Advertisement

Chlamydial Infections

  • E. Russell Alexander
  • H. Robert Harrison

Abstract

There are five quite different disease patterns that result from human infection with chlamydial organisms. Infection with Chlamydia trachomatis, by far the most important as a human pathogen, may result in trachoma, a variety of other syndromes that accompany ocular or genital infection, or lymphogranuloma venereum (Lgv). C. psittacii has one human disease manifestation—psittacosis. The fifth pattern is respiratory disease caused by C. pneumoniae. This species of Chlamydia was previously unclassified and was referred to as Twar strains(26) (after Taiwan and Acute Respiratory studies, from which they were first recovered).

Keywords

Chlamydia Trachomatis Bacterial Conjunctivitis Direct Fluorescent Antibody Gonococcal Urethritis Lymphogranuloma Venereum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Alexander, E. R., Chlamydia: The organism and neonatal infection, Hosp. Pract. 14: 63–69 (1979).PubMedGoogle Scholar
  2. 2.
    Alexander, E. R., Wang, S.-P., and Grayston, J. T., Further classification of Tric agents from ocular trachoma and other sources by the mouse toxicity prevention tests, Am. J. Ophthmal. 63:1469–1478 (1967).Google Scholar
  3. 3.
    Becker, Y., The Chlamydia: Molecular biology of procaryotic obligate parasites of eucaryocytes, Microbiol. Rev. 42:274–306 (1978).PubMedGoogle Scholar
  4. 4.
    Bedson, S. P., The use of the complement-fixation reaction in the diagnosis of human psittacosis, Lancet 2:1277–1280 (1935).CrossRefGoogle Scholar
  5. 5.
    Bedson, S. P., The psittacosis-lymphogranuloma group of viruses, Br. Med. Bull. 9:226–227 (1953).PubMedGoogle Scholar
  6. 6.
    Beem, M. O., and Saxon, E. M., Respiratory-tract colonization and a distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis. N. Engl. J. Med. 296:306–310 (1977).CrossRefGoogle Scholar
  7. 7.
    Berman, S., Harrison, H. R., Boyce, W. T., Haffner, J. J., Lewis, M., and Arthur, J. B., Low birth weight, prematurity and post partum endometritis: Association with prenatal cervical Mycoplasma hominis and Chlamydia trachomatis infections, J. Am. Med. Assoc. 257:1189–1194 (1987).CrossRefGoogle Scholar
  8. 8.
    Brunham, R. C., Paavonen, J., Stevens, C. E., Kiviat, N., Kuo, C. C., Critchlow, C. W., and Holmes, K. K., Mucopurulent cervicitis: The ignored counterpart in women of urethritis in men, N. Engl. J. Med. 311:1–6 (1984).PubMedCrossRefGoogle Scholar
  9. 9.
    Caldwell, H. D., and Kuo, C. C., Serologic diagnosis of lymphogranuloma venereum by counterimmunoelectrophoresis with a Chlamydia trachomatis protein antigen, J. Immunol. 118:442–446 (1977).PubMedGoogle Scholar
  10. 10.
    Campbell, L. A., Kuo, C. C., and Grayston, J. T., Characterization of the new chlamydia agent Twar as a unique organism by restriction endonuclease analysis and by Dna-Dna hybridization, J. Clin. Microbiol. 25:1911–1916 (1987).PubMedGoogle Scholar
  11. 11.
    Centers for Disease Control, Morbidity and Mortality Weekly Report Summary of Notifiable Disease: United States 1985, 34:3–4 (1987).Google Scholar
  12. 12.
    Centers for Disease Control, Psittacosis Surveillance, Summary (1975–84), 1987.Google Scholar
  13. 13.
    Centers for Disease Control, Sexually Transmitted Disease Statistics 1987, Issue No. 136, 1988.Google Scholar
  14. 14.
    Centers for Disease Control, Chlamydia trachomatis infections. Policy guidelines for prevention and control, Morbid. Mortal. Weekly Rep. (Suppl.) 34:535–745 (1988).Google Scholar
  15. 15.
    Collier, L. H., and Sowa, Jr., Isolation of trachoma virus in embryonated eggs, Lancet 1:993–994 (1958).PubMedCrossRefGoogle Scholar
  16. 16.
