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1.  Prevalence of nine different micro-organisms in the female genital tract. A comparison between women from a venereal disease clinic and from a health control department. 
In a study of the prevalence of nine different micro-organisms in the female genital tract in a Swedish population, significantly higher isolation rates occurred among women attending a venereal disease clinic than among those attending a gynaecological health control department. The prevalence of Candida albicans, however, was similar in different groups, individual susceptibility being the most important factor. Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma hominis occurred concomitantly with Neisseria gonorrhoeae, indicating a similar epidemiology for all these agents. Younger patients seemed to have an increased susceptibility to C. trachomatis whereas older patients had an increased susceptibility to T. vaginalis.
PMCID: PMC1045703  PMID: 230884
2.  Behavioural and social characteristics of the patient with repeated venereal disease and his effect on statistics on venereal diseases. 
The current study investigated personality characteristics and social circumstances in patients repeatedly infected with venereal diseases. An effort was made to identify characteristics that would differentiate a repeat patient (RP) from a non-repeat patient (NRP). Two studies were carried out. In the first, a group of patients from a venereal disease clinic in a large general hospital was first interviewed and then the patients were asked to complete a questionnaire. In the second study, an attempt was made to validate the findings from the first study by comparing data from RP and NRP venereal disease patients drawn from medical and social case histories from a second hospital. Results of both studies support the hypothesis that repeat patients are different from non-repeat venereal disease patients in terms of social and psychological characteristics. The significance of these findings is discussed.
PMCID: PMC1045373  PMID: 576846
3.  The value of a psychiatric service within the venereal disease clinic. 
A significant proportion of attenders at venereal diseases clinics can be regarded as potential psychiatric patients. However, there have been few reports on the value of readily available psychiatric advice at such clinics. The findings during a three-month period when a psychiatrist attended a venereal disease clinic are described. Twenty-two patients were referred for psychiatric assessment. Of the 20 who kept their appointment, 18 were diagnosed as mentally ill or as having a personality disorder. Of these two were already under psychiatric care, but 11 had never previously sought psychiatric assistance. The major sources of common venereological and psychiatric concern appeared to be among the promiscuous and the hypochondriacal patients. The former consisted of persons with personality disorders who were thought unlikely to respond to psychiatric treatment; but some of the latter improved after treatment with pimozide. Some patients defaulted and not all who persevered were helped. Nevertheless the results of a questionnnaire showed that the staff considered there was an important place for a psychiatrist within their clinic.
PMCID: PMC1045516  PMID: 581066
4.  Group B streptococci in venereal disease clinic patients. 
The isolation rates of group B streptococci for 457 men and 300 women attending a venereal disease clinic were 16-4 and 20-6% respectively. The frequencies were significantly increased by using a selective medium and by taking specimens from the female urethra as well as the cervix. In contrast to gonorrhoea the presence of group B streptococci could not be related to promiscuity. In addition, the isolation of group B streptococci was found to be independent of a concomitant gonococcal infection. This study indicates that group B streptococci have little relation to the clinical signs and symptoms of genital infection, such as dysuria, discharge and inflammatory mucosal reaction.
PMCID: PMC1045191  PMID: 130184
5.  Endemic non-venereal syphilis (bejel) in Saudi Arabia. 
A total of 2515 people attending a large military hospital in Saudi Arabia was studied clinically, serologically, and (when appropriate) radiologically for evidence of treponematosis. The indications are that non-venereal endemic syphilis (bejel) is prevalent among the nomadic communities living in rural areas. In contrast, venereal syphilis is much less common, and is found almost exclusively in urban populations. Some of the high risk regions for bejel have been identified, and many people from these locations complained of persistent pain in the legs, which was often associated with radiological evidence of osteoperiostitis of the long bones. Bejel also seems to have become clinically "attenuated" within the last 30 years, with the majority of seroreactors having latent disease. A hypothesis suggesting a reason for this change is put forward, and ways of controlling the infection are outlined.
PMCID: PMC1046341  PMID: 6487985
6.  Australia (Hepatitis-Associated) Antigen in Patients Attending a Venereal Disease Clinic 
British Medical Journal  1973;2(5864):455-456.
