Incidence of Chronic Genital Infection in Male Patients with Uveitis: A PRELIMINARY REPORT

Catterall, R. D.

doi:10.1136/sti.34.4.254

Cited by 5 publications

(5 citation statements)

References 6 publications

(3 reference statements)

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“…King suspected that idiopathic AAU, a common comorbidity of ReA and AS, was part of the same syndrome even when it occurred alone. King thus predicted that prostatic inflammation would be associated with isolated AAU ( 49 ), as previously reported in small case series ( 50 – 54 ). To formally demonstrate this association, King asked Catterall to perform a prospective study of all new male uveitis cases from May 1957 to December 1958 at the Institute of Ophthalmology in London ( 49 ).…”

Section: Postulation Of the Catterall–king Hypothesissupporting

confidence: 60%

“…King thus predicted that prostatic inflammation would be associated with isolated AAU ( 49 ), as previously reported in small case series ( 50 – 54 ). To formally demonstrate this association, King asked Catterall to perform a prospective study of all new male uveitis cases from May 1957 to December 1958 at the Institute of Ophthalmology in London ( 49 ). Catterall’s study confirmed that AAU was strongly associated with prostatic inflammation as compared to controls and to other patients in the series (Table 2 ) ( 27 , 28 ).…”

Section: Postulation Of the Catterall–king Hypothesissupporting

confidence: 60%

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Spondyloarthritis, Acute Anterior Uveitis, and Fungi: Updating the Catterall–King Hypothesis

Laurence¹,

Asquith

Rosenbaum

2018

Front. Med.

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Spondyloarthritis is a common type of arthritis which affects mostly adults. It consists of idiopathic chronic inflammation of the spine, joints, eyes, skin, gut, and prostate. Inflammation is often asymptomatic, especially in the gut and prostate. The HLA-B*27 allele group, which presents intracellular peptides to CD8+ T cells, is by far the strongest risk factor for spondyloarthritis. The precise mechanisms and antigens remain unknown. In 1959, Catterall and King advanced a novel hypothesis explaining the etiology of spondyloarthritis: an as-yet-unrecognized sexually acquired microbe would be causing all spondyloarthritis types, including acute anterior uveitis. Recent studies suggest an unrecognized sexually acquired fungal infection may be involved in prostate cancer and perhaps multiple sclerosis. This warrants reanalyzing the Catterall–King hypothesis based on the current literature. In the last decade, many links between spondyloarthritis and fungal infections have been found. Antibodies against the fungal cell wall component mannan are elevated in spondyloarthritis. Functional polymorphisms in genes regulating the innate immune response against fungi have been associated with spondyloarthritis (CARD9 and IL23R). Psoriasis and inflammatory bowel disease, two common comorbidities of spondyloarthritis, are both strongly associated with fungi. Evidence reviewed here lends credence to the Catterall–King hypothesis and implicates a common fungal etiology in prostate cancer, benign prostatic hyperplasia, multiple sclerosis, psoriasis, inflammatory bowel disease, and spondyloarthritis. However, the evidence available at this time is insufficient to definitely confirm this hypothesis. Future studies investigating the microbiome in relation to these conditions should screen specimens for fungi in addition to bacteria. Future clinical studies of spondyloarthritis should consider antifungals which are effective in psoriasis and multiple sclerosis, such as dimethyl fumarate and nystatin.

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Section: Postulation Of the Catterall–king Hypothesissupporting

confidence: 60%

Section: Postulation Of the Catterall–king Hypothesissupporting

confidence: 60%

Spondyloarthritis, Acute Anterior Uveitis, and Fungi: Updating the Catterall–King Hypothesis

Laurence¹,

Asquith

Rosenbaum

2018

Front. Med.

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“…Studies where the infection was not laboratory confirmed were also excluded (n = 10). An additional paper [28] was excluded because it reported the number of patients with Reiter’s disease and the number of patients with non-specific genital infection in a group of patients with uveitis, but did not report the relationship of interest (number of patients with genital infection and ReA from the total cohort). Thus, three articles [29–31] were retained for the systematic review (Fig 2).…”

Section: Resultsmentioning

confidence: 99%

The incidence of sexually acquired reactive arthritis: a systematic literature review

et al. 2016

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Objective-Reactive Arthritis (ReA) is an inflammatory spondyloarthritis occurring after infection at a distant site. Chlamydia trachomatis is proposed to be the most common cause ofReA, yet the incidence of sexually-acquired ReA (SARA) has not been well established. We therefore carried out a systematic literature review to collate and critically evaluate the published evidence regarding the incidence of SARA.Methods-MEDLINE and EMBASE databases were searched using free-text and MeSH terms relating to infection and ReA. The title and abstract of articles returned were screened independently by two reviewers and potentially relevant articles assessed in full. Data was extracted from relevant articles and a risk of bias assessment carried out using a validated tool. Heterogeneity of study methodology and results precluded meta-analysis.Results-The search yielded a total of 11680 articles, and a further 17 were identified from review articles. After screening, 55 papers were assessed in full, from which 3 met the relevant inclusion criteria for the review. The studies reported an incidence of SARA of 3.0% -8.1% and were found to be of low to moderate quality.Conclusions-More studies are required to address the lack of data regarding the incidence of SARA. Specific and sensitive classification criteria must be developed in order for consistent classification and valid conclusions to be drawn. In clinical practice, it is recommended clinicians discuss the possibility of ReA developing at the time of STI diagnosis, and to encourage patients to return if they experience any relevant symptoms.

