Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males

Article Abstract:

The highest rates of sexually transmitted diseases (STDs) are observed in young people, with 82 percent of all cases of gonorrhea occurring in young men between the ages of 15 to 29. Chlamydial infections occur in 15 percent of teenaged girls and eight percent of teenaged boys. The two infections screened in this study were chlamydia, caused by Chlamydia trachomatis and gonorrhea, caused by Neisseria gonorrhoea. Both conditions, if untreated, may result in pelvic inflammatory disease in females which can lead to sterility or ectopic pregnancies (implantation of a fertilized egg outside of the uterus). Because many males remain asymptomatic when they have an STD, routine methods of bacteria detection are necessary if the spread of chlamydia and gonorrhea infections is to be contained. The predictive ability of the urinary leukocyte esterase screening test for detecting these infections was examined. The leukocyte esterase screening test is noninvasive and fairly simple to conduct. A urine sample was analyzed for esterase (an enzyme) activity in a population of 948 asymptomatic sexually active adolescent males. Of this group, 76 (eight percent) tested positive. Urine culture follow-up tests were subsequently obtained from 435 males of the original group to confirm the accuracy of the urinary esterase test. The results indicated that the urinary leukocyte esterase test had significant predictive values. For sensitivity (the ability to detect persons with an illness) the test was 72 percent accurate and for specificity (the ability to detect individuals who do not have the illness) it was 93 accurate. Negative predictive values (predictions of individuals who do not have an illness) were greater than positive ones, at 96 and 58 percent, respectively. The net result of the study was that 38 infections were predicted by the esterase test and subsequently confirmed by the culture; these infections would not have been detected otherwise. Supplementation of the esterase test with urine cultures for antigen (foreign protein, such as bacteria, which stimulates antibody production) detection may be done from the same sample. This would improve the overall accuracy of predictions. It is recommended that the esterase test be further evaluated for use in screening STDs in asymptomatic males. Because of the simplicity, noninvasive nature, and cost-effectiveness of the esterase test, its wide-spread implementation could prove to be a valuable aid in the containment of STDs.

Evaluation, Diagnosis, Medical examination, Medical screening, Health screening, Gonorrhea, Urine, Urinalysis

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The association between Chlamydia trachomatis and ectopic pregnancy: a matched-pair, case-control study

Article Abstract:

In an ectopic pregnancy, the fetus grows outside of the uterus; this most commonly occurs in the fallopian tube. The number of ectopic pregnancies in the United States is currently so high that it is considered an epidemic; with 15.2 ectopic pregnancies per 1,000 pregnancies in 1985, the rate has increased four-fold since 1970. An ectopic pregnancy can be fatal to the mother if it is not recognized and terminated, and these abnormal pregnancies account for 11 percent of maternal mortality. Ectopic pregnancies can also cause reduced fertility and lead to a second ectopic pregnancy. Factors that have been linked to the dramatic increase in this complication include use of the IUD (intrauterine device), tubal sterilization, prior pelvic inflammatory disease (PID), and the sexually transmitted diseases that cause PID. Swedish studies have shown that the risk of ectopic pregnancy rises by a factor of seven after only one episode of PID, and the most common cause of PID in Sweden is infection with Chlamydia trachomatis. A study was performed to investigate the association between past chlamydia infection and the rate of ectopic pregnancy. The subjects were 306 women with an ectopic pregnancy, and 266 pregnant women acted as controls. Blood tests were performed to determine whether the women had antibodies against C. trachomatis, indicating prior exposure. The data showed that prior chlamydia infection was associated with a 2.4-fold increase in risk for ectopic pregnancy, after corrections were made for other influential factors. An unexpected finding was that douching was an independent risk factor for ectopic pregnancy, regardless of chlamydia history; the relative risk was 2.1. These findings show that chlamydia infection needs to be controlled to reduce the rate of ectopic pregnancies, and increased risk associated with douching should be studied further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Pregnancy, Ectopic, Ectopic pregnancy

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Improved pregnancy outcome following successful treatment of chlamydial infection

Article Abstract:

Infection of the cervix with Chlamydia trachomatis, an organism that is sexually transmitted, may be particularly harmful in pregnant women. The incidence of chlamydia infection in pregnant women ranges from 2 to 37 percent. At highest risk are women under age 20, who are unmarried and poor, and have multiple sexual partners. Studies concerning the effects of chlamydia infection on the outcome of pregnancy have reached conflicting conclusions. This study included three groups of pregnant women who were at high risk for chlamydia infection: 244 women who were successfully treated for chlamydia with antibiotics; 244 women without chlamydia; and 79 women who had chlamydia and failed to respond to the treatment. The rates of certain pregnancy complications were higher in the group with chlamydia that was not successfully treated than in the treated group or in the group that did not have the infection. These complications were premature contractions, premature rupture of membranes, and small-for-gestational-age (growth retarded) infants. In conclusion, populations of pregnant women at high risk for chlamydia infection can benefit from repeated chlamydia testing throughout pregnancy, and from treatment as needed with antibiotics, which should reduce the risk of adverse pregnancy outcomes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Infection, Prevention, Pregnant women, Cervix uteri, Pregnancy, Complications of, Pregnancy complications

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