Abstract
Sexually transmitted infections (STI) continue to spread, and show no international boundaries. Diseases such as gonorrhea and syphilis, which we thought were under control in Canadian populations, have increased in incidence. Sexually transmitted or associated syndromes such as cervicitis, enteric infections, epididymitis, genital ulcers, sexually related hepatitis, ophthalmia neonatorum, pelvic inflammatory disease, prostatitis and vulvovaginitis present a challenge for the physician to identify the microbial cause, treat the patient and manage contacts. During the past 10 years, new technologies developed for the diagnosis of STIs have provided a clearer understanding of the real accuracy of traditional tests for the diagnosis of infections caused byChlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex viruses, hepatitis B virus, human papillomaviruses, HIV,Haemophilus ducreyi, Trichomonas vaginalisand mycoplasmas. This has presented a major challenge to the diagnostic laboratory, namely, selecting the most sensitive and specific test matched with the most appropriate specimens to provide meaningful and timely results to facilitate optimal patient care.
Highlights
Most Canadian laboratories should be able to provide diagnostic services to determine the etiology of syndromes such as cervicitis, urethritis, pelvic inflammatory disease, prostatitis, genital ulcers, sexually transmitted infection (STI)related enteric infections, epididymitis, hepatitis, ophthalmia neonatorum, vulvovaginitis and vaginosis
The clinical diagnosis centres on the presence of endocervical yellow or green mucopus. Such a finding in high-risk patients is reasonably predictive of the presence of Chlamydia trachomatis or Neisseria gonorrhoeae and should result in syndromic treatment that is active against both pathogens
ENTERIC INFECTIONS Anal intercourse is the main mode of transmission of pathogens causing proctitis, whereas anal/oral activities promote proctocolitis, colitis and enteritis
Summary
Most Canadian laboratories should be able to provide diagnostic services to determine the etiology of syndromes such as cervicitis, urethritis, pelvic inflammatory disease, prostatitis, genital ulcers, sexually transmitted infection (STI)related enteric infections, epididymitis, hepatitis, ophthalmia neonatorum, vulvovaginitis and vaginosis. Such a finding in high-risk patients is reasonably predictive of the presence of Chlamydia trachomatis or Neisseria gonorrhoeae and should result in syndromic treatment that is active against both pathogens. C trachomatis and N gonorrhoeae are the most important causes of cervicitis and are frequently present alone or together, without symptoms, signs or a PMNL response.
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