Atherosclerosis 2006 May 16; (Read article online)

Marchesi S, Lupattelli G, Sensini A, Lombardini R, Brozzetti M, Roscini AR, Siepi D, Mannarino E, Vaudo G

There is much evidence to suggest the existence of racial differences between blacks and whites in the behaviour of endothelial function. Infective state, sustained by viral or bacterial agents, may injure the endothelial surface favouring the onset and progression of atherosclerotic process, mainly by an inflammatory mechanism. The aim of the study was to investigate endothelial function, expressed as brachial flow-mediated vasodilation (FMV), in black and white healthy subjects, along with antibody titer to cytomegalovirus, hepatitis virus (B, C), herpes virus-1 and 2, Epstein-Barr, Chlamydia pneumoniae and the expression of adhesion molecules. We enrolled 22 young (mean age 27+/-8 years) healthy subjects of black race (10 males) and 20 healthy young subjects (10 males, mean age 28+/-9 years) of white race. Total infectious burden (TIB) was defined as the number of serological positive infections. Black subjects have a reduced brachial FMV (6.9+/-3.5% versus 11.6+/-3.0%, p<0.01) and increased values of hsCRP (0.35+/-0.15mg/dL versus 0.07+/-0.08mg/dL, p<0.05), white cells (8578+/-1041/mmc versus 5833+/-998/mmc, p<0.01) and adhesion molecules (respectively: sVCAM-1 945+/-142 versus 779+/-93, sICAM-1 534+/-107ng/mL versus 325+/-80ng/mL; both p<0.01) in comparison to white subjects. The total infectious burden in black race was significantly higher than in white race (5+/-1 versus 2+/-1, p<0.01). At the univariate analysis, brachial FMV was significantly related to the levels of adhesion molecules (respectively: sVCAM-1 r=-0.49; sICAM-1 r=-0.50, both p<0.05), hsCRP (r=-0.47, p<0.05) and white blood cells (r=-0.43, p<0.05). TIB was associated with brachial FMV (r=-0.64, p<0.05), sVCAM-1 (r=0.55, p<0.05) and hsCRP (r=0.47, p<0.05). At the multivariate analysis the only predictive variables for brachial FMV were hsCRP, TIB and brachial diameter (respectively: beta=-0.49, -0.19, -0.54, all p<0.05). This study confirms that endothelial reactivity is impaired in young African black patients; moreover its behavior is strictly related to the inflammatory state and to the total infectious burden.

Eur J Clin Microbiol Infect Dis 2006 May 23; (Read article online)

Araújo RS, Guimarães EM, Alves MF, Sakurai E, Domingos LT, Fioravante FC, Machado AC

In order to determine the prevalence and risk factors for Chlamydia trachomatis infection in adolescent females and young women in central Brazil, 296 subjects attending two public health services were evaluated. The overall prevalence of C. trachomatis infection, as determined using polymerase chain reaction, was 19.6% (95% confidence interval [CI], 15.3-24.7). In multivariate analysis, young age (odds ratio [OR](adjusted) 2.32, 95%CI 1.1-4.8, p<0.05) and having 2-3 (OR(adjusted) 3.41, 95%CI 1.6-6.3, p<0.05) or >/=4 sexual partners in life (OR(adjusted) 3.10, 95%CI 1.1-6.3, p<0.05) were factors significantly associated with chlamydial infection. In conclusion, the prevalence of C. trachomatis infection was high in the studied population and risk factors were related to age and sexual behavior.

