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Letters to the Editor Sex Transm Inf 2000;76:407–414 407 A E MURRAY is not that high pro rata, possibly because Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from Department of Medical Microbiology cultural factors prohibit sex outside LETTERS TO Correspondence to: Dr Bhattacharjee marriage. Quinn et al3 have shown recently that viral load is the chief predictor of the risk of THE EDITOR 1 Sweet RL. Role of bacterial vaginosis in pelvic inflammatory disease. Clin Infect Dis heterosexual transmission of HIV-1, and that 1995;20(suppl 2):s271–5. transmission is rare among people with levels 2 Hay PE, Lamont, Taylor-Robinson D, et al. of less than 1500 copies of HIV-1 RNA per Abnormal bacterial colonisation of genital tract and preterm delivery and late miscarriage. ml. A study on the possible association of BMJ 1994;308:295–5. It may be that HAART (highly active 3 Korn AP, Bolan G, Padian, et al. Plasma cell antiretroviral therapy) for HIV infected peo- dysfunctional uterine bleeding with endometritis in women with bacterial ple has caused transmission to be low in the bacterial vaginosis, mycoplasma, vaginosis. Obstet Gynaecol 1995;85:387– 90. United Kingdom but, as Cohen says, such a ureaplasma, and Gardnerella vaginalis 4 Keane FFA,Thomas B, Renton A, et al. Investi- theory has not been proved.4 gation into possible role of bacterial vaginosis The viral subtype dominant in parts of EDITOR,—A number of studies in the recent in non-gonococcal urethritis. Genitourin Med Africa (clade C), has unique properties that years have shown that bacterial vaginosis or 1997;73:373–7. favour sexual transmission.5 Other factors its associated micro-organisms mycoplasma/ 5 Bhattacharjee B, Sunderland D, Herrington S, et al. Scanning electron microscopy of endo- that make Africans more susceptible to HIV ureaplasma may be associated with various metrial biopsy of patients with bacterial than those who live in more developed obstetric and gynaecological complications vaginosis shows morphology resemblimg countries include lack of host factors that such as pelvic inflammatory disease and mycoplasma/ureaplasma. Sex Transm Inf 1999; 75:202–10. reduce infection risk; the plasma HIV-1 infertility,1 premature rupture of membranes and preterm labour,2 plasma cell RNA level in seropositive people being Accepted for publication 7 June 2000 endometritis,3 non-specific urethritis in male higher in sub-Saharan Africans; the lack of partners,4 and in our previous study5 we mutations in the gene for chemokine showed colonisation of the endometrium by receptor 5; circumcision status, with most Ethnicity and country of acquisition of men in Africa being uncircumcised; and the mycoplasma and ureaplasma in patients with HIV in the current Leicester bacterial vaginosis high prevalence of ulcerative sexually genitourinary medicine clinic cohort 4 The purpose of this study was to see if transmitted diseases. Some of these factors will operate for Asian patients born in there is any association between dysfunc- EDITOR,—We have surveyed the regular HIV tional uterine bleeding (DUB) and myco- Africa. infected attenders in the Leicester genito- Thus, ethnicity and country of acquisi- plasma, ureaplasma, and/or bacterial vagino- urinary medicine (GUM) HIV cohort; there sis. tion of HIV in Leicester as elsewhere, are currently 60 men and 16 women. Twenty is a reflection of interwoven, genetic, Ten patients, all with dysfunctional uterine five per cent are black African and 13% are of bleeding admitted for abdominal hysterec- environmental and behavioural, political, Indian/Pakistani/Bangladeshi stock, while and geographical factors.4 Therefore, tomy, were recruited for the study. Patients 62% are white. This amounts to 19 of were between 38 and 48 years (mean age 44) we cannot just examine nationality in 8258 black Africans in the Leicestershire isolation when considering HIV epidemiol- and all except one were parous. Appropriate total county population (which includes ethics committee approval and informed ogy. Travellers from Britain to Thailand, the Leicester central district) being HIV positive. Philippines, India, and Africa especially consents were taken. Forty seven of 771 181 white people and should be forewarned of the risks of sex and A detailed history was taken, particularly 10 of 77 537 Asians in the Leicestershire healthcare needle exposure and/or blood obstetrics and gynaecological, and any his- total county population were also HIV transfusions in all travel medicine consulta- tory of bacterial vaginosis or troublesome positive (Leicester City Council, from 1991 tions. vaginal discharge. A preoperative high vaginal census figures, 2000, personal communica- swab for microscopic diagnosis of bacterial tion). DEREKTPEVANS vaginosis was taken. At operation, the en- VINCENT C RILEY For acquisition of HIV related to ethnicity, http://sti.bmj.com/ dometrial cavity was opened by splitting the the results are as displayed in table 1. PETER G FISK anterior wall of the uterus and an endome- In 1997, of those with heterosexually Department of Genito-urinary Medicine, Leicester trial swab and biopsy were taken for microbial transmitted HIV1 in the United Kingdom, Royal Infirmary, Leicester LE1 5WW culture and scanning electron microscopy for 3.3% were black Caribbeans, 49% were black Correspondence to: Dr Evans mycoplasma, ureaplasma, and Gardnerella African, with 33% being white, and 2.3% vaginalis. were Asian. None of the patient had any history of 1 Communicable Disease Report. 