , University of Washington School of Medicine , Seattle , Washigton , USA
| | - J Coleman
- a Division of Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - B Silver
- a Division of Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - M Barnes
- a Division of Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - L Crane
- d Planned Parenthood , Houston , Texas , USA
| | - P Fine
- d Planned Parenthood , Houston , Texas , USA
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Harding-Esch E, Sherrard-Smith E, Dangerfield C, Choi YH, Green N, Jit M, Marshall RD, Mercer C, Nardone A, Howell-Jones R, Johnson OA, Clarkson J, Wolstenholme J, Price CP, Gaydos CA, Sadiq ST, White PJ, Lowndes CM. P08.29 Web-tool to assess the cost-effectiveness of chlamydia point-of-care tests at the local level. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gaydos CA, Dize L, Barnes M, Barnes P, Hsieh YH, Duncan D, Marsiglia V. O10.4 Performance of self-collected penile swabs for the detection of chlamydia trachomatis, neisseria gonorrhoeae, trichomonas vaginalis, and mycoplasma genitalium. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shin DJ, Athamanolap P, Chen L, Hardick J, Gaydos CA, Wang TH. 002.6 A low-cost mobile naat platform for chlamydia trachomatis. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hsieh YH, Jett-Goheen M, Dize L, Barnes M, Barnes P, Gaydos CA. P02.07 Utilisation of risk score tool of internet i want the kit (iwtk) home self-collection program for sexually transmitted infections (stis) in males. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hsieh Y, Peterson S, Gauvey-Kern M, Gaydos CA, Holtgrave D, Rothman RE. P5.023 Novel Emergency Department Registration Kiosk For HIV Screening Increases Engagement of High Risk Patients and is Cost-Effective. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Matson PA, Chung S, Gaydos CA, Ellen JM. O20.4 Daily Variation in Feelings of Intimacy Predict Incident STI Within a Prospective Cohort of Urban Adolescent Females. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gaydos CA. PL05.2 New Technologies in STI Diagnosis and Control: Promising Future. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Taylor SN, Smith B, Schwebke J, Lebed J, Fuller D, Lillis R, Gaydos CA, Pol BVD, Nye M, Body B. P2.075 Evaluation of Female Urine and Vaginal Swabs Using the BD ProbeTec™ Trichomonas VaginalisQ xAmplified DNA Assay on the BD Viper™ System in Extracted Mode and a Cleared NAAT TV Assay as Compared to PIS. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gaydos CA, Pol BVD, Jett-Goheen M, Barnes M, Quinn N, Clark C, Daniel GE, Dixon PB, Hook EW. P5.062 An Easy to Use Real Time PCR Test For Chlamydia Trachomatis and Neisseria Gonorrhoeae Providing Results That Can Guide Treatment Choices Before the Patient Leaves the Clinic. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Melendez JH, Huppert J, Hesse E, Jett-Goheen M, Quinn N, Gaydos CA, Geddes CD. P5.061 Microwave-Accelerated Metal-Enhanced Fluorescence (MAMEF) Point-Of-Care Test For the Detection of Chlamydia Trachomatis. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gaydos CA, Rizzo-Price PA, Balakrishnan P, Mateta P, Leon SR, Verevochkin S, Yin YP, Quinn TC, Strader LC, Pequegnat W. Impact of international laboratory partnerships on the performance of HIV/sexually transmitted infection testing in five resource-constrained countries. Int J STD AIDS 2012; 22:645-52. [PMID: 22096049 DOI: 10.1258/ijsa.2011.010527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To review a quality control and quality assurance (QC/QA) model established to ensure the validity and reliability of collection, storage and analysis of biological outcome data, and to promote good laboratory practices (GLPs) and sustained operational improvements in international clinical laboratories, we conducted a two-arm randomized community-level HIV behavioural intervention trial in five countries: China, India, Peru, Russia and Zimbabwe. The trial was based on diffusion theory utilizing a Community Popular Opinion Leaders (CPOLs) intervention model with behavioural and biological outcomes. The QC/QA model was established by the Biological Outcome Workgroup, which collaborated with the Data Coordinating Center and John Hopkins University Reference Laboratory. Five international laboratories conducted chlamydia/gonorrhoea polymerase chain reaction (PRC)-based assays, herpes simplex virus type 2 enzyme immunoassay (EIA), syphilis serology (rapid plasma regain and Treponema pallidum particle agglutination assay, HIV serology (EIA/Western blot) and Trichomonas vaginalis culture. Data were collected at baseline, 12 and 24 months. Laboratory performance and infrastructure improved throughout the trial. Recommendations for improvement were consistently followed. Quality laboratories in resource-poor settings can be established, operating standards can be improved and certification can be obtained with consistent training, monitoring and technical support. Building collaborative partnership relations can establish a sustainable network for clinical trials, and can lead to accreditation and international laboratory development.
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Affiliation(s)
- C A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD 21205, USA.
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Aumakhan B, Gange SJ, Beyrer C, Gaydos CA, Minkoff H, Merenstein DJ, Cohen MH, Anastos K, Greenblatt R, Nowicki MJ, Quinn TC. Quantitative and qualitative correlates of cervicovaginal herpes simplex virus type 2 shedding among HIV-infected women in the Women's Interagency HIV Study. Int J STD AIDS 2011; 22:273-7. [PMID: 21571975 DOI: 10.1258/ijsa.2009.009296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We identified demographic, clinical and biological determinants of herpes simplex virus type 2 (HSV-2) shedding among HIV-infected participants in the Women's HIV Interagency Study (WIHS). Cervicovaginal lavage (CVL) specimens from 369 HIV-infected HSV seropositive women were tested with TaqMan polymerase chain reaction (PRC) for detection HSV-2 DNA. Seven percent of women tested positive for HSV-2 DNA in CVL. Significant correlates of the presence of HSV-2 DNA in CVL were being younger, African American or Hispanic race/ethnicity and injecting drugs in the past six months (P < 0.05). A borderline significant trend for reduced viral shedding with higher CD4+ T cell counts was observed (P = 0.08). All women who were never observed with any genital lesions and had consistently negative self-reported history of genital sores throughout the follow-up (n = 29, 8%) were negative for CVL HSV-2 DNA. HSV-2 DNA quantity was significantly associated with having frequent subsequent lesion recurrences (Spearman rho = 0.48, P = 0.016; adjusted prevalence ratio [APR] = 2.5, P = 0.012). Increasing the age of the host was inversely correlated with decreased viral shedding over time. However, a subset of older women continued to shed significant amounts of virus despite passage of time. This study provides genital HSV-2 DNA titre as a quantitative and symptom- and sign-based measures as qualitative predictors of HSV-2 shedding from the lower genital tract among HIV-infected women.