Immunobiology 2006; 211(5): 325-39 (Read article online)

Azenabor AA, Muili K, Akoachere JF, Chaudhry A

Latency, chronicity and recurrent nature are the features of Chlamydia pneumoniae biology which play a central role in the course and outcome of C. pneumoniae-host interaction. Since redox status is directly an indicator of inflammatory response via molecular signaling mechanisms, we decided to study the regulatory role of macrophage cellular redox balance on the molecular indices of C. pneumoniae chronicity. We examined GSH-GSSG status, the activities of antioxidant enzymes (SOD, GPx and gamma-GCS), along with their protein and gene expression, the MOMP and cHSP-60 protein and gene expression, and the consequence of redox balance on the establishment of productive infection in macrophages. Results showed that C. pneumoniae caused changes in GSH-GSSG levels, antioxidant enzymes activity, mRNA gene and protein expression in macrophages. The relevance of this to the state and status of C. pneumoniae in macrophages was assessed by inhibitor induced attenuation of antioxidant enzymes and there was evidence that, while SOD attenuation did not significantly affect MOMP and cHSP-60 gene and protein expression, gamma-GCS attenuation increased cHSP-60 gene and protein expression. The increase in molecular evidence of chronic forms of C. pneumoniae (cHSP-60) was consistent with decrease in normal forms of C. pneumoniae. These findings reflect the importance of redox balance modulation on the outcome of C. pneumoniae infection in macrophages, a significant process in the pathogenesis of chlamydial diseases.

Pediatr Clin North Am 2006 Jun; 53(3): 529-45 (Read article online)

Freeto JP, Jay MS

The purpose of this article is to review the common complaints related to the vaginal area in pubertal girls and offer an approach to those presenting with nonurologic perineal problems or issues related to emerging sexuality. Included is a discussion of the symptoms, diagnosis, and treatment of physiologic discharge, vulvovaginal candidiasis, bacterial vaginosis, trichomoniasis, gonorrhea, and chlamydia. Other vulvovaginal complaints are considered, and screening tests that can help differentiate the origin of the problem as urologic or gynecologic are briefly addressed.

Eur J Obstet Gynecol Reprod Biol 2006 May 13; (Read article online)

de Barbeyrac B, Papaxanthos-Roche A, Mathieu C, Germain C, Brun JL, Gachet M, Mayer G, Bébéar C, Chene G, Hocké C

OBJECTIVES: The objectives were to estimate the prevalence of Chlamydia trachomatis infection in subfertile couples and to study the relationship between markers of C. trachomatis infection and male infertility as well as pregnancy rates after in vitro fertilization (IVF). STUDY DESIGN: All consecutive couples consulting for infertility and IVF in Pellegrin Hospital were screened for C. trachomatis by direct (PCR test) and serological methods. RESULTS: Two hundred and seventy-seven couples were included in the study (mean age in years: 35 for men, 32 for women; mean duration of infertility: 4 years). The most frequent indication for IVF was tubal factor in 33%, endometriosis in 6%, dysovarian function in 12%, male infertility in 36% and others in 13%. C. trachomatis PCR was positive in 1.2% of men, 95% confidence interval (CI(95%)): (0.2%; 3.3%) and in 2.7% of women, CI(95%): (1.1%; 5.5%). When combining all chlamydial markers, 17.3% of men, CI(95%): (12.7%; 22.8%) and 20.4% of women, CI(95%): (15.6%; 25.9%) had at least one positive marker. The presence of positive markers was not associated with altered semen characteristics. Couples with positive markers had a pregnancy rate of 23.1% (12 out of 52) compared with 20.2% (24 out of 119) among those with negative markers. CONCLUSION: In this population, the presence of past or current C. trachomatis infection was associated with neither semen characteristics nor outcome of IVF in subfertile couples.

Ann Trop Paediatr 2006; 26(2): 87-94 (Read article online)

Weber MW, Gopalakrishna G, Awomoyi A, Cunningham A, Adegbola RA, Falade AG, Ogunlesi OO, Whittle HC, Mulholland KE