A total of 1,650 patients attending the venereal disease department at St. Mary's Hospital, London, have been tested for Australia antigen. Twenty-three positive results were obtained, or 1·39%, which is more than 10 times the rate noted by others in blood donor populations in the U.K. and U.S.A. The positive rates among female patients and European male heterosexual patients were 0·36% and 0·19% respectively. High rates were obtained for homosexual patients (3·8%) and non-European heterosexual patients (3·1%). The reasons for the higher rates found in these groups merit further study.
PMCID: PMC1589445  PMID: 4197240
7.  Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis in black and white patients attending a venereal disease clinic. 
Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis was studies in 2000 patients attending a venereal disease clinic. Of these patients, 64% were white and 36% were black. The incidence of gonococcal infections was highest in the period from June to August. The incidence of genital or rectal infections or both was higher in the black patients. Pharyngeal colonisation by gonococci was present in 1.3% of the patients. There was no significant associations between pharyngeal colonisation and the pharyngeal symptoms, race, sex, or marital state of the patients. Pharyngeal colonisation was more frequent in patients with gonococcal infections at other sites. However, in 40.7% of the patients with pharyngeal colonisation, the pharynx was the only culture-positive site. There was no significant difference in the auxotypes or in the antibiotic susceptibility of the pharyngeal and the rectal-genital isolates except in the susceptibility to spectinomycin. Our findings do not indicate that gonococci isolated from the pharynx differ significantly from gonococci isolated from rectal or genital sites. It was notable that meningococcal colonisation of the pharynx was significantly more frequent in the white patients. This may be a genetically determined phenomenon.
PMCID: PMC1045574  PMID: 106918
8.  Venereal disease education and a selected group of American college students. 
Education is considered to be an important factor in the control and possible eradication of venereal diseases. A study was undertaken to discover what effect education had had on a selected group of university students so as to determine suitable avenues for future educational programmes. Many of the schools attended by the students had issued information on venereal diseases; most students considered that this information was useful. The study did not generally show a significant relationship between previous health education, current attitude and behaviour, and the contraction of venereal disease. However, the data did appear to reveal a correlation between the lack of education at junior high school and the acquisition of venereal disease. The university student health service, together with books and pamphlets made available outside the school of classroom, were regarded as being important in venereal disease education. These findings can help those planning venereal disease education for young adults.
PMCID: PMC1045345  PMID: 576588
9.  A comparison of the absorbed fluorescent treponemal antibody (FTA-ABS) test and other screening tests for treponemal disease in patients attending a venereal disease clinic 
Journal of Clinical Pathology  1972;25(5):437-440.
Screening tests—absorbed fluorescent treponemal (FTA-ABS), the Reiter protein complement-fixation (RPCFT), VDRL slide test, automated reagin—and cardiolipin Wassermann reaction—were carried out on 1922 consecutive new patients attending the Whitechapel Clinic over a three-month period.
Taking the FTA-ABS test results as an index, the most efficient combination of conventional tests was found to be the RPCFT and automated reagin test. The cardiolipin WR proved to be under-sensitive and of little value compared with the other tests.
Forty-two per cent of the 107 sera reactive in the FTA-ABS test were not detected by the RPCFT or ART tests. An assessment based on the TPI test results and clinical findings in these patients is presented.
The scope and limitations of the FTA-ABS test as a screening procedure are discussed.
PMCID: PMC477342  PMID: 4558249
10.  Serological markers for treponemal infection in children in rural Kilimanjaro, Tanzania: evidence of syphilis or non-venereal treponematoses? 
Genitourinary Medicine  1997;73(6):522-527.
OBJECTIVE: To determine the seroprevalence of treponemal infection and possible risk factors among children aged 0-14 in the general population of a rural Tanzanian village. METHODS: The survey was conducted as a part of a cross section study of a total village population on HIV and sexually transmitted disease. Among 1708 registered children aged 0-14, the 553 first attending were tested for treponemal infection with both rapid plasma reagin test (RPR) and Treponema pallidum Haemagglutination test (TPHA). These children belonged to a household cohort--also including their parents, siblings, and other household members--with 1339 members; 1224 (91.4% participated in the survey and 82.1% of these were tested for treponemal infection. RESULTS: The overall prevalence for the TPHA test was 6.4% among girls and 1.1% among boys (odds ratio, OR = 6.5; 95% confidence interval, CI: 1.9-22.3). The sex difference was most pronounced in the age group 10-14; 11.1% among girls versus 1.0% among boys (OR = 12.8; CI: 1.6-101.9). Among the 20 children who were TPHA positive, we found two cases of active, congenital syphilis. There was a lack of association between positive serology in children and positive serology in their parents. CONCLUSION: The highly significant predominance of girls testing positive for TPHA, and the concomitant lack of association between parents' and children's serostatus might point to sexual transmission as being the most common route of transmission of treponemal infection in girls during childhood in this village. The sources of infection for the seropositive girls are possibly found outside the family.
