Epidemiological Study of Lymphogranuloma Venereum, Employing the Complement-Fixation Test.

Oct., 1944 Epidemiological Study of Lymphogranuloma Venereum, Employing the Complement-Fixation Test PAUL B. BEESON AND EDWARD S. MILLER Medical Service of the Grady Hospital and the Department of Medicine, Emory University School of Medicine, Atlanta, Ga. I MMUNOLOGICAL evidence of infection with the virus of lymphogranuloma venereum is frequently en-. countered in persons who show no sign of the clinical disease. This brings up certain problems, such as the actual prevalence of the infection, the duration of the immune reaction, and the possibility that infection can be acquired either in utero or through portals other than the genital tract. Some information on these problems can be had by studying groups of people for evidence of infection. While the Frei test for lymphogranuloma has been carried out on a considerable number of people as a part of the routine work-up in many venereal disease clinics, the results obtained have provided little information on the population as a whole. With the exception of a study in Puerto Rico, by Morales and Carrera,' there has been no systematic application of the Frei test to a study of the epidemiology of the disease. As a survey method it is somewhat cumbersome, because it necessitates two visits with each person tested. When Rake and his associates developed a simple complement-fixation test for lymphogranuloma venereum, a method was-provided which was more readily applied to epidemiological investigations. The present report is chiefly an. analysis of the results of a series of complement-fixation tests done on white and Negro clinic patients at Grady Hospital, Atlanta. It includes, in addition, the results of tests on the sera of new-born infants and their mothers, from the Colored Obstetrical Service of the same hospital. METHODS AND MATERIAL Kahn Test for Syphilis-The data in this article refer to the results obtained using the Standard Kahn Test, performed in the Grady Hospital labora- tories. Complement - Fixation T e s t f o r Lymphogranuloma Venereum - The technic employed was exactly the same as that outlined by McKee, Rake, and Shaffer.2 The antigen used was the commercial preparation, Lygranum C. F. (Squibb). Known positive and negative sera were included as controls in each group of tests. Each serum was diluted 1-5 and 1-20 before mixing with the other components, giving final dilutions of 1-25 and 1-100. These were set up against normal yolk sac material, as well as the infected yolk sac material. The result was interpreted as positive if there was complete or almost complete fixation with [1076] Vol. 34 1077 LYMPHOGRANULOMA VENEREUM either dilution of serum in the presence of the infected yolk material. No case was encountered in which there was a prozone giving fixation with the higher serum dilution and not with the lower. The complement-fixation test could not be interpreted in 34 of the 879 sera received from the out-patient clinics. In 7 of them the difficulty was anticomplementary action of the serum. In the remaining 27 there was fixation of complement in the presence of normal yolk sac control material. This reaction has been noted occasionally since the test first began to be used.3 It is found almost exclusively in the sera of persons with syphilis. In the present study 24 of the 27 sera which showed it gave positive Kahn reactions. Two of the others were from young women with chronic pelvic inflammatory disease, and the third was from a young man who gave a history of chancre 3 years previously, and who had received 7 intravenous treatments immediately after he had developed the chancre. There were 14 males and 13 females in this group. Twenty-six of them were Negroes. The ages of the 27 patients were distributed fairly uniformly throughout all periods of life, including 2 infants with congenital syphilis and 4 persons who were more than 55 years of age. Clinical Material-For the studies of the age and sex incidence 879 sera were received from persons attending the various out-patient clinics of the hos- TABLE 1 Incidence of Positive Serologic Tests for Lymphogranuloma Venereumn and Syphilis in Colored Females, According to Age Lymphogranuloma Venereum Complement-Fixation Age Group 0- 4 5- 9 10-14 15-24 25-34 35-44 45-54 55+ Total Kahn Number Tested 21 12 16 57 63 37 27 22 Number Positive 8 Positive 4.2 8.3 17.6 39.7 42.2 43.3 33.3 34.8 88 33.6 255 72 Number Tested 24 12 17 58 64 37 27 23 Number Positive 262 * -Per cent I 1 3 23 27 16 9 * 2 1 2 15 24 13 9 6 Per cent Positive 9.5 8.3 12.5 26.3 38.1 35.1 33.3 27.3 28.2 * No Kahn test on 7 patients TABLE 2 Incidence of Positive Serologic Tests for Lymphogranuloma Venereum and Syphilis in Colored Males, According to Age Lymphogranuloma Vener eum Complement-Fixation Age Group 0- 4 5- 9 10-14 15-24 25-34 35-44 45-54 55+ Total * Number Tested 29 16 Number Positive 0 1 18 33 43 0 9 22 29 30 37 235 * No Kahn test on 17 patients Kahn Per cent Positive 0 Number Positive 0 2 14 14 18 6.2 0 27.3 51.2 48.2 46.7 48.6 Number Tested 25 16 18 31 39 26 29 34 7 14 9 14 7 0 12.5 5.6 22.6 35.9 34.6 48.3 20.6 78 33.2 218 * 54 24.8 1 Per cent Positive 1078 AMERICAN JOURNAL OF PUBLIC HEALTH pital between November, 1942, and May, 1943. The sera were usually obtained in the course of a bleeding for a Kahn test. Since it is more or less routine to test all new clinic patients for evidence of syphilis, whatever their illness, these sera may be considered as being from an unselected group of clinic patients. Unfortunately, the clinical data obtainable from the records were often so brief, because of the minor nature of the illnesses, that it was not feasible to attempt a correlation between the results of the serologic test for lymphogranuloma and history of other evidence of this disease. The number of white males tested was comparatively small, because many were either in military service or were in 'an economic bracket which made them ineligible for clinic care in a charity hospital. RESULTS In Tables 1 and 2 are shown the results of complement-fixation tests for lymphogranuloma venereum on the sera of 497 Negroes, arranged according to age. For comparison, the results of Kahn tests on the same persons are included in the tables. Positive tests for lymphogranuloma venereum were given by approximately 33 per cent of the entire group of colored males and females. The incidence, of positive Kahn reactions was slightly lower, being 24.8 per cent for males and 28.8 per cent for females. When considered by age group it is observed that the proportion of positive tests for both diseases followed a somewhat similar pattern, being comparatively low in children under 15 years of age, but mounting rather sharply during the next decade, and then remaining at about the same level in succeeding age groups. If the data on children under 15 years of age are excluded, serologic evidence of lymphogranuloma venereum is found i (...truncated)