Rape and subsequent seroconversion to HIV.
Explore the source record for details and available documents.
Female↗
Biomedical subjects
D Taylor-Robinson
Publications and source records attributed to D Taylor-Robinson.
Urinary tract infections in men.
Explore the source record for details and available documents.
Bacterial Infections↗
Chlamydia trachomatis in reactive arthritis.
Evidence of deposition of chlamydial antigen in the joint was sought in 10 patients (9 of them male) with classic sexually acquired reactive arthritis, 15 women with unclassified seronegative oligoarthritis involving the knee and 15 individuals with established rheumatic disorders not associated with genital-tract or other infections. Using a fluorosceinated monoclonal antibody to the major outer membrane protein of Chlamydia trachomatis (MicroTrak, Syva) in a direct immunofluorescence test, particulate antigen with physical characteristics of chlamydial elementary bodies was seen in synovial fluid cell smears or synovial biopsies, or both, from 6, 5, and 0 patients, respectively. No typical chlamydial intracellular inclusions were seen. Corroborative evidence of recent chlamydial infection was provided by the finding of high titres of serum chlamydial antibody in all antigen-positive patients with sexually acquired reactive arthritis, including 3 from whom a genital-tract isolate was obtained, and 3 of the 5 women with unclassified arthritis. It is postulated that Chlamydia trachomatis organisms reach the joint during acute genital-tract infection, and the processing and presentation by class I major histocompatibility determinants of chlamydial antigens is a critical step in the initiation of reactive arthritis in some patients.
Adult↗
The role of Chlamydia trachomatis in chronic abacterial prostatitis: a study using ultrasound guided biopsy.
We studied 50 patients with chronic abacterial prostatitis as defined by the Stamey procedure via transrectal prostatic ultrasound and subsequent transperineal biopsy of the abnormal areas of the prostate to ascertain the role of Chlamydia trachomatis organisms (chlamydiae) in this condition. Chlamydiae were detected by an immunofluorescence technique in the urethra of 1 patient (2 per cent) but they were not recovered in McCoy cell culture from the prostatic tissue of any patient nor were they detected in the tissue by immunofluorescence. In addition, serum antibody to Chlamydia trachomatis was not found even in moderate titer. The approach in this study has overcome the problem of urethral contamination in the assessment of prostatic specimens from patients with chronic abacterial prostatitis. There is no evidence that chlamydiae are directly implicated in the disease, although the possibility of an earlier active role cannot be excluded.
Adult↗
Factors influencing the in-vitro sensitivity of Ureaplasma urealyticum to tetracyclines.
The sensitivity of 23 strains of Ureaplasma urealyticum to doxycycline was measured by a metabolism-inhibition technique. The minimal inhibitory concentrations were not influenced by using, as inocula in the tests, organisms either directly from the patient or after culture, providing that the numbers of organisms in the inocula were about the same in both. All the strains were sensitive to doxycycline but an apparent increase in the resistance of the cultured organisms occurred when the number, expressed as colour-changing units (ccu), in the inoculum was 10(5) or more/ml. Tests may be undertaken on cultured organisms of U. urealyticum but it is recommended that a standard inoculum of 10(3)-10(4) ccu/ml should be used.
Doxycycline↗
The common occurrence of human papillomavirus infection and intraepithelial neoplasia in women infected by HIV.
Eighteen out of 19 women who were clinically well but infected by HIV showed abnormalities of the lower genital tract. Seven patients had intraepithelial neoplasia, histologically verified in five, involving the cervix in four, the vulva in three and the perineum in one. Lesions (clinical and/or subclinical) compatible with human papillomavirus (HPV) infection were identified in these women, as well as in 10 out of the other 11 women infected with HIV. Disease at more than one site was detected in half of the patients and would have remained covert in more than half, had colposcopy not been undertaken. Women with HIV infection are at high risk of harbouring HPV and of developing lower genital tract neoplasia.
Adult↗
Oestradiol-induced infection of the genital tract of female mice by Mycoplasma hominis.