PMCID: PMC1195938  PMID: 9582474
11.  Herpesvirus hominis type 2 infection in Ibadan. Problem of non-venereal transmission. 
Examination of sera from blood donors, from patients attending a special treatment clinic, a family planning clinic, and an antenatal clinic showed that the prevalence of herpes virus hominis type 2 antibodies among the adult population in Ibadan is similar to that in other parts of the world. The possibility of non-venereal transmission of herpes virus infection was confirmed by the finding that herpesvirus hominis type 2 could survive on cloth samples under humid tropical conditions for long enough to allow transmission of infection via fomites.
PMCID: PMC1045726  PMID: 6245750
12.  Genital herpesvirus infection in women attending a venereal diseases clinic. 
Routine cervical viral cultures (and cultures from lesions if present) were performed on 2630 female patients attending a venereal diseases clinic over a period of four years. Of these patients 96 (3.7%) had genital herpetic infection; of these 23 (24%) were asymptomatic. The association of herpesvirus with other genital infections is considered, but no increase in the incidence of Neisseria gonorrhoeae, Trichomonas vaginalis, and genital warts was found; there was an increased incidence of Candida albicans. A significantly higher percentage of the patients with herpesvirus took oral contraceptives. The findings are discussed and compared with previous reports.
PMCID: PMC1045536  PMID: 213162
13.  Homosexuality and venereal disease in the United Kingdom. A second study. British Co-operative Clinical Group. 
The proportion of homosexually acquired cases of primary and secondary syphilis in patients attending venereal disease clinics in the United Kingdom has risen from 42.4% to 54% over a six-year period. Similarly, over the same period, the proportion of homosexually acquired cases of gonorrhoea has risen from 9.8% to 10.9%. The increase in incidence of homosexually acquired infections in both diseases occurred in all areas but particularly in London. Thus the very considerable epidemiological importance of male homosexuals as a high-risk group should receive more, not less, emphasis.
PMCID: PMC1045717  PMID: 7370722
14.  Clinical Pharmacokinetics and Effects of Vincristine Sulfate in Dogs with Transmissible Venereal Tumor (TVT) 
This study was conducted to evaluate the pharmacokinetic characteristics of vincristine and their correlation with its clinical effects in dogs with transmissible venereal tumor (TVT). Dogs with TVT were intravenously administered vincristine sulfate at a dose of 0.7 mg/m2 of body surface area. Blood samples were collected starting from 5 min to 48 hr after drug administration. The plasma concentration of vincristine was determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The pharmacokinetic parameters of vincristine were characterized using a two-compartmental pharmacokinetic model. The volume of distribution, distribution half-life, elimination half-life and plasma clearance were 0.660 ± 0.210 l/kg, 21.5 ± 6.90 min, 47.6 ± 14.2 min and 0.010 ± 0.001 l/min/kg, respectively. Tumor regression was determined at weekly interval by a physical examination and histopathological analysis. In our study, three to eight administrations of vincristine at a dose of 0.7 mg/m2 were able to induce a complete tumor regression without any evidence of gross lesion of disease. Therefore, this investigation provides the pharmacokinetic characteristics of vincristine in dogs with TVT, which may be used as an integration tool to gain a better understanding of the disposition properties of the drug and the correlation of these properties with the drug’s clinical effects. In addition, we validated the LC-MS/MS method and found that it is suitable for the pharmacokinetic study of vincristine in dog plasma.
PMCID: PMC4300367  PMID: 25649934
canine; LC-MS/MS; pharmacokinetics; transmissible venereal tumor (TVT); vincristine sulfate
15.  A comparison of three educational techniques used in a venereal disease clinic. 
Public Health Reports  1975;90(2):159-164.
