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Biomedical subjects

H Mallinson

Publications and source records attributed to H Mallinson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Comparison of urine, first and second endourethral swabs for PCR based detection of genital Chlamydia trachomatis infection in male patients.

OBJECTIVES: To compare endourethral swabs and urine as diagnostic specimens for the detection of genital Chlamydia trachomatis infection using the polymerase chain reaction (PCR), in male patients attending a genitourinary clinic and to assess whether the first endourethral swab used solely for diagnosing gonococcal infection could be used for C trachomatis detection as well. METHODS: Two endourethral swabs were taken from 80 male patients, in whom the likelihood of genital C trachomatis infection was high. The first swab was used for microscopy and culture for Neisseria gonorrhoeae, before being used for C trachomatis detection. First voided urine specimens were collected from 61 of these patients. All three specimens were processed for C trachomatis DNA detection using the Roche Cobas Amplicor PCR. A diagnosis of genital C trachomatis infection was made if any one of the specimens tested reproducibly positive. Samples from 13 patients showing discrepant PCR results between swabs and/or urine were retested by ligase chain reaction (LCR). RESULTS: Chlamydia trachomatis DNA was detected in 35 (43.8%) of the 80 patients. In 17 of the 35 patients (48.6%), all the genital specimens were positive. However, in 18 (51.4%) patients, one or more of the genital specimens had negative PCR results. Among the 18 patients with discrepant results, urine was found to be a more sensitive diagnostic specimen than the second urethral swab picking up 13 out of 16 positives (81.3%) as opposed to five out of 18 (27.8%). There was no significant difference between the two swabs. Retesting by LCR, of the samples from 13 of the 18 patients with discrepant PCR results confirmed them all as true positives, although as with PCR, not all specimens in the set were concordantly positive. LCR detected all the 13 positives in urine, while there was no difference in the detection rate between the first and the second urethral swabs. CONCLUSIONS: Urine appeared to be a better diagnostic specimen than the conventional second endourethral swab for C trachomatis detection by PCR in this cohort of male patients. There was no difference between the first swab, intended primarily for N gonorrhoeae testing and the second swab intended for C trachomatis detection. This raises questions over the need for the conventional second swab for detecting C trachomatis.

Adolescent↗
PubMed2001

Management of Chlamydia trachomatis in a women's hospital: a review of current practice.

OBJECTIVE: To establish a measure of testing for Chlamydia trachomatis within the Liverpool Women's Hospital with a view to optimising both testing and management of infection. DESIGN: Prospective observational study to review the outcome of Chlamydia testing and subsequent management of patients between September 1997 - September 1998. RESULTS: It was observed that opportunities for detecting infection were missed and testing was undertaken predominantly for diagnostic purposes. RECOMMENDATION: Consideration be given to a centralised system for overview of positive results linking with audit/education to reduce sequelae of Chlamydia within gynaecology.

Adult↗
PubMed2001

Evaluation of near patient testing for Chlamydia trachomatis in a pregnancy termination service.

AIM: To identify and evaluate advantages and disadvantages of a near patient test (NPT) for Chlamydia trachomatis, using Clearview Chlamydia MF (Unipath Ltd) in a British Pregnancy Advisory Service (BPAS) clinic. METHOD: The improved Clearview Chlamydia MF test was used to test endocervical swabs from 400 women attending BPAS clinic for termination of pregnancy. The results were compared with Ligase Chain Reaction (LCR), using Polymerase Chain Reaction (PCR) as the arbiter. RESULTS: Twenty-seven women tested positive by Clearview Chlamydia MF (24 confirmed by LCR) and 32 by LCR. COMMENT: NPT has potential advantages in specific situations where a quick result is required for optimal management of those testing positive. However, the current technology available for detection of Chlamydial infection results in time constraints, which limited its benefits in this study, where there was a high throughput of clients. A significant number of cases were missed by Clearview Chlamydia MF, though the sensitivity found is within the ranges reported for various enzyme immunoassays (EIA) - currently the most commonly used testing method. The study confirmed the high positivity in those attending for termination, especially in under 25-year-olds.