BACKGROUND: Little is known about the role of Chlamydia pneumoniae in the aetiology of acute respiratory tract infections (ARI) in children in developing countries.AIMS: To obtain better information, we studied the presence of C. pneumoniae and its association with clinical signs and symptoms of ARI in children under 5 years of age in The Gambia.METHODS: C. pneumoniae was sought by polymerase chain reaction in nasopharyngeal secretions and/or lung puncture aspirates from 324 infants under 3 months of age and 325 children between 3 months and 5 years of age with malnutrition, with or without pneumonia, and in control children. Clinical signs and symptoms for ARI and the spectrum of other viral and bacterial organisms were compared between those positive for C. pneumoniae and those negative.RESULTS: Of 324 young infants, ten (3.1%) showed the presence of C. pneumoniae whereas in the older children 50 of 325 (15%) were positive for C. pneumoniae. There was no significant association between clinical signs and symptoms of ARI and C. pneumoniae positivity in the young infants. Among older infants and children, there was a trend to more frequent lobar alveolar changes in those positive for C. pneumoniae. No bacterial pathogens were found to be significantly associated with C. pneumoniae infection. However, there was an association with measles in the malnutrition group and with RSV in the young infants group.CONCLUSIONS: In this study, C. pneumoniae was not associated with any particular clinical syndrome. We found no evidence that the organism plays a major role in ARI in young children in developing countries such as The Gambia.

Sex Transm Dis 2006 May 15; (Read article online)

Newman LM, Warner L, Weinstock HS

OBJECTIVE/GOAL:: The objective of this study was to identify characteristics associated with subsequent infection in patients attending a sexually transmitted disease (STD) clinic. STUDY DESIGN:: Records were retrospectively reviewed for patients from public STD clinics in 4 cities for 12 months after their initial visit to assess subsequent infection with gonorrhea, chlamydia, mucopurulent cervicitis, nongonococcal urethritis, pelvic inflammatory disease, primary or secondary syphilis, or trichomoniasis. RESULTS:: Among 64,463 patients, 33.9% had an initial STD and 7.0% had a subsequent STD. Patients with an initial STD had significantly higher probability of a subsequent STD than patients without (12.0% vs. 4.4%). A subsequent STD was significantly more likely for both sexes for those with an initial STD, who were symptomatic at initial visit, reporting exchange of sex, or under age 20 as well as for men reporting sex with men. CONCLUSIONS:: Patients with an initial STD were more likely to return with a subsequent STD. Routinely collected information such as initial diagnosis or age can help identify patients at increased risk of a subsequent STD.

Eur J Clin Microbiol Infect Dis 2006 May 16; (Read article online)

Huang HH, Zhang YY, Xiu QY, Zhou X, Huang SG, Lu Q, Wang DM, Wang F

The aim of this multicenter study was to identify the causative pathogens of community-acquired pneumonia (CAP) in Shanghai, China, and to determine their susceptibility to antimicrobial agents. Pathogens obtained from 389 patients with documented CAP during 2001-2003 were identified by multiple diagnostic tools that included bacterial culture, polymerase chain reaction (PCR), and specific immunological assays. Susceptibility of the bacterial isolates was tested by the broth microdilution method. A specific pathogen was identified in 39.8% (155/389) of the patients: Haemophilus influenzae (n=80), Klebsiella spp. (n=15), Streptococcus pneumoniae (n=12), Staphylococcus aureus (n=6), Moraxella catarrhalis (n=1), other gram-negative organisms (n=9), and atypical pathogens that comprised Mycoplasma pneumoniae (n=42), Chlamydia pneumoniae (n=17), and Legionella pneumophila (n=2). Most H. influenzae isolates were susceptible to ampicillin (88.3%), and all were susceptible to macrolides. Of the S. pneumoniae isolates, 75% (9/12) were susceptible to penicillin, while 25% (3/12) were intermediately susceptible. H. influenzae and atypical pathogens are among the most important pathogens of CAP. Ampicillin, cephalosporins, and the newer fluoroquinolones can be used as empirical therapy for CAP in the Shanghai area. The efficacy of monotherapy with newer macrolides for CAP caused by S. pneumoniae requires further evaluation.