The communications methods that could be used in educational programs for venereal disease patients were examined as to their relative effectiveness: a programed learning guide, an audiovisual (cinematographic) technique, and an interview method. An experimental design was used to study three groups of patients at a venereal disease clinic; (a) persons who were pretested, exposed to an educational method, and tested again, (b) a control group whose members were pretested and post-tested but not exposed to an educational method, and (c) another control group whose members were exposed to an educational method and then took a post-test. Each of those groups exposed to the educational techniques was further subdivided according to the technique applied. Analysis of the data collected from 443 subjects led to the following tentative conclusions: 1. Representation in the nine groups was demographically uniform as measured by age, sex, marital status, and ethnic origin. 2. All three educational techniques significantly raised the subjects' level of knowledge about venereal disease, as measured by their test scores. 3. All three techniques were favorably received by the subjects. The majority reported that the techniques were the right length (10 to 15 minutes), interesting, informative, useful, and anxiety-reducing. The three techniques apparently accounted for an increase of more than 20 percent in subjects' scores on tests about venereal disease, and the subjects perceived all three techniques as interesting and beneficial. The interview method proved significantly more effective than the other two techniques in raising the knowledge level. It was also the technique most favorably received by the subjects. As expected, those persons who entered the clinic with a low level of knowledge learned much more when exposed to an educational techniques than persons entering the clinic with a high level of knowledge. Reaction to the three methods did not differ significantly by the subjects' age or sex.
PMCID: PMC1435396  PMID: 48267
16.  Comparison of the Cerebrospinal Fluid (CSF) Toluidine Red Unheated Serum Test and the CSF Rapid Plasma Reagin Test with the CSF Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis among HIV-Negative Syphilis Patients in China 
Journal of Clinical Microbiology  2014;52(3):736-740.
In this study, we aimed to investigate the performance of nontreponemal antibody tests in cerebrospinal fluid (CSF) specimens from syphilis patients. From September 2009 to September 2012, CSF specimens were collected at the Shanghai Skin Disease Hospital in Shanghai, China, from 1,132 syphilis patients without HIV infection, including 154 with symptomatic and 56 with asymptomatic neurosyphilis. All of the CSF specimens underwent testing with a rapid plasma reagin (RPR) test, an RPR-V (commercial RPR antigen diluted 1:2 in 10% saline) test, the toluidine red unheated serum test (TRUST), and the Venereal Disease Research Laboratory (VDRL) test. Specificities, sensitivities, positive predictive values (PPVs), negative predictive values (NPVs), and kappa values were calculated to determine the performances of the tests. We compared results of the CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST among patients with symptomatic and asymptomatic neurosyphilis who had reactive CSF-Treponema pallidum particle agglutination (TPPA) test results. Overall, the CSF-VDRL test was reactive in 261 patients (23.1%). There were no cases in which the CSF-VDRL was nonreactive and CSF-RPR, CSF-RPR-V, or CSF-TRUST was reactive. Agreement between the results of CSF-TRUST and CSF-RPR was almost perfect (κ = 0.861), with substantial agreement between the results of CSF-RPR and CSF-RPR-V (κ = 0.740). The sensitivities of CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST were 81.4%, 76.2%, 79.5%, and 76.2%, respectively. Compared to CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST had comparable PPVs and NPVs. However, the specificity of CSF-VDRL (90.3%) was significantly lower than those of the other tests (92.7 to 93.4%). Therefore, CSF-RPR, CSF-RPR-V, and CSF-TRUST can be considered alternative tests for neurosyphilis diagnosis in HIV-negative populations, particularly when the CSF-VDRL is not available.
PMCID: PMC3957747  PMID: 24335955
17.  Evaluation of the usefulness of Treponema pallidum hemagglutination test in the diagnosis of syphilis in weak reactive Venereal Disease Research Laboratory sera 
Background and Objectives:
Biological false positive (BFP) reactivity by the Venereal Disease Research Laboratory (VDRL) test used for diagnosis of syphilis is a cause for concern. The use of the VDRL as a screening procedure is challenged by some studies. The aim of this study is to determine the prevalence of BFP reactions in different subject groups and to assess the usefulness of Treponema pallidum hemagglutination (TPHA) test in low titre VDRL reactive sera.
Materials and Methods:
A total of 5785 sera from sexually transmitted diseases (STD) clinic attendees, antenatal clinic attendees, husbands of antenatal cases, peripheral health centres attendees (representing community population) and from patients referred from different OPDs/wards were screened for BFP reactions by the VDRL test. Sera reactive in the VDRL test were confirmed by the TPHA test.
