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J Schachter

Publications and source records attributed to J Schachter.

At least 145 records · Page 8Linked to original sources
PubMed1990

Confirmatory assay increases specificity of the chlamydiazyme test for Chlamydia trachomatis infection of the cervix.

Enzyme immunoassays for the detection of chlamydial antigens are commonly used to diagnose Chlamydia trachomatis infection. As is true for all nonculture methods, the specificities of these tests are a concern. A confirmatory blocking assay (Abbott Laboratories, North Chicago, Ill.) was evaluated at four sexually transmitted disease test sites. This assay is designed to confirm true-positive Chlamydiazyme (CZ) specimens and to identify false-positive CZ reactions caused by cross-reacting bacteria. Cervical specimens were collected from 2,891 women. Chlamydia prevalence by tissue culture (TC) was 9.2% (266 of 2,891 specimens). Compared with TC, the sensitivity and specificity of CZ were 78.9% (210 of 266 specimens) and 98.2% (2,577 of 2,625 specimens), respectively. There were 48 CZ false-positive reactions. The direct fluorescent-antibody test (DFA) was positive for 31 of 48 false-positive reactions, indicating culture misses. Thus, when the standard was both TC and DFA, CZ sensitivity was 81.1% and CZ specificity was 99.3%. Of the 17 CZ-positive patients who were negative by both TC and DFA, 3 were negative on repeat CZ and 11 of 14 were identified as false positive by the confirmatory assay. The confirmatory test was positive for CZ-positive women who were positive by TC or DFA. Use of the confirmatory test, which increased the specificity to 99.9%, would increase confidence in positive CZ results and make the test more useful for screening populations with a low prevalence of C. trachomatis infection.

Adult↗
PubMed1990

Seroepidemiology of chlamydia in Costa Rica.

A population-based study of the sero-epidemiology of chlamydia was performed among a nationally representative sample of 760 Costa Rican women aged 25 to 59 years. Interviews and sera collection were completed between September 1984 and February 1985. The overall seroprevalence of chlamydial antibodies among these women was 56.1%. Women 25 to 39 years of age had a seroprevalence of 51.1%, while women 40 to 59 years of age had a seroprevalence of 64.2%. Women who reported no prior sexual activity had a seroprevalence rate of 48.6%, compared with a seroprevalence rate of 80.7% among women who reported three or more lifetime sexual partners. The geometric mean titre (GMT) of seropositive women ranged from 34.4 among the women who reported no prior sexual activity to 155.0 among the women with three or more lifetime sexual partners. Sero-positivity was more consistently associated with sexual activity than with age. Women with serological evidence of past Herpes simplex virus type 2 (HSV-2) or syphilis infection were more likely to be seropositive than were women without evidence of exposure to these sexually transmitted diseases, even when controlled for age and the number of lifetime sexual partners. The seropositivity among never sexually active women indicates the probable presence of Chlamydia pneumoniae infections, while the high seroprevalence of chlamydial antibodies among the sexually active women suggests that sexually transmitted Chlamydia trachomatis infections represent a public health problem not previously quantified in Costa Rica. Further seroepidemiological and/or culture studies are warranted to determine the incidence and prevalence of sexually transmitted chlamydial infection among men and younger women.

Adult↗
PubMed1990

Does a panel discussion on analytic technique have any effect on an audience of analysts?

This is a report of a followup study to determine whether attending a panel discussion group on post-termination patient-analyst contact influenced the analytic audience's attitude on that subject. A questionnaire about post-termination contact was given to 21 analysts who did not attend the discussion group and to 45 analysts before they attended. The same questionnaire was given again to both groups six months later. Responses by the 21 analysts who had not been present remained essentially unchanged. Responses of the 45 analysts, after attending the discussion group, when compared to responses of an earlier group of 300 analysts, showed an increase in the proportion of analysts who said, in reference to psychoanalytic psychotherapy patients, either that they hoped to hear from the patient or that they would like the patient to return to see them at some specified period after treatment termination. Attendance at the discussion seems responsible for a significant effect on the analytic audience's attitude on post-termination patient-analyst contact.

Attitude of Health Personnel↗
PubMed1990

Bronchial response to methacholine in "healthy" children of asthmatic parents. Effect of treatment with cromolyn sodium.

Cumulative dose response curves to inhaled methacholine were established in 24 "healthy" children of asthmatic parents and 7 healthy children of healthy parents. Atopic children of asthmatic parents demonstrated higher bronchial hyperreactivity (BHR) than nonatopic children. The BHR was about ten times less than in the atopic parents of asthmatic children, indicating marked increase in BHR with age in atopic members of asthmatic families. Six weeks of treatment with cromolyn sodium (disodium cromoglycate) decreased BHR significantly (p less than 0.05) in eight atopic children, while no change occurred in BHR in five nonatopic children.

Adolescent↗
PubMed1990

Office and Laboratory Testing for STDs: Present and Future.