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Affiliation(s)
- B Aumakhan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Sutcliffe S, Nevin RL, Pakpahan R, Elliott DJ, Cole SR, De Marzo AM, Gaydos CA, Isaacs WB, Nelson WG, Sokoll LJ, Zenilman JM, Cersovsky SB, Platz EA. Prostate involvement during sexually transmitted infections as measured by prostate-specific antigen concentration. Br J Cancer 2011; 105:602-5. [PMID: 21792196 PMCID: PMC3188942 DOI: 10.1038/bjc.2011.271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: We investigated prostate involvement during sexually transmitted infections by measuring serum prostate-specific antigen (PSA) as a marker of prostate infection, inflammation, and/or cell damage in young, male US military members. Methods: We measured PSA before and during infection for 299 chlamydia, 112 gonorrhoea, and 59 non-chlamydial, non-gonococcal urethritis (NCNGU) cases, and 256 controls. Results: Chlamydia and gonorrhoea, but not NCNGU, cases were more likely to have a large rise (⩾40%) in PSA than controls (33.6%, 19.1%, and 8.2% vs 8.8%, P<0.0001, 0.021, and 0.92, respectively). Conclusion: Chlamydia and gonorrhoea may infect the prostate of some infected men.
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Affiliation(s)
- S Sutcliffe
- Division of Public Health Sciences and the Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8100, Room 5026, St Louis, MO 63110, USA.
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Hardick J, Quinn N, Eshelman S, Piwowar-Manning E, Cummings V, Marsiglia VC, Gaydos CA. O3-S6.04 Multi-site screening for lymphogranuloma venereum (LGV) in the USA. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ginocchio CC, Chapin K, Smith JS, Aslanzadeh J, Snook J, Hill CS, Gaydos CA. O3-S2.05 Prevalence of Trichomonas vaginalis and co-infection with Chlamydia trachomatis and Neisseria gonorrhoea in the USA as determined by the APTIMA Trichomonas vaginalis nucleic acid amplification assay. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Agreda P, Dize L, West S, Williams JA, Van Der Pol B, Gaydos CA. P3-S1.16 Comparison of the Abbott m2000 RealTime CT assay for Chlamydia trachomatis monitoring in Tanzania compared to the Roche Amplicor CT assay. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andrinopoulos K, Kerrigan D, Figueroa JP, Reese R, Gaydos CA, Bennett L, Bloomfield B, Plunkett L, Maru C, Ellen JM. Establishment of an HIV/sexually transmitted disease programme and prevalence of infection among incarcerated men in Jamaica. Int J STD AIDS 2010; 21:114-9. [PMID: 20089997 DOI: 10.1258/ijsa.2009.008416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The goal of this study is to describe the establishment of an HIV testing and treatment programme in the Jamaican correctional system and to estimate the prevalence of HIV/sexually transmitted disease (STD) among adult incarcerated men in this country. A demonstration project was implemented by the Jamaican Department of Correctional Services and Ministry of Health in the nation's largest correctional centre. All inmates were offered HIV and syphilis testing, and a subset was offered chlamydia, gonorrhoea and trichomoniasis testing. Cross-sectional data from the project were reviewed to determine the prevalence and correlates of HIV/STD. HIV test acceptance was 63% for voluntary testers (n = 1200). The prevalence of HIV was 3.3% (95% confidence interval [CI] 2.33-4.64) (n = 1017) and the prevalence syphilis was 0.7% (95% CI 0.29-1.49) (n = 967). Among the subset tested (n = 396) the prevalence of chlamydia was 2.5% (95% CI 1.22-4.49) and for trichomoniasis it was 1.8% (95% CI 0.01-3.60), but no cases of gonorrhoea were detected (n = 396). The prevalence of HIV was significantly higher at 25% (95% CI 13.64-39.60) for persons located in a separate section where individuals labelled as men who have sex with men (MSM) are separated. HIV/STD testing is important and feasible in Jamaica. A special focus should be placed on providing services to inmates labelled as MSM. Other Caribbean nations may also benefit from similar programmes.
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Affiliation(s)
- K Andrinopoulos
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Hsieh YH, Shih TY, Lin HW, Hsieh TC, Kuo MJ, Lin CW, Gaydos CA. High-risk sexual behaviours and genital chlamydial infections in high school students in Southern Taiwan. Int J STD AIDS 2010; 21:253-9. [DOI: 10.1258/ijsa.2009.008512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Summary The objective of this study was to determine the prevalence of high-risk sexual behaviours and sexually transmitted infections (STIs) and associated risk factors in Taiwanese high school students. Students in grades 10 and 11 (mean age: 15.9 ± 0.9; range: 13–20 years) at two schools were recruited. An anonymous online real-time computer-assisted self-interviewing questionnaire was designed to assess demographic factors and sexual behaviours. Urine specimens were tested for genital chlamydial and gonococcal infections. The same survey and screening was conducted one year later on the same group of students. Overall, 670 individual students (993 visits) were enrolled with 323 students in both surveys. Twenty-seven percent had had sexual intercourse, and more than three quarters (79%) of them had engaged in high-risk sexual behaviours. Having friends using drugs increased the odds of practicing high-risk sexual behaviours (odds ratio [OR] 1.99, 95% CI: 1.13 to 3.50). Among 182 sexually active students, 8.8% had chlamydial (female: 12.5%; male: 5.3%) and 1.1% had gonococcal infections. Having sex with someone met on the Internet was the most significant risk factor for acquiring chlamydia (OR 8.14, 95% CI: 2.82 to 23.51). In conclusion, this adolescent population reported high prevalence of high-risk sexual behaviours and had a high prevalence of chlamydia supportive of a potential epidemic of STIs and HIV.
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Affiliation(s)
- Y-H Hsieh
- Department of Public Health, National Cheng Kung University Medical College, Tainan, Taiwan, ROC
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - T-Y Shih
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - H-W Lin
- Department of Public Health, National Cheng Kung University Medical College, Tainan, Taiwan, ROC
| | - T-C Hsieh
- Department of Public Health, National Cheng Kung University Medical College, Tainan, Taiwan, ROC
| | - M-J Kuo
- Department of Public Health, National Cheng Kung University Medical College, Tainan, Taiwan, ROC
| | - C-W Lin
- Department of Public Health, National Cheng Kung University Medical College, Tainan, Taiwan, ROC
| | - C A Gaydos
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Gaydos CA, Hsieh YH, Galbraith JS, Barnes M, Waterfield G, Stanton B. Focus-on-Teens, sexual risk-reduction intervention for high-school adolescents: impact on knowledge, change of risk-behaviours, and prevalence of sexually transmitted diseases. Int J STD AIDS 2008; 19:704-10. [PMID: 18824625 DOI: 10.1258/ijsa.2008.007291] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A community-based intervention, Focus-on-Kids (FOK) has demonstrated risk-behaviour reduction of urban youth. We modified FOK to Focus-on-Teens (FOT) for high schools. High school adolescents (n=1190) were enrolled over successive school semesters. The small-group sessions were presented during the school-lunch hours. Confidential surveys were conducted at baseline, immediate, six-, and 12-month postintervention for demographics, parental communication/monitoring, sexual risk behaviours and sexually transmitted diseases (STDs)/HIV/condom-usage knowledge. Sexually active participants were encouraged to volunteer for urine-based STDs testing at the School-Based Health Centres. Many (47.4%) students reported having had sexual intercourse at baseline. Overall behaviours changed towards 'safer' sex behaviours (intent-to-use and using condoms, communicating with partner/parents about sex/condoms/STDs) with time (P<0.05). Proportion of students with complete correct knowledge of STDs/HIV increased to 88% at time 4 from 80% at baseline after adjusting for age, gender and sexual activity (P<0.05). High prevalence of STDs was detected in 875 participants who reported for urine testing at time 1: trichomonas, 11.8%; chlamydia, 10.1% and gonorrhoea, 4.1%. Prevalence decreased significantly for 310 participants who re-tested; chlamydia: 27.4% to 6.1% and gonorrhoea: 11.3% to 3.2%. FOT was successfully implemented as an STDs/HIV risk-reduction intervention. Sustained improvements of knowledge about STDs/HIV/condom usage, decreases in sexual risk behaviours supported the effectiveness of this intervention.
