Seventy-six Neisseria gonorrhoeae isolates, isolated between 1940 and 1987, and seven Neisseria meningitidis isolates, isolated between 1963 and 1987, were screened for the presence of acquired mef(A), erm(B), erm(C), and erm(F) genes by using DNA-DNA hybridization, PCR analysis, and sequencing. The mef(A), erm(B), and erm(F) genes were all identified in a 1955 N. gonorrhoeae isolate, while the erm(C) gene was identified in a 1963 N. gonorrhoeae isolate. Similarly, both the mef(A) and erm(F) genes were identified in a 1963 N. meningitidis isolate. All four acquired genes were found in later isolates of both species. The mef(A) gene from a 1975 N. gonorrhoeae isolate was sequenced and had 100% DNA and amino acid identity with the mef(A) gene from a 1990s Streptococcus pneumoniae isolate. Selected early isolates were able to transfer their acquired genes to an Enterococcus faecalis recipient, suggesting that these genes are associated with conjugative transposons. These isolates are the oldest of any species to carry the mef(A) gene and among the oldest to carry these erm genes.
Among 830 women attending a clinic for sexually transmitted disease, Chlamydia trachomatis was isolated from 180 (22%) and Neisseria gonorrhoeae from 84 (10%). Retrospective analysis showed that 43 of the women were given outpatient treatment for acute pelvic inflammatory disease because they had low abdominal pain, deep dyspareunia, or unusual vaginal bleeding, or all of these, for less than 2 months in association with cervical motion or adnexal tenderness, or both. None had adnexal masses. C. trachomatis was isolated from 22 and N. gonorrhoeae from 15 of this subgroup of 43 women. This presentation of pelvic inflammatory disease occurred in 10 of the 37 women in the whole study with both C. trachomatis and N. gonorrhoeae, 12 of 143 women with C. trachomatis alone, five of 47 women with N. gonorrhoeae alone, and 16 of 603 women with neither organism. Thus, in North America, C. trachomatis is associated with a syndrome usually diagnosed as mild pelvic inflammatory disease and managed on an outpatient basis.
Testing for antibodies against human immunodeficiency virus (HIV) was introduced in 1984 in this major sexually transmitted disease (STD) clinic in Copenhagen, which is attended by about 10,000 new patients each year. From 1984 to 1987 the proportion of patients examined for antibodies to HIV rose from 6% to 32%. The overall incidence of HIV antibody positivity decreased from 30% in 1984 to 3% in 1987, the combined result of decreased positivity in high risk patients tested and increased screening in low risk patients. HIV antibody positivity has been confined largely to homosexual men and drug addicts. Since 1985, however, 21 out of 2623 (0.8%) heterosexuals who were not drug addicts were found to be HIV antibody positive. During 1984-6 the incidence of STDs most often encountered in high risk groups (syphilis and gonorrhoea) decreased by 64% and 41% respectively, whereas the incidence of diseases most often diagnosed in low risk groups (condylomata acuminata and genital herpes) increased by 70% and 34% respectively in the same period. The addition of HIV infection to the list of STDs requires the allocation of more resources to the STD clinics to enable these clinics to handle this new problem. Screening for all patients attending an STD clinic for antibodies to HIV must be considered, and in our area it would be cost effective.
The proband group consists of the 286 women who, in 1960, were treated for gonorrhoea in the Out-patient Clinic for Venereological Diseases in Malmö. During the years 1932 and 1973, they were responsible for 119 convictions for drunkeness, the expected number of convictions being 4, as calculated from an age- and calendar year specific risk table for Swedish women. The difference between numbers observed and those expected increased with age. Of the 82 patients aged 25 years or over in 1960, one in ten had previously been convicted for drunkenness, and one in seven, 13 years later. During the years 1939 to 1973, 12 gonorrhoea patients were subjected to compulsory treatment by the Temperance Boards. Of the patients aged 15 years or over in 1960, one in twenty had earlier been subjected to such treatment, and one in ten, 13 years later. It is concluded that gonorrhoeal infections, particularly in women 25 years and over, can constitute a "symptom" of alcohol problems.
