Visual inspection of the cervix with acetic acid is very sensitive for ectocervical lesions. The advantages of the VIA method are its low cost and ease of use (it can be used by paramedical workers), its high sensitivity and its immediate results (it is possible to "see and treat" at the first visit). Its main limitation is a high rate of false-positive results, which may lead to overtreatment if a "see and treat" policy is applied.

The Y chromosome-specific gene SRY is one of the key genes involved in human sex determination. The SRY gene encodes a testis-specific transcription factor that plays a key role in sexual differentiation and development in males and is located on the distal region of the short arm of the Y chromosome. Mutations in SRY gene result in XY sex reversal and pure gonadal dysgenesis. SRY expression initiates a network of gene activity that transforms the undifferentiated gonad, genital ridge into testis. Mutations in the SRY gene have been considered to account for only 10-15% of 46,XY gonadal dysgenesis cases, whereas the majority of the remaining cases may have mutation(s) in the SRY regulatory elements or other genes involved in the sex differentiation pathway. Patients both with gonadal dysgenesis and Y-chromosome presence are at high risk of developing gonadoblastoma. Using PCR, single strand conformational polymorphism (SSCP) and automated DNA sequencing, we analysed the mutations in the SRY gene in three 46,XY sex reversal patients. Two patients demonstrated nucleotide substitution (A-->G) within the open reading frame just outside and upstream of the conserved DNA-binding motif called the high-mobility group (HMG) box, replacing glutamine at codon 57 with arginine. Altered SSCP patterns were also observed in these patients. Histological examination of gonads in patient 1 revealed the formation of gonadoblastoma. Patient 3 demonstrated A-->T substitution which replaces serine at codon 143 with cysteine, just outside but downstream of the HMG box. Results suggest the involvement of SRY gene in sex reversal which further supports the relationship between SRY alterations, gonadal dysgenesis and/or primary infertility.

To improve the control of Chlamydia trachomatis infection in India, a rapid, specific and costeffective method is much needed. We developed an in-house PCR assay by targeting a unique genomic sequence encoding a protein from the C. trachomatis phospholipase D endonuclease superfamily that produces an amplified fragment of 368 bp. The specificity of the primers was confirmed using genomic DNA from other sexually transmitted disease-causing and related microorganisms and from humans. The assay was highly sensitive and could detect as low as 10 fg C. trachomatis DNA. Clinical evaluation of the in-house-developed PCR was carried out using 450 endocervical specimens that were divided in two groups. In group I (n5274), in-house PCR was evaluated against the direct fluorescence assay. The resolved sensitivity of the in-house PCR method was 97.22 % compared with 88 % for the direct fluorescent antibody assay. In group II (n5176), the in-house PCR was compared with the commercial Roche AMPLICOR MWP CT detection kit. The resolved sensitivity of the in-house PCR assay reported here was 93.1 % and the specificity was 97.46 %, making it a cost-effective alternative for routine diagnosis of genital infection by C. trachomatis. The method should facilitate early detection leading to better prevention and treatment of genital infection in India. INTRODUCTIONChlamydia trachomatis is one of the most common causative agents of sexually transmitted infections in developing countries including India. Infection with this agent is often asymptomatic (up to 80 % of women and 40 % of men) (Gaydos et al., 2004), making diagnosis and treatment difficult. Undetected genital infections may evolve into complications such as ectopic pregnancy, pelvic inflammatory disease, salpingitis with tubal scarring and infertility in female patients (Black, 1997;Semeniuk et al., 2002). In infected men, arthritis and epididymitis may result in urethral obstruction and decreased fertility. As asymptomatic and untreated patients can spread the disease to their partners, screening of all sexually active adolescents for C. trachomatis infection is recommended (CDC, 2002).Detection methods for C. trachomatis infection include serology, culture method, ELISA, direct fluorescence assay (DFA) and nucleic acid amplification tests (NAATs). Although antigen-based diagnostic assays are as sensitive as the culture method, they show variability due to the methods of sample collection, transport and storage (Mårdh et al., 1981;Mahony & Chernesky, 1985). PCR and ligase chain reaction are more sensitive and specific compared to other diagnostic methods (Black, 1998;Wylie et al., 1998;Semeniuk et al., 2002) and have facilitated the use of less-invasive procedures for detection of asymptomatic C. trachomatis infection in female patients. Currently, several commercial NAAT-based assays such as Gen-Probe APTIMA Combo 2 (AC2), BD Probe Tec ET and Roche AMPLICOR (COBAS and manual) PCRs are available but their high cost prevents their routine use in developing countries. There i...

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