Abortion Applicants↗
PubMed2000

Changing screening strategies for genital chlamydia in family planning clinics: a good public health strategy?

OBJECTIVE: To estimate the prevalence and factors associated with genital chlamydia in 1996 and to evaluate the introduction of restricted screening criteria based on diagnostic testing and prevention of iatrogenic pelvic inflammatory disease in 1997. PATIENTS: Women attending Liverpool family planning clinics. METHOD: Clinical and demographic data were recorded at routine clinic consultations. Data were analyzed using logistic regression. RESULTS: In 1996, a 5.7% (123/2165) chlamydial prevalence was detected. A significantly lower prevalence was observed in the over-25-year-old age group compared to those aged 16-19 years old (p < 0.0001), and in those with an interval of over 11 months since the last new sexual partner compared to those with a new partner in the past 1-3 months (p < 0.05). A significantly higher prevalence was detected in those only presenting with signs of infection alone compared to those presenting with either symptoms or both signs and symptoms of infection (p < 0.05). Those requesting a termination of pregnancy were at higher risk of genital chlamydia than those attending for contraceptive advice (odds ratio 1.97; 95% confidence interval 1.14-3.39). Using the restricted screening criteria, prevalences of 5.4% (78/1438) and 3.7% (60/1641) were found for 1996 and 1997, respectively. Prevalences were significantly higher in 1996 than 1997 when adjusted for the other factors (p < 0.05). CONCLUSION: The study raised awareness of genital chlamydia among women attending family planning clinics and showed that primary care could make a significant contribution to the prevention of chlamydial infection. It is only by initiating intervention strategies in such settings that genital chlamydia will be controlled effectively in the UK.

Adolescent↗
PubMed2000

Chlamydia trachomatis screening in young people in Merseyside.

OBJECTIVES: To evaluate the acceptability to young people of proactive Chlamydia trachomatis (CT) information and urine test. To discover the extent of CT infection and the practical implications for completing treatment and partner notification. DESIGN: Prospective screening with sexual health questionnaire. SETTING: Three family planning clinics for young people in Liverpool and South Sefton. PARTICIPANTS: Nine hundred and five women and 53 men had urine tests and answered the questionnaire. All aged 20 years or under attending the clinics were given information about CT and safer sex. MAIN OUTCOME MEASURES: The acceptability of proactive information and screening for CT using a urine test. Prevalence of CT infection. The time and effort incurred informing and managing those testing positive. RESULTS: The information and urine test were readily accepted. Prevalence of CT was 8.5% in women and 5.7% in men. More than three-quarters of those testing positive were treated, but it took much time and effort, as follow-up attendance was poor. CONCLUSIONS: The prevalence of CT was high in this population. Young people participated in screening readily. They are interested in this health issue, but it was difficult to hold their attention long enough to complete the process of treatment and contact tracing. Completing this successfully either needs a huge input of resources or a new approach. These results have led to the piloting of an outreach health adviser administering treatment and carrying out partner notification at the screening site. Some of the questions raised by the CMO have been addressed.

Adolescent↗
PubMed1998

Hepatitis B and hepatitis C virus infections: risk factors among drug users in Northwest England.

