Marius Domeika

Humoral Immune Response to Conserved Epitopes of Chlamydia trachomatis and Human 60-kDa Heat-Shock Protein in Women with Pelvic Inflammatory Disease

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.

Evaluation of vaginal introital sampling as an alternative approach for the detection of genital Chlamydia trachomatis infection in women

BACKGROUND Genital Chlamydia trachomatis infections in women are traditionally detected by testing cervical and urethral samples. This sampling approach is not acceptable in some, e.g. screening situations. We evaluate an alternative approach, i.e. use of vaginal self-collected specimen for testing by polymerase chain reaction. METHODS The sensitivity of self-collected vaginal (introital) samples to diagnose genital infections by Chlamydia trachomatis using Roche AMPLICOR CT/NG PCR was compared with the cervical- and first-voided urine samples from women consulting with- (Group 1; n=123) and without (Group 0; n=160) genital symptoms. Women were interviewed regarding genital hygiene. Genital symptoms and signs were noted. RESULTS C. trachomatis DNA was detected in 13.0% of women from Group 1 and in 5.0% of women from Group 0, i.e. in urine of 6.5% vs. 1.9%, in the cervical swab in 9.8% vs. 5.0% and in vaginal swab in 11.4% vs. 3.8% of women, respectively. The vaginal sample was the most sensitive specimen for detecting C. trachomatis in the Group 1 women. It had sensitivity of 87.5% vs. 75% for cervical- and 50% for urine specimens. In Group 0, the cervical sample was 100% sensitive, while the vaginal introital sample and urine had a sensitivity of 75% and 37.5%, respectively. C. trachomatis was less often detected in urine of women who routinely practised genital washing. CONCLUSIONS Vaginal sampling performed by the woman herself is a sensitive approach and might serve as an important stimulus for screening for C. trachomatis infections in young women at risk.

First evaluation of six nucleic acid amplification tests widely used in the diagnosis of Chlamydia trachomatis in Russia

Background  In Russia, nationally developed nucleic acid amplification tests (NAATs), which have never been validated to international commercially available NAATs, are mainly used in the diagnosis of Chlamydia trachomatis infection.

Mailed urine samples are not an effective screening approach for Chlamydia trachomatis case finding among young men

Background  Frequency of testing is known to be low for sexually transmitted infections (STIs) in men aged 20–24 years. The use of mailed, home‐obtained urine specimens could increase the uptake of young men and facilitate screening programmes for the detection of asymptomatic Chlamydia trachomatis.

Comparison of polymerase chain reaction, direct immunofluorescence, cell culture and enzyme immunoassay for the detection of Chlamydia psittaci in bull semen.

The polymerase chain reaction (PCR), direct immunofluorescence (DIF; JMAGEN Chlamydia, DAKO Diagnostics, UK), cell culture (CC) and enzyme immunoassay (EIA; Syva Micro Trak) were evaluated for detection of Chlamydia psittaci in bull semen. Three specimens were collected from each of 47 bulls at 3-6 month intervals (134 samples). Judging by the number of samples tested (n = 134), PCR showed a sensitivity of 90.9%, DIF of 93.9%, CC of 72.7% and EIA of 81.8%. PCR, DIF, CC and EIA were 100% specific, respectively. Of the 47 bulls the maximum number of chlamydia-positive animals (n = 14) was revealed when repeated tests were made by PCR. PCR detected 21.4% more positives than DIF and CC and 35.7% more than EIA. Although CC was less sensitive judging by the number of samples tested, it was as sensitive as DIF (78.6%) when judged by the number of bulls investigated. All bulls found to be chlamydia-positive remained so throughout the investigation, which lasted 18 months.

Recommended antimicrobial treatment of uncomplicated gonorrhoea in 2009 in 11 East European countries: implementation of a Neisseria gonorrhoeae antimicrobial susceptibility programme in this region is crucial.

Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (gonococcus) is a major problem worldwide. Quality-assured and quality-controlled AMR surveillance data on gonococci globally are crucial for public health purposes. In East European countries, knowledge regarding gonococcal AMR and its prevalence is limited. Objectives To ascertain the recommendations for antimicrobial treatment of uncomplicated gonorrhoea in 11 East European countries, valuable information for introducing an international gonococcal AMR surveillance programme. Methods A questionnaire was used to collect information regarding the types, doses and manufacturers of the antimicrobials recommended for gonorrhoea treatment in all countries. Results Ceftriaxone (250–1000 mg, intramuscularly (IM)×1) was reported as a first-line antimicrobial in all countries (n=11). Many of the second-line and alternative treatments seemed suboptimal for empirical treatment. Regionally manufactured antimicrobials were predominantly used and easily available, and some may be of suboptimal quality. This generates effective prerequisites for emergence, and rapid spread of gonococcal AMR and gonorrhoea. Conclusion Ceftriaxone was first-line antimicrobial in all the 11 East European countries, which is an appropriate choice also in a global perspective. However, the adherence, especially among private physicians, to these public sector recommendations is questionable. Implementation of national and international gonococcal AMR surveillance in this region is crucial; to provide evidence-based data for regular and timely updating of treatment guidelines, to identify emerging resistance, and to assist in the prevention, control and containment of gonococcal AMR and gonorrhoea.