Georgian Med News 2006 Apr; 21-4 (Read article online)

Tkeshelashvili B, Jugeli M, Bukia T, Kintraia N, Kereselidze M

Possibilities of colposcopy in the diagnostics of cervical chlamydia-mycoplastic infections are less investigated. The aim of given work was the study of this problem. Colposcopic examination was performed in 952 women (age - from 16 to 67) asked to clinics for examination and more precise definition of diagnosis because of different complaints. It was revealed specific colposcopic features of chlamydia-mycoplastic genital infections, which were compared with the results obtained from "gold standard" methods - direct immunofluorescence method and bacteriological analysis of cervical smears. High sensitivity (Se) - 0,96, specificity (Sp) - 0,79 and diagnostic effectiveness (De) - 0,93 of colposcopy were established. Authors conclude that the application of colposcopy for diagnostics of chlamydia-mycoplastic genital infection is particularly important: during urgent cases; during the case, when it is impossible to carry out the deep diagnostics of the sexually transmitted infections; for optimization of the diagnostics of the sexually transmitted infections.

Acta Ophthalmol Scand 2006 Jun; 84(3): 333-7 (Read article online)

Kessler W, Jantos CA, Dreier J, Pavlovic S

Purpose: Age-related macular degeneration (AMD) is the most frequent cause of severe visual impairment in western countries, but its aetiology remains unclear. A growing body of evidence suggests that inflammation contributes to the pathogenesis of AMD, similarly to that shown for atherosclerosis. In view of a number of shared risk factors between the two entities and the hypothesized link between Chlamydia pneumoniae infection and atherosclerosis, we investigated whether C. pneumoniae might be involved in exudative AMD. Methods: To examine whether C. pneumoniae contributes to the development of subretinal neovascular (SRNV) membranes in AMD, 13 consecutive SRNV membranes surgically excised from patients with exudative AMD were collected and assayed for the presence of C. pneumoniae or other bacterial pathogens by means of polymerase chain reaction (PCR). Results: The age of patients ranged from 68 to 85 years (median 73.5 years). In all 13 SRNV membranes, no DNA of either C. pneumoniae or other pathogens was found by PCR. Conclusions: These findings indicate that C. pneumoniae is not associated with the development of SRNV membranes in exudative AMD.

PLoS Pathog 2006 May 19; 2(5): e45 (Read article online)

Verbeke P, Welter-Stahl L, Ying S, Hansen J, Häcker G, Darville T, Ojcius DM

Chlamydiae replicate intracellularly in a vacuole called an inclusion. Chlamydial-infected host cells are protected from mitochondrion-dependent apoptosis, partly due to degradation of BH3-only proteins. The host-cell adapter protein 14-3-3beta can interact with host-cell apoptotic signaling pathways in a phosphorylation-dependent manner. In Chlamydia trachomatis-infected cells, 14-3-3beta co-localizes to the inclusion via direct interaction with a C. trachomatis-encoded inclusion membrane protein. We therefore explored the possibility that the phosphatidylinositol-3 kinase (PI3K) pathway may contribute to resistance of infected cells to apoptosis. We found that inhibition of PI3K renders C. trachomatis-infected cells sensitive to staurosporine-induced apoptosis, which is accompanied by mitochondrial cytochrome c release. 14-3-3beta does not associate with the Chlamydia pneumoniae inclusion, and inhibition of PI3K does not affect protection against apoptosis of C. pneumoniae-infected cells. In C. trachomatis-infected cells, the PI3K pathway activates AKT/protein kinase B, which leads to maintenance of the pro-apoptotic protein BAD in a phosphorylated state. Phosphorylated BAD is sequestered via 14-3-3beta to the inclusion, but it is released when PI3K is inhibited. Depletion of AKT through short-interfering RNA reverses the resistance to apoptosis of C. trachomatis-infected cells. BAD phosphorylation is not maintained and it is not recruited to the inclusion of Chlamydia muridarum, which protects poorly against apoptosis. Thus, sequestration of BAD away from mitochondria provides C. trachomatis with a mechanism to protect the host cell from apoptosis via the interaction of a C. trachomatis-encoded inclusion protein with a host-cell phosphoserine-binding protein.

