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Gas chromatography/mass spectrometry and selected ion monitoring (SIM), employing both electron (EI) and chemical ionization (CI), was used to detect 10-methyloctadecanoic (tuberculostearic) and 2, 4, 8, 8-tetramethyloctacosanoic (C32 mycocerosic) acids in bacteria of 14 species of Mycobacterium and 3 species of Nocardia. Tuberculostearic acid was found in all species studied, while C32 mycocerosic acid was demonstrated only in M. africanum, M bovis, M. bovis strain BCG, M. kansasii and M. tuberculosis. The relative amounts of these acids in the organisms of these five species varied, thereby constituting a presumptive diagnostic technique. The lowest detectable amount of C32 mycocerosic acid was approximately 5 pg when using EI-SIM, monitoring at m/zz 88 and m/z 101. When using CI, employing isobutane as reactant gas, and focusing at m/z 495, 2 pg could be detected, and when ammonia was the reactant gas, the corresponding figure was 1 pg, monitoring at m/z 512. Tuberculostearic acid was demonstrated in 5-day incubated sputum specimens from 6 patients with pulmonary tuberculosis, including 5 patients infected with M tuberculosis and 1 patient infected with M. avium. C32 mycocerosic acid was detected in 4 of the 5 patients with M. tuberculosis infection. None of the acids was found in a further 8 patients who had viral or bacterial (non-mycobacterial) pneumonia. Tuberculostearic acid could be demonstrated in 10 of another 12 sputum specimens from patients with tuberculosis, when the samples were analyzed directly, viz prior to culturing. The possibility of using SIM for the rapid diagnosis of pulmonary tuberculosis is thus worth consideration.

Cocci coated with IgG, IgA and IgM occurred in 21, 20 and 9 of 28 urine specimens, respectively, containing Staphylococcus saprophyticus. There was no correlation between the occurrence of antibody-coated cocci and symptoms from the upper or lower urinary tract. Nor was antibody-coating correlated to the occurrence of proteinuria or haematuria. Antibody-coated cocci occurred more often, however, in patients with symptoms for 7 days or more than in patients with symptoms for a shorter duration. Direct haemagglutination of sheep erythrocytes was demonstrated in 30 of 61 washed urine sediments containing S. saprophyticus. There was a significant correlation between non-haemagglutinating specimens and the occurrence of antibody-coated bacteria in these specimens.

Lysolecithin exhibits a lytic activity on acholeplasmas and mycoplasmas. The acholeplasmas studied, viz. Acholeplasma laidlawii A and B, were found less susceptible than were the mycoplasmas, viz. Mycoplasma gallisepticum and M. pneumoniae. The sensitivitxy to lysis was found to differ according to species, growth temperature and number of organisms used. Variations in age of the population and the concentration of bivalent ions in the test medium had but little influence. The greatest lytic activity of lysolecithin was found at the optimal growth temperature and decreased with lowering of the temperature. This lytic activity was inversely proportional to the density of the cell suspensions used. The possible mechanism of the lytic effect of lysolecithin is discussed.

A medium ("Y" medium) is described, which was more efficient for the isolation of Yersinia enterocolitica from experimentally infected faecal specimens than desoxycholate-citrate. McConkey, lactose-sucrose-urea (LSU) agar, and Yersinia selective medium (Wauter's medium). The "Y" medium consists of casein hydrolysate and peptone servings as carbon and energy sources. A high selectivity is achieved by its contents of sodium oxalate and bile salts. The oxalate suppresses growth of gram-negative rods, including members of the family Enterobacteriaceae and of Pseudomonas spp., while the bile salts inhibit growth of gram-positive bacteria. In the few instances coliform rods grew on the "Y" medium, they could easily be distinguished by their fermentation of lactose, included in the medium, and the fact that colonies of organisms were surrounded by an opaque zone of precipitated bile salts. The most optimal condition for the isolation of Y. enterocolitica from stools was achieved at incubation of the "Y" medium at 29 degrees C for 2 days.

A gas chromatographic (GC) head-space technique is presented, which is suitable for the analysis of volatile products in bacterial broth cultures. This is exemplified by studies on Clostridium septicum, Klebsiella pneumoniae and Proteus mirabilis. The media were acidified or made alkaline and after heating, samples of the gas phase above the media were directly injected into the gas chromatograph. A gas chromatograph equipped with dual columns and flame ionization detectors was used, employing Porapak Q and Chromosorb 103 as stationary phases. Analysis of acidified media, using Porapak Q, gave chromatograms representing acidic and neutral volatile products, while when analysing samples made alkaline, using Chromosorb 103, alkaline and neutral compounds could be detected. Interest was particularly concentrated on the analysis of bacterial amines. P. mirabilis was found to produce isobutylamine and isopentylamine, which were identified by mass spectrometry and GC retention times. C. septicum produced ethylamine. The GC head-space technique described constitutes a means for rapid identification of microorganisms. It is adaptable for use on a routine basis in the clinical microbiological laboratory.

Experimental infection with Chlamydia trachomatis, immunotype K, was carried out in six grivet monkeys. Three routes of infection were used: (A) into the uterine cavity through the cervical canal: (B) into the uterine cavity, but after ligature of the tubal isthmus, followed by curettement of the endometrium: (C) into the cervical epithelium. Two monkeys were used for each type of experiment. All monkeys inoculated by routes (A) and (C) developed marked signs of inflammation in the Fallopian tubes. Characteristically, the tubes were reddened and swollen. Exudate appeared in the abdominal ostia and in the cul-de-sac. In three of the four monkeys studied, a yellowish discharge was seen in the posterior vaginal fornix. An exudate composed mostly of lymphocytes and clusters of desquamated cells was found in the lumen of the tubes. The epithelium was injured in some areas and there were adhesions between the mucosal folds. In two of the monkeys, tubal occlusion was present two months after the inoculation. With one exception, all monkeys presented a significant rise in antibodies to C. trachomatis. In the two monkeys inoculated by route (B), no signs of inflammation in the upper genital tract were seen, but one of the animals died day 14 post inoculation;autopsy showed peritonitis and perihepatitis. One monkey was inoculated with non-infected yolk sac specimen by route (A) and another by route (B). Practically no inflammatory changes in the genital organs or elsewhere could be detected in these monkeys. The results indicate that C. trachomatis can cause salpingitis in female grivet monkeys by canalicular spread from the lower genital tract. The histological findings and the infection route in this experimentally induced salpingitis in the grivet monkeys closely resemble those ascribed to «gonococcal« salpingitis in man.

