Biomedical subjects
D Goldmeier
Publications and source records attributed to D Goldmeier.
Acquired syphilis in adults.
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Psychiatric illnesses in patients with HIV infection and AIDS referred to the liaison psychiatrist.
All referrals made to the liaison psychiatric service for HIV and AIDS patients over one year were reviewed. ICD-9 and CDC diagnoses were applied to each case at presentation. Sixty HIV-positive patients were assessed, of whom 35 had affective disorder, which was significantly associated with CDC group IV disease (AIDS). Adjustment reaction was seen in nine patients, paranoid states in six, dementia in four, personality changes in four and paranoid schizophrenia in two. CT scans of the brain were performed on 23 of the patients: 17 of these showed abnormalities. The proportion of registered AIDS patients who were referred was five times the proportion of HIV patients.
Use of the polymerase chain reaction to detect DNA sequences specific to pathogenic treponemes in cerebrospinal fluid.
The polymerase chain reaction was used to detect Treponema pallidum in specimens of cerebrospinal fluid (CSF), as a means of diagnosing syphilis. Segments of the TmpA and 4D genes were amplified to provide an estimated threshold sensitivity of approximately 65 organisms in 0.5 ml. A spectrum of pathogens known to cause meningitis, and several non-pathogenic treponemes were unreactive. Treponema pertenue, and only one of 30 control specimens of CSF were positive. In contrast, 10 of 19 CSFs from patients being evaluated for latent or tertiary syphilis were positive, as were 7 of 28 specimens from HIV-positive patients.
Amoxycillin, syphilis, and HIV infection.
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Scrotal ulceration in HIV-positive patients.
Four patients with scrotal ulceration were seen during a period of 9 months. All of them were HIV-positive homosexual men with coexisting skin conditions. Herpes simplex virus was not isolated from any of the ulcers, but a variety of bacteria was recovered. It is suggested that multiple factors peculiar to HIV-positive individuals may account for the development of such ulcers.
Trends in gonococcal infection: no room for complacency.
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Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chain reaction.
The polymerase chain reaction (PCR) was used to detect Treponema pallidum DNA in the cerebrospinal fluid (CSF) of patients with and without syphilis. The CSF from 10 of 19 patients with positive serological tests for syphilis who were being investigated for late syphilis were treponemal DNA-positive. In contrast, the CSF from only one of 30 patients with no known history of syphilis was DNA-positive. CSF from 28 HIV-positive patients was also tested. Fourteen of these patients had central nervous system (CNS) disease and seven were DNA-positive, whereas none of the 14 without CNS disease were DNA-positive. Five of the seven DNA-positive patients had a history of syphilis. Such a history in an HIV-positive patient who had CNS disease was predictive of finding treponemal DNA in the CSF. The PCR had a sensitivity of 47% and a specificity of 93% for detecting a known history of syphilis and is a potentially useful tool in treponemal diagnosis.
HIV infection among sub-Saharan African patients in the UK.
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Are serological tests of value in diagnosing and monitoring response to treatment of syphilis in patients infected with human immunodeficiency virus?
To assess the value of serological tests in diagnosing and monitoring the response to treatment of syphilis in patients infected with the human immunodeficiency virus (HIV), case notes of eight homosexual men with a history of treated syphilis, positive reactions to serological tests for syphilis, and documented subsequent conversion to HIV seropositivity were studied. No change was noted in serological markers of syphilis after HIV infection. The case notes of one man with primary syphilis, four men with secondary syphilis, and three men with latent syphilis, of whom all were HIV seropositive, were also studied. In seven of these patients the serological responses to infection and after treatment were consistent with the experience of syphilis in HIV seronegative patients. In one man treated for secondary syphilis, and confirmed as HIV seropositive eight months after treatment, the rapid plasma reagin (RPR) test result continued to be positive at a high titre for up to 20 months after treatment.
Psychosocial implications of recurrent genital herpes simplex virus infection.
Fifty seven patients experiencing first attacks of genital herpes simplex virus infection (HSVI) were compared with 50 patients who were concerned about frequently recurring attacks despite routine counselling and reassurance. Using the general health questionnaire this latter group was found to be more psychologically distressed and more socially naive than the first attack group, as measured by socioeconomic class and the lie score of the Eysenck personality questionnaire; otherwise the two groups were similar. Patients presenting to clinics with frequently recurring genital HSVI may therefore be especially psychologically distressed, socially naive, and disadvantaged. Managing these patients needs to include understanding these problems as well as giving advice and using antiviral agents.
Psychosocial aspects of AIDS.
Bereavement after diagnosing AIDS or other HIV disease, psychological symptoms secondary to brain disease and the social consequences of having AIDS all interact to produce a devastating illness where the patient may be intensely grieving, demented and totally rejected by all of society.
Is Entamoeba histolytica in homosexual men a pathogen?
Entamoeba histolytica (EH) in homosexual men is generally considered to be pathogenic. To test this hypothesis, the generally accepted features of invasion (haematophagous trophozoites in faeces; high-titre serum antibody; moderate to severe acute inflammatory change; and presence of EH in the mucosa on rectal biopsy) and the zymodeme pattern of cultured trophozoites were assessed in twenty-three EH excretors and eleven control homosexual men. No trophozoites or antibody to EH were found in either group. When other pathogens were excluded, no patient in either group had severe, acute histopathological proctitis. Moderately severe change was seen in 38% of EH excretors and 18% of controls (not significant). All the zymodemes were non-pathogenic. Successful eradication of EH did not result in even a trend towards normalisation of the moderate inflammatory histopathology. There are, therefore, no data here to suggest that EH is a pathogen in homosexual men.
Psychological aspects of recurrences of genital herpes.
Fifty-seven patients presenting with virologically confirmed first attacks of genital herpes were assessed for risk factors for time to the first recurrence. These factors included demographic details, personality traits, recent life events, herpes simplex biotype, frequency of orogenital intercourse and psychiatric illness as measured by the General Health Questionnaire (GHQ). This and our similar previous study (58 patients) were analysed separately and combined using a novel statistical technique (Cox's proportional hazards model). In the previous study there was a significant association only for GHQ score (p less than 0.02). For the present study age was the only statistical significant factor (the younger the patient the more likely a recurrence sooner (p less than 0.05), although there was a trend for high GHQ scorers to have recurrences sooner than low scorers. Data of the two studies combined showed that the only significant association with time to recurrence was the GHQ (p less than 0.02). These data support the notion that there is an association between psychiatric illness and recurrence of genital herpes.
Incidence of sexually transmitted diseases in rape victims during 1984.
During 1984, 46 women attended the sexually transmitted disease (STD) clinic at St Mary's Hospital alleging that they had been raped. At presentation, 31 (67%) were asymptomatic. Evidence of STD was found in 14 (30%) women, mixed infections occurring in four. Chlamydia trachomatis and Trichomonas vaginalis were each detected in six (13%) patients and Neisseria gonorrhoeae in three (6%). The source of the infection could not confidently be traced to the alleged rapist. Two patients were found to have cervical cytological abnormalities suggestive of cervical intraepithelial neoplasia of grades II or III. One woman became pregnant as a consequence of the sexual assault. Investigations may unveil infection or other abnormalities, which are incidental to the rape but nevertheless require further investigation and treatment.
Detection of Chlamydia trachomatis in the vaginal vault of women who have had hysterectomies.
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ABC of sexually transmitted diseases. Psychosexual problems.
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