Out of 80 qualitative VDRL reactive sera, 68 had <1:8 titre on quantitation and TPHA was positive in 59 samples, indicating BFP reactivity in 0.2% in all the subject groups. BFP was nil in the community population. The male-to-female ratio of BFP reactions was 2:1. VDRL and TPHA positivity was highest (76%) in the age group of 20-29 years. The seroprevalence of syphilis varied from 0.4% to 3.5% in different patient groups.
The results of this study highlight that the TPHA positivity was high (86.8%) in sera with VDRL titre less than 1:8. Therefore, for the diagnosis of syphilis, it is recommended that a confirmatory test such as TPHA should be performed on all sera with a reactive VDRL regardless of its titre.
PMCID: PMC3505284  PMID: 23188934
Biological false positive; Syphilis; Treponema pallidum hemagglutination; Venereal disease research laboratory
18.  Role of the Venereal Disease Research Laboratory test in the detection of syphilis. 
Of 9733 consecutive serological samples received by Portsmouth and Southampton Public Health Laboratories (PHL) and tested for syphilis, 190 (140 from men and 50 from women) gave positive results. Thirty new cases of syphilis were identified. Most sera were tested initially by both a specific antibody test (the Treponema pallidum haemaglutination (TPHA) test) and a cardiolipin test (the Venereal Disease Research Laboratory (VDRL) test). Among the 14 patients whose sera gave VDRL-positive but TPHA-negative results, 12 sera gave false-positive results. The sera of 90 patients gave TPHA-positive but VDRL-negative results; sera from only seven of these patients gave false-positive results. The VDRL test is very unlikely to identify a new case of syphilis where a TPHA test has failed to do so. The results of the survey suggest that the VDRL test should be withdrawn from initial testing for syphilis except where early primary disease is suspected.
PMCID: PMC1046122  PMID: 6337682
19.  Study of STDs in patients attending venereal disease clinics in Khartoum, Sudan. 
During the period October 1976 to January 1978, 290 patients were examined for sexually transmitted diseases in three venereal clinics in Khartoum Providence. Clinical and laboratory findings showed that nongonococcal urethritis was the commonest STD in men (35.1%), with gonorrhoea the second commonest (25.9%). Most of the patients with STDs were aged between 20 and 30 years. Of the infected men, 49.3% had acquired their infections from prostitutes.
PMCID: PMC1045669  PMID: 583132
20.  Comparison of a new rapid plasma reagin card test with the standard rapid plasma reagin 18-mm circle card test and the venereal disease research laboratory slide test for serodiagnosis of syphilis. 
Journal of Clinical Microbiology  1983;17(2):249-254.
The rapid plasma reagin (RPR) card test manufactured by Beckman Instruments, Inc., was compared, qualitatively and quantitatively, with the Venereal Disease Research Laboratory (VDRL) slide test and the standard RPR 18-mm circle card tests for the serodiagnosis of syphilis. Sera from 638 individuals were used in this study. Two pilot lots and two production lots of antigen were submitted by Beckman Instruments, Inc., for evaluation. Qualitative agreement among the three RPR card tests was 98.1%; between the Beckman RPR card and the VDRL slide tests, 95.0%; and between the reference RPR card and the VDRL slide tests, 95.5%. The Beckman RPR card test was 95.3% specific, whereas the specificities of the reference RPR card and the VDRL slide tests were 98.8% and 96.1%, respectively. Sensitivities of the three nontreponemal tests were: Beckman RPR card test production lots, 94.7%; reference RPR card test, 96.8%; and VDRL slide test, 90.6%. Quantitative agreement +/- 1 dilution among the three RPR card tests was 93.0%, whereas quantitative agreement was approximately 40% when both RPR card tests were compared with the VDRL slide test. We found the Beckman RPR card test comparable to the standard RPR card tests. Therefore, the decision of which test to use for the serodiagnosis of syphilis is at the discretion of the user.
PMCID: PMC272616  PMID: 6833479
21.  The Rapid Plasma Reagin Test Cannot Replace the Venereal Disease Research Laboratory Test for Neurosyphilis Diagnosis 
Sexually Transmitted Diseases  2012;39(6):453-457.
The cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test is a mainstay for neurosyphilis diagnosis, but it lacks diagnostic sensitivity and is logistically complicated. The Rapid Plasma Reagin (RPR) test is easier to perform, but its appropriateness for use on CSF is controversial.