Clin Microbiol Infect 2006 Jun; 12(6): 571-5 (Read article online)

Heddema ER, Beld MG, de Wever B, Langerak AA, Pannekoek Y, Duim B

Abstract A real-time PCR assay with a DNA purification and inhibition control (internal control; IC) was developed to detect Chlamydophila psittaci DNA in human clinical samples. Novel C. psittaci-specific primers targeting the ompA gene were developed. The IC DNA contained the same primer-binding sites and had the same length and nucleotide content as the C. psittaci DNA amplicon, but had a shuffled probe-binding region. The lower limit of detection was 80 target copies/PCR, corresponding to 6250 copies/mL in a clinical sample. Specificity was tested using reference strains of 30 bacterial species. No amplification was observed from any of these samples. Respiratory samples from eight patients were positive with this PCR. Six of these patients were confirmed as positive for C. psittaci with serological testing. Two patients had increasing antibody titres, but did not fulfil criteria proposed previously for serologically proven Chlamydia spp. infection. The real-time PCR described in this paper is a sensitive, specific and rapid method to detect C. psittaci DNA in human clinical respiratory samples.

Clin Microbiol Infect 2006 Jun; 12(6): 576-9 (Read article online)

De Martino SJ, de Barbeyrac B, Piemont Y, Barthel C, Monteil H, Jaulhac B

Abstract The automated MagNA Pure DNA extraction method for Chlamydia trachomatis was compared with the manual Cobas Amplicor protocol using 100 microL of input sample volume from 964 specimens. Agreement between protocols was 96.1%. The automated extraction method had a sensitivity of 99% and a specificity of 100%. Amplification inhibition observed after manual preparation of samples (3.8%) was not apparent following automated extraction. Using 200 microL of sample in the automated extraction process lowered the detection limit without raising the inhibition rate. Furthermore, the automated extraction method halved the hands-on time required for the procedure.

Vet Res 2006 Jul-Aug; 37(4): 623-32 (Read article online)

Verminnen K, Van Loock M, Hafez HM, Ducatelle R, Haesebrouck F, Vanrompay D

Chlamydophila psittaci (formerly Chlamydia psittaci) is one of the major pathogens associated with turkey respiratory disease. Devastating outbreaks with high mortality rates, similar to those of 1950 to 1970 in the USA occasionally occur, but respiratory signs without or with low mortality mostly characterize outbreaks now a day. Accurate diagnostic methods should be made available. The present study examined the sensitivity and specificity of a recombinant ELISA (rMOMP ELISA) for detecting Cp. psittaci major outer membrane specific antibodies in turkey sera. Test results were compared to those of immunoblotting and of a competitive ELISA (Chlamydia-psittaci-AK-EIA, Röhm Pharma, Germany) and an indirect ELISA (LPS/LGP) detecting antibodies to the lipopolysaccharide/lipoglycoprotein complex. The rMOMP ELISA was most sensitive as determined on serial dilutions of positive control sera originating from experimentally infected SPF turkeys. The competitive ELISA gave false positives since three negative controls reacted positive. For conventional sera, the sensitivities of the competitive ELISA, immunoblotting and the indirect ELISA were found to be 99.4, 93.1 and 82.2%, respectively, as compared to the rMOMP ELISA (100%). The specificities of the rMOMP ELISA, immunoblotting and the indirect ELISA were found to be 100% while the specificity of the competitive ELISA was only 2.7%. The rMOMP ELISA was chosen to compare the prevalence of chlamydiosis in 2002 with the one from 1992. In 2002, 188 on 200 (94%) turkey sera reacted positive compared to 175 on 200 (87.5%) in 1992 and like 10 years ago all examined farms were seropositive at slaughter. Interestingly, Belgian as well as French farms were seropositive.