    Darougar, S., Mannickendam, M. A., El-Shiekh, H., Treharne, J. D., Woodland, R. M., and Jones, B. R., Animal models for the study of chlamydial infections of the eye and genital tract, in: Nongonococcal Urethritis and Related Infections (D. Hobson and K. K. Holmes, eds.), pp. 186–198, American Society for Microbiology, Washington, D.C., 1977.Google Scholar
  17. 17.
    Dawson, C., Therapy of diseases caused by Chlamydia organisms: Int. Ophthalmol. Clin. 13:93–101 (1972).Google Scholar
  18. 18.
    Dawson, C. R., and Schachter, J., Strategies for treatment and control of blinding trachoma: Cost effectiveness of topical systemic antibiotic, Rev. Infect. Dis. 7:768–773 (1985).PubMedCrossRefGoogle Scholar
  19. 19.
    Dawson, C. R., Hanna, L., and Jawetz, E. Controlled treatment trials of trachoma in American Indian children, Lancet 2:961–963 (1967).PubMedCrossRefGoogle Scholar
  20. 20.
    Dawson, C. R., Jones, B. R., and Tarizzo, M. L., Trachoma control: Programmes for the prevention of blindness, Presented at the National Society for Prevention of Blindness, Committee on Ophthalmia Neonatorum, San Francisco, 1980.Google Scholar
  21. 21.
    Finn, M. P., Ohlin, A., and Schacter, J., Enzyme-linked immunosorbent assay for immunoglobulin G and M antibodies to Chlamydia trachomatis in human sera, J. Clin. Microbiol. 17:848–852 (1983).PubMedGoogle Scholar
  22. 22.
    Gordon, F. B., Harper, I. A., Guan, A. L., Treharne, J. D., Dwyer, R. Sr. C., and Garland, J. A., Detection of Chlamydia (Bedsonia) in certain infections of man. I. Laboratory procedures: Comparison of yolk sac and cell culture for detection and isolation, J. Infect. Dis. 120:451–462 (1969).PubMedCrossRefGoogle Scholar
  23. 23.
    Grayston, J. T., and Wang, S.-P., New knowledge of chlamydiae and the diseases they cause, J. Infect. Dis. 132: 87–105 (1975).PubMedCrossRefGoogle Scholar
  24. 24.
    Grayston, J. T., and Wang, S.-P., The potential for vaccine against infection of the genital tract with Chlamydia trachomatis, J. Am. Vener. Dis. Assoc. 5:78–79 (1978).Google Scholar
  25. 25.
    Grayston, J. T., Kuo, C. C., Wang, S. P., and Altman, J., A new Chlamydia psittacii strain called Twar from acute respiratory tract infections, N. Engl. J. Med. 315:161–168 (1986).PubMedCrossRefGoogle Scholar
  26. 26.
    Grayston, J. T., Kuo, C. C., Campbell, L. A., and Wang, S. P., Chlamydia pneumoniae sp nov for chlamydia strain Twar, Int. J. Syst. Bacteriol. (Jan. 1989).Google Scholar
  27. 27.
    Halberstaedter, L., and Von Prowazek, S., Uber Zelleinschliesse parasitarer Natur beim Trachom, Arb. Kais. Gesund. 26:44–47 (1907).Google Scholar
  28. 28.
    Hammerschlag, M. R., Chandler, J. W., Alexander, E. R., English, M., Chiang, W.-T., Koutsky, L., Eschenbach, D. A., and Smith, J. R., Erythromycin ointment for ocular prophylaxis of neonatal chlamydial infection, J. Am. Med. Assoc. 244:2291–2293 (1980).CrossRefGoogle Scholar
  29. 29.
    Handsfield, H. H., Jasman, L. L., Roberts, P. L., Hanson, V. W., Kothenbentel, R. C., and Stamm, W. E., Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics, J. Am. Med. Assoc. 255:1730–1734 (1986).CrossRefGoogle Scholar
  30. 30.
    Harrison, H. R., English, M. G., Lee, C. K., and Alexander, E. R., Chlamydia trachomatis infant pneumonitis. Comparison with matched controls and other infant pneumonitis, N. Engl. J. Med. 298:702–708 (1978).PubMedCrossRefGoogle Scholar
  31. 31.
