Genital Chlamydial Infection a 'New' Infection in Britain, Or an 'Old' And

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Genital Chlamydial Infection a 'New' Infection in Britain, Or an 'Old' And

Chlamydia: A Disease Without a History Michael Worboys Chlamydia: Most commonly reported STI in UK Incidence of STIs, 1998-2008 140000 120000 New diagnoses 100000 Syphilis (primary and 80000 secondary) Gonorrhea 60000 (uncomplicated) New casesNew Chlamydia 40000 (uncomplicated) 20000 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year Venereal Diseases 1860-1930 Venereal Disease/s – syphilis and gonorrhoea 1940s Syphilis, gonorrhoea and ‘Other conditions’ “balanoposthitis, lymphogranuloma venereum (LGV), non-gonococcal urethritis (NGU), thrush, trichomoniasis, ulcus actum vulvae, vaginitis, vulvovaginitis, and warts.” (McLachlan, 1944) Venereal Diseases Venereologists, 1940s War – invalidism, tropics, Special clinics Bacteriologically- and Laboratory-oriented: Wassermann Reaction Salvarsan, Sulphonamides Antibiotics Venereal Diseases 1948 WHO Expert Committee on Venereal Diseases First session, 12-16 January 1948 Venereal Diseases 1948 WHO Expert Committee on Venereal Diseases First session, 12-16 January 1948 Venereal Diseases 1948 WHO Expert Committee on Venereal Diseases 1950 A.H. Harkness, Non-gonococcal urethritis: including the genital manifestations of local and systemic diseases and infestations of the urinary tract with protozoa, metazoa and fungi. 1951 NGU first recorded, UK men only: 10,764 cases ( Cf. 14,975 gonorrhoea) 1965 NGU cases greater than gonorrhoea. Venereal Diseases NGU or Non-Specific Urethritis (NSU) 1960s Puzzle Rising incidence – But treatable (sulphonamides and tetracycline) Unsatisfactory, residual category Was its cause? inflammatory, or an infection. ? Trachoma-like agent (TRIC) ? Mycoplasma ? Trichomoniasis ? Fungi ? Haemophilus ? Virus Venereal Diseases NGU - NSU 1970s ‘In spite of much laboratory and other research, non- specific genital infection continues to be the venereologist’s most perplexing problem.’ Robbie Morton, 1975. ‘The Chlamydia genus is in fashion again’. Lancet, 1974 Cell culture of intracellular bacterium Chlamydia ≈ 25-58% of NGU/NSU Chlamydia in the Clinic 1980s NGU/NSU specific infections Chlamydia, mycoplasma, LGV Role in PID, Infertility Culture service HIV-AIDS STI clinics, specialism Chlamydia co-factor in HIV/AIDS Labs + New biotech companies GUM, Gynaecology, STIs Chlamydia in the Laboratory C. trachomatis Testing Direct ‘Observe’ the organism (culture/microscopy) Proxy Identify antibody Identify antigen Sensitivity? – Specificity? ‘Gold Standard’ II now ‘Gold Standard’ then http://www.chlamydiae.com/restricted/docs/labtests/diag_nucleicacidamplification.asp Chlamydia: A Disease without a History NGU Chlamydia NGU Chlamydia NGU > Chlamydia Chlamydia > NGU New infection or newly recognised? Increase? – ‘real’? – more you look, more you find? .

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