This chapter is aimed at the clinician in private practice or in a small clinic setting dealing with sexually transmitted diseases (STDs) but lacking immediate access to larger laboratories. Tests that should be routinely available for patients with STDs are described. Some of these tests may be performed on site, whereas others must be sent out to appropriate laboratories. Among the tests described are Gram stain testing, culture of Neisseria gonorrhoeae, darkfield examination, as well as testing for Chlamydia trachomatis, herpes simplex virus, chancroid, and syphilis.

Journal Article↗
PubMed1990

Post-termination patient-analyst contact: I. Analysts' attitudes and experience; II. Impact on patients.

Post-termination patient-analyst review, due to the increased psychological distance from the patient provided by the passage of time, generates an advantaged perspective of the gains and limitations of analytic work than was possible at treatment termination. Despite analysts' widespread belief that such analyst-initiated contact is deleterious to the patient, assessment of clinical experience with such contacts by Luborsky, Martin and Schlessinger, as well as by re-evaluated data of Wallerstein, indicates little or no damage to patients, and in some cases distinct benefits. Analysts generally make post-termination contact with their patients conditional upon the patient's need for additional help, although their personal experience is of unconditional extensive contacts with their own training analyst. Whether expectation of and experience of substantial post-termination contact with the patient's analyst impacts on either the degree of mourning or of resolution of residual transference requires evaluation.

Adolescent↗
PubMed1990

The epidemiology of trachoma predicts more blindness in the future.

Trachoma is considered the world's leading preventable cause of blindness, with hundreds of millions of people affected and approximately 6 to 9 million blinded as a result of the disease. It was once endemic in much of the world. It disappeared from most of Europe and North America, coincident with the improvements in hygienic conditions that accompanied the expanding industrial revolution in the latter part of the 19th century. Common wisdom states that trachoma is disappearing from much of the world today as a result of improvement in the standard of living. Unfortunately, this is not a realistic perception. In some hyperendemic areas neither the standard of living nor hygienic conditions are improving. Deaths due to acute infections have been reduced and the population is both growing and aging. In some parts of the world, because of demographics, it is likely that there are more people being exposed to trachoma as children and more will survive to old age when trachomatous blindness develops. In these countries there will be larger numbers of blind individuals in the future than there are today. This will tax public health and economic systems in the involved communities.

Blindness↗
PubMed1990

Amoxicillin therapy for Chlamydia trachomatis in pregnancy.

For treating Chlamydia trachomatis cervical infection in pregnancy, the Centers for Disease Control guidelines recommend either erythromycin base or erythromycin ethylsuccinate. There is no alternate therapy. Because of compliance problems with erythromycin regimens due to gastrointestinal side effects, such an alternative is needed. For this reason, we compared, in an open trial, the efficacy and patient compliance of amoxicillin (500 mg three times a day for 7 days) with those of erythromycin base (500 mg four times a day for 7 days) in treating C trachomatis cervical infections during pregnancy. In the amoxicillin group, 63 of 64 women (98.4%) had negative cervical cultures after treatment, compared with 55 of 58 women (94.8%) treated with erythromycin base. Vertical transmission to the infants was assessed by culture and/or persistent or rising immunoglobulin G antichlamydial antibody. In the amoxicillin group, 37 of 39 infants (94.9%) had no evidence of chlamydial infection, compared with 32 of 36 infants (88.8%) in the erythromycin group. These differences were not significant. The frequency of side effects was higher with erythromycin base than with amoxicillin (15 versus 8%), although not significantly so. However, the frequency of stopping medication because of side effects was significantly higher with erythromycin base than with amoxicillin (13 versus 2%; P less than .006). These results suggest that amoxicillin may be an acceptable alternative treatment for chlamydial infections in pregnancy.

Adult↗
PubMed1990

Chlamydial infection of subcutaneous conjunctival transplants in guinea pigs.

The development and testing of candidate vaccines for trachoma are constrained because only humans and nonhuman primates are susceptible to conjunctival infection with Chlamydia trachomatis. Guinea pig inclusion conjunctivitis (GPIC), an analogous disease of guinea pigs, provides a useful, less expensive model to study ocular chlamydial infections. GPIC is caused by a Chlamydia psittaci strain whose external constituents are very similar to those of C. trachomatis. To develop a better model for studying GPIC immunity, conjunctival pockets were established under the abdominal skin of guinea pigs by subcutaneous implantation. Up to six implants could be produced in each animal. The success rate of implantation was 79.0% (n = 148). These pockets were then infected with GPIC. The organism was recovered from the autografts indicating local replication, and tests for serum antibody by microimmunofluorescence showed production of GPIC-specific antibody of IgG and IgM classes after infection. There was minimal antibody response after moderate inoculating doses to the implants, and the titers increased more slowly than after eye infection with GPIC; with higher concentration of the inoculum, however, the antibody response increased to the same levels as with the ocular challenge but more slowly. Inoculation of pockets with GPIC also produced acute inflammatory changes in infected autografts (n = 101). Histologic examination of infected grafts showed chlamydial inclusions in epithelial cells and significant infiltration with lymphocytes and polymorphonuclear cells. Subcutaneous autografts may provide a useful model for chronologic studies of chlamydial infection. The delayed immunologic response, however, suggests that these pockets of implanted epithelium do not have full access to the immune system.