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Affiliation(s)
- C A Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD 21205, USA.
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Suntoke TR, Hardick A, Tobian AAR, Mpoza B, Laeyendecker O, Serwadda D, Opendi P, Gaydos CA, Gray RH, Wawer MJ, Quinn TC, Reynolds SJ. Evaluation of multiplex real-time PCR for detection of Haemophilus ducreyi, Treponema pallidum, herpes simplex virus type 1 and 2 in the diagnosis of genital ulcer disease in the Rakai District, Uganda. Sex Transm Infect 2008; 85:97-101. [PMID: 19066198 DOI: 10.1136/sti.2008.034207] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To develop a real-time PCR assay that reliably and accurately detects the predominant sexually transmitted aetiological agents of genital ulcer disease (GUD) (Haemophilus ducreyi, Treponema pallidum and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2)) and to assess the use of real-time PCR diagnostic testing in a rural African field site. METHODS Two multiplex real-time PCR reactions were used to detect H ducreyi/and HSV-1/HSV-2 in ulcer swabs from 100 people with symptomatic genital ulcers in rural Rakai, Uganda. Results were compared with syphilis, HSV-1 and HSV-2 serology. RESULTS Of 100 GUD samples analysed from 43 HIV positive and 57 HIV negative individuals, 71% were positive for one or more sexually transmitted infection (STI) pathogens by real-time PCR (61% for HSV-2, 5% for T pallidum, 3% for HSV-1, 1% for H ducreyi and 1% for dual H ducreyi/HSV-2). The frequency of HSV in genital ulcers was 56% (32/57) in HIV negative individuals and 77% (33/43) in HIV positive individuals (p = 0.037). Assay reproducibility was evaluated by repeat PCR testing in the USA with 96% agreement (kappa = 0.85). CONCLUSIONS STI pathogens were detected in the majority of GUD swab samples from symptomatic patients in Rakai, Uganda, by real-time PCR. HSV-2 was the predominant cause of genital ulcers. Real-time PCR technology can provide sensitive, rapid and reproducible evaluation of GUD aetiology in a resource-limited setting.
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Affiliation(s)
- T R Suntoke
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Portlock CS, Hamlin P, Noy A, Chey W, Gaydos CA, Palomba L, Schwartz I, Corcoran S, Rosenzweig L, Walker D, Papanicolaou G, Markowitz A. Infectious disease associations in advanced stage, indolent lymphoma (follicular and nonfollicular): developing a lymphoma prevention strategy. Ann Oncol 2007; 19:254-8. [PMID: 17965114 DOI: 10.1093/annonc/mdm484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Eradication of Helicobacter pylori in gastric mucosa-associated lymphoid tumor can result in lymphoma remission. We prospectively identified/treated infections in nonbulky, advanced stage indolent lymphoma (follicular; nonfollicular lymphoma) eligible for observation. MATERIALS AND METHODS Stool H. pylori, hepatitis C and Borrelia serologies, Borrelia and Chlamydia fixed tissue PCR, Chlamydia peripheral blood mononuclear cell PCR and hydrogen breath test for small bowel bacterial overgrowth (SBBO) were obtained. RESULTS Fifty-six patients were enrolled. Positive infections: H. pylori (13); hepatitis C (3); SBBO (11). Negative: Borrelia (13); Chlamydophila psittaci (12, except one PCR). Lymphoma responses to antimicrobial therapy: H. pylori [one complete response (CR), 24+ months; one transient near CR]; hepatitis C [two CRs, 18+ and 30+ months; one partial response (PR) but hepatitis C virus persistent]; SBBO (one PR, 30+ months). Patients with associated infections, but without lymphoma CR, have required lymphoma treatment sooner than those without initial infections (treatment-free survival at 23.4 months median follow-up, 40.5% versus 74.7%, P = 0.01), indicating a different biology. CONCLUSION Infections are common in advanced stage indolent lymphoma (37.5% in our series). Anecdotal lymphoma responses have been seen and three have been durable CRs (18 to 30+ months) with infection eradication alone. The identification and treatment of associated infections may be a first step towards developing a lymphoma prevention strategy.
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Affiliation(s)
- C S Portlock
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
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Rogers CK, Wood BJ, Rizzo P, Gaydos CA. Effect of endocervical-specimen adequacy on detection of Chlamydia trachomatis by the APTIMA COMBO 2 assay. J Clin Microbiol 2006; 44:4564-5. [PMID: 17065266 PMCID: PMC1698432 DOI: 10.1128/jcm.00981-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 07/10/2006] [Accepted: 10/09/2006] [Indexed: 11/20/2022] Open
Abstract
Six hundred one endocervical specimens were analyzed for Chlamydia trachomatis by the APTIMA Combo 2 assay and evaluated for columnar epithelial cell adequacy by direct fluorescent-antibody staining. With 5.5% positive adequate and 7.8% positive inadequate specimens (P=0.27), the study suggested no difference in positivity rates due to specimen adequacy when this amplified technology was used.
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Affiliation(s)
- C K Rogers
- Wyoming Public Health Laboratory, 517 Hathaway Bldg., 2300 Capitol Ave., Cheyenne, WY 82002, USA.
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Zhu J, Davidson M, Leinonen M, Saikku P, Gaydos CA, Canos DA, Gutman KA, Howard BV, Epstein SE. Prevalence and persistence of antibodies to herpes viruses, Chlamydia pneumoniae and Helicobacter pylori in Alaskan Eskimos: the GOCADAN Study. Clin Microbiol Infect 2006; 12:118-22. [PMID: 16441448 DOI: 10.1111/j.1469-0691.2005.01319.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence and persistence of antibodies against cytomegalovirus (CMV), herpes simplex virus types 1 (HSV1) and 2 (HSV2), Helicobacter pylori and Chlamydia pneumoniae were determined in Alaskan Eskimos. The study included 610 individuals (mean age 43 +/- 15 years; 45% males) participating in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. Archived serum samples and those collected during the GOCADAN study were analysed for antibodies against the above pathogens by ELISA. The current prevalence of antibody seropositivity was 94% to CMV, 90% to HSV1, 38% to HSV2, 80% to H. pylori, and 42% to C. pneumoniae. The persistence of antibodies (in both archived and current samples) against CMV, HSV1 and H. pylori was high (83%, 84% and 67%, respectively) compared with those against HSV2 (26%) and C. pneumoniae (29%). Moreover, the seroconversion rates to these organisms were low. Most individuals acquired CMV, HSV1 and H. pylori antibodies by the age of 24 years (94%, 90% and 72%, respectively), and >50% carried HSV2 and C. pneumoniae antibodies by the age of 45 years. There were gender differences in antibody seropositivity rates. Over 70% of individuals had antibodies to at least three of the five pathogens tested. The study demonstrated the high prevalence and lifelong persistence of multiple antibodies, suggesting chronic infections among Alaskan Eskimos.