    Hipp, S. S., Yangsook, H., and Murphy, D., Assessment of enzyme immunoassay and immunofluorescence test for detection of Chlamydia trachomatis, J. Clin. Microbiol. 25:1938–1943 (1987).PubMedGoogle Scholar
  32. 32.
    Hobson, D., Johnson, F. W. A., Rees, E., and Tait, A., Simplified method for diagnosis of genital and ocular infections with Chlamydia, Lancet 2:555–557 (1974).PubMedCrossRefGoogle Scholar
  33. 33.
    Holmes, K. K., Handsfield, H. H., Wang, S.-P., Wentworth, P. B., Turck, M., Anderson, J. B., and Alexander, E. R., Etiology of nongonococcal urethritis, N. Engl. J. Med. 292:1199–1206 (1975).PubMedCrossRefGoogle Scholar
  34. 34.
    Holmes, K. K., Berger, R. E., and Alexander, E. R., Acute epididymitis: Etiology and therapy, Arch. Androl. 3:309–316 (1979).PubMedCrossRefGoogle Scholar
  35. 35.
    Hunter, J. S., A Treatise on the Venereal Disease, London, 1786.Google Scholar
  36. 36.
    Kousa, M., Saikku, P., Richmond, S., and Lassus, A., Frequent association of chlamydial infection with Reiter’s syndrome, Sex. Transmit. Dis. 5:57–61 (1978).CrossRefGoogle Scholar
  37. 37.
    Jones, B. R., Prevention of blindness from trachoma, Trans. Ophthalmol. Soc. U.K. 95:16–33 (1974).Google Scholar
  38. 38.
    Jones, B. R., Collier, L. H., and Smith, C. H., Isolation of a virus from inclusion blennorrhea, Lancet 1:902–905 (1959).PubMedCrossRefGoogle Scholar
  39. 39.
    Juergensen, T., Handbuch der Speziellen Pathologie und Therapie, Apparate 2:3, Handbuch der Krankheiten des Respirations, Vogel, Leipzig, 1874.Google Scholar
  40. 40.
    Julianelle, L. A., The Etiology of Trachoma, The Commonwealth Fund, New York, 1938.Google Scholar
  41. 41.
    Keat, A. C., Thomas, B. J., Taylor-Robinson, D., Pegrum, G. D., Maini, R. N., and Scott, J. T., Evidence of Chlamydia trachomatis infection in sexually acquired reactive arthritis, Ann. Rheum. Dis. 39:431–437 (1980).PubMedCrossRefGoogle Scholar
  42. 42.
    Keat, A., Dixey, J., Sonnex, C., Thomas, B., Osborn, M., and Taylor-Robinson, D., Chlamydia trachomatis and reactive arthritis: The missing link, Lancet 1:72–74 (1987).PubMedCrossRefGoogle Scholar
  43. 43.
    Kleemola, M., Saikku, P., Visakorpi, R., Wang, S.-P., and Grayston, J. T., Epidemics of pneumonia caused by Twar, a new chlamydia organism, in military trainees in Finland, J. Infect. Dis. 157:230–236 (1988).PubMedCrossRefGoogle Scholar
  44. 44.
    Lindner, K., Zur Trachomforschung, Z. Augenheilkd. 22:547–549 (1909).Google Scholar
  45. 45.
    Mahoney, J. B., Chernesky, M. A., Bromberg, K., and Schacter, J., Accuracy of immunoglobulin M immunoassay for diagnosis of chlamydia infections in infants and adults, J. Clin. Microbiol. 24:731–735 (1986).Google Scholar
  46. 46.
    Mårdh, P.-A., An overview of infectious agents of salpingitis, their biology and recent advances in methods of detection, Am. J. Obstet. Gynecol. 138:933–951 (1980).PubMedGoogle Scholar
  47. 47.
    Meyer, K. F., The host spectrum of psittacosis-lymphogranuloma venereum (Pl) agents, Am. J. Ophthalmol. 63:1225–1246 (1967).PubMedGoogle Scholar
  48. 48.
    Meyer, K. F., Eddie, B., and Schachter, J., Psittacosis-lymphogranuloma venereum agents, in: Diagnostic Procedures for Viral and Rickettsial Infections, 4th ed. (E. H. Lennette and N. J. Schmidt, eds.), pp. 869–903, American Public Health Association, New York, 1969.Google Scholar
  49. 49.
