Biomedical subjects
F J Bowden
Publications and source records attributed to F J Bowden.
Why is Trichomonas vaginalis ignored?
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Estimating the prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus infection in indigenous women in northern Australia.
OBJECTIVE: To estimate more accurately the age specific prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus infection (HPV) in indigenous women living in urban, rural, and remote areas of the "Top End" of the Northern Territory (NT). DESIGN: Analysis of data obtained from two community based studies using self administered tampon specimens tested by polymerase chain reaction for sexually transmitted disease (STD). Data pertaining to the notifiable STDs (N gonorrhoeae and C trachomatis) were obtained from the NT health department. PATIENTS: 1090 indigenous women (age range 12-73 years) were enrolled when they attended local community health centres, family planning clinics, and STD clinics. The majority attended clinics in their home community in the course of "well women's checks" which encourage women to undergo screening for a variety of general medical conditions. RESULTS: The overall prevalence of T vaginalis, C trachomatis, N gonorrhoeae, and HPV was 0.25 (95% CI: 0.22-0.28), 0.11 (0.09-0.13), 0.17 (0.15-0.19), and 0.42 (0.37-0.48) respectively. Of the women found to be infected (excluding HPV), 25.5% had two or more of the above organisms detected. There was a statistically significant increase in the age specific prevalence of T vaginalis but a significant decrease with age for C trachomatis and HPV infection. There was no statistically significant change for N gonorrhoeae with age. CONCLUSIONS: STDs are hyperendemic in this population of indigenous women and the notification data significantly underestimate their prevalence. Distinct patterns of age specific prevalence were demonstrated, highlighting the need to tailor control strategies to specific epidemiological features.
Using self-administered tampons to diagnose STDs.
The new nucleic acid amplification techniques (e.g., LCR and PCR) have allowed the introduction of non- and minimally-invasive techniques for the detection of sexually transmitted diseases (STDs). In this article, we describe one of these-the self-administrated tampon method-which we have used to detect the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus in women.
Canadian and Australian aborigines. Similar epidemiology and needs?
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Reappraising the value of urine leukocyte esterase testing in the age of nucleic acid amplification.
BACKGROUND: The leukocyte esterase (LE) test has a limited role in determination of empiric therapy for male patients screened for urethritis because of its poor positive predictive value in low (< 5%) prevalence settings. The recent advent of nucleic acid amplification testing of first-void urine (FVU) has dramatically increased the ease with which widespread screening for Chlamydia trachomatis and Neisseria gonorrhoeae can be performed, but the costs of such testing may be prohibitive. The LE test may therefore have a role in management of urethritis because of its high negative predictive value. OBJECTIVES: To determine the sensitivity, specificity, and positive and negative predictive value of LE testing for the diagnosis of N. gonorrhoeae and C. trachomatis in male FVU specimens in a low-prevalence urban setting using a commercial polymerase chain reaction (PCR) as the gold standard. METHODS: Data were obtained on men presenting to an urban sexually transmitted disease clinic over a 16-month period. Patients were included if an FVU had been tested for the presence of LE using a rapid dipstick, read by an automated urine analyzer, and the sample (either an FVU or urethral swab) had then been processed for the detection of N. gonorrhoeae and C. trachomatis by PCR. RESULTS: Of 301 assessable patients, there were 14 cases of gonorrhoea, 21 cases of chlamydia, and 1 case of dual infection detected by PCR. Most men (245/301; 81.4%) were asymptomatic, of whom 12 of 245 (4.9%) had an infection detected compared with 24 of 56 (42.9%) in the symptomatic men (P < 0.001). Using a "< or = trace" cutoff, the overall value for the sensitivity of the LE test was 77.8% (95% confidence interval, 60.4-89.3), specificity 80.8% (75.4-85.2), positive predictive value 35.4% (25.2-47.1), and negative predictive value 96.4% (92.8-98.3). CONCLUSIONS: The negative predictive value of the LE test may be of use in determining which patients should proceed to specific diagnosis by nucleic amplification methods (e.g., PCR or ligase chain reaction). By limiting testing to patients with positive LE results, cost savings may be made, enabling the technology to be used in a wider community setting. The value of the LE test in higher prevalence populations with access to nucleic amplification testing remains to be established.
