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Title: Enhancement of the microbiological diagnosis of sexually transmitted infections
Author: Pond , Marcus James
ISNI:       0000 0004 5921 7810
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2015
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Presently, clinical management of sexually transmitted infection (STI) is performed empirically, in the absence of microbiological diagnosis and consequentially the use of suboptimal antimicrobial therapy. Current diagnostic methodologies cannot facilitate the polymicrobial detection required to identify the potential multiple organisms that contribute to STI's. In order to meet this requirement a PCR coupled micro array capable of detecting the presence or absence of 23 organisms relevant to STI was developed and evaluated. This method was applied to explore the differential organism prevalence in 129 first void urine specimens in patients of varying symptomology, revealing the absence of Lactobacilli may be associated with urethritis. Findings of this study also documented the inadequacy of Gram stained urethral smear (GSUS) for identification and stratification of urethritis cases. Performance of rapid automated urine flow cytometric (AUFC) of urinary white cell count (UWCC) as a potential replacement for GSUS was validated in a separate study of male clinic attendees (n=436). UWCC testing demonstrated significantly enhanced specificity when compared to GSUS; universal application of this method would have significantly improved identification of urethritis cases at the point of care. The degree of urethral inflammation implied by UWCC analysis exhibited a stronger association with pathogen load of Mycoplasma genitalium when compared to Chlamydia trachomatis. A notably high prevalence of azithromycin resistant M. genitalium infection was observed amongst study participants; subsequent phylogenetic analysis implied this finding was applicable beyond this patient population. The findings of this thesis contribute new approaches to tackling the inadequacies of current empirical approaches to STI management. Modification of treatment guidelines in light of these findings and adoption of UWCC testing may improve treatment efficacy and enhance detection of nongonococcal urethritis and related syndromes. Results observed also provide an insight into the pathogenic mechanisms of different STI organisms in relation to host inflammatory responses.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available