Comparing first-void urine specimens, self-collected vaginal swabs, and endocervical specimens to detect Chlamydia trachomatis and Neisseria gonorrhoeae by a nucleic acid amplification test.
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We set out to determine the prevalences of Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction as well as to determine the prevalence of Trichomonas vaginalis by culture in a large and diverse national sample of non-health-care-seeking young women entering the military; we also sought to compare the abilities of three different techniques of collecting specimens (first-void urine, self-collected vaginal swab, and clinician-collected endocervical swab) to identify a positive specimen. A cross-sectional sample of young women was voluntarily recruited; as a part of their routine entry pelvic examination visit, they completed a self-administered reproductive health questionnaire and provided first-void urine (used to detect C. trachomatis and N. gonorrhoeae) and self-collected vaginal swabs (used to detect C. trachomatis, N. gonorrhoeae, and T. vaginalis). The number of positive tests divided by the number of sexually active women screened by each sampling method determined the rates of prevalence. The rate of infection with any of the three sexually transmitted diseases (STDs) tested was 14.1%. The total positive rates for each STD (identified by >/=1 specimen) were the following: for C. trachomatis, 11.6%; N. gonorrhoeae, 2.4%; and T. vaginalis, 1.7%. The proportions of positives identified by specimen type were, for C. trachomatis and N. gonorrhoeae, respectively, endocervix, 65 and 40%; urine, 72 and 24%; and vagina, 81 and 72%. The proportions of positives when specimen results were combined were, for C. trachomatis and N. gonorrhoeae, respectively, cervix plus urine, 86 and 49%; cervix plus vagina, 91 and 93%; and vagina plus urine, 94 and 79%. We concluded that STDs were epidemic in this population. Self-collected vaginal swabs identified the highest number of positive test results among single specimens, with the combined cervix-vagina results identifying the highest number of positive results. Self-collected vaginal swab collections are a feasible alternative to cervical specimen collections in this population, and the use of multiple types of specimens increases the positive yield markedly. (+info)
A COMPARATIVE STUDY OF THE TRIPHENYLTETRAZOLIUM CHLORIDE (UROSCREEN) TEST AND CONVENTIONAL METHODS FOR THE DETECTION OF BACTERIURIA.
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Acute urinary tract infection may be preceded by and active pyelonephritis may be associated with asymptomatic bacteriuria. Treatment of asymptomatic bacteriuria may prevent or arrest active, chronic pyelonephritis and its sequelae. Consequently, there is a need for a reliable and simple screening procedure to detect asymptomatic bacteriuria in large segments of the population.The reliability and practicability of tests advocated for the detection of bacteriuria, including the new chemical triphenyltetrazolium chloride (T.T.C.) (Uroscreen) test, were evaluated. Reliability was assessed by correlating results of these tests with bacterial counts of tested urines. Significant bacteriuria is defined as the presence of 100,000 or more organisms per ml. of urine.The T.T.C. (Uroscreen) test was positive in 92.5% of cases of bacteriuria; there were 7.5% false-negative and 2.8% false-positive results. Bacteria on Gram-stained smear were found in 95.5% of the cases of bacteriuria and in 14.6% of those with non-infected urine; pyuria (more than three leukocytes per high-power field), in 60% of those with bacteriuria and in 15.9% of those with presumably non-infected urine. Bacteria were conspicuous in the urinary sediment in 91.1% of cases of bacteriuria and in 3.7% of presumably non-infected urines.The T.T.C. (Uroscreen) test fulfilled the criteria for a reliable and simple screening procedure. It should be used concomitantly with other screening tests when the urine is examined routinely. (+info)
THE DETECTION OF SIGNIFICANT BACTERIURIA: AN ASSESSMENT OF THE TRIPHENYLTETRAZOLIUM CHLORIDE REDUCTION TEST.
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The degree to which quantitative urine cultures and the triphenyltetrazolium chloride (TTC) reduction test can be correlated can be directly related to the species of organism involved, the actual level of bacterial population in the urine and the presence of antibiotics. The influence of these various factors is discussed and it is concluded that, depending upon the group of patients involved, the TTC test will detect 70-90% of cases of significant bacteriuria. The TTC test would appear to be a useful screening procedure in the surveillance of large outpatient populations and in the detection of bacteriuria during pregnancy, considering the difficulty of applying the technique of complete quantitative culture to these groups. (+info)
In vitro activity of spectinomycin against recent urinary tract isolates.
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The susceptibilities to spectinomycin of 303 recent urinary tract isolates were determined and compared to the susceptibilities of those strains to ampicillin, tetracycline, and gentamicin. Based on minimal inhibitory concentrations, 84% of Escherichia coli, Klebsiella, and Enterobacter, 31% of other Enterobacteriaceae, 7% of Staphylococcus aureus and Streptococcus (including enterococci), and 0% of Pseudomonas aeruginosa were susceptible to concentrations of spectinomycin that are easily surpassed in serum (+info)
Bacterial biofilm formation in the urinary bladder of spinal cord injured patients.