Ascending pyelonephritis was induced by Staphylococcus saprophyticus and Proteus mirabilis both by inoculating the organisms separately and in combination into rat bladders. Bacterial cultures of tissue homogenates showed that pyelonephritis by both bacteria occurred significantly more often in rats where the two organisms were instilled concomitantly, suggesting a synergistic virulence between the two species. The antibody response to the different organisms was the same either the bacteria were instilled separately or in combination.

The L-phase variants of three bacteria were at least 100-fold more susceptible to lysolecithin than their corresponding parents. Other bacteria, a yeast and protozoa were relatively resistant to lysolecithin although some bacteria, notably anaerobes, were particularly sensitive. It seems that some of the differences in sensitivity to lysolecithin may be accounted for, in part, by differences in the cholesterol content of the cell membranes and walls. Preliminary observations indicate that the infectivity of lipid-containing viruses, i.e. influenza B virus and Herpesvirus hominis type 1, but not of non-lipid-containing viruses, i.e. an adenovirus and a rhinovirus, was diminished by lysolecithin treatment. The possibility that lysolecithin production might interfere with the isolation of L-phase variants is discussed. Also considered is the possibility that the differential sensitivity of mycoplasmas and stable L-phase variants to lysolecithin might provide a means of distinguishing between them.

The present communication highlights some of the shortcomings of current surveillance programs as a base for understanding the prevailing epidemiological picture for sexually transmitted infections, with especial focus on genital chlamydial infections. Suggestions of how to possible improve them are given. It also discusses criteria for screening programs, incl. criteria for so called “selective screening”. The traditional groups for screening are mentioned as well as groups that have so far seldom been suggest to be subjected for such activities. The usefulness of breaking down monitored data from regional or national surveillance systems, specified to individual providers of collected data among private consultations and community clinics, even incl. subunits of the latter, is demonstrated. The difficulty in interpreting the result of diagnostic tests, particular in low-prevalence populations is put forward. The effectiveness of current recommended therapeutic regimens of Chlamydia trachomatis infections are considered in light of the notably high proportion of such recurrent and/or relapsing infections.

BACKGROUND: The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC. OBJECTIVES: To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures. METHODS: Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990--1999. The size of the female population in the county is approximately half a million. RESULTS: The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid- 1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for self-selection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed. CONCLUSION: The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions.

Objectives: To present sales figures of antifungal drugs for treatment of genital Candida infections in females, which had been purchased in the Swedish county of Skane (with approximately 1.2 million inhabitants) during the 1990s. To study the relative proportions of the drugs sold by prescription and as over-the-counter (OTC) products. Methods: Sales figures of antifungal drugs for therapy of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC), for the years 1990-99, were collected from the 'ACS' database of the National Corporation of Swedish Pharmacies. Results: The study showed an increase in sales of the type of drugs studied from 45 000 packages in 1990 until mid-93/94, when approximately 70 000 packages were sold (mainly azoles for topical use and fluconazole for oral intake). Thereafter there was a decrease until the end of November 1999, when 54 000 packages were purchased. Of the total sales, 93% were OTC products. Sales of clotrimazole and econazole (for vaginal installation) in 1993-1994 were equal to 85-90 packages/1000 women in the age group 15-45 years. Extremely high sales volumes of fluconazole and itraconazole, for one single year each, could be explained by marketing- related activities directed to the medical community. Conclusions: As many women with RVVC are not cured by iatrogenic initiatives and women consider themselves able to diagnose episodes of genital Candida infection, affected women generally turn to self- medication with antifungal OTC products. This stresses the role of pharmacy counseling. Short-term marked alterations in sales volumes may be due to marketing factors rather than changes in the epidemiology of genital Candida infections.

Objectives To study colonisation of extragenital sites by Candida in women with a history of recurrent vulvovaginal candidosis and to determine the association of such colonisation with clothing and sexual practice. Design A prospective case–control (current genital colonisation by candida organisms vs non-colonisation) study. Setting Outpatient clinic, University hospital, Kiev, Ukraine and Department of Obstetrics and Gynaecology, University Hospital, Lund, Sweden. Sample Women with a history of recurrent vulvovaginal candidosis and an assumed new attack of the condition. Methods Eighty-six women with a history of recurrent vulvovaginal candidosis and an assumed current attack of this condition underwent culture for Candida from the genital tract, the perianal skin, the rectum, the mouth and from voided urine samples, using Sabouraud and chromogenic agar. The women were interviewed about some factors that have been considered to trigger colonisation with Candida spp. Main outcome measures Colonisation of extragenital sites of women with recurrent vulvovaginal candidosis by different species of Candida. Correlation with oral and anal sex, and with clothing. Results Candida spp. was isolated from the mouth, the rectum, the perianal skin and from voided urine in 11(13%), 24(28%), 35(41%) and 16(19%) of women, respectively. Candida was recovered from one or more of these sites in 44(51%) of the women. The rate of culture of Candida from the extragenital sites was significantly higher (P < 0.05) in women who had a positive culture from the introitus or the vagina. The recovery rates of Candida in the 46 vaginal culture-positive women were 8 (17%), 24 (52%), 34 (74%) and 16 (35%) from the extragenital sites in the order mentioned. Species of Candida other than Candida albicans occurred more often at the extragenital than the genital sites. Neither oral nor anal sex was associated with colonisation of the mouth and the rectum with Candida spp. Neither tight-fitting trousers nor underwear produced from synthetic material was associated with colonisation of the perianal skin with Candida spp. Conclusions Extragenital sites are often colonised by Candida spp. in women with a history of recurrent vulvovaginal candidosis, but significantly more often if the genital tract is also colonised. Extragenital sites are significantly more commonly colonised with species other than C. albicans. Extragenital sites may be reservoirs for recolonisation of the genital tract in women with recurrent vulvovaginal candidosis. This has implications for treatment.

