Ingegerd Kallings

Type Specificity and Significance of Different Isotypes of Serum Antibodies to Human Papillomavirus Capsids

Isotype-specific serum antibody responses against human papillomavirus (HPV) type 16 were evaluated by use of cross-sectional, prospective, and population-based seroepidemiologic studies. IgG1 and IgA were the most abundant isotypes. No sample contained IgG2, and <25 samples contained IgG3 or IgM. Total IgG, IgA, and IgG1 were HPV type specific and were associated with HPV-16 DNA (odds ratios [ORs], 5.4, 5.0, and 5.9, respectively; P<.001) but not with other HPV DNA (ORs, 1.2, 1.2, and 0.8, respectively; P value was not significant). Total IgG and IgG1 were strongly associated with number of lifetime sex partners (P<.001); IgA was only associated with number of recent sex partners and lifetime sex partners among younger women. Total IgG, IgG1, and IgA were associated with cervical intraepithelial neoplasia type III and also predicted risk of future cervical neoplasia. IgG and IgG1 appeared to mark lifetime cumulative exposure, whereas IgA may mark recent or ongoing infection.

Seropositivity to human herpesvirus 8 in relation to sexual history and risk of sexually transmitted infections among women.

The mode of transmission of human herpesvirus 8 (HHV8) was investigated in two seroepidemiological studies of Swedish women who completed a questionnaire about sexual behavior. Seropositivity for HHV8 antibodies, measured using an indirect immunofluorescence assay, was linked to a high number (>10) of sexual partners (P < 0.004). It also correlated strongly with a history of other sexually transmitted diseases (STD; P < 0.0001), in particular with a history of Chlamydia trachomatis infection and condyloma acuminata. There was appreciable HHV8 seropositivity already among virginal or monogamous women (9%). In summary, HHV8 transmission to women in Sweden may occur nonsexually. When sexual transmission occurs, it appears to be associated with high risk‐taking sexual behavior. Int. J. Cancer 87:232–235, 2000.

A PROSPECTIVE STUDY OF CHLAMYDIA TRACHOMATIS INFECTION FOLLOWING LEGAL ABORTION

In a prospective study, 288 women were tested for Chlamydia trachomatis (CT) in the cervix prior to legal abortion. In the control group (n = 259), CT culturing was carried out only when postoperative infection was suspected. CT was isolated in 14.2% of asymptomatic women. These patients were treated preoperatively with Doxycyc‐line. In this group, no cases of postoperative infection were detected. Among those cases where CT was not detected, 4.9% contracted the infection, while in the control group the rate of infection was 9.7%. In the control group all the infections due to CT gave late symptoms after the operation (1–4 weeks).

Salpingitis; aspects of diagnosis and etiology: a 4-year study from a Swedish capital hospital.

359 patients underwent laparoscopy to verify the diagnosis of salpingitis. Pelvic inflammatory disease (PID) was found in 187 (52%) cases. Laparoscopy revealed normal conditions in 136 (37%) cases. Other diseases were diagnosed in 36 (10%) cases. Bacteriological cultures from the fimbrial lumen were positive in 24% of the PID cases. Chlamydia trachomatis (CT) was detected in 12%, Bacteroides species (BS) in 5%, Actinomyces israelii (AI) in 3%, Gardnerella vaginalis (GV) in 2%, Neisseria gonorrhoeae (NG) in 1%, and Ureaplasma urealyticum (UU) in 1%. Cervical cultures were positive for NG and/or CT in 71% of the PID cases but only in 19% of the non-PID cases. From these no positive intra-abdominal cultures were detected. Serological tests for CT were carried out. A positive acute titre of greater than or equal to 1/64 was noted in 37%, a seroconversion (X4) 2-3 weeks later was found in 14%. Positive serology despite a negative culture was registered in 19%.

Vaginal flora changes associated with Mycoplasma hominis

OBJECTIVE The aim of this study was to investigate any association between vaginal carriage of Mycoplasma hominis and genital signs and symptoms, other microbial findings, and some risk behavior factors in women with and without bacterial vaginosis. STUDY DESIGN Women who had attended two family planning clinics and a youth clinic for contraceptive advice were divided depending on the result of vaginal culture for Mycoplasma hominis and the occurrence of bacterial vaginosis. The study population included 123 (12.3%) women who harbored Mycoplasma hominis. Those 873 (87.7%) with a negative culture for Mycoplasma hominis served as a comparison group. In the former group, 50 (40.7%) had bacterial vaginosis, which was also the case in 81 (9.3%) of the women in the comparison group. The groups were compared with regard to genital signs and symptoms, results of vaginal wet smear microscopy and other office tests, vaginal flora changes as detected by culture, and other means and detection of sexually transmitted diseases. Any history of sexually transmitted diseases and other genital infections, reproductive history, use of oral contraceptives, and smoking habits were registered. RESULTS Women who harbored Mycoplasma hominis had significantly more often complained of a fishy odor, had a positive amine test, a vaginal pH > 4.7, and clue cells than did the comparison group; all these statements were true before and after bacterial vaginosis had been excluded. Vaginal discharge was not significantly more often complained of, and a pathologic discharge was not more often detected in the Mycoplasma hominis carriers. Ureaplasma urealyticum occurred in 75% of the Mycoplasma hominis-positive women and in 59% of the comparison group (p = 0.001). The leukocyte/epithelial cell ratio did not differ significantly from that of the Mycoplasma hominis culture-negative controls. CONCLUSION The study suggests that Mycoplasma hominis is associated with a number of genital signs and symptoms even after exclusion of bacterial vaginosis.

