Sexually Transmitted Infections

Robertson, D H; McMillan, A

doi: 10.1136/sti.51.2.79pmid: 1093636

In 1,129 patients attending the Department for Sexually Transmitted Diseases, the serum was examined by three screening tests (VDRL slide, RPCF, and TPHA) and twelve cases of syphilis (1 per cent. of patients attenting the clinic) were discovered. Six of these patients were considered to have latent syphilis (5 acquired, 1 congenital) and were detected only by the TPHA; all six cases were confirmed by the FTA-ABS, The TPHA failed to detect three of the remaining six cases (2 primary and 1 very early, the latter in a contact of a patient with primary syphilis). All six cases were, however, detected by the VDRL. In seven cases, the TPHA was positive in the absence of other evidence of present or previous syphilis. In these cases the FTA-ABS was also negative. The clinical application of the TPHA test in the detection of syphilis is discussed.

Farzadegan, H; Roth, I L

doi: 10.1136/sti.51.2.83pmid: 805629

Urethral exudates from male patients with gonorrhoea were studied by use of the critical point drying technique for scanning electron microscopy. The surfaces of phagocytes were extensively ruffled. This was interpreted to be the three-dimensional appearance of pseudopodia. Epithelial cells present in the urethral exudate showed a highly convoluted surface structure. Specimens of urethral exudate prepared by the freeze-etch technique showed that most N. gonorrhoeae were engulfed individually in phagocytes. Some phagosomes contained two or more gonococcal cells. Phagocytes containing gonococci were degranulated, but small granules were present in the phagosomes. Nuclear pores on the surface of the nuclear membrane were always associated with an indentation of the nuclear membrane. The outer layer of the nuclear membrane was smooth compared to the inner layer,

Maeland, J A; Larsen, B

doi: 10.1136/sti.51.2.92pmid: 48404

Sera from fifty patients with gonorrhoea, thirty with non-specific urethritis, and eighty blood donors were treated with mercaptoethanol (ME) and examined by the indirect haemagglutination test for antibodies against endotoxin from gonococci. Erythrocytes sensitized with determinant a of endotoxin from Strains 8551, V, and VII, or determinant b from Strain V were used. The percentage of sera active in the haemagglutination test was much higher in the gonorrhoea group than in the controls. The geometric mean titre was also significantly higher in the gonorrhoea group. This applied for all four antigens used. Results obtained in an anti-globulin test indicated that the titre of ME-treated serum was determined by IgG antibodies against the endotoxin. Many sera had titres which varied according to the strain origin of the antigen used in the test. The sensitivity of tests for antibodies was increased by using endotoxin from several different strains of gonococci for the examination of each serum. A simplified procedure for determination of antibodies against endotoxin from different strains of gonococci was elaborated.

Shahidullah, M

doi: 10.1136/sti.51.2.97pmid: 1093637

Minocycline in a single 300 mg. oral dose was given to 103 men with uncomplicated gonorrhoea, of whom 85 were followed-up for at least 2 weeks. The cure rate in the 85 followed was 94.1 per cent. There were no side-effects. Thus minocycline could be considered as an effective and safe alternative to penicillin in the single-dose treatment of uncomplicated gonorrhoea in the male, but at the moment it is too expensive for routine use.

Enfors, W; Eriksson, G

doi: 10.1136/sti.51.2.99pmid: 1093638

An account is given of a computer-processed 1-year study comprising 1,124 patients (625 males and 499 females) with uncomplicated gonorrhoea. Alternate patients were treated with either two oral doses of 1 g. ampicillin 5 hours apart, or 0.3 g. doxycycline in a single oral dose. Ampicillin remained as efficacious as in 1968 to 1970, in both males and females, in whom the failure rates were 1.1 and 1 per cent. respectively. After doxycycline the failure rate was 8.1 per cent. in males, 5.7 per cent. in females, and 7.1 per cent. overall. Ampicillin was significantly better than doxycycline in the treatment of men (P less than 0.001) as well as of women (0.05 greater than P greater than 0.01). 89.7 per cent. (29/29) of the relapses in doxycycline-treated patients occurred in those harbouring strains sensitive to tetracycline. Sensitivity to doxycycline followed the pattern of tetracycline sensitivity. Thus sensitivity tests with these antibiotics provided no practical aid to therapy. The high incidence of nausea and vomiting in patients treated with doxycycline (12 per cent.) makes it inadvisable to increase the dose; instead, multiple doses are necessary to obtain satisfactory results. There were very few adverse reactions to ampicillin; a rash occurred in only three patients (0.5 per cent.). In the group treated with doxycycline, 31.5 per cent. of the patients infected by streptomycin-resistant strains relapsed compared with only 1.8 per cent. of patients infected by streptomycin-sensitive strains. This difference is highly significant (P less than 0.001). Thus the sensitivity of gonococcal strains to streptomycin in vitro may serve as a valuable guide to the likely outcome of treatment with tetracyclines.

