Comparison of two enzyme-linked immunosorbent assays and one rapid immunoblot assay for detection of herpes simplex virus type 2-specific antibodies in serum

The sensitivities and specificities of three immunoassays for the detection of herpes simplex virus type 2 (HSV-2)-specific immunoglobulin G antibodies in serum, including the one-strip rapid immunoblot assay (RIBA; Chiron Corporation) and two indirect enzyme immunosorbent assays (EIA; Gull Laboratories and Centocor), were compared by testing a panel of 1,250 serum samples from individuals attending an outpatient clinic for sexually transmitted diseases. A qualitative agreement among the three assays was observed with 1,080 serum samples (86.4%); 291 of the serum samples (23.3%) were positive, 789 samples (63.1%) were negative, and 170 serum samples (13.6%) gave a discordant result. Results were considered conclusive when a concordant result was obtained with two of three assays. The sensitivities and specificities of the RIBA, the Gull EIA, and the Centocor EIA proved to be 99.2, 99.7, and 89.9% and 97.1, 96.7, and 99.3%, respectively. These results indicate that the Chiron RIBA and the Gull EIA are especially useful and reliable fo

Improved diagnosis of Trichomonas vaginalis infection by PCR using vaginal swabs and urine specimens compared to diagnosis by wet mount microscopy, culture, and fluorescent staining

Four vaginal cotton swab specimens were obtained from each of 804 women visiting the outpatient sexually transmitted disease clinic of the Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands, for validation of various forms of Trichomonas vaginalis diagnostic procedures. One swab specimen was immediately examined by wet mount microscopy, a second swab was placed in Kupferberg's Trichosel medium for cultivation, and two swabs were placed in phosphate-buffered saline (PBS), pH 7.2. The resulting PBS suspension was used for direct staining with acridine orange and fluorescence microscopy, inoculation of modified Diamond's culture medium, and a PCR specific for T. vaginalis. A total of 70 samples positive in one or more of the tests were identified: 31 (3.8%) infections were detected by wet mount microscopy, and 36 (4.4%) were

Bacterial vaginosis (clue cell-positive discharge) : diagnostic, ultra-structural and therapeutic aspects

This thesis deals with several aspects of (abnormal) vaginal discharge, focusing especially on clue cell-positive discharge (bacterial vaginosis, nonspecific vaginitis). It reports data on epidemiology and clinical features, pathogenesis, and treatment of this vaginal disease entity, as well as on women's experience of troublesome vaginal discharge. Chapter III discusses the question whether or not symptoms and signs have a discriminatory ability in the diagnosis of specific vaginal infections. If so, this could help the physician to reach a diagnosis with minimum effort. However, data from the literature indicate that this ability is limitedl. While bacterial vaginosis and trichomoniasis undoubtedly have much in common, e.g. the overgrowth of anaerobic bacteria, the question is whether the difference between the two entities ends with the pathognomonic presence of clue cells and trichomonads, or whether other discriminating features can be detected. Chapter IV reports on an extensive clinical and laboratory study of women with these vaginal infections. The available information on the extent of the problem of vaginal discharge is incomplete. Hard figures, which probably represent only the tip of the iceberg, are being collected by several sentinel stations. Data on views of women on vaginal discharge and their behaviour in this context are virtually lacking. In order to find answers to some questions, a survey was held among 5,900 women. It is reported in chapter V. Wet mount microscopy of vaginal discharge from women with clue cellpositive discharge (CCPD) invariably shows that a minority of vaginal epithelial cells (VECs) are covered with bacteria, a finding also reported by other authors. Chapter VI studies this 'selective' bacterial adherence and focuses on vitality and glycogen content of VECs, as well as on the morphology of bacterium-VEC interaction. Chapter VII evaluates the efficacy of single-dose tinidazole in the treatment of non-specific vaginitis. Metronidazole, another nitroimidazole combination, has been shown to be very effective in a regimen of 2x500 mg for one week. From the point of view of patient compliance and cost effectiveness single-dose treatment seems preferable. Although there is no convincing evidence that metronidazole has teratogenic properties in human beings, the drug should be used only reluctantly during pregnancy. Since CCPD is perhaps the most prevalent vaginal infection, the development of an effective treatment which can be safely used during pregnancy seems important. In chapter VIII the efficacy of amoxycillin and amoxycillin plus clavulanic acid in the treatment of CCPD is compared with that of metronidazole. Povidone-iodine has been used for local treatment of vaginitis since the early Sixties. Its vaginal use nowadays mainly concerns the treatment of chronic, non-specific vaginal infections. Most studies report moderate efficacy (up to 70%) of povidone-iodine, administered either as pessary, solution or gel. Only one study seriously questions the efficacy of povidone-iodine as a vaginal therapeutic • Chapter IX concerns a double-blind, placebo-controlled study of the efficacy of povidone-iodine in the treatment of CCPD

Prevalence and association between herpes simplex virus types 1 and 2-specific antibodies in attendees at a sexually transmitted disease clinic

BACKGROUND: Seroprevalence of herpes simplex virus type 1 (HSV-1) and HSV-2 was determined in 1993 and 1998 in a randomly selected study group of 1024 and 654 attendees, respectively, at the sexually transmitted disease (STD) clinic of the University Hospital Rotterdam-Dijkzigt, The Netherlands. Correlations of HSV-1 and HSV-2 seropositivity were investigated. The relationship between HSV-1 and HSV-2 antibodies was also studied. METHODS: Data were collected in a cross-sectional study from February 1993 until February 1994 and from January 1998 until December 1998. Glycoprotein G (gG) HSV type specific serum IgG was determined. RESULTS: Seroprevalence of HSV-1 was 68% versus 59% (1993 versus 1998, chi(2)-test P < 0.001), of HSV-2 it was 30% versus 22% (1993 versus 1998, chi(2)-test P < 0.001). Using logistic regression analyses, HSV-1 and HSV-2 seropositivity were significantly associated with age and ethnicity in both groups. In 1993, HSV-1 seropositivity also correlated with lower level of education and female gender, whereas in 1998 it correlated with 'number of sexual partners in the past 6 months' and 'present diagnosis of STD'. In both groups, HSV-2 seropositivity was also more prevalent in females and related to sexual lifestyle variables. In an exposure-disease model, HSV-1 seropositivity was not correlated with HSV-2 seropositivity (odds ratio 1993 = 1.1, 95% CI : 0.8--1.7; odds ratio in 1998 = 1.0, 95% CI : 0.5--1.8). CONCLUSIONS: Seroprevalence of HSV-1 and HSV-2 is falling among STD clinic attendees in Rotterdam. A changing pattern of risk factors for HSV-1 seropositivity indicates increasing sexual transmission of HSV-1. Seropositivity for HSV-2 correlated with known risk factors. A previous HSV-1 infection does not reduce susceptibility to subsequent genital HSV-2 infections