Anesthesia-related mortality is higher in children with heart disease and in particular those with pulmonary hypertension. The lack of anesthetic-related deaths in children who did not have major comorbidities reinforces the safety of pediatric anesthesia in healthy children.

M genitalium was less common than C trachomatis and N gonorrhoeae in MSM attending male-only saunas and was most often detected as an asymptomatic rectal or a urethral infection but was absent from the pharynx. To inform STI screening strategies in MSM, more data are needed to understand how common M genitalium infection is in urethral and non-urethral sites in MSM, and how it contributes to clinical symptoms.

The high prevalence rate of gonorrhea and chlamydia supports the concept of a screening program in Melbourne male-only saunas. The low participation rate has highlighted the need to consider alternative methods for making contact with men in the saunas or offering incentives to participate in future screening programs. Although anonymous participation encouraged participation for some men, future programs should attempt to obtain contact details for follow up of positive test results.

Screening guidelines for men who have sex with men (MSM) recommend testing of extragenital sites (pharyngeal and rectal) for gonorrhoea and chlamydia. Testing of specimens from these sites is not validated by most commercial nucleic amplification tests, such as the COBAS Amplicor assay. To investigate the utility of the COBAS Amplicor assay for detection of Chlamydia trachomatis in extragenital specimens, this study developed and evaluated confirmatory tests using the omp1 gene as an alternative target for amplification by PCR. Of anal and throat swabs collected from men in male-only saunas, 52 swabs that tested C. trachomatis positive by COBAS Amplicor and 30 swabs that tested as negative were included for confirmatory omp1 PCR testing. A total of 49 (94%) COBAS Amplicor-positive samples were confirmed by the omp1 PCR. A substantial proportion of specimens were confirmed by using a nested omp1 PCR (27%). Not confirmed by any omp1 PCR were three anal swabs (6%). It is most probable that these samples contained lower bacterial levels that were near or below the detection level of the omp1 PCR assays. The findings of this study support the confident reporting of C. trachomatis detected by COBAS Amplicor in extragenital specimens and support the utility of this assay as a screening test for MSM.

During 2001 and 2002 an anonymous outreach-screening programme in Melbourne, Australia, offered testing for gonorrhoea and chlamydia on-site at men-only saunas. Modifications were made to this screening programme to offer a comprehensive testing clinic for sexually transmissible infections (STIs), including HIV. The comprehensive clinic was evaluated after one year of operation, and comparisons were made with the earlier anonymous screening programme. The comprehensive outreach clinic made contact with fewer men (n = 557), however, men tested had a higher prevalence of gonorrhoea and chlamydia (17%), and all men tested positive for STIs/HIV were followed up. The findings and comparisons outlined in this paper may be used for different communities to decide what screening programme model best suits their individual situation: anonymous programme with fewer tests offered, confidential and comprehensive STI/HIV testing programme, or both. On the basis of our evaluation, we have opted to continue the comprehensive STI/HIV testing programme in local men-only saunas.

C. trachomatis serovars can be differentiated by sequencing the omp1 gene, which codes for the major outer membrane protein (MOMP) (1, 5, 8, 15-17, 25, 31). Preliminary evidence suggests that MOMP is a porin that assembles as ␤ barrels containing conserved domains (CDs) of transmembrane ␤ strands and periplasmic loops and four variable domains (VDs) located on the outer loops (14, 28). Serovars exhibit MOMP sequence heterogeneity that is mainly localized to the VDs (27, 36). Variability in the MOMP sequence is presumably a result of host selection and bacterial adaptation (3,4,19), although recent analysis of nucleotide and amino acid substitutions for omp1 and MOMP, respectively, showed a lack of evolutionary pattern with respect to disease or tissue tropism (29). The findings from studies of the clinical manifestations of disease and the association of those manifestations with specific serovars (2,7,12,17,23,26,34), geographic clustering (5, 8, 11), and the amount of variation within genotypes and the changes in the frequencies of the genotypes circulating over time (16,17,25,30,35) have been mixed. Other studies have highlighted the importance of MOMP diversity in strains isolated from sex workers, whose sexual network was described as a core group creating selective immune pressure on circulating strains (3, 4). Overall, of the serovars usually associated with urogenital infection (serovars D to K), serovars D, E, and F are the most common (1,5,8,11,12,15,17,23,30,31).The aims of the present study were to characterize the C. trachomatis strains detected in samples collected during a sauna screening program (20) by sequencing the omp1 gene and determining the corresponding serovars. Determination of the serovars and the omp1 variability of the C. trachomatis strains detected in these samples may give insight into the C. trachomatis strains circulating among MSM who frequent saunas. MATERIALS AND METHODSClinical samples. A sample of 47 C. trachomatis-positive specimens collected from 39 men who participated in a screening program in male-only saunas in Melbourne, Victoria, Australia (20), was used. These 47 samples comprised 34 anal swab specimens, 10 urine samples, and 3 throat swab specimens. Two anal swab specimens were collected from each of five men, and two urine samples were collected from each of two men; i.e., the samples were collected at the initial consultation in the sauna and repeat samples were then collected (for confirmation before antibiotic treatment). C. trachomatis was detected at two anatomical sites in one man: from an anal swab specimen and a urine sample.Isolation of DNA and omp1-specific PCR. DNA extraction and omp1-specific PCR were performed as described previously (20,21). Three omp1-specific PCRs were used: PCR VD1-4 with primers P1 and OMP2 to amplify a region of the gene containing all four variable domains (17), nested PCR VD1/2 with primers P1 and CT6 (5) to amplify a region containing VD1 and VD2, and nested PCR VD3/4 with primers CT6 (sense) and OMP2 to amplify a region con...

The introduction of a computer reminder for new guidelines was temporally associated with screening that conformed more closely to clinical guidelines.

These findings strongly support screening among MSM and in particular not testing asymptomatic MSM for urethral gonorrhoea or any MSM for pharyngeal chlamydia.