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“…Studies where the infection was not laboratory confirmed were also excluded (n = 9). An additional paper (Catterall, 1958) was excluded because it reported the number of patients with Reiter's disease and the number of patients with non-specific genital infection in a group of patients with uveitis, but did not report the relationship of interest (number of patients with genital infection and ReA from the total cohort). Thus, three articles (Keat et al, 1978, Rich et al, 1996, Carter et al, 2013 were retained for the systematic review (Figure 7.2).…”

Section: Study Selectionmentioning

confidence: 99%

Healthcare-seeking behaviour for sexually transmitted infection testing in New Zealand: A mixed methods study

Denison

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<p>Sexually transmitted infections (STIs) are a global public health problem. Sequelae for infected individuals can be serious and STIs impose a substantial financial burden on healthcare systems. Duration of infection is one factor influencing transmission rates, and is modifiable through secondary prevention methods, namely ‘test and treat’. For this approach to be effective, at-risk individuals must choose to present for testing. New Zealand provides a useful case-study to investigate healthcare-seeking behaviour for STI testing, as incidence rates of common STIs are especially high. The aims of this thesis were to quantify healthcare-seeking behaviour for STI symptoms and assess the risk of transmission in this period, to identify the barriers to STI testing, to understand the personal drivers for getting an STI test, to examine how STI knowledge is associated with testing behaviour, and finally, to collate and critically evaluate the published evidence regarding the incidence of a lesser known sequela of STI, reactive arthritis. This thesis took a mixed method approach, employing both qualitative and quantitative methods to address the research aims. The results showed that delays in healthcare-seeking for STI symptoms were common among patients attending an inner-city Sexual Health Clinic (SHC). Almost half of people with symptoms waited longer than seven days to seek healthcare, although there were no identified predictors of delayed healthcare-seeking. Around a third of people with symptoms continued to have sex after they first thought they may need to seek healthcare. Among these individuals, infrequent condom use was reported more by those who had sex with existing sexual partners than by those who had sex with new partners. Having sex while symptomatic was statistically significantly associated with delaying seeking healthcare for more than seven days (odds ratio (OR) = 3.25, 95% CI 1.225 – 8.623, p = 0.018). Analysis of qualitative interview data revealed three types of barriers to testing. These were personal (underestimating risk, perceiving STIs as not serious, fear of invasive procedure, self-consciousness in genital examination and being too busy), structural (financial cost of test and clinician attributes and attitude) and social (concern of being stigmatised). This work also revealed several drivers for testing including crisis, partners, clinicians, routines, and previous knowledge. Knowledge of the incidence, asymptomatic nature and sequelae of STIs featured prominently in the explanations of those who undertook routine testing. However, at the same time, many of the participants felt they did not have a good knowledge base and that their school-based sex education had been lacking. STI knowledge was investigated further using quantitative methodology. Levels of STI knowledge were generally good and did not differ between a Student Health Service population and an SHC population. Individuals who had tested before had significantly better knowledge than those who were attending for testing for the first time (U = 10089.500, Z = -4.684, p < 0.001). In addition, total knowledge score was an independent predictor of having had a previous test (OR = 1.436, 95% CI 1.217-1.694, p < 0.001). Reactive arthritis can be triggered by STI, thus STI screening patients who present with reactive arthritis has the potential to identify undiagnosed infection. This thesis provides the first assessment of the international literature regarding the incidence of reactive arthritis after STI. The systematic review found only three published studies which had prospectively examined the incidence of reactive arthritis after STI. The studies reported an incidence of reactive arthritis after STI of 3.0% to 8.1% and were found to be of low to moderate quality. In conclusion, this thesis provides healthcare service providers, policy makers and clinicians with data to inform practice and public health interventions aimed at improving healthcare-seeking behaviour for STI testing. It illustrates that delayed healthcare-seeking for STI symptoms is a common behaviour in New Zealand and could potentially be contributing to STI transmission and downstream burden on the health system. This work provides evidence of the drivers of STI testing that can be promoted, and the barriers that need to be removed. Specifically, improving STI knowledge may positively impact on testing rates. Lastly, this research indicates that there is a need for more studies assessing the incidence of reactive arthritis after an STI.</p>

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Incidence of Chronic Genital Infection in Male Patients with Uveitis: A PRELIMINARY REPORT

Cited by 5 publications

References 6 publications

Spondyloarthritis, Acute Anterior Uveitis, and Fungi: Updating the Catterall–King Hypothesis

Spondyloarthritis, Acute Anterior Uveitis, and Fungi: Updating the Catterall–King Hypothesis

The incidence of sexually acquired reactive arthritis: a systematic literature review

Healthcare-seeking behaviour for sexually transmitted infection testing in New Zealand: A mixed methods study

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