    Mohanty, K. C., O’Neill, J. J., and Hainbling, M. H., Comparison of enzyme immunoassays and cell culture for detecting Chlamydia trachomatis, Genitourin. Med. 62:175–176 (1986).Google Scholar
  50. 50.
    Mordhorst, C. H., Wang, S.-P., and Grayston, J. T., Childhood trachoma in a nonendemic area, J. Am. Med. Assoc. 239:1765–1771 (1978).CrossRefGoogle Scholar
  51. 51.
    Moulder, J. W., The relation of the psittacosis group (chlamydiae) to bacteria and viruses, Annu. Rev. Microbiol. 20:107–130 (1966).PubMedCrossRefGoogle Scholar
  52. 52.
    Nichols, R. I., Bobb, A. A., Haddad, A., and Mccomb, D. E., Immunofluorescent studies of the microbiologic epidemiology of trachoma in Saudi Arabia, Am. J. Ophthalmol. 63:1372–1408 (1967).PubMedGoogle Scholar
  53. 53.
    Nicolle, C., Cuenod, A., and Blaisot, L., Étude experimentalle du trachome, Arch. Inst. Pasteur Tunis 3:185–188 (1911).Google Scholar
  54. 54.
    Paavonen, J., Kiviat, N., Brunham, R. C., Stevens, C. E., Kuo, C. C., Stamm, W. E., Miettinen, A., Soules, M., Eschenbach, D. A., and Holmes, K. K., Prevalence and manifestations of endometritis among women with cervicitis, Am. J. Obstet. Gynecol. 152:280–286 (1985).PubMedGoogle Scholar
  55. 55.
    Patton, D., Kuo, C. C., Wang, S.-P., and Halbert, S. A., Distal tubal obstruction induced by repeated Chlamydia trachomatis salpingeal infection in pig-tailed macaques, J. Infect. Dis. 155:1292–1299 (1987).PubMedCrossRefGoogle Scholar
  56. 56.
    Phillips, R. S., Hauff, P. A., Kaufmann, R. S., and Aronson, M. D., Use of a direct fluorescent antibody test for detecting Chlamydia trachomatis cervical infection in women seeking routine gynecologic care, J. Infect. Dis. 156:575–581 (1987).CrossRefGoogle Scholar
  57. 57.
    Rake, G., Shaffer, M. F., and Thygeson, P., Relationship of agents of trachoma and inclusion conjunctivitis to those of lymphogranuloma-psittacosis group, Proc. Soc. Exp. Biol. Med. 99:545–547 (1942).Google Scholar
  58. 58.
    Ripa, K. T., and Mardh, P.-A., Cultivation of Chlamydia trachomatis in cyclohexamide-treated McCoy cells, J. Clin. Microbiol. 6:328–330 (1977).PubMedGoogle Scholar
  59. 59.
    Schachter, J. S., Human Chlamydia psittacii infection, in: Chlamydia Infections (D. Oriel, G. Ridgway, J. S. Schachter, D. Taylor-Robinson, and M. Ward, eds.), pp. 311–320, Cambridge University Press, London, 1986.Google Scholar
  60. 60.
    Schachter, J., and Dawson, C. R., Comparative efficacy of various diagnostic methods for chlamydial infection, in: Nongonococcal Urethritis and Related Infections (D. Hobson and K. K. Holmes, eds.), pp. 337–341, American Society for Microbiology, Washington, D.C., 1977.Google Scholar
  61. 61.
    Schachter, J., and Dawson, C. R., Human Chlamydia Infections, p. 218, Psg, Littleton, Mass., 1978.Google Scholar
  62. 62.
    Schachter, J., Smith, D. E., Dawson, C. R., Anderson, W. R., Deller, J. J., Jr., Hoke, A. W., Smartt, W. H., and Meyer, K. F., Lymphogranuloma venereum. I. Comparison of Frei test, complement fixation test, and isolation of the agent, J. Infect. Dis. 120:372–375 (1969).PubMedCrossRefGoogle Scholar
  63. 63.