Objectives: To determine the leukocyte esterase (LE) activity in vaginal lavage fluid of women with acute and recurrent vulvovaginal candidosis (VVC and RVVC respectively), bacterial vaginosis (BV), and in pregnant and non-pregnant women without evidence of the three conditions. Also to compare the result of LE tests in women consulting at different weeks in the cycle and trimesters of pregnancy. The LE activity was correlated to vaginal pH, number of inflammatory cells in stained vaginal smears, type of predominating vaginal bacteria and presence of yeast morphotypes. Methods: One hundred and thirteen women with a history of RVVC, i.e. with at least four attacks of the condition during the previous year and who had consulted with an assumed new attack of the condition, were studied. Furthermore, we studied 16 women with VVC, 15 women with BV, and 27 women attending for control of cytological abnormalities, who all presented without evidence of either vaginitis or vaginosis. Finally, 73 pregnant women were investigated. The LE activity in vaginal fluid during different weeks in the cycle of 53 of the women was measured. Results: In the non-pregnant women, an increased LE activity was found in 96, 88, 73 and 56% of those with RVVC, VVC and BV and in the non-VVC/BV cases, respectively. In 73% of pregnant women in the second trimester, and 76% of those in the third, the LE test was positive. In all groups of non-pregnant women tested, the LE activity correlated with the number of leukocytes in vaginal smears, but it did not in those who were pregnant. There was no correlation between LE activity and week in cycle. The vaginal pH showed no correlation to LE activity in any of the groups studied. Conclusions: The use of commercial LE dipsticks has a limited value in the differential diagnosis of RVVC, VVC and BV. There is no correlation between the LE activity in vaginal secretion on one hand and vaginal pH, week in the menstrual cycle and trimester in pregnancy on the other. Women with BV often have signs of inflammation as evidenced by a positive LE test and inflammatory cells in genital smears.

This chapter presents different means by which community initiatives have been undertaken to reduce the prevalence and incidence of genital and allied infections caused by Chlamydia trachomatis . As most of these infections in the majority of infected individuals do not produce symptoms that are likely to urge them to attend any health care unit, screening programmes are mandatory to be able to influence the epidemic of infections with this agent. In many societies there has been a skewed gender distribution in the number of chlamydia-positive persons; this probably indicates that diagnostic service activities have been directed more against one gender than the other. The important role of partner notification, as in the case of other sexually transmitted infections, has been documented. Different means of community initiative have included counselling of school children and groups of persons more likely to be infected. Counselling by the pharmacy has an important role in many societies. Selected cohorts have been offered – via the mass media, Internet, radio and television programmes – sampling kits which can be mailed to a laboratory for testing. The establishment of youth clinics has been found effective for detecting teenagers harbouring C. trachomatis , similarly to screening at antenatal clinics. The offer of free consultations, aetiological tests and therapy has been a part of community initiatives, mimicking the services offered for some of the classic sexually transmitted infections. This chapter considers the usefulness of different test methods and stresses the need to retest those found to be positive. Barriers to the successful introduction of screening activities and diagnostic services are also considered.

Background. To characterize history, signs, and symptoms in women with a history of recurrent vulvovaginal candidosis (RVVC) and who had consulted with symptoms generally associated with the condition. Methods. Eighty-three women with a history consistent with RVVC were interviewed regarding 32 parameters and 10 signs found at the clinical examination were noted. Candida cultures were made from the introitus and the posterior vaginal fornix. Results. Only in a few of the 43 women with and the 40 without a positive yeast culture could any of the many etiological factors that have been associated with RVVC be traced. Only two factors differed between the groups, namely yogurt intake, which was reported by 28 (68%) and 38 (95%) women in these groups, respectively. Vaginal douching was performed by 10 (23%) women in the Candida-positive group and by 17 (42%) women in the Candida-negative group. Pruritis and burning occurred in 31 (72%) and 22 (51%) of culture-positive patients, which was less frequent than in the culture-negative group, i.e. reported by 19 (47%) and 9 (22%) patients, respectively (p = 0.022 and p = 0.007). Edema (p = 0.026) of the vulva as well as erythema (p = 0.019) and edema (p = 0.008) of the vaginal mucosa, caseous discharge (p = 0.016), were found more often in the Candida culture-positive cases. Conclusions. History and results of clinical examination of patients with RVVC are not enough to distinguish those who are culture-positive from those who are culture-negative for Candida from the genital tract. (Less)

Objective:To investigate if introital and vaginal flushing samples inoculated on chromogenic agar could increase the recovery rate and rapid identification ofCandidaand non-albicansspecies, as compared to culture of posterior vaginal fornix samples on Sabouraud agar and speciation of isolates by biochemical tests.Methods:Samples from the introitus and the posterior vaginal fornix and vaginal lavage samples were collected from 91 women with a history suggestive of recurrent vulvovaginal candidosis (RVVC), and with a suspected new attack of the condition. The specimens were cultured on Sabouraud and CHROMagar®. Speciation of yeast isolates was made on the chromogenic agar by API 32C®kits and by an atomized system (Vitek®).Results:Forty-six (51%) women were positive forCandidafromone or more of the samples. The introital cultures were positive in 43 (47%) women, both on Sabouraud and chromogenic agar. From the posterior vaginal fomix, 42 (46%) women were positive on the Sabouraud and 43 (47%) on chromogenic agar cultures, while the vaginal lavage cultures yieldedCandidaon those two media in 40 (44%) and 4l (45%) cases, respectively.Candida albicanswas the most frequent species recovered, from 40 (87%) cases, followed byC. kruseiin 4 (9%),C. glabratain 2 (4%), andC. parapsilosisin one case. There was only onewoman who had a mixed yeast infection, byC. albicansandC. krusei. There was only one discrepancy in the speciation as demonstrated by mean of chromogenic agar and API 32C kit.Conclusions:Neither cultures of introital nor of vaginal lavage samples increases the detection rate ofCandidain RVVC cases as compared to cultures of posterior vaginal fornix samples. Use of chromogenic agar is a convenient and reliable means to detect colonization byCandidaand differentiate betweenC. albicansand non-albicansspecies.

The species Neisseria gonorrhoeae in the genus Neisseria belongs to the family Neisseriaceae, which consists mostly of gram-negative cocci that divide in two planes at right angles to each other. Gonococci can be detected in Gram-and methylene blue-stained smears of body secretions, in which characteristic “coffee bean” diplococci can be seen. Gonococci may also be detected in the rectum in patients with gonococcal proctitis; in eye secretions in cases of gonococcal conjunctivitis, including in newborns with ophthalmia neonatorum; in the oropharynx of patients with gonococcal pharyngitis; and in skin blisters in cases of disseminated gonococcal infections (DGI) (i.e., gonococcal septicemia). The chapter first focuses on epidemiology of gonorrhea. Next, it concentrates on long-term sequelae of gonorrhea, and specified complications. Gonococcal endometritis is usually regarded as part of an ascending infection reaching the fallopian tubes leading to salpingitis. Since it is difficult to distinguish between these entities clinically, the term pelvic inflammatory disease (PID) is used to cover both conditions. Serological studies have demonstrated that gonococci, chlamydia, and mycoplasma organisms are independently associated with tubal factor infertility (TFI). Both gonococci and chlamydia organisms can cause a profound destruction of the tubal epithelium. Ectopic or extrauterine pregnancy may be long-term sequela of gonococcal salpingitis. Urethral stricture is also one of the long-term sequelae of gonorrhea. Finally, the chapter focuses on primary and secondary interventions to reduce complications and sequelae of gonorrhea.