J Immunol 2006 Jun 1; 176(11): 6982-6990 (Read article online)

Rothfuchs AG, Trumstedt C, Mattei F, Schiavoni G, Hidmark A, Wigzell H, Rottenberg ME

STAT1 mediates signaling in response to IFN-alpha, -beta, and -gamma, cytokines required for protective immunity against several viral, bacterial, and eukaryotic pathogens. The protective role of STAT1 in the control of intranasal infection with the obligate intracellular bacterium Chlamydia pneumoniae was analyzed. IFN-gamma(-/-) or IFN-gamma receptor (R)(-/-) mice were highly susceptible to infection with C. pneumoniae. We found that STAT1(-/-) mice were even more susceptible to C. pneumoniae than IFN-gamma(-/-) or IFN-gammaR(-/-) mice. Phosphorylation of STAT1 was detected in the lungs of C. pneumoniae-infected wild-type, IFN-gammaR(-/-), and IFN-alphabetaR(-/-) mice, but not in mice lacking both IFN-alphabetaR and IFN-gammaR. In line with this, IFN-alphabetaR(-/-)/IFN-gammaR(-/-) mice showed increased susceptibility to infection compared with IFN-gammaR(-/-) mice. However, C. pneumoniae-infected IFN-alphabetaR(-/-) or IFN regulatory factor 3(-/-) mice showed no increased susceptibility and similar IFN-gamma expression compared with wild-type mice. CD4(+) or CD8(+) cells released IFN-gamma in vivo and conferred protection against C. pneumoniae in a STAT1-independent manner. In contrast, STAT1 mediated a nonredundant protective role of nonhemopoietic cells but not of hemopoietic cells. Nonhemopoietic cells accounted for the expression of STAT1-mediated indoleamine 2, 3-dioxygenase and the p47 GTPase LRG-47, but not inducible NO synthase mRNA. In summary, we demonstrate that STAT1 mediates a cooperative effect of IFN-alphabeta and IFN-gamma on nonhemopoietic cells, resulting in protection against C. pneumoniae.

J Clin Immunol 2006 May 16; (Read article online)

Scott ME, Ma Y, Farhat S, Shiboski S, Moscicki AB

Measurements of mucosal immune parameters in the uterine cervix are potentially influenced by numerous factors, including infections, endogenous and exogenous hormones, semen, and nicotine and its metabolites in cervical mucus. The objective of this study was to examine correlates of immunoregulatory cytokine mRNA expression in cervical cytology samples in a cross-sectional design. Samples, collected at study entry by cervical cytology brush from 368 women aged 13-21 enrolled in a longitudinal study of the natural history of human papillomavirus (HPV) infection, were tested by quantitative RT-PCR for expression of IFN-gamma, IL-4, IL-10, and IL-12. In a multivariate analysis, elevated levels of IFN-gamma, IL-10, and IL-12 were significantly (p < 0.05) associated with several variables, including current C. trachomatis infection, recent intercourse, and current oral contraceptive pill use. Suppressed IL-4 and IL-10 levels were associated with cigarette smoking within the last 24 h. Time since last menstrual period did not affect any of the cytokines; in a substudy of weekly cytokine variability, however, IL-10 showed a non-significant trend toward higher levels around the time of menstruation.

Drugs Today (Barc) 2006 Mar; 42 Suppl A: 75-81 (Read article online)

Severin JA, Ossewaarde JM

Innate immunity is of key importance in primary recognition of invading pathogens. Infected epithelial cells respond in similar, but not identical ways to different invading pathogens and the pathogens are capable of modifying the host cell response. Chlamydia trachomatis is a major cause of preventable blindness in underdeveloped countries and of sexually transmitted infections with sequelae such as infertility, pelvic inflammatory disease, and extrauterine gravidity throughout the world. Limited knowledge about molecular mediators and effectors, immunocompetent cells, and host response in chlamydial mucosal infections will be described. Recent findings of a differential response to invasive and noninvasive chlamydial infections are highlighted.

Eur J Pediatr 2006 May 12; (Read article online)