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Affiliation(s)
- J Zhu
- MedStar Research Institute, Penn Medical Laboratory, Washington, DC 20010, USA.
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Melese M, West ES, Alemayehu W, Munoz B, Worku A, Gaydos CA, West SK. Characteristics of trichiasis patients presenting for surgery in rural Ethiopia. Br J Ophthalmol 2005; 89:1084-8. [PMID: 16113353 PMCID: PMC1772827 DOI: 10.1136/bjo.2005.066076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine the characteristics of trichiasis patients presenting for surgery in Wolayta Zone of Ethiopia. METHODS Patients referred for trichiasis surgery by community health agents were evaluated by trained integrated eye care workers (IECWs) for the presence of trichiasis, locations of inturned lashes, severity of trichiasis, corneal opacity, and visual acuity. RESULTS 1635 individuals with trichiasis presented for surgery. 82% had bilateral trichiasis; 91% of patients reported trichiasis duration of >2 years. Epilation was practised by over three fourths of the study subjects. A high proportion of patients tested positive for ocular Chlamydia trachomatis at presentation. 17% had monocular blindness and 8% were binocularly blind. Corneal opacity was highly associated with the trichiasis duration and severity and visual loss was associated with corneal opacity. CONCLUSION Severe trichiasis reflects the magnitude of the trachoma problem in Ethiopia. Visual impairment due to trichiasis is highly associated with disease severity and duration. Early intervention to correct trichiasis before it become severe is recommended to prevent visual impairment.
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Affiliation(s)
- M Melese
- Project ORBIS, Addis Ababa, Ethiopia
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Sosman JM, MacGowan RJ, Margolis AD, Eldridge E, Flanigan T, Vardaman J, Fitzgerald C, Kacanek D, Binson D, Seal DW, Gaydos CA. Screening for sexually transmitted diseases and hepatitis in 18-29-year-old men recently released from prison: feasibility and acceptability. Int J STD AIDS 2005; 16:117-22. [PMID: 15825246 DOI: 10.1258/0956462053057594] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Men entering prisons have high rates of sexually transmitted disease (STD), hepatitis, and HIV. This study sought to determine the acceptability and feasibility of screening for STD and hepatitis in young men released from prison. Participants were interviewed six months after release and offered free screening. Of 42 (56%) eligible men who participated in the qualitative interview, 33 (79%) provided at least a blood or urine specimen. Eight of 33 (24%) men tested had chlamydia, trichomoniasis, hepatitis B or C virus (HBV or HCV). Three of 32 (9%) had chlamydia, three of 32 (9%) had trichomoniasis, two of 28 (7%) had prior syphilis, and two of 28 (7%) had HCV. Of 28 tested for HBV, six (21%) were immune, two (7%) had chronic infection, and 20 (71%) were susceptible. Barriers to screening included lack of forewarning, inconvenience, and insufficient incentive. In conclusion, screening for STD and hepatitis among former inmates can be acceptable and feasible. Forewarning, reducing the time burden, and providing monetary incentives may increase screening rates.
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Affiliation(s)
- J M Sosman
- Department of Medicine, University of Wisconsin Medical School, Madison, WI 53705, USA.
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Miller GA, Klausner JD, Coates TJ, Meza R, Gaydos CA, Hardick J, Leon S, Caceres CF. Assessment of a rapid antigen detection system for Trichomonas vaginalis infection. Clin Diagn Lab Immunol 2004; 10:1157-8. [PMID: 14607884 PMCID: PMC262444 DOI: 10.1128/cdli.10.6.1157-1158.2003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hsieh YH, Howell MR, Gaydos JC, McKee KT, Quinn TC, Gaydos CA. Preference among female Army recruits for use of self-administrated vaginal swabs or urine to screen for Chlamydia trachomatis genital infections. Sex Transm Dis 2003; 30:769-73. [PMID: 14520176 DOI: 10.1097/01.olq.0000079048.11771.46] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Use of self-administered vaginal swabs (SAS) for the detection of Chlamydia trachomatis by nucleic acid amplification tests simplifies specimen collection and transport, especially for women in nonclinical settings. GOAL We investigated the preference and comfort level of military women for the collection of SAS, compared with urine, for the diagnosis of genital chlamydial infections. STUDY DESIGN During March through August 1999, female Army recruits in basic training at Fort Jackson, South Carolina, were invited to participate in the study. Participants were requested to complete a questionnaire after providing both first-void urine (FVU) and SAS specimens. Participant characteristics, preferences, and comfort levels were assessed using multivariate logistic regression. RESULTS From 4496 eligible female recruits, 1403 (31%) completed questionnaires and 1382 provided both specimens; 11.8% (166 of 1403) of participants were infected with chlamydia. The relative sensitivity and specificity of the C. trachomatis Ligase Chain Reaction test on SAS in 1382 matched pairs was 81.1% and 98.6%, respectively, using the test result on urine specimens as the comparison standard. Most of the participants (90.8%) reported that they felt comfortable collecting the FVU specimen, and 69.6% indicated that they felt comfortable collecting SAS. Either specimen collection type received high acceptability at home and in the field, and more women reported that they would collect FVU than reported they would collect SAS in the future (in the field: FVU: 79.4%, SAS: 68.8%, P <0.001); at home: FVU: 90.9%, SAS: 82.9%, P <0.001). When questioned about ease of use, 60.4% of women reported that urine was the easier method. Preferences for SAS were associated with being white and having had sexual risk behaviors in the past 3 months. CONCLUSION A study of preferences for urine versus self-administered vaginal swabs for the detection of C. trachomatis in military women showed that women generally found SAS acceptable. SAS should be a feasible alternative to urine collection in situations in which specimen storage or transport is an issue.