National surveillance of antimicrobial susceptibility in Neisseria gonorrhoeae in 2005–2006 and recommendations of first-line antimicrobial drugs for gonorrhoea treatment in Russia

Objectives: To investigate comprehensively the antimicrobial susceptibility and resistance of Neisseria gonorrhoeae during 2005–2006 in a national survey and to recommend effective antimicrobial drugs for the treatment of gonorrhoea in Russia. Methods: The susceptibility of N gonorrhoeae isolates, cultured mainly from consecutive gonorrhoea patients (n  =  1030) during the period January 2005 to December 2006 in Russia, to penicillin G, ceftriaxone, ciprofloxacin, tetracycline and spectinomycin was analysed using the agar dilution method. Nitrocefin discs were used for β-lactamase detection. Results: All isolates were susceptible to ceftriaxone. During 2005 and 2006, however, 5%, 50%, 70% and 77% displayed intermediate susceptibility or resistance to spectinomycin, ciprofloxacin, tetracycline and penicillin G, respectively. Furthermore, 4% of the isolates were β-lactamase producing during these years. The different federal districts of Russia displayed substantial heterogeneities with regard to the prevalence of gonorrhoea and antimicrobial resistance among N gonorrhoeae isolates. Conclusions: In Russia, penicillins, ciprofloxacin, or tetracycline should definitively not be used in the empirical treatment of gonorrhoea. The recommended first-line antimicrobial drug should be ceftriaxone. If ceftriaxone is not available, spectinomycin ought to be used. Increasing levels of intermediate susceptibility and resistance to spectinomycin have, however, been observed during recent years and, accordingly, great care and monitoring should be undertaken when using this agent. Continuous local, national and international surveillance of N gonorrhoeae antimicrobial susceptibility, in order to reveal the emergence of new resistance, to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis, is crucial.

Demographic data on prostitutes from Bulgaria--a recruitment country for international (migratory) prostitutes

Summary: The study was aimed at investigating the conditions and circumstances for the recruitment of prostitutes, as well as their reproductive history, working conditions, knowledge of and attitudes to sexually transmitted diseases (STDs), and use of prophylactic antibiotic therapy of these diseases. Two hundred prostitutes were investigated by in-depth interviews at STD clinics, private practices and hotels. Of the 200 prostitutes, 8 (4%) were less than 15 years old and 32 (16%) more than 25 years old. Most of the women came from rural villages. Half of them were gypsies. Most had a boyfriend (often the pimp). One-quarter had been or were on their way abroad to prostitute. Half were migrating within Bulgaria to prostitute. They claimed a high rate of condom use with customers, but seldom with their pimps or boyfriends. About one-tenth used antibiotics prophylactically. They had knowledge of classical STDs and HIV/AIDS but only in exceptional cases had they heard about chlamydial and human papillomavirus infections. They often cohabited with a female friend also often practising prostitution. It was concluded that recruitment is often easy as the prostitute can earn more from only one contact with a customer than their parents earn from work in a month. Symptoms suggestive of STD were very common in the prostitutes, i.e. in 43%. Bulgaria is a recruitment area for international prostitutes.

Guidelines for the Laboratory Diagnosis of Mycoplasma genitalium Infections in East European Countries

The present guidelines aim to provide comprehensive information regarding laboratory diagnosis of Mycoplasma genitalium infections in East European countries. These guidelines are intended primarily for laboratory professionals testing specimens from patients at sexual health care clinics, but may also be useful for community-based screening programmes. Diagnosis of M. genitalium infection is performed exclusively using nucleic acid amplification tests (NAATs), owing to the poor and slow growth of the bacterium in culture. Because no internationally validated and approved commercial NAAT for M. genitalium detection is presently available, it is necessary that laboratories performing M. genitalium diagnostics not only carefully evaluate and validate their in-house PCRs before using them routinely, but also use comprehensive internal controls and take part in external quality assessment programmes. The guidelines were elaborated as a consensus document of the Eastern European Sexual and Reproductive Health (EE SRH) Network, and comprise one element of a series of guidelines aimed at optimizing, standardizing, and providing guidance on quality laboratory testing for reproductive tract infections.

Pooling Samples: the Key to Sensitive, Specific and Cost-effective Genetic Diagnosis of Chlamydia trachomatis in Low-Resource Countries

The aims of this study were to compare the performance characteristics and cost-effectiveness of pooling endocervical samples for screening and diagnosis of Chlamydia trachomatis, and to investigate the prevalence of C. trachomatis infection in women in Leningrad Oblast, Russia. A total of 1500 endocervical samples were tested individually and when pooled in groups of 5 and 10 samples, respectively. A previously evaluated in-house diagnostic polymerase chain reaction (PCR) assay was utilized. The sensitivity and specificity of the PCR were not affected by either pooling strategy. The estimated prevalence of genital C. trachomatis infection was 6.6%, 6.1% and 6.0% based on individually tested samples, and pools of 5 and 10, respectively. For diagnosis of individual samples, the pooling strategies resulted in cost savings of 53.3% (5 samples per pool) and 44.0% (10 samples per pool). Pooling samples for PCR detection of C. trachomatis is an accurate and cost-saving approach for diagnosis and large-scale prevalence studies in St Petersburg, Russia.