CLINICAL PROBLEMS IN SEXUALLY TRANSMITTED DISEASES

CLINICAL PROBLEMS IN SEXUALLY TRANSMITTED DISEASES

NEW PERSPECTIVES IN CLINICAL MICROBIOLOGY Brumfitt W, ed Hamilton-Miller JMT, assist. ed: New perspectives in clinical microbiology. 1978. ISBN 90-247-2074-5 Tyrrell DAJ, ed: Aspects of slow and persistent virus infections. 1979. ISBN 90-247-2281-0 Brumfitt W, Curcio L, Silvestri L, eds: Combined antimicrobial therapy. 1979. ISBN 90-247-2280-2 van Furth R, ed: Developments in antibiotic treatment of respiratory infections. 1981. ISBN 90-247-2493-7 van Furth R, ed: Evaluation and management of hospital infections. 1982. ISBN 90-247-2754-5 Kuwahara S, Pierce NF, eds:advances in research on cholera and related diarrheas 1. 1983. ISBN 0-89838-592-X Ristic M, Ambroise-Thomas P, Kreier J, eds: Malaria and babesiosis: Research findings and control measures. 1984. ISBN 0-89838-675-6 Kuwahara S, Pierce NF, eds: Advances in research on cholera and related diarrheas 2. 1984. ISBN 0-89838-680-2 Takeda Y: Bacterial diarrheal diseases. 1984. ISBN 0-89838-681-0 Hill MJ, Borriello SP, Hardie JM, Hudson MJ, Lysons RJ, Tabaqchali S, eds: Models of anaerobic infection. 1984. ISBN 0-89838-688-8 Taylor-Robinson D, ed: Clinical problems in sexually transmitted diseases. 1985. ISBN 0-89838-720-5

CLINICAL PROBLEMS IN SEXUALLY TRANSMITTED DISEASES edited by D. TAYLOR-ROBINSON, MD Division of Sexually Transmitted Diseases, MRC Clinical Research Centre, Harrow, Middlesex, United Kingdom 1985 MARTINUS NIJHOFF PUBLISHERS a member of the KLUWER ACADEMIC PUBLISHERS GROUP DORDRECHT / BOSTON / LANCASTER

Distributors for the United States and Canada;, Kluwer Academic Publishers, 190 Old Derby Street, Hingham, MA 02043, USA for the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited, Falcon House, Queen Square, Lancaster LAI lrn, UK for all other countries: Kluwer Academic Publishers Group, Distribution Center, P.O. Box 322, 3300 AH Dordrecht, The Netherlands Library of Congress Cataloging in Publication Data Main entry under title: Clinical problems in sexually transmitted diseases. (New perspectives in clinical microbiology) Includes bibliographies and index. 1. Venereal diseases. I. Taylor-Robinson, David. II. Series. [DNLM: 1. Venereal Diseases. W1 NE484C / WC 140 C641) RC200.C57 1985 616.9'5 85-4924 I SBN-13: 978-94-010-8720-9 e-1 SBN-13: 978-94-009-5014-6 DOl: 10.1007/978-94-009-5014-6 ISBN-13:978-94-010-8720-9 Copyright 1985 by Martinus Nijhoff Publishers, Dordrecht. Softcover reprint of the hardcover 1st edition 1985 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers, Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht, The Netherlands.

Preface It goes almost without saying that there has been a marked increase in the incidence of sexually transmitted diseases throughout the world in the past two to three decades. Indeed, despite the progress that has been made in methods of diagnosis and treatment, the sexually transmitted diseases as a whole are the most common communicable diseases and as such constitute an important health problem. The increase in incidence may be accounted for by changes in sexual behaviour, the introduction of contraceptives and the increasing mobility of the population. In addition, during the same time period, the number of infectious agents recognized as being sexually transmitted has increased considerably. These include Chlamydia trachomatis, herpes simplex virus, cytomegalovirus and hepatitis B virus. Indeed, some are as dependent on sexual transmission as the agents which cause the traditional venereal diseases and collectively they cause morbidity which has out-stripped that caused by gonorrhoea and syphilis. It could almost be said that to know the sexually transmitted diseases is to know microbiology. However, the approach taken in this book has not been to consider individual infectious agents and evaluate what they do and do not cause but to consider clinical conditions and what might be responsible for them. To cover the complete spectrum of the sexually transmitted diseases in a comprehensive way now takes a text book of massive proportion. No attempt has been made to do this here, but the topics considered do cover in an easily manageable volume a majority of the clinical problems encountered by physicians in this field. The approach has been to consider first problems primarily affecting men, then those affecting women and finally those which affect both, concluding with a chapter on the acquired immune deficiency syndrome: last but certainly not least. Although information on the latter topic will rapidly become out of date no current discussion of the sexually transmitted diseases can do without its coverage. To accomplish all of this, a group of contributors has been brought together each of whom is actively engaged in research in the topic concerned and who understands the problems. The authorship list contains some outstanding contributors from abroad but it is evident that it has a strong 'home-grown' flavour. I make no