The current article deals with the problem of distinguishing between relapse and reinfection of genital chlamydial infections due to the chronic character of such infections. The problem of detecting and treating chlamydial pelvic inflammatory disease is considered. Factors that may affect the clinical presentation of such infections, such as hormonal therapy, are also highlighted. Observations on novel manifestations of Chlamydia trachomatis infections, such as spontaneous abortion, prematurity and intrauterine infections as well as a statistical correlation of a certain serovar to cervical cancer, are described. The representivity of the data on infections with C. trachomatis monitored in national surveillance programs is questioned. The paper also elaborates on which type of sample, sample site and detection method may be optimal for the diagnosis of such infections in women. Whether to screen at clinics and self-sampling at home of specimens from an index case and a sexual partner to be mailed to a laboratory for testing is discussed. Whether or not females are more susceptible to genital chlamydial infections and their sequelae than males is also discussed. The effectiveness of recommended antibiotic regimens is considered, e.g. in relation to the recent detection of the existence of strains of C. trachomatis that show heterotypic resistance to drugs commonly used for their treatment.

Women prostituting in Vilnius City, Lithuania, were studied with regard to their socioeconomic background, drug and alcohol abuse, conditions for prostituting and for the carrier rate of sexually transmitted infectious agents. The 73 women studied represented a group of low-socioeconomic prostitutes with a great age span, i.e. 14-52 years. Forty-five per cent had one or more children. Roughly one-third were part-time prostitutes. Some had been trafficking for more than one decade. Some started trafficking at the age of 13, while the other extreme was a woman who began to prostitute at 51 years of age. This group of Vilnius street walkers had few customers per day. Eighteen were intravenous drug users and almost all abused alcohol. All, but one, had one or more sexually transmitted infections (STIs). Syphilis was diagnosed in 8 (13%) and another 10 (16%) had a serological scar of such an infection. HIV infections were not diagnosed. Condoms were not consistently used during their social contacts.

This study aimed to investigate if there is an association between bacterial vaginosis (BV) and smoking. This cohort study included 956 randomly chosen, apparently healthy women at 2 family planning and one youth clinic. Of the 956 women, 131 women fulfilled the criteria for BV and the remaining 825 served as a control group. BV, BV-associated bacteria and gynaecological infections were diagnosed. Structured personal interviews concerning, smoking, alcohol and drug habits, sexual behaviour and reproductive history were made. Before and after adjustment for possible confounding factors, smoking, but not alcohol and drug use, was significantly associated with BV. Of the women with BV 52% were smokers versus 32% in the control group. Age-adjusted odds ratio (OR) for smokers was 2.3 before, and 3.0 (95% confidence interval [CI] 1.3-6.9) after adjustment for sexual risk behaviour, reproductive history, and alcohol use. There was also a significant dose-response relationship between BV and smoking habits. The data suggest that there might be a causal association between BV and smoking.

Ibuprofen, a non-steroidal anti-inflammatory drug, exhibited antimicrobial activity against Candida albicans and non-albicans strains. At 10 mg/ml, ibuprofen showed a rapid cidal activity against exponential growth phase C. albicans, accompanied by rapid and extensive leakage of intracellular K+, permeation to propidium iodide, lysis of spheroplasts and severe membrane ultrastructural alterations. These results indicate that the killing of Candida cells is due to direct damage to the cytoplasmic membrane. At 5 mg/ml, ibuprofen inhibited growth; however, it did not kill the yeasts and did not directly affect the cytoplasmic membrane. Evaluation of yeast metabolic vitality with the fluorescent probe FUN-1 showed that growth inhibition induced by the fungistatic drug concentration was due to metabolic alterations. The combination of ibuprofen with fluconazole resulted in synergic activity with eight of the 12 Candida strains studied, including four of the five fluconazole-resistant strains. The MICs of fluconazole for the fluconazole-resistant strains decreased 2-128-fold when the drug was associated with ibuprofen. When in combination with fluconazole, MICs for ibuprofen decreased by up to 64-fold for all the 12 strains studied. These results point to the practicability of using ibuprofen, alone or in combination with azoles, in the treatment of candidosis, particularly when applied topically, taking advantage of the drug's antifungal and anti-inflammatory properties.

Formation of germ tubes by Candida albicans has been assumed as a putative virulence factor. Local anesthetics (LAs), e.g., lidocaine and bupivacaine, are known to inhibit germ tube formation. The study confirmed this observation for the novel drug ropivacaine, although it was less potent than the former two drugs. Hypothesizing that the effect is due to blockading ionic channels, we exposed Candida albicans to selective calcium blockers, i.e., nifedipine and verapamil, and to a general blocker of ionic channels, i.e., lanthanum. All blockers inhibited germ tube formation. The effect was dose-dependent and pH-independent. Addition of calcium reverted the effect of the blockers as well as the effect of lidocaine and ropivacaine. The study suggests that the inhibitory effect of LAs on germ tube formation by C. albicans is due to blockade of ionic channels, particularly calcium channels. Therefore, LAs can affect morphology and probably also the pathogenesis of C. albicans.

To investigate whether women who made an early sexual debut differ from those with a later debut regarding genital signs and symptoms.The study included women who considered themselves gynecologically healthy and who attended 17 family planning centers in 13 European countries for contraceptive advice. There were 629 women who made their sexual debut at the age of 16 years or earlier (study population) and 927 women who had their first sexual intercourse at the age of 19 years or later (comparison group). Genital symptoms and signs, contraceptive use, smoking, and genital hygiene habits and previous genital infections were recorded on a structured patient record form. Detection of Chlamydia trachomatis was made by means of a polymerase chain reaction on first-void urine. The study was made, on average, 7-10 years after the women's sexual debut.The mean age of first intercourse was 15.3 years for the study group versus 20.7 years for the control group (p0.001). The study population had significantly more symptoms, such as vaginal discharge and pruritus, and signs, such as abnormal discharge, erythema of the vaginal mucosa and lower genital tract infections, than the comparison group. Twice as many women in the study group were smokers and there was a ten-fold increase among these subjects of using low-pH solutions for genital hygiene. The prevalence of C. trachomatis infection did not differ between the two groups (p = 0.22).Age at first intercourse is not only a predictor of sexual risk behavior, but also a predictor, regarding both signs and symptoms, of future gynecological problems.