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Affiliation(s)
- Y-H Hsieh
- Division of Infectious Diseases, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
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Wendel KA, Erbelding EJ, Gaydos CA, Rompalo AM. Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic. Sex Transm Infect 2003; 79:151-3. [PMID: 12690140 PMCID: PMC1744621 DOI: 10.1136/sti.79.2.151] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the prevalence and clinical features of Trichomonas vaginalis (TV) infection in men. METHODS Men attending a public STD clinic in Baltimore, Maryland, were evaluated between March and July 2000. Clinicians recorded a standardised history and clinical examination. Urethral swab specimens were collected for Gram stain and Neisseria gonorrhoeae culture. First fraction urine samples were evaluated with TV culture and chlamydia and TV polymerase chain reaction (PCR). True positive TV was defined as a positive TV culture or a positive TV PCR confirmed with a second primer set. RESULTS 355 men were evaluated in 363 visits. The prevalence of gonorrhoea, TV, and chlamydia were 19%, 13%, and 11%, respectively. In men over 28 years, the prevalence of TV was significantly higher than chlamydia. Age and urethritis by Gram stain were associated with a positive result on TV culture (p=0.03 and p=0.02, respectively) but not associated with TV infection as defined by a positive TV culture or a confirmed TV PCR. Discharge or dysuria was reported in 47% and 22% of men with TV, respectively. CONCLUSIONS TV prevalence in an urban STD clinic setting was high. Older age and urethritis were not significantly associated with TV infection as defined by a positive TV culture or a confirmed TV PCR.
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Affiliation(s)
- K A Wendel
- Division of Infectious Diseases, Oklahoma University Health Science Center, Oklahoma, USA
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Gaydos CA, Quinn TC, Willis D, Weissfeld A, Hook EW, Martin DH, Ferrero DV, Schachter J. Performance of the APTIMA Combo 2 assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in female urine and endocervical swab specimens. J Clin Microbiol 2003; 41:304-9. [PMID: 12517865 PMCID: PMC149571 DOI: 10.1128/jcm.41.1.304-309.2003] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The greater sensitivity of nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae permits the use of urine and other noninvasive specimens, which can increase the reach and decrease the costs of public health screening programs aimed at controlling these infections. This study evaluated the performance of the APTIMA Combo 2 assay, a multiplex assay based on the transcription-mediated amplification reaction, for the simultaneous detection of both pathogens in endocervical swab and urine specimens from females. Combo 2 assay results were compared with patient infected status, which were available by using other commercial NAATs. Sensitivity and specificity for C. trachomatis were 94.2 and 97.6%, respectively, in swabs and 94.7 and 98.9%, respectively, in first-catch urine (FCU). Sensitivity and specificity for N. gonorrhoeae were 99.2 and 98.7%, respectively, in swabs and 91.3 and 99.3%, respectively, in FCU. The assay reliably detected both infections in coinfected patients. The Combo 2 assay can be recommended for use with endocervical swab and urine specimens from females, especially for screening tests for asymptomatic women in sexually transmitted disease surveillance programs. This Food and Drug Administration-cleared assay can be a useful tool in efforts to reduce the prevalence and incidence of C. trachomatis and N. gonorrhoeae infections in sexually active women and to prevent their costly and serious sequelae.
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Affiliation(s)
- C A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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Kaufman M, Gaydos CA, Sriram S, Boman J, Tondella ML, Norton HJ. Is Chlamydia pneumoniae found in spinal fluid samples from multiple sclerosis patients? Conflicting results. Mult Scler 2002; 8:289-94. [PMID: 12166498 DOI: 10.1191/1352458502ms815oa] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cerebrospinal fluid samples from controls and patients with multiple sclerosis (MS) were split and sent to laboratories with different experiences for the detection of Chlamydia pneumoniae by polymerase chain reaction. Vanderbilt investigators identified C. pneumoniae in the majority of patients with MS and uncommonly in controls. Laboratories at Johns Hopkins University, University of Umeå, and the Centers for Disease Control and Prevention did not identify C. pneumoniae in any of the samples. Conflicting reports of C. pneumoniae detection in the some samples from patents with MS highlight the need to exchange detection techniques among laboratories involved in this controversy.
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Affiliation(s)
- M Kaufman
- Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
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Cecil JA, Howell MR, Tawes JJ, Gaydos JC, McKee KT, Quinn TC, Gaydos CA. Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male Army recruits. J Infect Dis 2001; 184:1216-9. [PMID: 11598849 DOI: 10.1086/323662] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2001] [Revised: 07/06/2001] [Indexed: 11/03/2022] Open
Abstract
Non-health care-seeking male United States Army recruits were tested for Chlamydia trachomatis (n=2245) and Neisseria gonorrhoeae (n=884), using a urine ligase chain reaction test to determine prevalence and potential risk factors for infection. The prevalence of chlamydial infection was 5.3%. Black race, a new sex partner, a history of trichomonas, and the presence of symptoms were associated with chlamydial infection. The prevalence of N. gonorrhoeae infection was 0.6%. Only a reported history of or positive test for C. trachomatis was associated with gonorrheal infection. Of those testing positive for chlamydia, 14% reported symptoms versus 40% of those with gonorrhea. Younger age was not a predictor of either infection, as has been shown for women. A substantial number of male army recruits are infected with C. trachomatis, but few are infected with N. gonorrhoeae. Screening on the basis of symptoms alone would miss the majority of both infections.
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Affiliation(s)
- J A Cecil
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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Rompalo AM, Gaydos CA, Shah N, Tennant M, Crotchfelt KA, Madico G, Quinn TC, Daniel R, Shah KV, Gaydos JC, McKee KT. Evaluation of use of a single intravaginal swab to detect multiple sexually transmitted infections in active-duty military women. Clin Infect Dis 2001; 33:1455-61. [PMID: 11568849 DOI: 10.1086/322588] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2000] [Revised: 03/22/2001] [Indexed: 11/03/2022] Open
Abstract
The accuracy and suitability of use of a single intravaginal swab (SIS) for polymerase chain reaction detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and human papillomavirus infection was assessed in a cross-sectional study of 841 active-duty military women. The SIS, compared with standard diagnostic tests, allowed detection of more gonorrhea, more chlamydial infection, and more trichomoniasis. Sensitivity and specificity of SIS detection compared with adjudicated true-positive diagnoses were 95.8% and 97.8%, respectively, for gonorrhea, 94.6% and 99.3% for chlamydial infection, and 92.2% and 98.2% for trichomonal infection. Results with SISs were comparable to those with cervical swabs tested for human papillomavirus. Assay of clinician-collected and self-collected SISs yielded prevalences similar to those of standard diagnostic tests for all sexually transmitted infections. Therefore, the use of SISs is acceptable for the simultaneous diagnosis of multiple sexually transmitted infections and has potential for use as a self-administered diagnostic tool with widespread applicability among women.