VI apologies for this for these authors too are outstanding and their nearness has made my task a little easier. To provide some semblance of uniformity where the subject matter allowed, and clearly this has not been possible throughout, the chapters have been arranged in the following way: clinical picture, causative micro-organisms, clinical diagnosis, laboratory diagnosis, antibiotic sensitivity of micro-organisms, treatment and prevention. In addition, no inhibition has been placed on extensive bibliographies. In this way, the book should provide an authoritative and up-to-date account of current clinical problems and hopefully will be of value not only to clinicians who deal with patients but also to research workers and, indeed, all those who are concerned with the problems of diagnosing, treating and controlling sexually transmitted diseases, problems which are likely to be with us for the unforeseeable future. London, January 1985 David Taylor-Robinson

List of contributors Michael W. Adler, Department of Genitourinary Medicine, Middlesex Hospital Medical School, Mortimer Street, London WI, United Kingdom Helmut Brunner, Institute for Chemotherapy, Bayer AG, Aprather Weg, 5600 Wuppertall, Federal Republic of Germany Dulcie V. Coleman, Department of Pathology, St. Mary's Hospital Medical School, Praed Street, London W2 IPG, United Kingdom Charles S.F. Easmon, Department of Medical Microbiology, St. Mary's Hospital Medical School, Praed Street, London W21PG, United Kingdom David Goldmeier, The Pread Street Clinic, St. Mary's Hospital, Praed Street, London W2 IPG, United Kingdom M.J. Hare, Department of Obstetrics and Gynaecology, Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire TE18 8NT, United Kingdom Catherine A. Ison, Department of Medical Microbiology, St. Mary's Hospital Medical School, Praed Street, London W2 IPG, United Kingdom Donald J. Jeffries, Division of Virology, Department of Medical Microbiology, St. Mary's Hospital Medical School, Praed Street, London W2 IPG, United Kingdom Andrew C. Keat, Department of Rheumatology, Westminster Medical School, Dean Ryle Street, Horseferry Road, London SWIP 2AP, United Kingdom Per-Anders Miirdh, Institute of Clinical Bacteriology, University of Uppsala, Uppsala, Sweden Andre Meheus, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium Patricia E. Munday, Division of Sexually Transmitted Diseases, MRC Clinical Research Centre, Watford Road, Harrow, Middlesex HAI3UJ, United Kingdom Peter Piot, Department of Microbiology, Institute of Tropical Medicine, Nationale Straat 155, 2000 Antwerp, Belgium David Taylor-Robinson, Division of Sexually Transmitted Diseases, MRC Clini-

VIII cal Research Centre, Watford Road, Harrow, Middlesex HAl 3UJ, United Kingdom Brenda J. Thomas, Division of Sexually Transmitted Diseases, MRC Clinical Research Centre, Watford Road, Harrow, Middlesex HA13UJ, United Kingdom Jonathan Weber, St. Mary's Hospital, Praed Street, London W2, United Kingdom W. Weidner, Department of Urology, Justus Liebig University, 6300 Giessen, Federal Republic of Germany Lars Westrom, Department of Obstetrics and Gynaecology, University Hospital, S-22l 85 Lund, Sweden

Table of contents Preface V List of contributors VII l. Criteria for the diagnosis of sexually transmitted diseases 1 M.W. Adler 2. Persistent and recurrent non-gonococcal urethritis 15 P.E. Munday 3. Acute and chronic prostatitis 37 H. Brunner and W. Weidner 4. Sexually acquired reactive arthritis 61 A.c. Keat and B.J. Thomas 5. Microbial vaginitis and vaginosis 93 C.A. Ison and C.S.F. Easmon 6. Cervicitis 107 M.J. Hare 7. Genital warts, human papillomaviruses and cervical cancer 141 D.V. Coleman 8. Salpingitis 159 P-A. Mfudh and L. Westrom 9. Infection in infertility 183 D. Taylor-Robinson 10. Genital ulcerations 207 P. Piot and A. Meheus 11. Proctitis 237 D. Goldmeier 12. Viral hepatitis 285 D.J. Jeffries 13. The acquired immune deficiency syndrome (AIDS) 301 J. Weber Index of subjects 333