    Sompolinsky, D., and Richmond, S., Growth of Chlamydia trachomatis in McCoy cells treated with cytochalasin B, Appl. Microbiol. 28:912–914 (1974).PubMedGoogle Scholar
  64. 64.
    Stamm, W. E., Wager, K. F., Amsel, R., Alexander, E. R., Turck, M., Counts, G. W., and Holmes, K. K., Causes of the acute urethral syndrome in women, N. Engl. J. Med. 303:409–415 (1980).PubMedCrossRefGoogle Scholar
  65. 65.
    Stamm, W. E., Hansen, H. R., Alexander, E. R., Cles, L. D., Spence, M. R., and Guinn, T. C., Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions: A multicenter trial, Ann. Intern. Med. 101:638–641 (1984).PubMedGoogle Scholar
  66. 66.
    Tack, K. J., Rasp, F. L., Hanto, D., Peterson, P. K., O’Leary, M., Simmons, R. L., and Sabath, L. D., Isolation of Chlamydia trachomatis from the lower respiratory tract of adults, Lancet 2:116 (1980).CrossRefGoogle Scholar
  67. 67.
    Tait, I. A., Rees, E., Hobson, D., Byng, R. E., and Tweedie, C. K., Chlamydial infection of the cervix in contacts of men with nongonococcal urethritis, Br. J. Vener. Dis. 56:37–41 (1980).PubMedGoogle Scholar
  68. 68.
    T’Ang, F. F., Chang, H. L., Huang, Y. T., and Wang, K. C., Trachoma virus in chick embryo, Natl. Med. J. China 43:81–86 (1957).Google Scholar
  69. 69.
    Taylor-Robinson, D., Thomas, B. J., Dixey, J., Osborne, M. F., Furr, P. M., and Keat, A. C., Evidence that Chlamydia trachomatis causes seronegative arthritis in women, Ann. Rheum. Dis. 47:295–299 (1988).PubMedCrossRefGoogle Scholar
  70. 70.
    Thygeson, P., Trachoma virus: Historical background and review of isolates, Ann. N.Y. Acad. Sci. 98:6–13 (1962).PubMedCrossRefGoogle Scholar
  71. 71.
    Thygeson, P., and Stone, W., Jr., The epidemiology of inclusion conjunctivitis, Arch. Ophthalmol. 27:91–122 (1942).CrossRefGoogle Scholar
  72. 72.
    Thylefors, B., Development of trachoma control programs and the involvement of natural resources, Rev. Infect. Dis. 7:774–776 (1985).PubMedCrossRefGoogle Scholar
  73. 73.
    Treharne, J. D., The community epidemiology of trachoma, Rev. Infect. Dis. 7:760–764 (1985).PubMedCrossRefGoogle Scholar
  74. 74.
    Wager, G. P., Martin, D. H., Koutsky, L., Eschenbach, D. A., Daling, J. R., Chiang, W. T., Alexander, E. R., and Holmes, K. K., Puerperal infectious morbidity: Relationship to route of delivery and to antepartum Chlamydia trachomatis infections, Am. J. Obstet. Gynecol. 138:1028–1033 (1980).PubMedGoogle Scholar
  75. 75.
    Wang, S.-P., and Grayston, J. T., Immunologic relationship between genital Tric, lymphogranuloma venereum, and related organisms in a new microtiter indirect immunofluorescence test, Am. J. Ophthalmol. 70:367–374 (1970).PubMedGoogle Scholar
  76. 76.
    Wang, S.-P., Kuo, C. C., and Grayston, J. T., A simplified method for immunological typing of trachoma-inclusion conjunctivitis-lymphogranuloma venereum organisms, Infect. Immun. 7:356–360 (1973).PubMedGoogle Scholar
  77. 77.
    Wang, S.-P., Grayston, J. T., Alexander, E. R., and Holmes, K. K., A simplified microimmunofluorescence test with trachoma lymphogranuloma venereum (Chlamydia trachomatis) antigens for use as a screening test for antibody, J. Clin. Microbiol. 1:250–255 (1975).PubMedGoogle Scholar
  78. 78.
    Wang, S.-P., Eschenbach, D. A., Holmes, K. K., Wager, G., and Grayston, J. T., Chlamydia trachomatis infection in Fitz-Hugh—Curtis syndrome, Am. J. Obstet. Gynecol. 138: 1034–1035 (1980).PubMedGoogle Scholar
  79. 79.