The incidence of Neisseria gonorrhoeae with reduced susceptibility to quinolones increased from 0.18% (63 of 3285) in 1992 to 0.56% (15 of 2663) in 1993 and 0.62% (46 of 2846) in 1994. In all, 65 of the 67 isolates of Neisseria gonorrhoeae with decreased susceptibility to quinolones were characterised by pulsed-field gel electrophoresis (PFGE), auxotyping, serotyping and plasmid content. The strains were distributed among 14 auxotype/serovar (A/S) classes. Thirty isolates (46.2%) which were penicillin-susceptible with ciprofloxacin MIC90 of 0.12 mg/L and norfloxacin MIC90 of 1.0 mg/L belonged to a single A/S class, OUHL/IA-2. All but two of the 30 isolates had identical PFGE restriction profiles with NheI restriction endonuclease. Fifteen isolates (23.1%) with MICs in the intermediate (or resistant) categories for penicillin and with ciprofloxacin and norfloxacin MIC90 of 0.25 and 4.0 mg/L and (0.5 and 4.0 mg/L) respectively, belonged to A/S class P/IB-1. The 15 isolates showed nine different patterns with NheI and eight patterns with SpeI restriction endonucleases. Two of three beta-lactamase-producing (PPNG) isolates belonged to A/S class P/IB-5 and had a dissimilar PFGE restriction profile with NheI endonuclease; the other isolate belonged to A/S class P/IB-8. The remaining 17 isolates were distributed among 11 A/S classes. Three isolates within the common A/S class NR/IB-1 were subdivided into two types by PFGE as were three isolates belonging to A/S class NR/IB-2. Overall the 65 isolates of N. gonorrhoeae were distributed into 30 NheI and 26 SpeI macrorestriction profiles. All but one isolate harboured the 2.6-MDa cryptic plasmid and 18 isolates carried the 24.5-MDa transferable plasmid. The three PPNG isolates carried the 4.5-MDa Asian beta-lactamase-producing plasmid and a 25.2-MDa conjugative plasmid was found in the two TRNG isolates.
During one year 738 gonococcal isolates from 731 consecutive patients with gonorrhoea were collected and classified by co-agglutination using W I and W II/III specific monoclonal antibodies. Eight W I and 30 W II/III serovars (serovariants) were seen. In both serogroups the most frequent serovar among isolates from women and heterosexual men differed from that among isolates from homosexual men. Forty-two per cent of the serovars, were confined only to one subpopulation, i.e. women, heterosexual men or homosexual men, representing 19 (3%) of the 738 isolates. Out of these 19 isolates 42% were acquired abroad compared with 12% of the 653 isolates in the serovars shared between two or all three subpopulations (p less than 0.005). Imported W I isolates were often of the same serovar that dominated in Stockholm. W II/III isolates acquired abroad were often of unusual serovars (p less than 0.0005) and might be a source of future changes of the serovar pattern in Sweden. In this way we can follow the introduction of new serovars into our society and their circulation between the subpopulations.
Sexually Transmitted Diseases (STD) are a major health problem all over the world. The diseases are often spread by unsuspecting asymptomatic individuals. One important means of controlling STD is thus the identification of asymptomatic persons. The purposes of this thesis were a) to describe methods of identifying infected individuals through contact tracing and screening, b) to evaluate contact tracing routines, c) to compare epidemiological characteristics of two different groups of chlamydia-infected women and their partners and d) to see if data from contact tracing could be used in a model describing partner choice and STD spread. A microepidemic of penicillinase-producing gonococci was effectively controlled through contact tracing by cooperating counsellors. Serotyping of gonococci and graphic description proved of great help in mapping the contact chain. Contact tracing integrated in the psychosocial long-term care of HIV-infected patients resulted in identification of a great number of previously unidentified individuals. Screening for Chlamydia trachomatis (Ct) among asymptomatic patients of family planning clinics revealed a 7.3% Ct prevalence. Four factors were significantly correlated to the risk of being infected: age 18-23, duration of present relationship less than 1 year, failure to use condoms and no previous history of genital infection. Abstention from testing was especially high in areas with low socio-economic status. In these areas, increased resources for health care are needed. Five different levels of management of Ct infections were compared. Increased measures to verify that reported partners were examined decreased reinfections and after Ct was included in the STD Act more reported partners than before came for examination. Index patients found by chlamydia screening and their partners have a lower average number of recent partners than index patients visiting an STD clinic and their partners. Partners of female patients in the STD clinic group were also more often Ct-positive. The differences between the groups are small and do not justify different ambitions in partner management. Choice of steady partner was rather restricted and choice of casual partner followed a more random pattern. Our data thus do not support a pure random mixing model for STD spread.
BACKGROUND: Sexually transmitted infections are leading causes of morbidity for Canadian Aboriginal women. To date, very few initiatives have been successful in screening, treating, and limiting these infections among these populations. OBJECTIVES: To evaluate the efficacy of universal screening, treatment and contact tracing as a means of capturing a more accurate count of chlamydia and gonorrhea prevalence and limiting transmission among Inuit communities. METHODS: 181 participants were screened for chlamydia and gonorrhea and interviewed in a cross-sectional survey (Aug-Sept/03). Information was collected on demographics, use of health services, sexual histories and STI knowledge among others. A random sample (n = 100) from the cross-sectional group was selected for the longitudinal cohort. Individuals were followed every two months post baseline for four visits (Oct/03-May/04). At each visit, participants were screened for chlamydia/gonorrhea. All positive cases and their partners were treated and contact tracing completed. Logistic Regression analysis and the McNemar Test of Correlated Proportions were used to analyze the data. RESULTS: Overall, 35 cases of chlamydia were detected, with 21 detected at baseline and 14 during follow-up. The baseline prevalence was 11.6% in comparison with 2.7% that was previously estimated. No gonorrhea was detected. The strongest factor associated with a positive chlamydia was having recent STI (OR 9.82, CI: 2.70, 35.77). CONCLUSIONS: Consistent with the literature, the results support the use of universal screening followed by prompt treatment and contact tracing in populations with greater than 10% chlamydia prevalence.