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Biomedical subjects

E R Alexander

Publications and source records attributed to E R Alexander.

At least 37 records · Page 2Linked to original sources
PubMed1988

Gonorrhea in the newborn.

Gonorrhea prevalence in pregnant women in the United States is generally low (less than 1%), although the prevalence in certain subsets of the population remains a matter of concern. Rates of 10% have been found in some central city adolescent prenatal clinics. Rates as high as this are quite often found in developing countries. The risks of transmission to the newborn are well studied for ophthalmia neonatorum and are 30%-40%. The risks of disseminated gonococcal infection of the newborn (sepsis or arthritis) are unmeasured, but are clearly rare events. In developing countries, maternal gonorrheal infection has been linked to premature delivery, which had been previously suggested in earlier studies in the United States. There is no evidence that the increasing occurrence of penicillinase-producing Neisseria gonorrheae (PPNG) affects maternal-neonatal transmission other than to require alternative therapy.

Drug Resistance, Microbial↗
PubMed1987

Chancroid in the United States. Reestablishment of an old disease.

For 30 years, chancroid has been an uncommon and geographically localized disease in the United States; a mean of 878 cases were reported annually between 1971 and 1980. Since 1981, however, numerous outbreaks have established chancroid as an endemic disease in many additional areas and, in 1986, 3418 cases, the largest number since 1952, were reported. Cases are occurring preponderantly among men who patronize prostitutes, and infected individuals who have traveled from outbreak areas or from outside the United States are suspected of having contributed to the spread of disease. Efforts to eradicate disease in outbreak areas have been only occasionally effective and have been hampered by difficulty in locating potentially infected individuals and by travel by infected individuals. The failure to eradicate outbreaks leaves residual sources for new disease transmission into yet additional areas.

Black or African American↗
PubMed1987

Genital human papillomavirus infection. A growing concern.

HPV infections of the genital tract are one of the most common sexually transmitted viral infections in the United States. Data from STD clinics and private physicians' offices reveal that genital warts, one manifestation of genital HPV infection, have been diagnosed more frequently in recent years. Using a variety of diagnostic techniques, asymptomatic HPV infection has been identified in men and women and is probably much more common than clinically apparent infection.

Epidemiologic Methods↗
PubMed1987

Sexually transmitted diseases in children and adolescents.

Sexually transmitted diseases have an impact on children's health at three times in their development: during pregnancy or delivery (through maternal-neonatal transmission), during prepubertal childhood (through sexual transmission), and during adolescence (through sexual transmission). These phases must be considered distinctly by the physician, since not only the type of infection but also the management and long-term implications of the disease vary with the time period in which it was acquired.

Adolescent↗
PubMed1985

Cervical Chlamydia trachomatis infection in university women: relationship to history, contraception, ectopy, and cervicitis.

Endocervical Chlamydia trachomatis infection was found in 13 of 162 volunteer female university students (8%). Infection was correlated with younger age (p less than 0.05), less than or equal to 4 years of intercourse (p less than 0.05), a history of gonorrhea (p less than 0.01), and exposure to a partner with urethritis (p less than 0.01). Women who used intrauterine or barrier contraception had less infection (2%) than did women who used oral contraception (14.3%, p less than 0.05) or none at all (10.7%, p less than 0.05). Infection was strongly associated with a cervicitis score calculated from erythema, ectopy, discharge, and secretions that contained white blood cells (p less than 0.0001). By multivariate analysis, a proposed clinical approach was arrived at for testing for chlamydial organisms all women with cervicitis who were not using barrier contraception. The positive predictive value of this approach for chlamydial infection was 28%, and the negative predictive value 98.4%. Cervical ectopy was increased in women who used oral contraception (p less than 0.01), and infection was increased in women with ectopy, regardless of their contraceptive method (p less than 0.001). These results will aid in more rapid diagnosis of endocervical chlamydial infection and in the choice of contraception in young women and high-prevalence groups.

Adolescent↗
PubMed1985

Infection with Chlamydia trachomatis immunotype J associated with trachoma in children in an area previously endemic for trachoma.

Chlamydia trachomatis immunotype J was isolated from the eye of a five-year-old Navajo child with trachoma. This is the first such isolate from a patient in an area previously endemic for trachoma. Chlamydial infection of the genitals among the Navajo Indians is common, and we have isolated immunotype J from the genital tract of women in this area. This most recent case points to the occurrence of "genital" trachoma. This occurrence adds evidence to the assertion that trachoma may be caused by the "genital" immunotypes of C. trachomatis. Therefore, the traditional distinction between ocular and genital strains may be artifactual.

Antibodies, Monoclonal↗
PubMed1985

Epidemiology of cytomegaloviral infection in a heterogeneous population of pregnant women.