A significant difference has recently been reported in the occurrence of serum antibodies to the lymphogranuloma venereum (LGV) immunotypes of Chlamydia trachomatis in patients with Crohn's disease and controls. In the present study, sera from 107 patients with Crohn's disease, 33 males and 74 females, were tested for antibodies to C. trachomatis by an indirect immunofluorescence test, using two pools of antigens. These pools contained antigens to immunotypes TRIC D-K and LGV 1-3, respectively. None of the patients had IgM antibodies to the organism. IgG antibodies occurred significantly more often in the female than in male patients. No correlation could be demonstrated between activity and duration of Crohn's disease and the results of the antibody tests. For comparison, the sera of 50 puerperal women were studied. No difference in the occurence of IgG antibodies was found between patients and controls, neither when using the two pools of antigen, thus indicating that the antibodies detected had probably been induced by TRIC rather than LGV organisms. To conclude, the study did not indicate an association between Crohn's disease and infection with C. trachomatis.

OBJECTIVE AND STUDY DESIGN: We report for the first time an inhibitory effect on cell division and germ tube formation by Candida albicans and strains of other Candida species by putrescine and cadaverine. RESULTS: Both bacterial amines showed a dose-dependent inhibition of germ tube formation by C albicans, as well as budding (inhibition of cell division) of strains of other Candida species (ie, C glabrata, C krusei, and C tropicalis). CONCLUSIONS: We hypothesize that the presence of these and possibly other bacterial amines produced by anaerobes in the vaginal flora and seen in bacterial vaginosis, as in the healthy gut, may explain why candidosis is rarely seen in these instances.

To investigate associations between a history of induced abortion and current or previous sexually transmitted diseases and other gynecologic infections.A cohort study was performed at two family planning clinics and one youth clinic. Of 996 women, 192 (19.3%) admitted a history of induced abortion, whereas the remaining 804 women served as a control group. A structured, personal interview which included details on previous genital infections and gynecologic symptoms and a gynecologic examination was performed. Genital chlamydial infection, gonorrhea, genital herpes, genital warts, cervical human papillomavirus infection, bacterial vaginosis, candidiasis, and bacteria associated with bacterial vaginosis were diagnosed.Both a history of genital infections, with the exception of vulvovaginal candidiasis, and current genital symptoms were more common in women with a history of induced abortion, compared with the control group. Age-adjusted odds ratios ranged from 1.5 (history of genital warts, 95% confidence interval (95% CI 0.9-2.5) to 5.0 (history of gonorrhea, 95% CI 2.6-9.7). Odds ratios for current bacterial vaginosis was 1.9 (95% CI 1.2-2.9) and for vulvovaginal candidiasis 1.8 (95% CI 1.1-2.7).Women attending a clinic for an induced abortion could be a target group for sexually transmitted disease information programs.This study examines the relationship between a history of induced abortion and current or previous sexually transmitted diseases (STDs) and other gynecologic symptoms. Study participants consisted of a cohort of women attending 2 family planning and 1 youth clinic; 192 were admitted with history of induced abortion and 804 women served as controls. A structured interview to obtain data on previous genital infections and gynecologic symptoms was conducted and gynecologic examination was performed. Various types of STDs and gynecologic symptoms were diagnosed including chlamydial infection, gonorrhea, genital herpes, genital warts, cervical human papillomavirus infection, bacterial vaginosis, candidiasis, and bacterial vaginosis. The study found a high frequency of gynecologic symptoms in women with history of induced abortion such as abnormal vaginal discharges, pruritus, genital malodor, deep dyspareunia and urinary symptoms. Moreover, a history of gonorrhea, genital chlamydial infection, genital warts, and genital herpes were 1.5-5 times more common among women who experienced induced abortion. As a consequence of the 3-fold increase in the history of STDs, the study found a 4-fold increase of a history of pelvic inflammatory disease in women with induced abortion history. Considering these findings, women attending clinics for induced abortions could be a good target population for STD information programs and campaigns.

Hydrophobic interaction is generally considered to play an important role in the adherence of microorganisms to eukaryotic cells and also to certain inert surfaces. Using a microbe adhesion assay to hydrocarbons (n-hexadecane), 68 strains of Candida albicans and 30 non-albicans strains were studied. Influence of source of isolate, age of the culture, and percentage of germ tube formation on adhesion were studied. C. albicans blastoconidia were found to be hydrophilic; conversely, blastoconidia of non-albicans strains were slightly more hydrophobic. Germ tube formation was associated with a significant rise in cell surface hydrophobicity.

Objective. To determine the safety and efficacy of transdermal estrogen replacement therapy in liver transplanted menopausal women.Subjects. Thirty-two menopausal women who had at least 6 months earlier undergone liver transplantation, ages from 46–70 years old receiving hormone replacement therapy.Methods. The study was an open prospective. The subjects received transdermal estradiol replacement therapy in combination with progestin (EstracombR-Ciba, 50 mg/24h, 250 mg/24h) if the uterus was intact, and estradiol alone (EstradermR-Ciba, 50 mg) if the uterus had been removed. The follow-up time was 6 months. Liver function parameters and hemostatic parameters were measured at 0, 3 and 6 months. Gynecological transvaginal ultrasound (TVS) was performed at 0 and 6 months. The efficacy of the hormonal treatment was assessed by measuring serum concentrations of estradiol, estrone, FSH, LH and SHBG, by measuring endometrial thickness with TVS and by recording changes in subjective climacteric symptoms at 0 and 6 ...