OBJECTIVES: to identify the risk factors for hepatitis B (HBV) and hepatitis C (HCV) virus infections in drug users attending two drug treatment centres in Northwest England, and to evaluate the effect of both needle exchange and hepatitis B vaccination on the prevalence of hepatitis B and hepatitis C infections. METHODS: a retrospective, cross-sectional study performed at the Regional Infectious Disease Unit and a Primary Care Centre for drug users in Liverpool. The study population included 773 drug users who had hepatitis serology performed between January 1992 and April 1996. Information on risk factors was obtained from clinical records; hepatitis serology data were obtained from the Liverpool Public Health Laboratory database. RESULTS: the overall seroprevalences of exposure markers for HBV (anti-HBc antibody) and HCV (anti-HCV antibody) were 48% and 67%, respectively. Duration of injecting drug use was the strongest predictor of HCV infection, with a crude odds ratio of 8.9 (95% confidence interval (CI): 4.5-17) for >10 compared to <3 years of injecting, and was also a strong predictor of HBV infection, with an adjusted odds ratio (controlled for the effects of HBV vaccination) of 5.7 (95% CI: 3.2-10) for >10 compared to <3 years' injecting. Vaccination against HBV was associated with greatly reduced HBV seroprevalence (crude odds ratio 0.11, 95% CI: 0.06-0.18). Overall, HCV was acquired earlier in the injecting career than HBV, but drug users who were not vaccinated against HBV acquired markers for HBV even more rapidly than for HCV. We found no independent protective effect for either anti-HBc or anti-HCV acquisition after the introduction of a needle-exchange scheme. CONCLUSIONS: hepatitis C is highly prevalent among Merseyside drug users and is likely to prove difficult to control because of rapid acquisition early in the injecting career. Vaccination against hepatitis B is the best means of protecting drug users from hepatitis B, and should be offered before injecting is commenced.

Adolescent↗
PubMed1998

There is more to a test than technology-evaluation of testing for chlamydia infection in a charitable sector termination service.

In order to develop a possible strategy for chlamydia testing throughout the British Pregnancy Advisory Service (BPAS), it was decided to first find the prevalence of the infection in women attending and to examine the practicalities involved in offering tests and dealing with positive results. Urine samples at initial consultation were tested by a method based on the Ligase Chain Reaction (LCR). Five hundred and eighty seven women were tested with an overall chlamydia positivity of 8.1 per cent, but of 12.4 per cent (25/202) in women up to and including 20 years of age. Tests in women over 25 years showed a positivity of only 0.7 per cent (1/147). Urine testing proved to be a convenient, non-intrusive means of chlamydia detection with the potential to lead to prompt management of positive cases. However, in comparison with EIA testing of endocervical swabs, detection of chlamydia in the population studied was not enhanced and some limitations were demonstrated, imposed by requirements for controlled temperature for transport and storage of specimens. Alternative approaches to testing and management was discussed. The time and commitment required to offer this service effectively were observed to be important factors when staff and client were focused on the direct issues relating to the current pregnancy. Modified request forms enabled uniform data to be collated in the laboratory and compared with that from other services currently studied. Ongoing monitoring of chlamydia positivity in this nationwide termination service could provide useful sentinel data about the infection.

Abortion Applicants↗
PubMed1997

Epidemiology of genital Chlamydia trachomatis in England and Wales.

OBJECTIVE: To describe the recent epidemiology of genital Chlamydia trachomatis infection in England and Wales. DESIGN: Retrospective study of routinely available surveillance datasets and ad hoc prevalence studies. METHODS: Numbers of new cases of genital C trachomatis infection, obtained from the Department of Health and Welsh Office, were combined with the estimated mid-year resident population of England and Wales. Rates were analysed for trend over time using a log linear age period model in GLIM4. Ad hoc prevalence and case finding studies carried out over the past 20 years were critically assessed in terms of study design and testing methodologies. RESULTS: Attendance rates at genitourinary medicine (GUM) clinics were higher for women than men over the period 1989 to 1994 as were the number of laboratory reports. The highest rate of attendance (GUM clinic data) was for women aged 16 to 19 years. There was an overall significant linear decrease in the attendance rates over time for both men (p = 0.0172) and women (p = 0.0000) between 1989 and 1994. There was considerable variation in the prevalence of genital C trachomatis infection detected within different clinical settings, together with a substantial level of asymptomatic infection. CONCLUSIONS: Genital C trachomatis infection is broadly distributed throughout the sexually active population, with a substantial reservoir of asymptomatic infection among those generally perceived to be at low risk of a sexually transmitted infection. Young people, particularly women aged 16 to 19 years, are at highest risk of genital C trachomatis infection. This is of concern since younger women are more susceptible than older women to developing complications of chlamydial infection, such as pelvic inflammatory disease. The broad distribution of infection across all sexually active health service attenders and the high level of asymptomatic infection suggest that a new, screening based, approach to the control of genital C trachomatis infection is required. Recommendations are made as to the epidemiological research required to guide such work.