RPR reactivity was determined for CSF from 149 individuals with syphilis using two methods. The CSF-RPR was performed according to the method for serum. The CSF RPR-V was performed using the method recommended for the CSF-VDRL. Laboratory defined neurosyphilis included reactive CSF-Fluorescent Treponemal Antibody Absorption test and CSF white blood cells > 20/ul. Symptomatic neurosyphilis was defined as vision loss or hearing loss.
CSF-VDRL was reactive in 45 (30.2%) patients. Of these, 29 (64.4%) were CSF-RPR reactive and 37 (82.2%) were CSF-RPR-V reactive. There were no instances where the CSF VDRL was nonreactive but the CSF-RPR or CSF-RPR-V was reactive. Among the 28 samples that were reactive in all three tests, CSF-VDRL titers (median [IQR], 1:4 [1:4-1:16]) were significantly higher than CSF-RPR (1:2 [1:1-1:4], p=0.0002) and CSF-RPR-V titers (1:4 [1:2-60 1:8], p=0.01). The CSF RPR and the CSF-RPR-V tests had lower sensitivities than the CSF VDRL: 56.4% and 59.0% vs. 71.8% for laboratory-diagnosed neurosyphilis and 51.5% and 57.6% vs. 66.7% for symptomatic neurosyphilis.
Compared to the CSF-VDRL, the CSF-RPR has a high false-negative rate, thus not improving upon this known limitation of the CSF-VDRL for neurosyphilis diagnosis. Adapting the RPR procedure to mimic the CSF-VDRL decreased, but did not eliminate, the number of false negatives, and did not avoid all the logistical complications of the CSF VDRL.
PMCID: PMC3355326  PMID: 22592831
syphilis; neurosyphilis; diagnosis; Venereal Disease Research Laboratory test; Rapid Plasma Reagin test; cerebrospinal fluid
22.  Social factors in homosexually acquired venereal disease. Comparison between Sweden and Australia. 
The prevalence of venereal disease was studied in homosexuals in two countries, Sweden and Australia, which are similar apart from their different legal and social attitudes to homosexuality. Social attitudes were not generally associated with differences in the numbers of infections and reinfections in homosexual men with sexually transmitted diseases. Using a non-clinical sample there was some evidence that sexually transmitted diseases in homosexuals are grossly overestimated if cases rather than individuals are used as an index. Furthermore, the incidence of syphilis was related to the numbers of partners and the latency of symptoms in both societies.
PMCID: PMC1046063  PMID: 6896667
23.  Whole-Blood Hemagglutination Inhibition Test for Venereal Disease Research Laboratory (VDRL) Antibodies 
Journal of Clinical Microbiology  2000;38(9):3413-3414.
Nontreponemal antibody tests such as the Venereal Disease Research Laboratory (VDRL) test are carried out on serum and widely used as screening tests for syphilis. The aim of the present study was to develop a screening test for syphilis making use of whole blood and VDRL liposomes. Antibody to human red blood cells was conjugated to VDRL liposomes and reacted with a diluted sample of patient whole blood. A total of 951 samples were tested by the new test and the VDRL tube test. All 49 VDRL samples positive by the VDRL test showed inhibition of hemagglutination in the whole-blood test (sensitivity, 100%). Of 902 samples with negative results by the VDRL test, 901 caused hemagglutination when tested with the liposomes (specificity, 99.9%). The hemagglutination inhibition method tests for syphilis in a simple one-step procedure in which whole blood is added to a tube containing liposomes. The new test has potential for point-of-care testing in developing countries.
PMCID: PMC87396  PMID: 10970393
24.  Intermittent Preventive Treatment of Malaria in Pregnancy with Mefloquine in HIV-Negative Women: A Multicentre Randomized Controlled Trial 
PLoS Medicine  2014;11(9):e1001733.
Clara Menéndez and colleagues conducted an open-label randomized controlled trial in HIV-negative pregnant women in Benin, Gabon, Mozambique, and Tanzania to evaluate the safety and efficacy of mefloquine compared to sulfadoxine-pyrimethamine for intermittent preventative therapy for malaria.