Risky behavior in women with history of casual travel sex

Objectives: To define epidemiologic and psychosocial characteristics in women with a history of casual travel sex abroad. Study Design: 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. Results: 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. Conclusions: 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.

Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis

Abstract In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild ( 16 64 ), a moderate ( 26 64 ), or a severe ( 22 64 ) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3–6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36 64 (56%) ( 9 16 with a mild form, 13 26 with moderate form and 14 22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15 64 (23%) ( 5 16 with a mild form, 4 26 with a moderate form and 6 22 with a severe form of the disease). Oviductal cultures for CT were found in 12 64 (19%) ( 1 16 with a mild form, 4 26 with a moderate and 7 25 with severe form of salpingitis). Oviductal isolates for NG were found in 2 64 (13%) ( 2 16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).

Gynecological Symptoms and Vaginal Wet Smear Findings in Women with Cervical Human Papillomavirus Infection

OBJECTIVES To investigate the signs, symptoms and changes in the vaginal milieu that could be associated with cervical human papillomavirus infection (CHPI). STUDY DESIGN Women (n = 972) attending for contraceptive advice were tested for human papillomavirus in cervical samples. Results of gynecological history, examination, and vaginal wet smear findings were compared between CHPI patients and negative women. RESULTS Sixty-six (6.8%) of the women had a CHPI. Bacterial vaginosis was more common among those with, than without, CHPI, but the significance of this association was abolished after adjustment for age and for markers of sexual risk-taking. Vaginal discharge with a fishy odor, a positive amine test, and genital fissures showed significant correlations with CHPI, which persisted after adjustments. Symptoms of proctitis also correlated with CHPI, and remained significant after adjustment for anal sex. CONCLUSION Bacterial vaginosis is associated with the presence of CHPI, possibly due to sexual behavioral factors. However, several other features, in particular the presence of amines, may be independently associated with CHPI.

Serologic Classification and Contact-tracing in the Control of Microepidemics of β-lactamase-producing Neisseria gonorrhoeae

Serologic classification of isolated gonococcal strains and thorough contact-tracing were proved to be valuable in controlling an indigenous outbreak of infections caused by beta-lactamase-producing Neisseria gonorrhoeae (PPNG). Only 1-2% of gonococcal strains isolated in Sweden are PPNG, and before 1983 most of them were imported. During January-August 1983, 43 PPNG strains were isolated from 42 patients in Gothenburg. The PPNG strains were auxotyped and classified serologically. PPNG strains of serogroup WI, serovar (subgroup) Ae and of the prototrophic auxotype were isolated from 27 patients, including six prostitutes. Information obtained at interviews with these patients indicated that there had been a chain of infections. Quick and thorough contact-tracing stopped this microepidemic within three months. The serologic classification of the PPNG strains helped us to concentrate the epidemiologic efforts on those persons known to be infected with the epidemic strain, to trace this infection to other parts of Sweden, and to determine when the outbreak was finished.

Clustering of seropositivities for sexually transmitted infections.

Background Serology for different sexually transmitted infections (STIs) is useful for epidemiologic studies on the spread of STIs in different populations. Studying whether seropositivities for different STIs cluster could be useful, both for development of improved serologic markers of sexual behavior in populations and for understanding how STIs may differ in terms of the dynamics of their spread. Goal To evaluate the degree of clustering of different STIs in relation to sexual history. Study Design An age- and sexual history–stratified subsample of 275 women from a survey of healthy Swedish women seeking contraceptive advice was tested for human papillomavirus (HPV) types 6, 11, 16, 18, and 33;Chlamydia trachomatis; herpes simplex virus 2 (HSV-2); and human herpesvirus 8. Results Significant clustering was observed only for HPV types 6 and 11; for HPV types 16, 18, and 33; and for C trachomatis and HSV-2. The serologic marker that correlated best with lifetime number of sex partners was HPV type 16 (odds ratio [OR], 10.2; 95% CI, 3.8–27.6). The combined serologic marker that correlated most highly with sexual history was joint positivity for HPV types 16 and 33 (OR, 25.5; 95% CI, 5.4–120.4). Conclusions The degree of clustering between different STIs varies from nonexistent to strong, implying that different STIs commonly have very different transmission dynamics. Certain combinations of STI serologic tests may be useful in epidemiologic studies for predicting sexual behavior in groups.