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Laboratory Diagnosis of Sexually Transmitted Diseases
  1. Geoffrey L Ridgway
  1. Department of Clinical Microbiology, UCH Accident and Emergency Building, London WC1E 6DB

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    Pp 135; Sw fr 35/$31.50, in developing countries Sw fr 24.50. Geneva: World Health Organisation, 1999. ISBN 92 4 154501 1.

    “Venereal diseases are like the fine arts—it is pointless to ask who invented them.” (Voltaire, Dictionaire philosophique).

    Sexually transmitted diseases (STDs) now rank among the top ten diseases for which adults in developing countries seek health care. The economic burden of STDs on both developed and developing countries is enormous. Infection with conventional STDs is a risk factor for transmission of infection with HIV, and therefore for the development and spread of the AIDS

    It is imperative that laboratory services are available to guide the clinician to the correct diagnosis and treatment of these conditions, and to give an accurate epidemiological picture of their prevalence in a particular community in order to target relevant populations and ensure optimal and economic use of available resources. Yet, the availability of both funds and technology varies widely between different settings.

    This manual sets out to give comprehensive guidance on tests available and applicable to the level of expertise and funding available.

    Nine chapters cover the major STDs, encompassing bacterial and viral infections, and under the umbrella of vaginitis in adults; trichomoniasis, candidiasis, and bacterial vaginosis. Each chapter begins with a brief description of the microbiology of the infective agent and the clinical spectrum of disease. The detail given is not consistent, being comprehensive for chancroid and granuloma inguinale, and surprisingly brief for HIV and chlamydia by way of contrast. Then follows a description of collection and transport requirements, and of techniques for diagnosis. The emphasis is on tests that are possible in a reasonably well equipped laboratory, but not one capable of reference facilities. Tests that are suitable for use in the field are highlighted. An evaluation of sensitivity and specificity is also given. Other tests available in central or reference laboratories are mentioned in brief, usually with supporting references.

    Two annexes cover media, reagents and stains, and details of equipment required to diagnose each condition. A third annex is an interesting table of which tests should be available at “peripheral,” “intermediate,” and “central” laboratories.

    Overall, this manual is to be welcomed as an educational and reference source for medical microbiologists, technologists, and clinicians. However, I would recommend that the authors “road test” the manual to discover omissions in technical detail that would prevent the sole use of the manual in the field.

    Indifferent colour reproduction detracts from the quality of the text—for example, blue reactions appearing as red in the figure.

    For the next edition, a chapter on basic microscopical techniques and another on the general principles and interpretation of laboratory tests would provide useful introductions to an otherwise excellent publication.

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    • (Available in English, French, and Spanish.)

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