Abdomen↗
PubMed1989

In vitro activity of ofloxacin against Chlamydia trachomatis.

The activity of ofloxacin against Chlamydia trachomatis isolates obtained from eight metropolitan areas in the United States has been evaluated. Growth of C. trachomatis in first passage was completely inhibited by less than 1 microgram/ml of ofloxacin (all 27 isolates tested). The bactericidal effect (inability to pass in the absence of antibiotics) was less than or equal to 1 microgram for 26 of the 27 isolates. Other studies have shown that less than 0.1 microgram/ml of ofloxacin is the minimal inhibitory concentration for 90 percent of strains tested (MIC90) for Neisseria gonorrhoeae and less than 2 micrograms/ml is the MIC90 for Haemophilus ducreyi. Ofloxacin is less active (MIC90, 8 to 25 micrograms/ml) against Ureaplasma urealyticum. These in vitro results suggest that ofloxacin may be useful in the treatment of bacterial sexually transmitted diseases. Because there is a need for a single antibiotic active against both chlamydiae and gonococci, this quinolone could play an important role in the management of these infections.

Chlamydia trachomatis↗
PubMed1989

Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin.

A prospective, randomized, controlled, non-blind clinical trial was conducted to compare the efficacy of monotherapy with ciprofloxacin with that of a combination of clindamycin plus gentamicin in the treatment of patients with acute pelvic inflammatory disease. Pretreatment and post-treatment cervical culture specimens were obtained for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum. Pretreatment and post-treatment endometrial culture specimens were obtained for those organisms plus facultative and anaerobic bacteria. Minimal inhibitory concentrations were determined on all isolates by agar dilution. Clinical resolution of infection was seen in 31 of 33 (94 percent) ciprofloxacin-treated patients compared with 34 of 35 (97 percent) clindamycin/gentamicin-treated patients. N. gonorrhoeae was eradicated in all cases and C. trachomatis in 12 of 13 cases (92 percent). Ciprofloxacin appeared less effective than clindamycin/gentamicin in eradicating bacterial-vaginosis-associated organisms from post-treatment culture specimens obtained from the endometrium. Comparable clinical response was seen with both regimens. The significance of persistent bacterial-vaginosis-associated organisms following ciprofloxacin therapy is unclear. However, since one goal of treatment of pelvic inflammatory disease should be to eliminate organisms from the upper genital tract, ciprofloxacin may not provide optimal single-agent therapy for pelvic inflammatory disease.

Acute Disease↗
PubMed1989

Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males.

We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males. Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+). Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%). The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively. Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected. The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.

Adolescent↗
PubMed1989

Sulbactam/ampicillin in the treatment of acute pelvic inflammatory disease.

Acute pelvic inflammatory disease is associated with significant adverse reproductive sequelae. To prevent these serious sequelae, treatment regimens must cover the major etiologic agents which are Neisseria gonorrhoeae, Chlamydia trachomatis, and mixed anaerobic-aerobic bacteria. This report concerns the prospective evaluation of the efficacy of the combination of sulbactam with ampicillin in patients hospitalized with acute pelvic inflammatory disease. Clinical cure was noted in 33 (94%) of 35 patients and post-treatment cultures demonstrated eradication of N. gonorrhoeae and C. trachomatis in all cases.

Adult↗
PubMed1989

Differences in biologic maturation, sexual behavior, and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia.

Because several cofactors may influence the development of cervical intraepithelial neoplasia (CIN) in young women, we compared differences in behaviors (sexual activity, contraception, and cigarette use), sexually transmitted disease (STD) infection rates (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus), and cervical maturation (age of menarche and percentage of cervical ectopy) in groups of sexually active female adolescents with and without CIN. Those with CIN were compared with three non-CIN groups: (1) teenagers who were referred to a teen colposcopy clinic but had no evidence of CIN (high-risk group), (2) teenagers seen at a gynecology clinic without STD symptoms (asymptomatic group), and (3) teenagers seen at the gynecology clinic with STD symptoms (symptomatic group). The percentage of cervical ectopy was measured by colpophotography. Subjects with CIN had more lifetime sexual partners than the asymptomatic group (p less than 0.001) and were more likely to smoke cigarettes than either gynecology clinic group (p less than 0.01). No differences in behaviors existed between the CIN and high-risk groups. The mean age of menarche in those with CIN was 1 year older than all three non-CIN groups (p less than 0.05), and those with CIN had a greater area of ectopy than those without CIN (p less than 0.02). Those with CIN were more likely to have a past or present history of C. trachomatis infection than the two gynecology clinic groups; no difference was found between the CIN and high-risk groups. We conclude that cofactors such as smoking, sexual promiscuity, and C. trachomatis infection may influence cervical vulnerability. However, cervical biologic immaturity is an important risk factor for development of CIN in adolescent girls.

Adolescent↗