1999;9(No 22): In 1999, the Communicable Disease 200. bacterial vaginosis, troublesome vaginal 2 Report stated that, of female HIV infected 2 Communicable Disease Report. 1999;9(No 26): discharge, or any obstetric or gynaeco- people in England and Wales, 32% were 236. on September 24, 2021 by guest. Protected copyright. logical complications. Microscopic exam- white people and 49.5% were black Africans, 3 Quinn TC, Wawer MJ, Sewankambo N, et al. ination of the high vaginal swabs were and 2.7% were black Caribbeans, and 1.3% Viral load and heterosexual transmission of all normal except one with possible bac- human immunodeficiency virus type I. N Engl were south Asians. JMed2000;342:921–9. terial vaginosis. Microbial culture and Compared with the latter England and 4 Cohen MS. Preventing sexual transmission of scanning electron microscopy showed no Wales figures, Leicester appears to have a HIV—new idea from sub-Saharan Africa. N mycoplasma, ureaplasma, or Gardnerella Engl J Med 2000;342:970–2. moderate underrepresentation of black 5 Ping LH, Nelson JA, HoVman IH. Charac- vaginalis. Africans with HIV, and a moderate terisation of V3 sequence heterogenicity in Although there is definite association of overrepresentation of Asians in its cohort. sub-type C human immunodeficiency virus colonisation of the endometrium by This latter figure is to be expected because type I isolates from Malawi under- mycoplasma and ureaplasma in patients with representation of X4 variants. J Virol 1999;73: Leicester’s Asian population is 23.7% of the 6271–81. bacterial vaginosis, as we showed in our total population of the city (Leicester City previous study, this study did not show Council, 1991 census figures, 2000, personal any association of DUB with bacterial communication). However, the Asian figure Accepted for publication 14 June 2000 vaginosis, Gardnerella vaginalis, mycoplasma, or ureaplasma. Any significant association of DUB and bacterial vaginosis appears un- likely, as the age group of the majority of Table 1 Table of ethnicity in relation to country of acquisition of HIV,as found in the Leicester genitourinary medicine clinic HIV cohort, and assessed in April 2000 patients with DUB, as in this study, is also diVerent from the age group for bacterial vaginosis. Ethnicity Country of acquisition Asian African White Total (%) B BHATTACHARJEE A K GHOSH Asia 2 (3%) 2 (3%) 2 (3%)* 9% Department of Genitourinary Medicine, Arrowe Park Africa 2 (3%) 15 (25%) 2 (3%) 31% UK 2 (3%) 2 (3%) 43 (54%) 60% Hospital, Upton, Wirral, Merseyside, L49 5PE Total 9% 31% 60% 100% A MURRAY Department of Obstetrics and Gynaecology *Thailand. www.sextransinf.com 408 Letters, Notices, Correction, Current publications Detection of 14-3-3 brain protein in protein in CSF is not useful for diagnosis of Hepatitis B vaccination in a high risk Sex Transm Infect: first published as 10.1136/sti.76.5.408 on 1 October 2000. Downloaded from cerebrospinal fluid of HIV infected HADC. Detectable 14-3-3 protein has MSM population: the need for vaccine patients previously been reported in a non-HIV education infected patient with CNS lymphoma,3 so EDITOR,—The 14-3-3 proteins are a group of this observation in our patient is not unique, EDITOR,—Estimates of the prevalence of highly conserved proteins involved in although brain necrosis from coexisting cer- hepatitis B virus (HBV) markers among men intracellular signalling. Detection of 14-3-3 ebral toxoplasmosis provides an alternative who have sex with men (MSM) range from brain protein has been described in cere- explanation. Of the two patients with ex- 5% to 81%, and the prevalence of HBV sur- brospinal fluid (CSF) of patients with traneural lymphoma and detectable 14-3-3 face antigen varies from 1% to 11%.12 transmissible spongiform encephalopathies protein in CSF, one had EBV DNA in CSF Despite a safe and eVective vaccine against including both sporadic and variant and so was at high risk of developing cerebral HBV, sexually active MSM are not vacci- Creutzfeldt–Jakob disease.12 False positive lymphoma. This possibility could not be nated adequately.2–5 Few empirical data de- results have been reported in conditions confirmed as necropsy was not performed. scribe the factors associated with HBV vacci- producing (sub)acute neuronal destruction, In neither of the latter two patients was there nation among MSM. We conducted a study including herpes simplex encephalitis, ischae- a CSF pleocytosis, so contamination by to identify correlates of HBV vaccination mic stroke, multi-infarct dementia, and para- 14-3-3 protein derived from peripheral among MSM that could inform future inter- neoplastic syndromes.1–3 We postulated that blood leucocytes is unlikely.
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