The association between humoral immunity to unique and conserved epitopes of the Chlamydia trachomatis 60-kDa heat-shock protein (hsp60) and immunity to human hsp60 was examined in 129 women with laparoscopically verified pelvic inflammatory disease. An ELISA was used to detect antichlamydial IgG and IgA antibodies, IgG antibodies to recombinant human hsp60, and antibodies to two synthetic peptides of chlamydial hsp60. Half of the patients had antibodies to human hsp60, which correlated with the presence of antibodies to the chlamydial hsp60 peptide 260-271 homologous to the human hsp60 (P = .01). Antibodies to peptide 260-271 were associated with antichlamydial IgG (P < .0001) and IgA (P < .0001). The results suggest that the autoimmune response to human hsp60 can develop following C. trachomatis upper genital tract infection in women, probably as a consequence of an immune response to an epitope of chlamydial hsp60 cross-reactive with the human hsp60.

The present communication concerns the potential of current surveillance programs for understanding the epidemiology of sexually transmitted infections. The often limited knowledge or the negligence of such infections both among health providers and in the general population, and the non-existence of laboratory services or poor utilization thereof, for example the lack of sampling material, lack of transport services for samples, lack of laboratory reagents and the use of unsensitive and unspecific detection methods, challenge the value of almost any surveillance system of these infections. Other factors are poor health-seeking behavior in the population, including hard-core groups for sexually transmitted infections, poor health economy, limited possibilities for attendees themselves to pay for etiological tests and lack of educated health providers for this type of infectious disease. Still other factors adding to the difficulty of interpreting sexually transmitted infection epidemics on the basis of monitored data are, for example, anonymous testing, double or multiple registration of detected sexually transmitted infection cases, and the chronicity of many sexually transmitted infections with relapses, which makes it difficult to differentiate between incidence and prevalence. Furthermore, partner notification legislations and bureaucracy in reporting cases can influence surveillance programs for sexually transmitted infections.

The present communication considers possibilities of how to improve surveillance programs for sexually transmitted infections and some conditions not yet included among the 'established' sexually transmitted infections. An extended list of sexually transmitted infection agents is proposed for monitoring and a syndrome-based surveillance program for what and when to screen pregnant women is discussed. Problems of how to deal with recurrences in chronic sexually transmitted infections are discussed. The value of concomitant surveillance programs, for clinicians and laboratories, is stressed. The importance of reporting the method(s) used to establish the diagnosis, as well as the circumstances under which the sampling was made, for example at screening, is also highlighted.

We evaluated the cost effectiveness of treating uncomplicated gonorrhoea in a theoretical cohort of 1000 adults (nonpregnant women of reproductive age, or men) with either intramuscular ceftriaxone 125 mg or a single oral dose of cefixime 400 mg, ofloxacin 400 mg or ciprofloxacin 500 mg. We assumed that all patients were also empirically treated for uncomplicated chlamydial infection, with either a single oral dose of azithromycin 1 g, or oral doxycycline 100 mg twice daily for 7 days. Treatment of gonorrhoea with intramuscular ceftriaxone was found to be the most cost-effective alternative. This was followed by treatment with the either of the fluoroquinolones (ofloxacin or ciprofloxacin), then cefixime. For empirical treatment of uncomplicated chlamydial infection, doxycycline was more cost effective than azithromycin when approximately more than 80% of the patients were assumed to comply with the doxycycline regimen. When patients' compliance was poor with the doxycycline regimen, the azithromycin therapy became more cost effective from a societal viewpoint. Nevertheless, its relatively high cost to the individual patient with limited financial resources might prevent him or her from filling prescriptions. Any decrease in patients' compliance with the azithromycin therapy would favour treatment with doxycycline.

To define epidemiologic and psychosocial characteristics in women with a history of casual travel sex abroad.The participants consisted of 996 women attending for contraceptive advice, of whom 276 admitted that they had experience of casual travel sex. The remaining women served as a comparison group. In structured interviews, questions were asked about educational level, partnerships, reproductive history, contraceptive and drug use, smoking, and psychosocial factors such as wariness, success, and attractiveness.The women with experience of casual travel sex were more often single, had more often experienced broken relationships, were more often smokers, and used alcohol or cannabis at a higher-frequency. Their educational level was higher and a history of induced abortions was more common.The results of this study indicate that women with experience of casual travel sex not only take sexual risks, but take other risks that might impose danger to their health.The aim of this study was to define epidemiologic and psychosocial characteristics of women with a history of casual travel sex abroad. The participants were 996 women seeking contraceptive advice, of whom 276 admitted that they had experienced casual travel sex. The remaining women served as a comparison group. In structured interviews, questions were asked about educational level, partnerships, reproductive history, contraceptive and drug use, smoking, and psychosocial factors such as wariness, success, and attractiveness. The women who had experienced casual travel sex were more often single, had more often experienced broken relationships, were more often smokers, and used alcohol or cannabis at a higher frequency. Their educational level was higher and a history of induced abortions was more common. The results of this study indicate that women with experience of casual travel sex not only take sexual risks but also take other risks that might represent a danger to their health.

The aim of the study was to investigate if bacterial vaginosis (BV) is associated with use of specific contraceptives. Women at family planning and youth clinics (n = 956), among whom 131 had BV, were subjects for structured in-depth interviews including current and previous contraceptive use. Variables measuring sexual risk-taking were ascertained. Current users of contraceptives were compared with non-users. Both oral contraceptive (OC) and condom use showed a significant protective effect against BV, adjusted for possible confounders (odds ratios were 0.4 and 0.3, respectively). Intrauterine device use (IUD) showed no association with BV. Women with BV had less often used any contraceptives, including condom, at their sexual debut than the women in the comparison group. In this study, OC and condom use seemed to exert a protective effect against BV, whereas no effect for IUD use was found.To determine whether bacterial vaginosis (BV) is associated with use of specific contraceptive methods, 956 women from family planning and youth clinics at 3 Swedish hospitals were enrolled in a cohort study. 131 women had at least 3 of the 4 clinical signs of BV: a homogenous gray vaginal discharge, a vaginal pH of 4.7, a positive amine test, and the presence of "clue" cells. Age at first intercourse was 16 years among those with and without BV; however, 8.4% of women with BV, compared with only 1.7% of controls, had had more than 1 sex partner in the last 6 months. Other factors associated with BV were more than 10 lifetime sex partners, non-use of contraception at first intercourse, a history of sexual abuse, an induced abortion, smoking, and alcohol consumption. After adjustment for sexual risk-taking, there was a significant negative association between BV and oral contraceptive (OC) use (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2-0.8). There was also a significant negative association with condom use (OR, 0.3; 95% CI, 0.1-0.9). There was no association between BV and IUD use, before or after adjustment for confounding factors. Insufficient numbers of diaphragm or spermicide users were available for analysis. The finding of an apparently protective effect against BV of OCs and condoms lacks a biological explanation at present, although it is speculated that OC use increases the glycogen content of vaginal epithelial cells, in turn inhibiting the in vitro growth of certain bacteria.

