DETECTION OF PATHOGENS CAUSING GENITAL ULCER DISEASE BY MULTIPLEX POLYMERASE CHAIN REACTION

Objective To establish a multiplex polymerase chain reaction (M-PCR) assay for simultaneous detection of pathogens causing genital ulcer disease (GUD). Methods Based on the gene-specific region of the following pathogens: Chlamydia trachomatis omp1/ompb, herpes simplex virus (HSV) DNA polymerase, Treponema pallidum tpp47, Haemophilus ducreyi 16s rRNA, four sets of primers were designed and an M-PCR assay was developed to detect four pathogens in one test. The assay was evaluated with diagnostic result of golden standard for each pathogen. Results Of the 51 clinical samples, M-PCR showed slightly higher positive rate (47.1%) of HSV than cell culture (23.6%).Meanwhile, the positive rate of T. pallidum detected by M-PCR and dark-field microscopy was 19.6% (10/51) and 15.7% (8/51), respectively. Only one sample was positive for H. ducreyi and no sample was positive for C. trachomatis detected by both M-PCR assay and culture. Conclusion This primary study indicated that M-PCR assay can simultaneously and rapidly detect the four etiologic pathogens causing GUD.

2019 Chinese expert consensus statement on diagnosis and treatment of syphilis

Syphilis,caused by Treponema pallidum subsp pallidum(T.pallidum),is a chronic,systemic human disease transmitted through sexual contact.The incidence and prevalence of syphilis is still high in China.[1]To guide the prevention measures and management of this disease,we renew the guidelines on diagnosis and treatment of syphilis[Supplementary file,http://links.lww.com/CM9/A292].Manifestations and diagnosis of all stages of syphilis are presented in Table 1,and management in Table 2.

Suboptimal Chlamydia trachomatis Detection Method Is Still Widely Used in China: Results of External Quality Assessments from 2013 to 2018

Objective:Laboratory capacity for Chlamydia trachomatis (C.trachomatis) detection is important in the diagnosis and treatment of C.trachomatis infection,appropriate clinical management of patients,and providing evidence for prevention programs.We conducted this study to assess laboratory capabilities for detecting C.trachomatis in China by analysis of external quality assessment (EQA) results from 2013 to 2018.Methods:Overall,310/1,048 (29.58%) laboratories at national sexually transmitted disease (STD) sentinel site with 252-272 laboratories per time participated in six times of EQA.Each laboratory was requested to test the samples from EQA organization by the common method used,and the test results were reported to EQA organization for assessment.Z test and multinomial logistic regression analyses were used for data analyses.Results:Immunochromatographic test,nucleic acid amplification test (NAAT),and ELISA were used and accounted for 76.69%,21.54%,1.77%,respectively of all participating laboratories from 2013 to 2018.The total specificity for negative samples was 94.76%,the sensitivity for positive samples with medium and high concentration of C.trachomatis samples were 94.31% and 95.51%,respectively,but the sensitivity for sample with low concentration of Co trachomatis was 36.89%,and the immunochromatographic test had the worst sensitivity for detection of this sample (21.17% [95% C/s:18.93%-23.60%]) among the three methods.Three factors were found to be significantly associated with the sensitivity of the low-concentration sample:the location of laboratories (East China:adjusted odds ratio [AOR] =2.98,95% C/s:1.69-5.25,P < 0.05;South China:AOR =3.34,95% CIs:1.38-5.48,P < 0.05;Southwest China:AOR=2.75,95% CIs:1.37-5.48,P<0.05,as compared with Northwest China);the types of hospitals (prevention and control agencies:AOR =0.56,95% CIs:0.40-0.80,P < 0.05,as compared with general hospitals);and the method used (NAAT:AOR=46.99,95% CIs:28.49-77.48,P< 0.050;ELISA:AOR=5.42,95% CIS:2.40-12.25,P<0.05,as compared with immunochromatographic test).Conclusion:Immunochromatographic test is widely used for C.trachomatis antigen in China;however,based on its suboptimal detection sensitivity,methods with high sensitivity such as NAAT-based point-of-care diagnostic method are recommended to apply for C.trachomatis detection,and efforts should be performed to promote the high-sensitivity methods among laboratories.

National Guidelines on Diagnosis and Treatment of Gonorrhea in China (2020)

Gonorrhea is one of the main sexually transmitted diseases in China.It mainly affects the genitourinary tract,and its clinical manifestations vary from asymptomatic to complicated types.The diagnosis of gonorrhea should be based on the patient's epidemiologicai history,clinical manifestations,and laboratory examination results.Treatment should be prompt and standardized and should involve the recommended treatment regimens.Patients should be appropriately followed up after treatment.The antimicrobial resistance of gonococcal isolates has become a severe problem of clinical concern.In order to provide technical guidance of the diagnosis and treatment of gonorrhea for health care workers,the authors developed the guidelines based on the version of 2014,which will be of important in the standardizing medical care of gonorrhea,and further facilitating control and prevention of the disease.

Toe Absence Related to Verrucous Carcinoma

Introduction:Verrucous carcinoma is a rare variant of squamous cell carcinoma.It generally grows exogenously and bone erosion is rare.Here we present a case of verrucous carcinoma on the foot with toe absence.Case presentation:A 64-year-old man presented with a 6-year history of a slowly growing exogenous hyperkeratotic verrucous lesion on the right fifth toe,which had been absent for 1year.Before the lesion appeared,he had undergone nail extraction on this toe.The culture of fungi and mycobacteria were negative.Three-dimensional computed tomography showed that the fifth toe of the right foot was absent.Histopathological examination showed that the lesion was exogenous and verrucous and exhibited moderate keratinocyte hyperplasia.Combined with clinical manifestation and histopathological examination,verrucous carcinoma is suggested.The lesion was surgically excised,and the patient was followed up for more than 6months without recurrence.Discussion:Verrucous carcinoma is an exophytic tumor with verrucous growth at the beginning,which can invade deep tissues and even cause limb mutilation.When encountering a patient with a wart-like plaque on the foot that responds poorly to conventional treatments,clinicians should maintain a high degree of clinical vigilance and a low threshold for biopsy.Conclusion:We observed a rare outcome of toe absence associated with verrucous carcinoma.Therefore,early diagnosis of verrucous carcinoma is very important.Surgical excision is an effective treatment at present.Extensive resection is usually required to avoid recurrence.