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Chlamydia trachomatis infection and veneral disease.

Chlamydia trachomatis was isolated by the irradiated McCoy cell technique from 44 out of 103 men with non-gonorrhoeic urethritis and from 11 out of 15 patients with post-gonococcal urethritis. In women attending the venereal diseases clinics, chlamydial infection was observed in 49 out of 130 patients (38%), an infection incidence of the same order of magnitude as the one noted for gonococcal infection (40%). In 19% both infections occurred simultaneously. Treatment with tetracycline eliminated symptoms and chlamydial infection in almost all cases. The significance of the findings is discussed.

Anti-Bacterial Agents↗

[Penis friction edema: not a venereal disease].

A 35-year-old man presented with a local swelling of the penis, which increased until the entire penis was thick and swollen. After infectious and obstructive causes had been eliminated, a diagnosis of 'penis friction oedema' was made. The swelling disappeared during several weeks of abstinence from sexual intercourse. Penile abnormalities can be divided into venereal diseases (STDs), incidental affections of the skin or mucous membranes in that location, and disorders of vascularisation and lymph drainage. A traumatic disorder of lymph drainage is sometimes referred to, unjustifiably, as 'penile venereal oedema'; it is a result of friction and manifests itself as local or total penile oedema or as a cordlike congestion of the lymphatic vessels. The diagnosis is by exclusion and the treatment is temporary abstinence from sexual intercourse.

Adult↗

Biological false-positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera.

This retrospective study on syphilis screening at the sexually transmitted infection (STI) unit of a University Department emphasizes the necessity of a treponemal-specific test as the appropriate screening test. The Venereal Disease Research Laboratory (VDRL) test for syphilis screening may, under certain circumstances, yield positive results in patients not infected with Treponema pallidum, a phenomenon referred to as biological false-positive (BFP) VDRL test. The aim of this study was to determine the frequency of BFP tests in a large sample of sera. In this retrospective study, we analysed the results of parallel VDRL and T. pallidum haemagglutination (TPHA) testing of a total of 514,940 blood samples obtained from patients at the Vienna General Hospital between January 1988 and November 1999. Patients' sera with incomplete data on stage and sex and duplicate sera were excluded, leaving 300,000 sera for analysis. The seroprevalence for syphilis was 1.77% (n = 5320), as determined by a positive TPHA test. It was significantly higher in male than in female patients (2.03% versus 1.58%, P<0.001). Of the patients reactive in the TPHA test, 3257 (61.2%) were negative in the VDRL. With regard to reactivity in VDRL testing, 2799 patients (0.92%) of the study population were positive, of whom 736 (26%) were biological false positive. BFP reactivity was found in 0.24% of all patients and was significantly higher in women than in men (0.27% versus 0.20%, P<0.001) and in patients over 60 years of age (0.34%) as compared with those under 60 (0.25%, P<0.001). This proportion might be even higher, as reactivity in the VDRL at 1:0 and 1:2 dilutions without a positive treponemal test was not reported. The subgroup of HIV-positive patients (n = 1415) revealed a 10-fold higher rate of BFP tests (2.1% versus 0.24), an effect being statistically significant. In a low syphilis prevalence population, BFP reactions comprise a high proportion of all VDRL reactors. Therefore, the use of the VDRL as a screening procedure is challenged.

Adolescent↗

Cytomegalovirus infection: a seroepidemiologic comparison of nuns and women from a venereal disease clinic.

A seroepidemiologic study of prevalence of antibody to cytomegalovirus (CMV) was simultaneously done in four populations: group I, nuns working as nurses or school teachers; group II, women admitted to a upper socioeconomic private hospital; group III, women admitted to a lower socioeconomic county hospital, and group and IV women attending a veneral disease clinic. Groups II, III and IV, were not statistically different and showed an abrupt rise in antibody prevalence during your adulthood. Group I, however, did not show the expected abrupt rise in antibody prevalence during young adulthood, and the prevalence in this group was singificantly lower than that in the other three groups at all but the oldest age range. These differences could not be accounted for by race, socioeconomic status or respiratory exposure to CMV. The data suggest that there may be more than one mechanism of CMV transmission and that venereal or intimate salivary contact may be a significant mode of spread in adults.