Please see later in the article for the Editors' Summary
Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended by WHO to prevent malaria in African pregnant women. The spread of SP parasite resistance has raised concerns regarding long-term use for IPT. Mefloquine (MQ) is the most promising of available alternatives to SP based on safety profile, long half-life, and high efficacy in Africa. We evaluated the safety and efficacy of MQ for IPTp compared to those of SP in HIV-negative women.
Methods and Findings
A total of 4,749 pregnant women were enrolled in an open-label randomized clinical trial conducted in Benin, Gabon, Mozambique, and Tanzania comparing two-dose MQ or SP for IPTp and MQ tolerability of two different regimens. The study arms were: (1) SP, (2) single dose MQ (15 mg/kg), and (3) split-dose MQ in the context of long lasting insecticide treated nets. There was no difference on low birth weight prevalence (primary study outcome) between groups (360/2,778 [13.0%]) for MQ group and 177/1,398 (12.7%) for SP group; risk ratio [RR], 1.02 (95% CI 0.86–1.22; p = 0.80 in the ITT analysis). Women receiving MQ had reduced risks of parasitemia (63/1,372 [4.6%] in the SP group and 88/2,737 [3.2%] in the MQ group; RR, 0.70 [95% CI 0.51–0.96]; p = 0.03) and anemia at delivery (609/1,380 [44.1%] in the SP group and 1,110/2743 [40.5%] in the MQ group; RR, 0.92 [95% CI 0.85–0.99]; p = 0.03), and reduced incidence of clinical malaria (96/551.8 malaria episodes person/year [PYAR] in the SP group and 130/1,103.2 episodes PYAR in the MQ group; RR, 0.67 [95% CI 0.52–0.88]; p = 0.004) and all-cause outpatient attendances during pregnancy (850/557.8 outpatients visits PYAR in the SP group and 1,480/1,110.1 visits PYAR in the MQ group; RR, 0.86 [0.78–0.95]; p = 0.003). There were no differences in the prevalence of placental infection and adverse pregnancy outcomes between groups. Tolerability was poorer in the two MQ groups compared to SP. The most frequently reported related adverse events were dizziness (ranging from 33.9% to 35.5% after dose 1; and 16.0% to 20.8% after dose 2) and vomiting (30.2% to 31.7%, after dose 1 and 15.3% to 17.4% after dose 2) with similar proportions in the full and split MQ arms. The open-label design is a limitation of the study that affects mainly the safety assessment.
Women taking MQ IPTp (15 mg/kg) in the context of long lasting insecticide treated nets had similar prevalence rates of low birth weight as those taking SP IPTp. MQ recipients had less clinical malaria than SP recipients, and the pregnancy outcomes and safety profile were similar. MQ had poorer tolerability even when splitting the dose over two days. These results do not support a change in the current IPTp policy.
Trial registration NCT 00811421; Pan African Clinical Trials Registry PACTR 2010020001429343
Please see later in the article for the Editors' Summary
Editors' Summary
Half the world's population is at risk of malaria, a mosquito-borne parasitic disease that kills about 600,000 people every year. Most of these deaths occur among young children in sub-Saharan Africa but pregnant women and their unborn children living in Africa are also very vulnerable to malaria. Infection with malaria during pregnancy can cause severe maternal anemia (reduced red blood cell numbers), stillbirths, and pre-term and low-birthweight babies, and is responsible for the deaths of many African babies and women. To prevent this loss of life, the World Health Organization (WHO) recommends a three-pronged approach—the delivery to pregnant women of the antimalarial drug sulfadoxine-pyrimethamine (SP) at each scheduled antenatal care visit given at least one month apart (intermittent preventive treatment in pregnancy; IPTp), the use of insecticide treated bed nets to protect pregnant women from the bites of infected mosquitoes, and effective case management of pregnant women with malarial illness.
Why Was This Study Done?
IPTp with SP reduces the delivery of low-birth-weight babies and neonatal deaths but malaria parasites are becoming resistant to SP. Thus, other antimalarial drugs need to be evaluated for use in IPTp. Suitable drugs need to remain in the body for a long time to maximize their prophylactic (preventative) effect, they need to be given as a single dose at antenatal clinic visits to ensure compliance, and they must not harm the unborn child. In this open-label, randomized controlled trial (RCT), the researchers compare the efficacy and safety of IPTp with SP and mefloquine (MQ, an antimalarial drug that matches these criteria) in HIV-negative women living in Africa. The study also compares the tolerability of two MQ regimens. RCTs compare outcomes in groups of people chosen to receive different interventions through the play of chance; in open-label RCTs, both the researchers and the study participants know which treatment is being administered. IPTp with SP is only recommended for HIV-negative women because SP interacts with cotrimoxazole, which is routinely given to HIV-positive individuals to prevent infections.
