ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Research proceeds in the search for effective, safe, and convenient treatment regimens for gonococcal and chlamydial genital infections. Though single-dose ceftriaxone forNeisseria gonorrhoeaeand 1 week of doxycycline forChlamydia trachomatisremain the standards of care, other third-generation cephalosporins, quinolones, and the new azalides may also be considered in certain circumstances.

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The current epidemic of syphilis has served to focus renewed attention on the clinical complexities of the disease as well as limitations in methods for its diagnosis. As serologic screening efforts for identifying active disease intensify in response to the syphilis epidemic, new studies show that titers of nontreponemal tests for syphilis (eg, Venereal Disease Research Laboratory or rapid plasma reagin) posttherapy do not decline as rapidly as previously asserted, although levels in patients with low initial titers or first infection episodes appear to decline more rapidly than those of repeat infections or later stages of the disease. After therapy, seroreversion of treponemal tests for syphilis (eg, microhemagglutination assay for antibodies toTreponema pallidumor fluorescent treponemal antibody-absorbed test) can also be as high as 13% to 24% in patients with first-episode primary syphilis. In patients coinfected withT. pallidumand human immunodeficiency virus, there is increasing evidence that nonreactive treponemal or nontreponemal serologic tests may not exclude past or present syphilis infection. Enzyme immunoassay is being exploited in new serologic tests for syphilis, with assays for IgG reportedly having high sensitivity and specificity, although some studies revealed lower sensitivity and positive predictive value when used as a serologic screening assay; cross reactivity with antigens ofBorrelia burgdorferialso were reported. Immunoblotting (Western blotting) has also been employed with high sensitivity and specificity (compared with the double-staining fluorescent treponemal antibody-absorbed test) to detect IgG specific forT. pallidumin the serologic diagnosis of acquired syphilis. With the inability to cultureT. pallidum, the polymerase chain reaction continues to hold promise as a surrogate marker for treponemal infection through the detection ofT. pallidumDNA in tissues and body fluids. New diagnostic approaches to facilitate the diagnosis of congenital syphilis, particularly in asymptomatic infants born to mothers with suspected active disease, include the combined use of immunoblotting for neonatal serum IgM as well as polymerase chain reaction for the detection of treponemal DNA in amniotic fluid and neonatal blood, serum, and cerebrospinal fluid. However, the recognition that mothers with incubating or primary syphilis and their infants may present with nonreactive maternal or neonatal serologic tests for syphilis at the time of delivery, and the reemergence of congenital syphilis in areas where cases previously were rare, underscore the need for improved diagnostic methods and renewed attention towards the diagnostic dilemma of both acquired and congenital syphilis.

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Among persons with herpes simplex virus type 2 infection, approximately 75% are asymptomatic and can be identified only by serologic testing with type-specific assays. Among serologic assays, the Western immunoblot assay, the glycoprotein G-2 immunodot assay, and the glycoprotein G-2 enzyme immunoassay appear sensitive and type-specific, although the latter appears less sensitive in immunocompromised individuals. Commercial enzyme immunoassays give inaccurate or misleading results regarding virus type. In epidemiologic studies, type-specific serologic assays have been used prospectively to study risk factors for the transmission of genital herpes in heterosexual couples, to identify couples at unsuspected risk for transmission of genital herpes during pregnancy, and to assess the role of genital herpes as a risk factor for human immunodeficiency virus infection in heterosexuals.

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Substantial clinical, epidemiologic, and experimental evidence suggests an etiologic role for the high-risk human papillomavirus (HPV) types in anogenital squamous cell neoplasias. As the link between HPV and neoplasia has become stronger, the issue of whether the detection of HPV DNA in the genital tract would identify women at risk has been repeatedly raised. However, the high prevalence of HPV DNA in the population renders the utility of HPV DNA detection methods in cancer detection questionable. Thus, more molecular, immunologic, clinical, and epidemiologic studies are needed to understand the pathobiology of HPV-related anogenital disease. Clearly, the mere detection of HPV 16/18 in the anogenital tract specimens is not proof of high risk for progression to neoplastic disease. However, since HPV 16/18 is probably an important risk factor, combined use of cytologic screening and HPV DNA testing might improve the identification of women with high-grade lesions. Cervical cancer is a disease of gene transcription, and HPV seems to turn wrong genes on at the wrong time. Fortunately, cells strongly resist malignant transformation, which is the reason most genital squamous cell cancers require 20 or more years to develop.

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Until recently, vaginal douching has been considered a relatively benign procedure. However, in recent years, a number of papers have reported an association between current vaginal douching and pelvic inflammatory disease or ectopic pregnancy. Although it is biologically plausible that the act of vaginal douching could be associated with introduction of bacteria into the upper genital tract thus causing salpingitis and its sequelae, the epidemiologic data are far from compelling, yet it is clear that douching is a voluntary act and not a necessity. The data suggesting a causative role are too strong to ignore. There is an urgent need for further studies to help define any possible causative role for vaginal douching in pelvic inflammatory disease or ectopic pregnancy. It is likely that intervention programs could be more successfully aimed at modifying douching behaviors than at reducing infection rates with the sexually transmitted disease agents that cause acute salpingitis. In the meantime, without a medical indication for vaginal douching, together with the possible risks, one must ask, why douche?

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Urinary tract infection remains a common clinical problem. In comparison with the intense research on diagnosis and management, relatively little attention has been focused on the behavioral and genetic factors that may relate to an increased risk of urinary tract infection. Among behavioral risk factors in women, sexual activity and diaphragm spermicide use are clearly associated with increased risk; postcoital voiding and voiding soon after the urge to urinate may be protective factors. Data regarding other behavioral risk factors in women have been inconclusive. In men, identified behavioral risk factors have included rectal intercourse and lack of circumcision. Regarding genetic influences, it appears that a woman's blood group secretor status influences her susceptibility to recurrent urinary tract infection.

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

After a century of absence, epidemic cholera has finally attacked the American continent. The outbreak started at the beginning of 1991 and has since spread with extraordinary velocity and strength. Important advances were achieved in the past year that could improve the global effort to control this dreaded disease. In contrast to the epidemic in Africa, the Latin American countries are obtaining a remarkably low case fatality rate. The strain causing the epidemic in Latin America seems to have evolved from the seventh pandemic strain with which it shares several similarities, although they are not identical. New methods for detectingVibrio choleraeand its toxin have been developed. A second enterotoxin produced byV. cholerae01 has been discovered and characterized. This might accelerate the development of better vaccine candidates and improve our understanding of the mechanisms of infectious diarrhea. As it was established more than a century ago, contamination of drinking water continues to be the most important way of transmitting this disease.

ISSN:0951-7375    

出版商:OVID    

年代:1993

数据来源: OVID