Adolescent↗

Venereal diseases in the Pacific Islands. Papua New Guinea.

Papua New Guinea, which contains nearly three-quarters of the population of the 20 islands, or island groups, studied by the South Pacific Commission has a commensurate proportion of reported cases of syphilis and gonorrhoea. It is a country with an exceptional interest for the venereologist as it exhibits all the facets of venereal disease problems as experienced the world over. With the opening up of communications syphilis has gained a foothold in what were areas previously endemic with yaws; moreover, some yaws still remains (particularly in the offshore islands)--the two conditions tending to be mutually exclusive. In the area around the capital, Port Moresby, the prevalence of Donovanosis is unparalleled.

Gonorrhea↗

Role of the Venereal Disease Research Laboratory test in the detection of syphilis.

Of 9733 consecutive serological samples received by Portsmouth and Southampton Public Health Laboratories (PHL) and tested for syphilis, 190 (140 from men and 50 from women) gave positive results. Thirty new cases of syphilis were identified. Most sera were tested initially by both a specific antibody test (the Treponema pallidum haemaglutination (TPHA) test) and a cardiolipin test (the Venereal Disease Research Laboratory (VDRL) test). Among the 14 patients whose sera gave VDRL-positive but TPHA-negative results, 12 sera gave false-positive results. The sera of 90 patients gave TPHA-positive but VDRL-negative results; sera from only seven of these patients gave false-positive results. The VDRL test is very unlikely to identify a new case of syphilis where a TPHA test has failed to do so. The results of the survey suggest that the VDRL test should be withdrawn from initial testing for syphilis except where early primary disease is suspected.

Antibodies, Bacterial↗

Venereal disease among immigrant workers in Vienna.

Official physical examinations of migrant workers upon immigration are required before work permits are issued. The screening of 74,983 applicants during 1972 to 1974 revealed sera reactive to serological tests for syphilis in 0-8 per cent. (range 0-5 to 1-1 per cent.) of all persons concerned and fifteen cases of early syphilis. The incidence of recent infections among immigrants is lower than that reported among the inhabitants of Vienna. General statistics on the spread of venereal diseases among immigrant workers are not available after they start work. Some evidence is provided by those who had to be traced for compulsory examination because they had defaulted from treatment or follow-up, because they were suspected of clandestine prostitution, or because they were reported to be sources of infection. 257 (60-6 per cent.) of 414 individuals who were wanted for reasons of syphilis control could be located and eighteen (7 per cent.) of those who were examined had early infectious lesions.

Austria↗

Drug treatment of venereal disease: analysis of 273 cases in Ghana.

The presence of non-gonococcal urethritis, resistant to penicillin therapy was noted by Ikejiani in Nigeria as early as 1955. This syndrome is now known as non-specific urethritis, or non-specific genital infection in the female. Sarrat (1973) has shown the effectiveness of penicillin plus probenecid, specti nomycin, and cotrimoxazole in male cases of gonorrhoea in Dakar. Sogbetun and Osoba (1974) have shown the effectiveness of metronidazole in trichomoniasis in males in Nigeria. Our study was made on a mixed University population of 2,700 students seen in one clinic during the year 1975. There were 273 cases of sexually transmitted diseases including gonorrhoea, non-specific urethritis or genital disease, trichomoniasis and chronic urethritis or vaginitis. Treatment of gonorrhoea with penicillin alone or with spectinomycin was only 50% effective. But good results were obtained with penicillin plus probenecid or penicillin plus cotrimoxazole. Good results were obtained in non-specific urethritis, or non-specific genital disease, when tetracycline or its derivatives were used. Good results were obtained in the treatment of trichomoniasis with metronidazole in males and females. It was concluded that in gonorrhoea penicillin should be given (in adequate dosage) with probenecid or cotrimoxazole. Spectinomycin should be used at a dose level of 4 g instead of 2 g. The management of chronic urethritis and vaginitis was very difficult. The drug treatment of venereal disease in Ghana has not revealed any unique characteristics except, perhaps, an increased resistance of the gonococcus to spectinomycin.

Female↗