    Wang, S.-P., Kuo, C. C., Barnes, R. C., Stephens, R. S., and Grayston, J. T., Immunotyping of Chlamydia trachomatis with monoclonal antibodies, J. Infect. Dis. 152:791–800 (1985).PubMedCrossRefGoogle Scholar
  80. 80.
    Wang, S.-P., and Grayston, J. T., Microimmunofluorescence serological studies with the Twar organisms, in: Chlamydia Infections (D. Oriel, G. Ridgway, J. S. Schachter, D. Taylor-Robinson, and M. Ward, eds.), pp. 329–332, Cambridge University Press, London, 1986.Google Scholar
  81. 81.
    Washington, A. E., Johnson, R. E., Sanders, L. L., Barnes, R. C., and Alexander, E. R., Incidence of Chlamydia trachomatis infections in the United States using reported Neisseria gonorrhoeae as a surrogate, in: Chlamydia Infections (D. Oriel, G. Ridgway, J. S. Schachter, D. Taylor-Robinson, and M. Ward, eds.), pp. 987–990, Cambridge University Press, London, 1986.Google Scholar
  82. 82.
    Wathne, B., Hovelius, B., and Mardh, P. A., Causes of frequency and dysuria in women, Scand. J. Infect. Dis. 19:223–229 (1987).PubMedCrossRefGoogle Scholar
  83. 83.
    Watts, D. H., and Eschenbach, D. A., The role of Chlamydia trachomatis in post-partum endometritis, in: Chlamydia Infections (D. Oriel, G. Ridgway, J. S. Schachter, D. Taylor-Robinson, and M. Ward, eds.), pp. 245–250, Cambridge University Press, London, 1986.Google Scholar
  84. 84.
    Wentworth, B. B., and Alexander, E. R., Isolation of Chlamydia trachomatis by use of 5-iodo-2-deoxyuridine-treat-ed cells, Appl. Microbiol. 27:912–916 (1974).PubMedGoogle Scholar
  85. 85.
    World Health Organization Report, Fourth W.H.O. Scientific Group on Trachoma Research, No. 330, Geneva, 1966.Google Scholar
  86. 86.
    World Health Organization, World Health Organization Guide to Trachoma Control, Who, Geneva, 1981.Google Scholar
  87. 87.
    Yoneda, C., Dawson, C. R., Daghfous, T., Hoshiwara, I., Jones, P., Messadi, M., and Schachter, J., Cytology as a guide to the presence of chlamydial inclusions in Giemsastained conjunctival smears in severe endemic trachoma, Br. J. Ophthalmol. 59:116–124 (1975).PubMedCrossRefGoogle Scholar

Suggested Reading

  1. Batteiger, B. E., and Jones, R. B., Chlamydia infections, Infect. Dis. Clin. North Am. 1:55–81 (1987).PubMedGoogle Scholar
  2. Holmes, K. K., Mardh, P. A., Sparling, P. F., Weisner, P. J., Cates, W., Lemon, S. M., and Stamm, W. E., (eds.), Sexually Transmitted Diseases, Chapters 15–17, McGraw—Hill, New York, 1990.Google Scholar
  3. Schachter, J., and Caldwell, H. D., Chlamydiae, Annu. Rev. Microbiol. 34:285–309 (1980).PubMedCrossRefGoogle Scholar
  4. Schachter, J., and Dawson, C. R., Human Chlamydial Infections, Psg, Littleton, Mass., 1978.Google Scholar
  5. Taylor-Robinson, D., and Thomas, B. J., The role of Chlamydia trachomatis in genital-tract and associated diseases, J. Clin. Pathol. 33:205–233 (1980).PubMedCrossRefGoogle Scholar
  6. Thompson, S. E., and Washington, A. E., Epidemiology of sexually transmitted Chlamydia trachomatis infections, Epidemiol. Rev. 5:96–123 (1983).PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • E. Russell Alexander
    • 1
  • H. Robert Harrison
    • 1
  1. 1.Division of Sexually Transmitted Diseases, Center for Prevention ServicesCenters for Disease ControlAtlantaUSA

Personalised recommendations