Cervical cultures for cytomegalovirus (CMV) and samples of blood for antibody to CMV were obtained from 1,129 pregnant women: 57% of the women had antibody to CMV, and 14% of seropositive women shed virus. Logistic regression analysis showed that seropositivity correlated with lower socioeconomic status, birth outside North America, multigravidity, older age, history of abnormal cervical cytology, infection with Trichomonas vaginalis, a first pregnancy at less than or equal to 15 years of age, and greater total numbers of sex partners. Thus, past exposure to CMV relates both to sociocultural factors and to sexual behavior. Absence of such risk factors identifies women who are at highest risk for primary infection with CMV during pregnancy. Culture positivity in seropositive women was independently associated with younger age, later stages of pregnancy, and race. Among seropositive women less than or equal to 21 years of age, 35% shed CMV in the third trimester, a finding of epidemiological importance with regard to perinatal transmission.

Adult↗
PubMed1985

The epidemiology of cytomegaloviral infection in women attending a sexually transmitted disease clinic.

To test the hypothesis that cytomegalovirus (CMV) is sexually transmitted, we examined the association of CMV infection with indices of sexual activity in 347 women attending a sexually transmitted disease (STD) clinic. Stepwise multivariate logistic regression analysis showed that seropositivity to CMV (complement-fixation antibody titer, greater than or equal to 1:8) was most closely associated with number of sex partners in the subjects' lifetime (P less than .0001), young age at first sexual intercourse (P = .0002), and nonwhite race (P = .0007). Among seropositive women, cervical shedding of CMV was most strongly associated with younger age (P = .0001) and the presence of cervical chlamydial infection (P = .016). Among 84 seronegative women followed up for a mean of 18.4 weeks, 11 (13%) developed primary CMV infections, an annual incidence of 37%. Sexual contact seems to be an important mode of acquisition of CMV in some young women.

Adult↗
PubMed1984

In vitro activity of clindamycin against strains of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum isolated from pregnant women.

Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum are genital agents that are being increasingly implicated in infectious pregnancy complications and abnormal pregnancy outcomes. We measured the in vitro activity of clindamycin against strains of these three agents which were isolated from pregnant women. For 30 strains of C. trachomatis, the median minimal inhibitory concentration was 1.0 microgram/ml (range, 0.25 to 2.0 micrograms/ml). For 27 strains of M. hominis, the median minimal inhibitory concentration was 0.12 microgram/ml (range, 0.06 to 0.25 microgram/ml) and the median minimal bactericidal concentration was 0.5 microgram/ml (range, 0.06 to 2.0 micrograms/ml). For 27 strains of U. urealyticum, the mean minimal inhibitory concentration was 4 micrograms/ml (range, 1.0 to 32.0 micrograms/ml) and the mean minimal bactericidal concentration was 32.0 micrograms/ml (range, 4.0 to 128 micrograms/ml). Thus in vitro clindamycin would appear to be highly active against pregnancy-associated strains of M. hominis, less active against strains of C. trachomatis, and least active against strains of U. urealyticum. Since M. hominis has been strongly linked to postabortal fever and to postpartum fever and endometritis, our results indicate that clindamycin should be evaluated in treatment trials in pregnancy aimed at prevention of M. hominis-induced morbidity as well as in treatment of the complications themselves.

Chlamydia Infections↗
PubMed1984

Establishment of genital tract infection in the CF-1 mouse by intravaginal inoculation of a human oculogenital isolate of Chlamydia trachomatis.

A human oculogenital strain of Chlamydia trachomatis was instilled intravaginally in the outbred CF-1 mouse to establish cervical infection. The mice were neither hormonally nor immunologically manipulated before inoculation. Duration of chlamydial excretion varied from two to ten days. In the culture-positive animals, IgG and IgM antibody titers were elevated in 38% and 17%, respectively. Neither intracytoplasmic inclusions nor elementary bodies of C. trachomatis were detected in genital tissues. Infection was limited primarily to the cervix and only rarely extended into the uterus. Chlamydial infection could only be established during specific periods of the estrus cycle (metestrus-2, diestrus, and proestrus; P less than .001), stages when leukocytes are present in the vaginal smear. Thus, chlamydial infection of the cervix is cycle-dependent in the mouse. In summary, infection of the cervix of the mouse has been established with a human oculogenital strain of C. trachomatis and may be useful as a model of human chlamydial cervicitis.

Animals↗
PubMed1984

Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions. A multicenter trial.

Because few clinicians have access to laboratories offering cell culture confirmation of suspected Chlamydia trachomatis genital infections, we evaluated a diagnostic method in which fluorescein-conjugated monoclonal antibodies were used to directly identify C. trachomatis elementary bodies in slides made from genital secretions. Compared with culture results, the direct smear had a sensitivity of 92% and a specificity of 96% in 576 men, most of whom had symptoms and signs of urethritis. Among 595 women attending the same clinics, sensitivity of the direct smear for cervical infection was 89% and specificity was 99%. In 225 pregnant women screened in a prenatal or abortion clinic, the sensitivity and specificity of the test were 86% and 99% respectively. Direct detection of elementary bodies in genital smears offers an alternative diagnostic approach for C. trachomatis infections.

Bacteriological Techniques↗