Eriksson, G; Persson, L; Wessman, J

doi: 10.1136/sti.51.2.104pmid: 1093632

An automatic data handling system for the storage and evaluation of data from investigations on sexually-transmitted diseases has been developed. Among the clinical applications are epidemiological investigations, evaluation of diagnostic procedures, and evaluation of treatment regimens. One of the main features of the system is its flexibility, which allows the inclusion of an unlimited number of further evaluation programs. After a running-in period of about 3 years, during which time a number of changes were found to be necessary, the method has been found to satisfy medical and data processing requirements.

Sparks, R A; Williams, G L; Boyce, J M; Fitzgerald, T C; Shelley, G

doi: 10.1136/sti.51.2.110pmid: 805628

Gonorrhoea was not found to be a problem in antenatal patients. It was found in only one out of 625 women, thus confirming other British surveys which do not agree with the North American figures. Candidiasis is commoner than trichomoniasis (27.4 and 4.7 per cent. prevalence respectively) and culture of a high vaginal swab is more effective as a means of diagnosis than a cervical cytology smear. The two conditions seldom occur together. The detection rate for Candida increases with gestation, but not with age, parity, or premarital and extramarital conception. The species isolated was predominantly Candida albicans. Trichomonads are detected in culture of a high vaginal swab more often than in a cervical cytology smear. Detection does not increase with age, parity, or gestation, but does increase with premarital and extramarital conception. It is difficult to diagnose clinically the cause of vaginal discharge in a pregnant woman.

Thin, R N; Atia, W; Parker, J D; Nicol, C S; Canti, G

doi: 10.1136/sti.51.2.116pmid: 165860

In the diagnosis of trichomoniasis Papanicolaou-stained cervical smears gave marginally better results than cultures of vaginal secretion; stained cervical smears and wet films of vaginal material gave similar results. Culture of vaginal secretion on Sabouraud's medium gave the best results in the diagnosis of candidiasis; Papanicolaou-stained smears gave significantly fewer positive results than either cultures or Gram-stained vaginal smears. Papanicolaou-stained smears were reported as positive in only two of five patients with cervical herpes simplex virus infection. It is concluded that Papanicolaou smears are as good as wet films or cultures in the diagnosis of trichomoniasis but cannot be relied on for the diagnosis of candidiasis, or for detecting herpes simplex virus infection.

Willmott, F E

doi: 10.1136/sti.51.2.119pmid: 165861

A study of 552 female patients was undertaken to determine the frequency of yeast infections in women attending a V.D. clinic. The findings were as follows: (1) 207 of the 552 (37.5 per cent.) were found to have yeasts. (2) C. albicans accounted for 86 per cent. of these yeasts. (3) There was no difference in incidence related to age or seasonal variation. (4) Oral contraceptives increased the incidence of yeasts (43.2 per cent. on "the pill"; 33.2 per cent. not on the pill"), but the incidence of Trichomonas was decreased (6.8 per cent. on "the pill", 19.3 per cent. not on "the pill"). (5) Previous antibiotics also contributed to the incidence; 23.2 per cent. of patients with yeasts had had antibiotics previously compared with 13.6 per cent. of those without yeasts. (6) Other infections were associated in seventy cases (33.8 per cent.). (7) Culture is essential for the detection of yeasts; 64 per cent. were positive only on culture. (8) Symptoms were present in 70 per cent. of patients with yeasts. (9) 93 male consorts were seen and in 31 (33 per cent.) yeasts were detected by smear, or culture. Of the 47 in whom cultures were examined, 23 (49 per cent.) were positive. The general factors affecting the incidence of yeasts are discussed as well as the differentiation of the saprophytic from the pathogenic role of yeasts. It is suggested that asymptomatic yeast infections are often best treated, but that each case should be considered individually. Male consorts should also be treated to prevent re-infection.

Morris, D F; Sugrue, D L

doi: 10.1136/sti.51.2.123pmid: 1093633

In a double-blind study of the treatment of vaginal candidiasis, miconazole nitrate gave a cure-rate of 88 per cent. (29 out of 33) compared with 58 per cent. (21 out of 36) using chlordantoin. Although approximately two-thirds of the patients who responded did so to a 10-day course of treatment, the different rates of cure with these preparations at this stage were not statistically significant. However, when a second course of treatment was given to those women who still had proven candidiasis, the overall cure-rate with miconazole was significantly greater than that with chlordantoin.