In a study of 972 women, sexual characteristics of 66 women with a cervical human papillomavirus infection (CHPI) were compared to the remaining study population. Among a number of sexual variables that were significantly correlated with CHPI were number of lifetime sexual partners, short partnerships, many recent partners, infidelity, casual travel sex, sexual début abroad, oral and anal sex, and sexual abuse. In multifactorial analyses four variables remained significantly correlated with CHPI, i.e., number of lifetime sexual partners, casual travel sex, sexual début abroad, and infidelity. It is concluded that CHPI shows most of the epidemiological characteristics of a sexually transmitted disease.

OBJECTIVE: To estimate the prevalence of Chlamydia trachomatis, C. psittaci and C. pneumoniae antibodies in sera from altogether 931 blood donors, patients with symptoms of urethritis, assumed salpingitis and sexually acquired reactive arthritis (SARA), and women with fertility problems. METHODS: IgG antibodies to C. trachomatis, C. psittaci and C. pneumoniae were determined by microimmunofluorescence (MIF) tests. All patients were also tested for genital C. trachomatis infection using direct immunofluorescence (DIF) tests. RESULTS: The DIF-positive cases had a significantly (p < 0.0001) higher prevalence of C. trachomatis antibodies than the DIF negatives, i.e. 88.5% versus 14% in men with urethritis, 94.3% versus 36.4% in women with salpingitis, 66.7% versus 16.7% in SARA patients and 90.6% versus 20.8% in women with fertility problems. Antibody reactivity to all three chlamydial species was found significantly (p < 0.0001) more often in the patient groups and in those with a DIF-confirmed genital C. trachomatis infection than in blood donors. CONCLUSIONS: Presence of serum antibodies to C. trachomatis is tightly associated with the presence of chlamydiae in the genital tract, which also influences the cross-reactivities occurring in the MIF tests between chlamydial species.

OBJECTIVES. The study investigated if women with experience of casual travel sex, with a previously unknown man abroad, on different types of journeys (charter, vagabond, business and education trips), differ with regard to sexual risk behavior and history of sexually transmitted diseases (STDs). STUDY DESIGN. The study population consisted of 996 women. Of these, 27.7% admitted that they had had casual sex during journeys. The remaining women were used as a comparison group. History of STDs and sexual risk behaviors were investigated. RESULTS. The frequency of women who had more than ten lifetime sexual partners were greatly increased in all groups, as compared to the controls. A history of gonorrhea was most frequent among the charter travellers. A history of genital chlamydial infection was most common among the vagabond travellers. The lowest frequencies of a history of STDs was observed in women engaging in casual sex on 'business' journeys and they had significantly less often a history of STDs as compared to the charter travellers. A high frequency of STDs were seen in women who had experience of casual sex on different types of journeys. CONCLUSION. Women on business trips, although they had a similar sexual risk behaviour as the other groups of travellers, had less often a history of STDs. (Less)

The study was conducted to investigate whether cervical human papillomavirus infections (CHPI) are associated with contraceptive use and reproductive history. The contraceptive and reproductive histories in 972 women seeking contraceptive advice were noted and screening conducted for human papillomavirus infection. The interview included number of pregnancies and childbirths, legal and spontaneous abortions, and menstrual pattern. Information about current use of contraceptive methods, about casual sex, and history of combined oral contraceptive pill (OC) use was obtained. Women with a history of spontaneous abortion showed a significant correlation with CHPI, as did women who used high-dose OCs when compared with the remaining study population (odds ratio 3.0). There was no association between use of low-dose OCs and CHPI. In multifactorial analyses with adjustment for age, number of lifetime sexual partners, number of partners during the preceding six months and age at first intercourse, the significant correlation between use of high-dose OCs and CHPI remained (adjusted odds ratio 2.8). The results indicate a relationship between female steroid hormones and the occurrence of CHPI. An association with high-dose OCs could not be excluded.

A glycoprotein present in Chlamydia trachomatis, serotype L1, elementary bodies (EBs) was earlier found to bind the lectin from Galanthus nivalis (GNA). In the present paper we investigate the interaction of GNA with chlamydial EBs and its effect on in vitro infectivity. The binding affinity was studied with 125I-GNA lectin. Within 15 min about 80% maximal binding was obtained. The chlamydia-GNA interaction was inhibited by alpha-methylmannoside, causing a decrease of about 50% at 1 mM. Curve fit analyses indicated two types of binding sites for GNA on the EBs. The affinity to these differed by a factor of 15. The influence of the lectin on the ability of C. trachomatis to infect McCoy cells was also investigated. There was a GNA-dependent inhibition with a 50% reduction in the number of intracellular inclusions at 0.2 microM of the lectin. The findings indicate the presence of terminal mannose structures on the chlamydial surface at or in the proximity of the cell-binding domains. Mannose-binding proteins of eukaryotic cells could be important for the initial uptake of EBs.

BACKGROUND. This study was performed in women who had attended the clinic for contraceptive advice to determine whether a history of casual sex with a foreign male, previously unknown to them (SFM) in their home country (Sweden), constituted an increased risk for acquiring sexually transmitted diseases (STD) as compared to women without such an experience (COMP). METHODS. Of 996 women enrolled, and who were subjected to a structured deep-interview performed by midwives, 595 (59.7%) stated that they had experienced casual sex within Sweden with for them a previously unknown Swedish male (SSM). RESULTS. A history of SFM was reported by 120 (12.0%) women. A history of chlamydial infection (26.0%) and gonorrhea (13.0%) were more common in the SFM women than in either the COMP (16.0% and 3.0%) or the SSM (19.0% and 4.0%) groups. Genital warts (8.0%) and bacterial vaginosis (23.0%) were found more often in the SFM group as compared to both the COMP (3.0% and 12.0%) and the SSM (4.0% and 13.0%) group. Women in the SFM group more often had a current genital chlamydial infection (13.0%) than those in the COMP group (8.0%). When adjustment was made for markers of sexual risk taking, only genital warts remained significantly (p = 0.05) associated with SFM as compared to both SSM and COMP. CONCLUSIONS. To conclude, the study shows that women with experience of SFM had, more often, a history of one or more STDs and were more often carriers of STD agents than those lacking experience of SFM and/or SSM. However, there was no such difference when comparing the SFM and SSM women when making adjustments for sexual risk behavior. Thus a sexual risky lifestyle is more important than the origin of the sex partner for acquiring STDs with possible exception of HIV/AIDS in the society studied. (Less)