Is the eradication of donovanosis possible in Australia?
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The tampon test for trichomoniasis: a comparison between conventional methods and a polymerase chain reaction for Trichomonas vaginalis in women.
OBJECTIVES: Trichomonas vaginalis is the most common STD worldwide and the infection has been linked with an increased risk of HIV transmission. We present a detailed comparison between conventional collection and testing methods and the polymerase chain reaction (PCR) tampon test for T vaginalis. METHODS: Women were tested for the presence of T vaginalis by PCR analysis of a tampon specimen and by conventional methods which included one or more of the following: culture and microscopy from a high vaginal swab (HVS) or endocervical swab (ECS), and microscopy of a Papanicolaou (Pap) smear. RESULTS: T vaginalis was detected in 51/590 (8.6%) conventional tests and 93/590 (15.8%) tampon specimens. Retesting of all tampon PCR positive specimens confirmed 89/93 (95.7%) tests. Using the tampon PCR as the reference, the sensitivities of the different conventional sampling and testing methods for the detection of T vaginalis were 8.3% (5/60) for ECS microscopy or culture, 31% (13/42) for HVS microscopy or culture, 52.8% (19/36) for HVS directly inoculated into Trichomonas medium and 59.4% (38/64) for Pap smear. CONCLUSIONS: No conventional test in the remote setting has comparable sensitivity to PCR. The Pap smear is the next most sensitive, but requires a speculum examination. The use of PCR will allow inclusion of T vaginalis into STD screening programmes in both developed (lower prevalence) and developing (higher prevalence) countries.
Donovanosis: treatment with azithromycin.
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Comparison of tampon and urine as self-administered methods of specimen collection in the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in women.
Self-administered sampling techniques for the detection of sexually transmitted diseases (STDs) are particularly useful due to their ease of collection and better patient compliance. Urine specimens, and recently tampons, have been described as methods of specimen collection for the detection of some STDs in women. In this study, 660 women had both first-void urine (FVU) and tampon specimens analysed by polymerase chain reaction (PCR) for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Overall 6.5%, 10.1% and 17.9% of urine samples were positive whereas 7%, 21.2% and 22% of tampon specimens were positive for C. trachomatis, N. gonorrhoeae and T. vaginalis respectively. Tampon-collected specimens tested by PCR were more sensitive than urine specimens for the detection of N. gonorrhoeae and T. vaginalis (P < 0.001) and equally sensitive for the detection of C. trachomatis (P=0.45).
Azithromycin for the treatment of donovanosis.
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Sexually transmitted diseases in disadvantaged Australian communities.
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A profile of inpatient STD-related pelvic inflammatory disease in the Top End of the Northern Territory of Australia.
OBJECTIVE: To obtain a profile of inpatient STD-related pelvic inflammatory disease (PID) in the Top End of the Northern Territory. DESIGN: Review of case records. SETTING: The Royal Darwin Hospital, the tertiary referral centre for the Top End, during the three years from June 1991 to May 1994. PATIENTS: All admissions with a diagnosis of STD-related PID. MAIN OUTCOME MEASURES: The presentation and incidence of STD-related PID in Aboriginal and non-Aboriginal women. RESULTS: PID was the reason for 14% of admissions of Aboriginal women and 2% of non-Aboriginal women. Of 175 episodes of PID in 169 patients admitted over the three years of the study, 41 (23%) had gonorrhoea, 64 (37%) had chlamydia and 7 (4%) had both organisms isolated on genital swab. Aboriginal women were more than twice as likely to have gonorrhoea (38% versus 18%; risk ratio, 2.12; 95% confidence interval, 1.27-3.53) as non-Aboriginal women. Median time from first symptoms to presentation was six days. All gonococcal isolates were penicillin susceptible. CONCLUSIONS: STD-related pelvic inflammatory disease is an important problem among women in the Top End of the Northern Territory. As PID is a preventable illness, further measures aimed at prevention and earlier, more effective treatment of STDs that cause PID are urgently required.