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Affiliation(s)
- A M Rompalo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Van Der Pol B, Martin DH, Schachter J, Quinn TC, Gaydos CA, Jones RB, Crotchfelt K, Moncada J, Jungkind D, Turner B, Peyton C, Kelly JF, Weiss JB, Rosenstraus M. Enhancing the specificity of the COBAS AMPLICOR CT/NG test for Neisseria gonorrhoeae by retesting specimens with equivocal results. J Clin Microbiol 2001; 39:3092-8. [PMID: 11526134 PMCID: PMC88302 DOI: 10.1128/jcm.39.9.3092-3098.2001] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COBAS AMPLICOR CT/NG test for Neisseria gonorrhoeae cross-reacts with certain strains of nonpathogenic Neisseria species. In some strains, the target sequence is identical to that of N. gonorrhoeae, whereas other strains have a small number of mismatches within the regions recognized by the primers or probe used in the COBAS AMPLICOR NG test. These cross-reactive strains are occasionally present in urogenital specimens, causing false-positive results in the COBAS AMPLICOR NG test. Analysis of the data generated in a large multicenter clinical trial showed that 2.9% of the specimens gave signals between A(660)s of 0.2 and 3.5 but that one-half of these equivocal specimens did not contain N. gonorrhoeae. Most of these equivocal specimens were correctly classified as true positive or true negative by retesting in duplicate and defining a PCR-positive result as two of three results with an A(660) of > or =2.0. If specimens had been classified as positive or negative based on a single test result using a cutoff of an A(660) of 0.2, specificity would have ranged from 96.2 to 98.9% depending on specimen type, sex, and presence of symptoms. By employing the equivocal zone-retesting algorithm, specificity increased to 98.6 to 99.9% with little effect (0.1 to 4.9% decrease) on sensitivity in most specimen types, enabling the test to achieve a positive predictive value of at least 90% in populations with a prevalence of 4% or higher. In lower-prevalence populations, the test could be used to screen for presumptive infections that would have to be confirmed by an independent test.
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Affiliation(s)
- B Van Der Pol
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Shah KV, Daniel RW, Tennant MK, Shah N, McKee KT, Gaydos CA, Gaydos JC, Rompalo A. Diagnosis of human papillomavirus infection by dry vaginal swabs in military women. Sex Transm Infect 2001; 77:260-4. [PMID: 11463925 PMCID: PMC1744351 DOI: 10.1136/sti.77.4.260] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Human papillomavirus (HPV) assays are likely to be used with increasing frequency in clinical management of women with abnormal Papanicolaou smears and in cervical cancer screening. Our objective was to simplify the method of collection of female genital tract specimens. The utility of vaginal dry swabs for HPV diagnosis was evaluated. METHODS Specimens for cytology and for HPV identification were collected by a clinician from 189 female soldiers attending a military clinic. Three methods of specimen collection for HPV identification were compared: a vaginal dry swab (v-DRY), and vaginal and cervical swabs placed into specimen transport medium (v-STM and c-STM). Swabs were shipped to a STD laboratory for processing. Specific HPV types were identified by a consensus primer based PCR based method. Results from 165 women were evaluable. RESULTS HPV prevalence by the three methods was similar and ranged from 44.8% to 50.9%. 53 (32.1%) women were HPV positive and 60 (36.4%) women were HPV negative by all three collection methods. With respect to the risk categories of specific HPV types, there was greater agreement between the results from the two vaginal (v-DRY and v-STM) samples (kappa values of 0.69-0.81) than between the cervical (c-STM) and either of the vaginal samples (kappa values of 0.37-0.55). The HPV yield from c-STM was somewhat greater than that from the vaginal specimens but the correlation between cytological abnormalities and HPV was high for all three methods. CONCLUSION A dry vaginal swab may be an acceptable method of specimen collection for HPV diagnosis.
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Affiliation(s)
- K V Shah
- Johns Hopkins University School of Public Health and Hygiene, Baltimore, MD, USA
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Kacena KA, Dohnal K, Benesova V, Grivna M, Deliopolu J, Trýzna R, Horák J, Gaydos CA, Quinn TC. Chlamydia, gonorrhea, and HIV-1 prevalence among five populations of women in the Czech and Slovak Republics. Sex Transm Dis 2001; 28:356-62. [PMID: 11403195 DOI: 10.1097/00007435-200106000-00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Five populations at risk for sexually transmitted diseases (STDs) in the Czech and Slovak Republics were sampled. GOAL To estimate prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV-1 infections. STUDY DESIGN Urine specimens were collected serially from women at a Prague prenatal clinic (n = 134), a Prague dermatovenerealogy clinic (n = 91), sex workers from northern and central Bohemia (n = 35), students from a northern Bohemian school (n = 217), and Gypsies from Jarovnice, Slovakia (n = 128). These specimens were tested for chlamydia and gonorrhea using a ligase chain reaction pooling algorithm, and for HIV using an enzyme immunoassay confirmed by Western blot. RESULTS The prevalence of chlamydia was 2.2% (95% CI, 0.4-6.4) in the prenatal clinic, 5.5% (95% CI, 1.8-12.4) in the STD clinic, 22.9% (95% CI, 10.4-40.1) among street sex workers, 8.2% (95% CI, 3.6-15.6) among sexually active female high school students, and 3.9% (95% CI, 1.3-8.9) among Gypsy women. Gonorrhea was found in only two populations: 2.2% (95% CI, 0.3-7.7) in the STD clinic, and 2.9% (95% CI, 0.1-14.9) among sex workers. No HIV-1 infection was detected. CONCLUSIONS Urine screening was an efficient and accurate method for identifying groups at risk for STDs in the Czech Republic and Slovakia because sample collection was fast and noninvasive, and potential participation bias was reduced by high acceptability.
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Affiliation(s)
- K A Kacena
- Division of Infectious Diseases, The Johns Hopkins University, Baltimore, Maryland 21205, USA
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Van Der Pol B, Ferrero DV, Buck-Barrington L, Hook E, Lenderman C, Quinn T, Gaydos CA, Lovchik J, Schachter J, Moncada J, Hall G, Tuohy MJ, Jones RB. Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs. J Clin Microbiol 2001; 39:1008-16. [PMID: 11230419 PMCID: PMC87865 DOI: 10.1128/jcm.39.3.1008-1016.2001] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of the Becton Dickinson BDProbe Tec ET System Chlamydia trachomatis and Neisseria gonorrhoeae Amplified DNA Assays (BD Biosciences, Sparks, Md.) was evaluated in a multicenter study. Specimens were collected from 2,109 men and women, with or without symptoms, attending sexually transmitted disease, family planning, and obstetrics and gynecology clinics. Both swab and urine samples were collected, and the results obtained from 4,131 specimens were compared to those from culture and the LCx nucleic acid amplification test (Abbott Industries, Abbott Park, Ill.). PCR and cytospin of the culture transport medium with chlamydia direct fluorescent antibody staining were used to adjudicate chlamydia culture-negative results. Sensitivity and specificity were calculated both with and without use of the amplification control (AC), with little apparent difference in the results. Without the AC result, sensitivity for C. trachomatis and N. gonorrhoeae were 92.8 and 96.6%, respectively, for cervical swabs and 80.5 and 84.9% for urine from women. C. trachomatis and N. gonorrhoeae sensitivities were 92.5 and 98.5%, respectively, for male urethral swabs and 93.1 and 97.9% for urine from men. This amplified DNA system for simultaneous detection of chlamydial and gonococcal infections demonstrated superior sensitivity compared to chlamydia culture and has performance characteristics comparable to those of other commercially available nucleic acid-based assays for these organisms.