To compare the clinical usefulness of culture and wet smear microscopy in low-symptomatic vulvovaginal candidosis (VVC) diagnosis. Study design: Women attending for contraceptive advice were screened for vaginal yeast fungi by culture and wet smear microscopy. A positive culture was found in 130 (13.2%) of the 983 women studied, while a positive wet smear was found in 133 (13.9%). In (30%) of these women both the culture and wet smear was positive. Results: The methods were equally sensitive in predicting symptoms of VVC, such as prutitus, smarting and burning pain, as well as for dyspareunia (35% vs. 36%), but wet smear microscopy was more sensitive in predicting signs of VVC, such as erythema and abnormal discharge (52% vs. 34%). The highest sensitivity was reached when both methods were positive (60% for symptoms, 75% for signs). There was no quantative correlation between number of Candida colonies on culture on the one hand and symptoms, signs or a positive wet smear on the other hand. Using four parameters as a diagnostic battery for VVC, the two methods complemented each other. The correlation between symptoms and/or signs for wet smear was higher than for culture. Conclusion: Wet smear microscopy of vaginal secretion, along with signs found at examination, should be the first-line test in the diagnosis of VVC. Culture must, however, be used when there is a clinical suspicion of VVC and a negative wet smear, or when speciation or antibiotic susceptibility test of isolates are required.

Glycoproteins in Chlamydia trachomatis, serotype L1, elementary bodies were studied by lectin blotting. A panel of 23 lectins representing a variety of sugar specificities was used. The pattern of lectin-binding specificities at a peptide band was studied in order to determine the type and structure of its glycoconjugate. To establish chlamydial origin of the glycopeptide bands in the blot, control samples from non-infected host cell membranes were run in parallel. Terminal mannosidic structures were demonstrated in a 72 kDa glycopeptide (gp72) by its selective binding of Galanthus nivalis lectin (GNA). Sialic acids were found in two chlamydial glycopeptides, gp40 and gp64, which appear to carry O-linked glycoconjugates as they bound the peanut agglutinin (PNA, both gp40 and gp64) and jackfruit lectin (Jac, only gp40). Such structures were also present in other chlamydial glycopeptides. Lectins with specificities for fucose in different links, galactose and N-acetyl glucosamine bound to several chlamydial peptides. On the basis of our results we suggest an alternative mechanism for uptake of chlamydial elementary bodies into host cells, namely phagocytosis mediated by eukaryotic cell surface lectins.

Of 101 women, 15-50 years of age, presenting with vaginal discharge, 34 had bacterial vaginosis and were randomly assigned to a seven-day course of oral treatment with either erythromycin (0.5 g b.i.d.) or metronidazole (0.4 g b.i.d.) in a single-blind, cross-over study. Treatment failure (or = three clinical signs of bacterial vaginosis) occurred in 13 (81%) of 16 patients given erythromycin, as compared with three (17%) of 18 women treated with metronidazole (p0.001). Persistence of Gardnerella vaginalis, Mobiluncus species and/or Mycoplasma hominis was found in 14 of 16 patients treated with erythromycin, and in four of 16 patients treated with metronidazole. Treatment with metronidazole was successful (or = two clinical signs of bacterial vaginosis) in eight of 10 cases of erythromycin treatment failure. Neither of two cases of metronidazole treatment failure was cured with erythromycin. At three-month follow-up of 31 women, persistence or recurrence of bacterial vaginosis was diagnosed in 11 cases (36%).

Antibacterial activities of several 'non-antibiotic drugs' used in treatment of a variety of non-infectious human diseases have been observed. Such an effect has been noticed for barbiturates, beta-adrenergic receptor antagonists, diuretic drugs, H1 antihistamines, mucolytic agents, nonsteroid anti-inflammatory drugs, proton pump inhibitors and psychotherapeutic drugs. A synergic or antagonistic effect with antibiotics of several of these drugs have also been noticed. In this overview the knowledge in the field is summarized, omitting hormones, drugs with local effects and those with low therapeutic indexes. Therapeutic implications and future considerations are discussed.

Saliva samples from 51 children ranging from 1 month to 12 years of age were studied for their effect on the capacity of Chlamydia trachomatis, serotypes I and L2 elementary bodies (EB), to form inclusions in cycloheximide-treated McCoy cell cultures. The results were compared to those of tests using saliva from adults. No antibodies against C. trachomatis or Chlamydia pneumoniae could be detected by microimmunofluorescence tests in either group. Saliva of children between 1-4 years of age showed an age-related decrease in the chlamydial inclusion count (i.c.). Saliva from children older than 4 years of age, like saliva from healthy adults, showed a pronounced reduction of the i.c. (up to 70%). The study indicates that children between 1-4 years gradually develop a natural antichlamydial activity against C. trachomatis, and above that age they exhibit the same level of antichlamydial activity as adults. The inhibitory activity was heat-resistant.

Udgivelsesdato: 2009-Nov-10 OBJECTIVES: To determine the serum concentration of mannan-binding lectin (MBL), a component of the innate immune system, in women with a history of recurrent vulvovaginal candidiasis (RVVC) and to correlate the result to candida-cultures, contraceptive use, if any, and to different antifungal therapies. STUDY DESIGN: Twenty-nine women with a history of RVVC were investigated. Cultures of vulvar and vaginal samples were grown on chromogenic agar. Serum levels of MBL were determined by a sandwich time-resolved immunofluorometric assay, using anti-MBL coated microtiter wells containing samples, which were washed, incubated with biotinylated anti-MBL followed by europium-labeled streptavidin and measured by time-resolved flourometry. RESULTS: The median MBL level was higher in the RVVC cases than in 30 women with no history of genital candida infection who served as a comparison group (p=0.006). It was also higher in the candida-positive than in the culture-negative RVVC (p=0.02). The median concentration of MBL was also higher in hormonal contraceptive users as compared to condom-users and those using no contraceptive at all (p=0.03). CONCLUSION: The result indicates a role of MBL in RVVC and the production may correlate to vulvar/vaginal colonization by Candida, hormonal contraceptive use, and antifungal therapies.