Adolescent↗
PubMed1991

Serological diagnosis with the Chlamydia Spot-IF test.

Using a set of sera for which full chlamydial micro-immunofluorescence results suggested a clear diagnosis, we have evaluated the Chlamydia Spot-IF test (bioMerieux), which allows a comparison of titres to Chlamydia trachomatis and C. psittaci antigens. A modification of the test in which the antigen slides were pre-treated with a monoclonal antibody to chlamydial lipopolysaccharide, improved its ability to differentiate infections with C. trachomatis from those with C. psittaci or C. pneumoniae.

Adult↗
PubMed1990

Per-nasal swabbing as an aid to the diagnosis of chlamydial and adenovirus conjunctivitis.

Two hundred and thirty four patients (adults and babies) with conjunctivitis were investigated by taking eye swabs and in addition by taking per-nasal swabs. Chlamydia trachomatis was isolated from 20 patients and adenovirus from 14 patients. Per-nasal swabbing led to a 53% increase in chlamydia diagnosis and a 27% increase in the diagnosis of adenovirus infection. It is suggested that per-nasal swabbing has an important role to play in detecting chlamydial conjunctivitis which itself may be an indicator for high morbidity in patients and their contacts.

Adenovirus Infections, Human↗
PubMed1987

Adult follicular conjunctivitis and neonatal ophthalmia in a Liverpool eye hospital, 1980-1984.

In the five year period between 1980 and 1984, 2146 adults and 172 neonates suffering from acute conjunctivitis underwent laboratory investigation for Chlamydia trachomatis (CT), Adenoviruses (AV), Herpes Simplex Virus (HSV) and pathogenic bacteria. Epidemiology and clinical features are presented and discussed. CT was detected in 29 per cent of neonates with conjunctivitis. 5.6 per cent of adults and older children investigated for follicular conjunctivitis were CT positive. There was a significant female preponderance among CT positive neonates of 1.9:1 (p less than 0.02). 91 per cent of neonates and 62 per cent of adults in whom CT was detected were receiving some sort of treatment. Serotypes 7, 3, 10, 4 and 8 were responsible in decreasing order of frequency for 96 per cent of AV infections. Serotype 7 was seen for the first time in an adult age distribution. HSV was isolated in 1.3 per cent of cases in the absence of typical lid or corneal lesions. Viral infection was not detected in any neonate. Bacterial infection was a more likely cause than CT in neonates if infection had persisted longer than 5 weeks (p much less than 0.001). Neonates with Staph aureus infection tended to present earlier in the course of disease than those with Haemophilus sp or Pneumococcus (p less than 0.05).

Adenoviridae Infections↗
PubMed1986

Evaluation of a seven day course of oxytetracycline in women with chlamydial cervicitis.

In an urban clinic for sexually-transmitted diseases, 270 women with cervical swabs culture positive for Chlamydia trachomatis were treated with 250 mg oxytetracycline orally four times daily for 7 days. Chlamydial infection was found again in 17 of 220 (7.3%) women examined one month after treatment, and in 12 of 113 (9.7%) women reexamined three months after treatment. Even in cases where reinfection seemed unlikely, only 177 of 198 (89%) were cured. Most post-treatment infections were not clinically apparent, and laboratory follow-up was essential for evaluation of chemotherapy.

Chlamydia Infections↗