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Ten spinal cord injured patients aged 8 to 55 years (mean 32) were followed for up to 2 months after admission to a rehabilitation setting from an acute care hospital. Urinary fluid and bladder epithelial cells were collected weekly by intermittent catheterization and examined for bacterial colonization. Six patients had no history of urinary tract infection upon admission, likely due to the antimicrobial coverage given during acute care. All the patients subsequently became colonized with uropathogens at some time during the study period. Bacterial biofilms were found in 73% of the samples (73% Gram negative organisms, 27% Gram positive), with mean pathogenic adhesion counts of 29 organisms per bladder cell. In 16% of cases, bladder biofilms were found when urine culture was negative. Bacterial biofilms were also evident during antimicrobial therapy in 10 of 12 samples tested and urine cultures showed breakthrough infections in 50% of cases. Two asymptomatic patients were colonized with Klebsiella pneumoniae and Pseudomonas aeruginosa and were dismissed without requiring therapy. Clearly, bacterial biofilms can exist on bladder epithelia, without being detected in urine samples and without giving rise to symptoms. The extent to which they occur and damage the host remains to be determined, as does the answer to the question, should these patients be treated? (+info)
Molecular epidemiology of asymptomatic bacteriuria in the elderly.
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OBJECTIVES: to determine the incidence and the dynamics of asymptomatic bacteriuria in ambulatory nursing home residents, and to characterise bacteria according to their phenotype and genotype. DESIGN: an 18 months prospective longitudinal study. SUBJECTS: 42 nursing home residents (31 female, 11 males) without indwelling catheters. METHODS: urine was sampled every 3 months. Antibiograms, biotyping and ribotyping were performed. RESULTS: the cumulative percent of infection for females and males was 75% and 27% respectively. Osteoporosis was associated with bacteriuria. Ribotypes of consecutive Escherichia coli isolates indicated that each patient harboured a different strain. CONCLUSIONS: asymptomatic bacteriuria in the elderly is a dynamic and transient phenomenon. Osteoporosis is common among this population. Ribotyping is a powerful tool in the elucidation of the epidemiology of this bacteriuria. (+info)
Evaluation of the IRIS 939 UDx flow microscope as a screening system for urinary tract infection.
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AIMS: To evaluate the IRIS flow microscope for the examination of urine specimens and to compare its performance with that of manual methods; in addition, to assess its usefulness as a screening system for the detection of significant bacteriuria in a routine clinical laboratory. METHODS: The IRIS system was compared with manual quantitative microscopy for the detection of formed elements and with a variety of culture methods to detect urinary tract infection. RESULTS: The IRIS had a higher sensitivity for the detection of clinically significant formed elements than did manual methods, and using a combination of bacterial and white cell counts produced a sensitivity and specificity of 94.9% and 54.4%, respectively, for predicting positive significant growth, with a 98.5% predictive value for a negative result. Approximately 50% of specimens could be reported as negative on the day of receipt using the screening algorithm. CONCLUSIONS: The sensitivity and specificity of the IRIS is equivalent to that of other automated screening systems and would remove the need for manual microscopy for most specimens. The system was easy to operate and is a useful addition to the methods currently available for the examination of urine specimens. (+info)
Generalized symptoms in adult women with acute uncomplicated lower urinary tract infection: an observational study.
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Several generalized symptoms in acute lower urinary tract infection (UTI) have previously been identified in a qualitative study. The aim of the present study was to explore the frequency and distribution of generalized symptoms in adult women with acute uncomplicated lower UTI in general practice. A total of 398 women aged 18-87 years consulting for acute dysuria and/or urinary frequency were enrolled in an observational study and filled in a structured symptom questionnaire. A total of 252 of these had bacteriuria (>or= 10(5) uropathogens/mL). Generalized symptoms occurred frequently: feeling unwell 68%, week and tired 67%, irritable and restless 53%, and hot 52%. Other symptoms were voiding-related symptoms (dysuria 90%, urinary frequency 93%, urge 80%) and local, constant symptoms (pressure in the genital area 73%, suprapubic discomfort 68%). Factor analysis revealed 2 main components of cystitic symptoms: "feeling out of sorts" (generalized symptoms) predominantly found among women aged 50-65 years, and the "distressed bladder" (voiding-related and local, constant symptoms) most often in the group aged 18-35 years. No differences in frequency or degree of symptoms were related to the presence of bacteriuria. In conclusion, generalized symptoms of feeling out of sorts are frequent in adult women with acute uncomplicated lower UTI, and equally frequent in all ages whether the patient shows bacteriuria or not. (+info)