Treatment of female BALB/c mice with oestradiol rendered them susceptible to vaginal colonization by three of four different strains of Mycoplasma hominis. Overall, the organisms were recovered persistently from the vagina of 68 (87%) of 78 of these mice. Strain TO mice given one of the strains were at least susceptible, all of ten becoming colonized and larger numbers of organisms being recovered. The hormone arrested the reproductive cycle in the oestrous phase, characterized by non-nucleated, cornified vaginal epithelial cells. In contrast, M. hominis organisms were isolated transiently from only seven (10.5%) of 66 BALB/c mice not treated with oestradiol, after intravaginal inoculation; treatment with progesterone, which induced the dioestrous phase of the cycle, did not render any of 10 BALB/c mice susceptible to vaginal colonization. The minimum number of organisms (2.5 x 10(5)) of one strain of M. hominis and the minimum dose of oestradiol (0.05 mg) required to induce persistent colonization were established. Vaginal colonization persisted for more than 200 d in some mice, the numbers of organisms recovered ranging between 10(1) and 10(8). At autopsy there was evidence of spread to the uterine horns and ovaries, and also to the oropharynx, of some animals but not to other organs. Infection was not associated with a polymorphonuclear leucocyte response in the vagina or elsewhere, but a fourfold serum antibody response to M. hominis, measured by the metabolism-inhibition technique, was detected in almost half of the mice tested.
Animals↗
The establishment and persistence of Ureaplasma urealyticum in oestradiol-treated female mice.
Administration of oestradiol to three strains of female mice induced the oestrous phase of the reproductive cycle in which there are few or no polymorphonuclear leucocytes (PMNL) in vaginal smears. This treatment rendered the mice susceptible to genital tract colonisation by serotype 8 of Ureaplasma urealyticum, inoculated intravaginally. BALB/c mice were the most susceptible, all of 10 becoming colonised; two other strains were less susceptible and untreated mice were resistant. The numbers of ureaplasmas recovered from the vagina ranged from 10(2) to 10(7) colour-changing units (ccu)/ml, irrespective of the strain of mice, and in some there was spread to the uterine horns and ovaries, and to the spleen in one mouse. Vaginal colonisation persisted for 21-163 days and subsequent failure to recover the organisms seemed to be associated with re-establishment of the oestrous cycle. There was no evidence of a genital tract PMNL response but some of the mice developed a four-fold or greater antibody response, measured by the metabolism-inhibition technique. This, however, was insufficient to protect mice against recolonization by the same serotype of U. urealyticum.
Animals↗
Resistance of mice to genital infection with Neisseria gonorrhoeae.
Five strains of mice (C3H, CBA, BALB/c, TO and ICR) were inoculated intra-vaginally with Neisseria gonorrhoeae in an attempt to produce an animal model of gonorrhoea. Of a total of 68 mice inoculated, only three (4.4%) were culture-positive after 3 days. Histological examination of both the genital mucosa of inoculated animals, and the mucosa of genital tract organ cultures inoculated in vitro failed to show any evidence of gonococcal adherence or colonisation. Mice of these strains, therefore, appear resistant to gonococcal infection of the genital tract.
Animals↗
The susceptibility of germ-free, oestradiol-treated, mice to Mycoplasma hominis.
Conventionally reared female BALB/c mice, rendered susceptible to Mycoplasma hominis infection of the genital tract by treatment with oestradiol, have increased numbers of endogenous vaginal bacteria. The latter was reflected by the occurrence of bacterial growth in 95 (65.5%) of 145 cultures undertaken to isolate M. hominis from oestradiol-treated mice, but in only seven (4.8%) of 146 cultures from untreated animals. In addition, larger numbers of bacteria were seen in vaginal smears from oestradiol-treated mice than from untreated ones. Furthermore, abscesses developed in the genital region of 27 (17%) of 155 oestradiol-treated mice but in none of 50 that were untreated. However, such proliferation of the endogenous vaginal bacteria was not necessary for colonisation of the vagina by M. hominis. This was determined by showing that six germ-free, oestradiol-treated BALB/c mice given 2.5 x 10(5) ccu of M. hominis intravaginally became colonised vaginally for at least 14 days, with multiplication and spread of the organisms to the upper genital tract and elsewhere, whereas six similar untreated mice given the same inoculum remained uninfected.
Abscess↗
Acute epididymitis: a microbiological and ultrasonographic study.
In a prospective study of 24 men (mean age 28.3 years) with acute epididymitis who underwent epididymal aspiration, micro-organisms were detected in 15 (62.5%). Chlamydia trachomatis accounted for 10 (42%) of the cases, being located in both the urethra and epididymis in 5 individuals. Chlamydial serology supported the diagnosis of chlamydial infection, there being a strong correlation between the detection of C. trachomatis and elevated titres of both chlamydial IgG and IgM antibodies. In 4 patients (mean age 55.5 years), Escherichia coli was cultured from both mid-stream urine and epididymal aspirate. Transrectal ultrasound revealed abnormal prostatic scans in 19 patients (79%). These data confirm the aetiological role of C. trachomatis, support the notion that micro-organisms spread intra-canalicularly and suggest that the prostate is also involved in the inflammatory process in acute epididymitis.
Acute Disease↗
A search for infectious agents in chronic abacterial prostatitis using ultrasound guided biopsy.