Schessl J, Luther B, Kirschner J, Mauff G, Korinthenberg R

INTRODUCTION: We performed a prospective, multicentre study in children with Guillain-Barré syndrome (GBS), diagnosed according to international criteria, to investigate the frequency and aetiology of antecedent diseases. All infections and vaccinations occurring within a 6-week period prior to the onset of GBS were documented. MATERIALS AND METHODS: Stool cultures, standardised serological investigations and PCR analyses for 24 different infective agents were performed. Serological findings were regarded as significant if specific immunoglobulin (Ig)M or IgA antibodies were detected, if the IgM enzyme immunoassay or immunfluorescence assay findings were confirmed by immunoblot, if complement fixation test titres rose fourfold or if geometric titres were more than threefold higher than in uninfected control persons. Ninety-five children with GBS were included in the study over a 40-month period. Preceding events were reported in 82%. RESULTS: Microbiological studies carried out on 84 patients resulted in a probable diagnosis in 46 (55%). Coxsackieviruses (15%), Chlamydia pneumoniae (8%), cytomegalovirus (7%) and Mycoplasma pneumoniae (7%) were the most frequently involved agents. Serological evidence of a Campylobacter jejuni infection was found in six patients (7%). Eight children had been vaccinated during the 6 weeks preceding the onset of GBS; in six of these children concomitant infectious diseases were reported, and in one child the time between vaccination and GBS was extremely short. CONCLUSION: We conclude that, in contrast to adults, Campylobacter spp. does not seem to play a major role in childhood GBS in German-speaking countries. The aetiology of antecedent diseases is distributed over a wide spectrum of paediatric infectious diseases. Most of the children who had been vaccinated showed concomitant infectious diseases, thus obscuring the causative role for GBS.

Drugs Today (Barc) 2006 Mar; 42 Suppl A: 43-5 (Read article online)

Perenboom RM

A recent outbreak of lymphogranuloma venereum (LVG) proctitis caused by Chlamydia trachomatis serovar L2 has been detected in HIV-positive men in the Netherlands and Belgium. This sexually transmitted disease (STD), which is well known and frequently occurring in tropical countries, was quite unusual in Europe until 2003. STDs with ulcerative lesions, such as LGV, facilitate transmission of other microorganisms, including HIV and hepatitis C. This in combination with risky sexual behavior, such as unprotected anal sexual intercourse or use of sex toys, increases the risk of blood-blood contact and hence the risk of contracting multiple STDs. Two cases of patients who in a short time period contracted multiple STDs, including LGV proctitis, is presented.

Nippon Koshu Eisei Zasshi 2006 Mar; 53(3): 167-77 (Read article online)

Shima T, Isshiki M, Kondo M, Tsukada M, Shiomi S, Imai M

OBJECTIVE: As an attempt to make HIV testing more accessible to many people, rapid HIV tests were introduced to a public health center. We evaluated logistic issues and effects of the introduction. METHODS: In January 2003, the Tochigi Prefectural Kennan Public Health and Welfare Center introduced rapid HIV tests simultaneously with conventional HIV tests. We studied the number and types of the clients before and after its introduction as well as comparing them with those of other public centers. Information on rapid HIV test practices was uploaded on the website, "HIV Kensa-Soudan Map" and its effects were also evaluated. RESULTS: The public health center had performed 130 conventional HIV tests in 2002 prior to the introduction of rapid HIV tests but performed 453 HIV tests in 2003 (250% increase). Of those, 404 clients (94%) preferred the rapid tests. Out of the 404 rapid HIV tests performed, five were tested positive but only one was confirmed to be positive (false positive rate 1%). The introduction of rapid HIV tests had a negative impact on other sexually transmitted infection (STI) tests. The access rates to TP antibody tests (rapid tests) and Chlamydia antibody tests (non rapid tests) offered to HIV test recipients declined from 77% to 63% and from 76% to 33%, respectively. However, the actual number of these STI tests increased due to the increased number of HIV tests. Sixty-one per cent of those who came to take the HIV tests referred to the website "HIV Kensa-Soudan Map". During the same time period, the increase rate in the number of those who took the non rapid HIV tests provided at other public health centers in Tochigi prefecture was 0% and the increase rate nationwide was 20%. CONCLUSIONS: The introduction of these tests to public health centers greatly increases access to HIV testing. It was found that the website "HIV Kensa-Soudan Map" was a useful information source for HIV testing. However, because of high false positive rate (about 1%), it is important to establish an effective pre- and post-test counseling system. It is also necessary to prevent the number of tests for other STIs from declining when rapid HIV tests are implemented simultaneously.