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Affiliation(s)
- B Van Der Pol
- Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Apfalter P, Blasi F, Boman J, Gaydos CA, Kundi M, Maass M, Makristathis A, Meijer A, Nadrchal R, Persson K, Rotter ML, Tong CY, Stanek G, Hirschl AM. Multicenter comparison trial of DNA extraction methods and PCR assays for detection of Chlamydia pneumoniae in endarterectomy specimens. J Clin Microbiol 2001; 39:519-24. [PMID: 11158100 PMCID: PMC87769 DOI: 10.1128/jcm.39.2.519-524.2001] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The reported rate of detection of Chlamydia pneumoniae DNA within atherosclerotic lesions by PCR varies between 0 and 100%. In this study, identical sets of coded experimental atheroma samples (n = 15) and spiked controls (n = 5) were analyzed by 16 test methods in nine centers by means of PCR. The positive controls were correctly identified to levels of 1, 0.1, and 0.01 inclusion bodies of C. pneumoniae/ml of tissue homogenate by 16 (100%), 11 (69%), and 3 (19%) of the test methods, respectively. Three out of 16 negative controls (19%) were rated positive. Positivity rates for atheroma samples varied between 0 and 60% for the different test methods, with the maximum concordant result for positivity being only 25% for one carotid artery sample. There was no consistent pattern of positive results among the various laboratories, and there was no correlation between the detection rates and the sensitivity of the assay used.
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Affiliation(s)
- P Apfalter
- Department of Clinical Microbiology, Hygiene-Institute, University of Vienna, Vienna, Austria.
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Burstein GR, Zenilman JM, Gaydos CA, Diener-West M, Howell MR, Brathwaite W, Quinn TC. Predictors of repeat Chlamydia trachomatis infections diagnosed by DNA amplification testing among inner city females. Sex Transm Infect 2001; 77:26-32. [PMID: 11158688 PMCID: PMC1758317 DOI: 10.1136/sti.77.1.26] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of prevalent and incident chlamydia infection in order to assess the appropriate interval for chlamydia screening; and to identify risk factors predictive of infection and repeat infections. DESIGN Prospective longitudinal study of a consecutive sample of 3860 sexually active females aged 12-60 years tested for C. trachomatis by polymerase chain reaction in Baltimore City clinics during 11,904 patient visits over a 33 month period. RESULTS Chlamydia prevalence, incidence, and frequency to diagnosis of infection varied by age. Among 2073 females < 25 years, chlamydia infection was found in 31.2%. The median times to first and repeat incident infections were 7.0 months and 7.6 months, respectively. Among 1787 females > or = 25 years, chlamydia infection was found in 9.6%. Median times to first and repeat incident infections were 13.8 months and 11.0 months, respectively. Age < 25 years yielded the highest risk of infection. CONCLUSIONS Since a high burden of chlamydia was found among mostly asymptomatic females < 25 years in a spectrum of clinical settings, we recommend chlamydia screening for all sexually active females < 25 years at least twice yearly.
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Affiliation(s)
- G R Burstein
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA.
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Burnett MS, Gaydos CA, Madico GE, Glad SM, Paigen B, Quinn TC, Epstein SE. Atherosclerosis in apoE knockout mice infected with multiple pathogens. J Infect Dis 2001; 183:226-231. [PMID: 11120928 DOI: 10.1086/317938] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2000] [Revised: 10/11/2000] [Indexed: 12/24/2022] Open
Abstract
Cytomegalovirus (CMV) and Chlamydia pneumoniae (CP) possibly contribute to atherosclerosis. Murine CMV (MCMV) and CP increase lesion size in apoE knockout mice. In this study, apoE knockout mice were infected with MCMV and CP to determine whether infection with multiple pathogens increases lesion size to a greater extent than either pathogen alone and whether infection with MCMV changes serum cytokine levels in a manner that could increase lesion development. One group of mice received MCMV at 2 weeks of age, followed by 2 doses of CP at 6 and 8 weeks of age. Additional groups received only MCMV or CP. Animals were killed at 16 weeks of age to determine lesion area. Infection with MCMV alone, CP alone, and both MCMV and CP increased lesion size 84% (P<.001), 70% (P<.0001), and 45% (P<.01), respectively. The MCMV-induced increase in circulating levels of interferon-gamma may have contributed to this increase.
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Affiliation(s)
- M S Burnett
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA
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Rothstein NM, Quinn TC, Madico G, Gaydos CA, Lowenstein CJ. Effect of azithromycin on murine arteriosclerosis exacerbated by Chlamydia pneumoniae. J Infect Dis 2001; 183:232-238. [PMID: 11120929 DOI: 10.1086/317941] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2000] [Revised: 10/11/2000] [Indexed: 11/04/2022] Open
Abstract
Chlamydia pneumoniae infection can exacerbate atherosclerosis in animals. To test the hypothesis that antibiotic therapy inhibits the atherogenic effects of C. pneumoniae infection, 10-week-old apolipoprotein E (ApoE) null mice were infected with C. pneumoniae or placebo, were treated for 2 weeks after infection with azithromycin or placebo, and were killed at 20 weeks of age. Infection did not affect the size of the aortic lesion, and antibiotic treatment had no effect. Another group of mice, 12-week-old ApoE mice, were infected with C. pneumoniae or placebo, were treated for 2 weeks after infection with azithromycin or placebo, and were killed at 26 weeks of age. C. pneumoniae infection increased the size of the lesion in infected mice, but azithromycin did not reduce the size of the aortic lesion in infected mice. Therefore, immediate therapy of acute infection may be necessary to prevent the proatherogenic effects of C. pneumoniae infection.
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Affiliation(s)
- N M Rothstein
- Division of Cardiology, Dept. of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Abstract
BACKGROUND Screening women for genital Chlamydia trachomatis at entry to military service provides an opportunity to reduce costs associated with sequelae of this infection. However, financial responsibility for screening may be debated. More than 50% of recruits return to civilian life within 2 years. The military and the civilian health care systems would both benefit from a screening program. OBJECTIVE To assess the cost-effectiveness and relative cost savings to the military and civilian health sectors of three screening strategies for U.S. Army female recruits for C. trachomatis using urine ligase chain reaction: screening all recruits, screening recruits aged < or = 25 years, and no screening. METHODS We applied a decision analytic model. Cost factors included screening, lost military training, morbid pelvic inflammatory disease, and other sequelae. Using a 5-year analytic horizon, we conducted analyses from military and civilian perspectives. RESULTS Screening 10,000 female army recruits would cost 193,500 dollars and prevent 282 cases of sequelae, with a projected savings of 53,325 dollars to the military and 505,053 dollars to the civilian sector. From a military perspective, screening women aged < or = 25 years provided the highest cost savings. Screening all female recruits incurred an incremental cost of $1199 per sequela prevented. From a civilian perspective, screening all recruits offered the greatest cost savings. CONCLUSIONS Screening female Army recruits for C. trachomatis offers substantial savings in health care costs for both the military and civilian health care systems. Relative financial benefit derived from recruit screening is disproportionate; greatest cost savings are enjoyed by the civilian sector.