A series of 60 patients with a diagnosis of chronic abacterial prostatitis, as defined by the Stamey procedure, was studied by transrectal prostatic ultrasound and subsequent transperineal biopsy of the abnormal areas of the prostate in order to ascertain the role of micro-organisms in this condition. Histological assessment revealed a chronic inflammatory infiltrate, generally of low grade, in 53 patients (88%). Organisms were isolated from the prostatic tissue of only 9 patients (15%) and were considered to be contaminants from the perineal skin, since treatment with an appropriate antimicrobial agent failed to alter symptoms or affect the leucocyte count in the urine or prostatic fluid. Chronic abacterial prostatitis may be a non-organismal inflammatory process.
Adult↗
Topical anaesthesia with lidocaine-prilocaine cream for vulval biopsy.
Explore the source record for details and available documents.
Anesthesia, Local↗
Improved sensitivity of an enzyme immunoassay IDEIA for detecting Chlamydia trachomatis.
In tests on 375 genital tract specimens a commercially available enzyme immunoassay for Chlamydia trachomatis (IDEIA; Boots-Celltech) was found to have sensitivity values of 62% for men and 74% for women, and a specificity of 97% for both groups, relative to the results obtained by a fluorescence assay (Micro Trak; Syva). The positive predictive value and the negative predictive value of the immunoassay were 91% and 87%, respectively. Collection of samples for IDEIA in transport medium in plastic phials, as opposed to glass phials recommended by the manufacturer, had no effect on these values. Tests of the sensitivity of IDEIA using laboratory strains of C trachomatis showed that the assay detected chlamydial elementary bodies only at dilutions at least 10-fold lower than those at which they could be detected by Micro Trak. Tests of the specificity of the assay with microorganisms found in the genital tract, other than chlamydiae, showed that reactions occurred with a number of these. Testing three cervical swabs from the same patient, with the material taken into a single phial of transport medium, increased the sensitivity of IDEIA from 74% to 96%, without reducing the specificity which remained at 97%. It is concluded that this approach enchances the value of the test in a sexually transmitted disease clinic population and may do so in a population with a low prevalence of chlamydiae.
Chlamydia trachomatis↗
Value of colposcopy in sexually transmitted diseases clinic based on first year's experience.
Two hundred and thirty two patients underwent cervical colposcopy within the first year of establishing a colposcopy service in the sexually transmitted diseases clinic at St Mary's Hospital, London. Their mean age was 27 years. Cervical intraepithelial neoplasia (CIN) was identified in 68 of 81 (84%) patients whose smears showed dyskaryosis and who underwent biopsy. CIN was also detected in 14 of 41 (34%) patients who underwent biopsy and whose repeat smears were reported as giving normal results. The value of assessing two consecutive smears was evident, however, because none of the 99 patients with CIN had two normal smear results consecutively. Patients requiring treatment underwent laser ablation, which was provided in the department of gynaecology. These results show that colposcopy plays a vital part in managing patients with abnormal smears and indicate that genitourinary physicians need to give priority to developing colposcopy services in their specialty.
Adolescent↗
Recognising covert disease in women with chronic vulval symptoms attending an STD clinic: value of detailed examination including colposcopy.
A vulval colposcopy clinic was established in the sexually transmitted diseases (STD) clinic of St Mary's Hospital, London, to investigate patients with chronic symptoms (mean duration 3 1/2 years). Fifty patients with a mean age of 33 were studied for 12 months, and a specific diagnosis was established for many of them. Forty complained of pruritus vulvae, 33 of dyspareunia, and 30 of vulvodynia. One or more macroscopic abnormality was seen in 29 of the women, the most common being erythema, papules, plaques, and fissures. Colposcopic abnormalities, however, were identified in 45 of the women, the most common being acetowhite epithelium in a flat, papillary, or cobblestone pattern. Biopsy specimens were obtained from 33 of the patients, and all had abnormal histological features. Those of human papillomavirus (HPV) infection were the most common, and were found in 27 specimens; evidence of vulval intraepithelial neoplasia was seen in seven and that of dermatoses in 10. Further work is required, however, before concluding that HPV was necessarily responsible for the chronic symptoms.
Adult↗
Detecting Chlamydia trachomatis by direct immunofluorescence using a Cytobrush sampling technique.
Explore the source record for details and available documents.
Chlamydia trachomatis↗
Genital mycoplasma infections.
Seven different mycoplasmas have been isolated from the human genitourinary tract. The diseases they cause or with which they have been associated are described. Diagnosis of infection by cultural and noncultural (antigen detection, DNA probes) methods is discussed in detail. The more useful serologic procedures are included as well.
Antibodies, Bacterial↗