What Did the Researchers Do and Find?
The researchers assigned 4,749 pregnant women in Benin, Gabon, Mozambique, and Tanzania to one of three study groups. Participants in the SP and MQ groups received two doses of SP or MQ, respectively, administered at least one month apart. Participants in the split-dose MQ group received each MQ dose as half doses given on consecutive days. The prevalence of low-birth-weight deliveries (the study's primary outcome; the prevalence of a condition is the proportion of a population with that condition) was similar in the SP group and in the combined MQ groups. However, compared to women who received SP, women who received MQ had a lower risk of parasitemia (parasites in the blood), a lower risk of anemia at delivery, fewer episodes of clinical malaria, and fewer outpatient attendances. The prevalence of placental infection with malaria parasites and of adverse pregnancy outcomes such as stillbirth was similar in all the study groups. Finally, the tolerability of IPTp was poorer in the two MQ intervention groups than in the SP group, but similar proportions of adverse events (mainly dizziness and vomiting) were reported for the two MQ dosing regimens.
What Do These Findings Mean?
These findings indicate that HIV-negative African women taking MQ for IPTp had a similar risk of a low-birth-weight delivery (the study's primary outcome) and lower risk of malaria illness during pregnancy than women taking SP for IPTp. Because the study did not have a no-IPTp arm (for ethical reasons), these findings provide no information about the efficacy or safety or either MQ or SP per se; these findings only indicate that MQ is no more efficacious than SP in the prevention of low-birth-weight babies. Moreover, because the study was open-label, the accuracy of the findings related to the tolerability and safety of MQ compared to SP may be limited because of biases in the assessment of safety outcomes. Given that the MQ dose used here for IPTp was associated with poorer tolerability than that of SP, these findings do not support the use of MQ instead of SP for IPTp.
Additional Information
Please access these websites via the online version of this summary at
A related PLOS Medicine Research Article by Raquel González and colleagues examines IPTp-MQ in HIV-infected women receiving cotrimoxazole prophylaxis
This study is further discussed in a PLOS Medicine Perspective by Richard Steketee.
Information is available from the World Health Organization on malaria (in several languages) and on malaria in pregnancy; information on IPTp and the updated WHO policy recommendation on IPTp with SP are available; the 2013 World Malaria Report provides details of the current global malaria situation
The US Centers for Disease Control and Prevention also provides information on malaria; a personal story about malaria in pregnancy is available
Information is available from the Roll Back Malaria Partnership on all aspects of global malaria control, including information on malaria in pregnancy
The Malaria in Pregnancy Consortium is undertaking research into the prevention and treatment of malaria in pregnancy
MedlinePlus provides links to additional information on malaria (in English and Spanish)
PMCID: PMC4172436  PMID: 25247709
25.  Prevalence and significance of Mycoplasma hominis and Ureaplasma urealyticum in the urines of a non-venereal disease population. 
Epidemiology and Infection  1987;98(3):353-359.
Ureaplasma urealyticum organisms (ureaplasmas) and Mycoplasma hominis organisms (mycoplasmas) were sought in mid-stream urines collected from 200 men and 200 women attending hospital with conditions of a non-venereal nature. In addition, the urines from 100 male and 100 female healthy volunteers were examined. Overall, ureaplasmas were isolated four times more often than mycoplasmas. In individuals less than 50 years of age, the organisms were found in about 20% of men and about 40% of women. In individuals 50 years or older, they were found about one-third to one-half as frequently. Centrifugation of urine and examination of the resuspended deposit did not increase the isolation rates. In men, the numbers of organisms in the urine were usually small (less than or equal to 10(3) c.c.u./ml) with less than tenfold more in the urine of women. The occurrence of 51- greater than 1000 leucocytes per mm3 in some of the urines was not associated with either the presence or an increased number of ureaplasmas/mycoplasmas, whereas they were associated with the presence of 10(5) or more bacteria/ml. The significance of these findings in the context of defining the role of ureaplasmas/mycoplasmas in genital-tract disease is discussed.
PMCID: PMC2235370  PMID: 3595751

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