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Affiliation(s)
- M R Howell
- Johns Hopkins University, Division of Infectious Diseases, , Baltimore, Maryland 21205, USA
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Martin DH, Cammarata C, Van Der Pol B, Jones RB, Quinn TC, Gaydos CA, Crotchfelt K, Schachter J, Moncada J, Jungkind D, Turner B, Peyton C. Multicenter evaluation of AMPLICOR and automated COBAS AMPLICOR CT/NG tests for Neisseria gonorrhoeae. J Clin Microbiol 2000; 38:3544-9. [PMID: 11015361 PMCID: PMC87434 DOI: 10.1128/jcm.38.10.3544-3549.2000] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The fully automated COBAS AMPLICOR CT/NG and semiautomated AMPLICOR CT/NG tests were evaluated in a multicenter trial for their ability to detect Neisseria gonorrhoeae infections. Test performance compared to that of culturing was evaluated for 2,192 matched endocervical swab and urine specimens obtained from women and for 1, 981 matched urethral swab and urine specimens obtained from men. Culture-negative, PCR-positive specimens that tested positive in a confirmatory PCR test for an alternative target sequence within the N. gonorrhoeae 16S rRNA gene were considered to be true positives. The overall prevalences of gonorrhea were 6.6% in women and 20.1% in men. The COBAS AMPLICOR and AMPLICOR formats yielded concordant results for 98.8% of the specimens and exhibited virtually identical sensitivities and specificities. The results that follow are for the COBAS AMPLICOR format. With the infected patient as the reference standard, the resolved sensitivities of PCR were 92.4% for endocervical swab specimens and 64.8% for female urine specimens. There were no significant differences in these rates between women with and without symptoms. Among symptomatic men, COBAS AMPLICOR sensitivities were 94.1% for urine and 98.1% for urethral swabs; for asymptomatic men, the results were 42.3 and 73.1%, respectively. In comparison, the sensitivities of culturing were 84.8% for endocervical specimens, 92.7% for symptomatic male urethral specimens, and only 46.2% for urethral specimens obtained from asymptomatic men. When PCR results were analyzed as if only a single test had been performed on a single specimen type, the resolved sensitivity was always higher. The resolved specificities of PCR were 99.5% for endocervical swab specimens, 99.8% for female urine specimens, 98.9% for male urethral swab specimens, and 99.9% for male urine specimens. The internal control revealed that 2.1% of specimens were inhibitory when initially tested. Nevertheless, valid results were obtained for 99.2% of specimens because 60.0% of the inhibitory specimens were not inhibitory when a second aliquot was tested. The COBAS AMPLICOR CT/NG test for N. gonorrhoeae exhibited high sensitivity and specificity with urethral swab and urine specimens from men and endocervical swab specimens from women and thus is well suited for diagnosing and screening for N. gonorrhoeae infection.
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Affiliation(s)
- D H Martin
- Department of Internal Medicine, Louisiana State University, New Orleans, Louisiana 70118, USA.
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Peeling RW, Wang SP, Grayston JT, Blasi F, Boman J, Clad A, Freidank H, Gaydos CA, Gnarpe J, Hagiwara T, Jones RB, Orfila J, Persson K, Puolakkainen M, Saikku P, Schachter J. Chlamydia pneumoniae serology: interlaboratory variation in microimmunofluorescence assay results. J Infect Dis 2000; 181 Suppl 3:S426-9. [PMID: 10839729 DOI: 10.1086/315603] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The lack of standardization in chlamydia serology has made interpretation of published data difficult. This study was initiated to determine the extent of interlaboratory variation of microimmunofluorescence (MIF) test results for the serodiagnosis of Chlamydia pneumoniae infections. Identical panels of 22 sera were sent to 14 laboratories in eight countries for the determination of IgG and IgM antibodies by MIF. Although there was extensive variation in the numeric titer values, the overall percentage agreement with the reference standard titers from the University of Washington was 80%. For results by serodiagnostic category, the best agreement was for four-fold rise in IgG titers, while the lowest agreement was for negative or low IgG titers. Agreement for IgM titers was 50%-95%. Four laboratories failed to discern false-positive IgM titers possibly because of the presence of rheumatoid factor. Further studies are underway to determine the source of interlaboratory variation for the MIF test.
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Affiliation(s)
- R W Peeling
- Laboratory Centre for Disease Control, Winnipeg, Manitoba, Canada R3E 3R2.
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Tompkins LS, Schachter J, Boman J, Chernesky MA, Dowell S, Gaydos CA, Levison ME, Maass M, Madico G, Orfila J, Ouchi K, Peeling RW, Taylor-Robinson D, Stamm WE, Wang SP, Blasi F, Relman D. Collaborative multidisciplinary workshop report: detection, culture, serology, and antimicrobial susceptibility testing of Chlamydia pneumoniae. J Infect Dis 2000; 181 Suppl 3:S460-1. [PMID: 10839740 DOI: 10.1086/315599] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- L S Tompkins
- Stanford University Medical Center, H 1537J, Stanford, CA 94305, USA
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Abstract
Several recently published studies suggest that Chlamydia pneumoniae may represent a risk factor for atherosclerosis or its complications. In order to establish whether C. pneumoniae is causally linked to atherosclerotic diseases, clinical intervention trials may be needed. However, to identify eligible subjects with a persistent C. pneumoniae infection and to monitor the effect of antibiotic therapy, there is a need for a reliable diagnostic marker. Blood-based polymerase chain reaction assays may be of value for identifying patients persistently infected with C. pneumoniae and for assessing the microbiologic efficacy of antichlamydial therapy in clinical intervention trials.
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Affiliation(s)
- J Boman
- Dept. of Clinical Virology, Umeâ University Hospital, S-901 85 Umeâ, Sweden.
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Abstract
The proposed pathogenesis of Chlamydia pneumoniae in atherosclerosis is supported by the finding that C. pneumoniae can initiate and sustain growth in human vascular cells. In vitro growth of C. pneumoniae is found in macrophages, peripheral blood monocyte (PBMC)-derived macrophages, endothelial cells, and aortic artery smooth muscle cells. U-937 macrophages infected with C. pneumoniae are capable of transmitting the infection to human coronary artery endothelial cells (CAEC) with direct cellular contact. Production of cytokines by cells infected with C. pneumoniae indicates that the organism can stimulate the immune system. CAEC infected with C. pneumoniae produce more interleukin-8 than cells sham inoculated with negative control cells. When interferon-gamma is used to stimulate HEp-2 cells, U-937 cells, and PBMC (before infection with C. pneumoniae), inhibition of a productive growth cycle occurs in a dose-related response. Studies are needed to learn the relationship between productive infection and persistence, the ability of C. pneumoniae to affect the immune response, and the potential for C. pneumoniae to influence atheromatous lesions.
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Affiliation(s)
- C A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD 21205.
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