Self administered tampons can be used to diagnose sexually transmitted diseases.
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A self-administered technique for the detection of sexually transmitted diseases in remote communities.
The control of sexually transmitted diseases (STDs) in remote rural communities would be enhanced by a sensitive self-administered method for the detection of asymptomatic infection. Results of conventional methods for the detection of STDs were compared with results of tampon-collected specimens analyzed by polymerase chain reaction (PCR) for 480 women. Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis were detected by routine methods in 4 (1%), 14 (3%), and 41 (9%) samples, respectively, while PCR detected these organisms from 52 (11%), 26 (5%), and 75 (16%) tampons, respectively. The detection of each organism was significantly greater by PCR in tampon-collected samples than by routine conventional methods (P < .01). Discrepant results were confirmed by separate primers in 40 of 48 specimens for N. gonorrhoeae, in 11 of 12 specimens for C. trachomatis, and in 31 of 32 specimens for T. vaginalis. Tampons tested by PCR provide an acceptable and sensitive method for detection of STDs in women living in remote areas.
A community-based approach to the control of sexually transmitted diseases in the Northern Territory.
A program to control sexually transmitted diseases (STDs) was undertaken during a Men's Health Week in a remote Aboriginal community in Western Arnhem Land, Northern Territory. A total of 151 men aged 13 years and over who attended over a five-day period underwent a full physical examination, and first-void urine specimens were tested for the presence of leukocytes, chlamydia (by enzyme immunoassay antigen detection) and gonorrhoea (by culture and antigen detection). Blood was taken for syphilis serology from all patients and for human immunodeficiency virus (HIV) from patients with a proven STD or at the patient's request. Consent for testing was obtained from all participants. Patients with a positive urinary leukocyte test or symptoms were offered urethral swab investigations and treated empirically according to a set protocol. Patients with STDs detected by subsequent laboratory investigations were followed up and treated. The overall prevalence of one or more of syphilis, gonorrhoea or chlamydia was 17.4 per cent. No men presented with genitourinary symptoms and none was HIV-infected. In this population, STDs were an important cause of morbidity, and a community-based approach was adopted to identify infected persons. The use of urine for the detection of gonorrhoea and chlamydia was highly acceptable. Although not used in this study, polymerase chain reaction and ligase chain reaction technology will facilitate similar activities in the future.
Culture of the causative organism of donovanosis (Calymmatobacterium granulomatis) in HEp-2 cells.
We report successful culture of Calymmatobacterium granulomatis by standard cell culture methods. Swabs were obtained from lesions in three patients with a clinical diagnosis of donovanosis. For two patients, there was histological confirmation of the disease (i.e., the presence of Donovan bodies in Giemsa-stained smears). Specimens were inoculated onto cycloheximide-treated HEp-2 cell monolayers in RPMI 1640 medium (supplemented with fetal calf serum, NaHCO3, vancomycin hydrochloride, and benzylpenicillin). At 48 h, organisms resembling Donovan bodies were identified in monolayer cultures from all three specimens. The organisms appeared as pleomorphic bacilli with characteristic bipolar staining and "safety pin" appearance. Using a PCR designed to differentiate C. granulomatis from the Klebsiella species (which have a high degree of molecular homology), we were able to demonstrate that the cultured organisms produced a PCR product identical to that obtained from the original swab specimens. It is now possible to test in vitro susceptibility of C. granulomatis to antibiotics and to provide a ready source of DNA and antigenic material to enable the development of serological tests and, possibly in the future, a vaccine.
Managing HIV. Common drug interactions in HIV medicine.
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